TY - JOUR
T1 - Sex differences in vectorcardiogram of African-Americans with and without cardiovascular disease
T2 - A cross-sectional study in the Jackson Heart Study cohort
AU - Pollard, James D.
AU - Haq, Kazi T.
AU - Lutz, Katherine J.
AU - Rogovoy, Nichole M.
AU - Paternostro, Kevin A.
AU - Soliman, Elsayed Z.
AU - Maher, Joseph
AU - Lima, Joao A.C.
AU - Musani, Solomon
AU - Tereshchenko, Larisa G.
N1 - Funding Information:
Funding The Jackson Heart Study (JHS) is supported and conducted in collaboration with Jackson State University (HHSN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I) and the University of Mississippi Medical Centre (HHSN268201800010I, HHSN268201800011I and HHSN268201800012I) contracts from the National Heart, Lung and Blood Institute (NHLBI) and the National Institute for Minority Health and Health Disparities (NIMHD). This work was supported by HL118277 (LT).
Publisher Copyright:
©
PY - 2021/1/31
Y1 - 2021/1/31
N2 - Objectives We hypothesised that (1) the prevalent cardiovascular disease (CVD) is associated with global electrical heterogeneity (GEH) after adjustment for demographic, anthropometric, socioeconomic and traditional cardiovascular risk factors, (2) there are sex differences in GEH and (3) sex modifies an association of prevalent CVD with GEH. Design Cross-sectional, cohort study. Setting Prospective African-American The Jackson Heart Study (JHS) with a nested family cohort in 2000-2004 enrolled residents of the Jackson, Mississippi metropolitan area. Participants Participants from the JHS with analysable ECGs recorded in 2009-2013 (n=3679; 62±12 y; 36% men; 863 family units). QRS, T and spatial ventricular gradient (SVG) vectors' magnitude and direction, spatial QRS-T angle and sum absolute QRST integral (SAI QRST) were measured. Outcome Prevalent CVD was defined as the history of (1) coronary heart disease defined as diagnosed/silent myocardial infarction, or (2) revascularisation procedure defined as prior coronary/peripheral arterial revascularisation, or (3) carotid angioplasty/carotid endarterectomy, or (4) stroke. Results In adjusted mixed linear models, women had a smaller spatial QRS-T angle (-12.2 (95% CI-19.4 to-5.1)°; p=0.001) and SAI QRST (-29.8 (-39.3 to-20.3) mV∗ms; p<0.0001) than men, but larger SVG azimuth (+16.2(10.5-21.9)°; p<0.0001), with a significant random effect between families (+20.8 (8.2-33.5)°; p=0.001). SAI QRST was larger in women with CVD as compared with CVD-free women or men (+15.1 (3.8-26.4) mV∗ms; p=0.009). Men with CVD had a smaller T area (by 5.1 (95% CI 1.2 to 9.0) mV∗ms) and T peak magnitude (by 44 (95%CI 16 to 71) μV) than CVD-free men. T vectors pointed more posteriorly in women as compared with men (peak T azimuth + 17.2(8.9-25.6)°; p<0.0001), with larger sex differences in T azimuth in some families by +26.3(7.4-45.3)°; p=0.006. Conclusions There are sex differences in the electrical signature of CVD in African-American men and women. There is a significant effect of unmeasured genetic and environmental factors on cardiac repolarisation.
AB - Objectives We hypothesised that (1) the prevalent cardiovascular disease (CVD) is associated with global electrical heterogeneity (GEH) after adjustment for demographic, anthropometric, socioeconomic and traditional cardiovascular risk factors, (2) there are sex differences in GEH and (3) sex modifies an association of prevalent CVD with GEH. Design Cross-sectional, cohort study. Setting Prospective African-American The Jackson Heart Study (JHS) with a nested family cohort in 2000-2004 enrolled residents of the Jackson, Mississippi metropolitan area. Participants Participants from the JHS with analysable ECGs recorded in 2009-2013 (n=3679; 62±12 y; 36% men; 863 family units). QRS, T and spatial ventricular gradient (SVG) vectors' magnitude and direction, spatial QRS-T angle and sum absolute QRST integral (SAI QRST) were measured. Outcome Prevalent CVD was defined as the history of (1) coronary heart disease defined as diagnosed/silent myocardial infarction, or (2) revascularisation procedure defined as prior coronary/peripheral arterial revascularisation, or (3) carotid angioplasty/carotid endarterectomy, or (4) stroke. Results In adjusted mixed linear models, women had a smaller spatial QRS-T angle (-12.2 (95% CI-19.4 to-5.1)°; p=0.001) and SAI QRST (-29.8 (-39.3 to-20.3) mV∗ms; p<0.0001) than men, but larger SVG azimuth (+16.2(10.5-21.9)°; p<0.0001), with a significant random effect between families (+20.8 (8.2-33.5)°; p=0.001). SAI QRST was larger in women with CVD as compared with CVD-free women or men (+15.1 (3.8-26.4) mV∗ms; p=0.009). Men with CVD had a smaller T area (by 5.1 (95% CI 1.2 to 9.0) mV∗ms) and T peak magnitude (by 44 (95%CI 16 to 71) μV) than CVD-free men. T vectors pointed more posteriorly in women as compared with men (peak T azimuth + 17.2(8.9-25.6)°; p<0.0001), with larger sex differences in T azimuth in some families by +26.3(7.4-45.3)°; p=0.006. Conclusions There are sex differences in the electrical signature of CVD in African-American men and women. There is a significant effect of unmeasured genetic and environmental factors on cardiac repolarisation.
KW - adult cardiology
KW - cardiac epidemiology
KW - coronary heart disease
KW - pacing & electrophysiology
UR - http://www.scopus.com/inward/record.url?scp=85100435877&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85100435877&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-042899
DO - 10.1136/bmjopen-2020-042899
M3 - Article
C2 - 33518522
AN - SCOPUS:85100435877
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 1
M1 - e042899
ER -