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Global ECG Measures and Cardiac Structure and Function: The ARIC Study (Atherosclerosis Risk in Communities).

TitleGlobal ECG Measures and Cardiac Structure and Function: The ARIC Study (Atherosclerosis Risk in Communities).
Publication TypeJournal Article
Year of Publication2018
AuthorsBiering-Sørensen T, Kabir M, Waks JW, Thomas J, Post WS, Soliman EZ, Buxton AE, Shah AM, Solomon SD
Secondary AuthorsTereshchenko LG
JournalCirc Arrhythm Electrophysiol
Date Published2018 03
KeywordsAged, Atherosclerosis, Cross-Sectional Studies, Disease Progression, Echocardiography, Electrocardiography, Female, Follow-Up Studies, Heart Ventricles, Humans, Male, Middle Aged, Myocardial Contraction, Prospective Studies, Risk Assessment, Risk Factors, Stroke Volume, Vectorcardiography, Ventricular Function, Left

BACKGROUND: Electric excitation initiates myocardial mechanical contraction and coordinates myocardial pumping. We hypothesized that ECG global electric heterogeneity (GEH) and its longitudinal changes are associated with cardiac structure and function.

METHODS AND RESULTS: Participants from the ARIC study (Atherosclerosis Risk in Communities) (N=5114; 58% female; 22% blacks) with resting 12-lead ECGs (visits 1-5) and echocardiographic assessment of left ventricular (LV) ejection fraction, LV global longitudinal strain, LV mass index, LV end-diastolic volume index, and LV end-systolic volume index at visit 5 were included. Longitudinal analysis included ARIC participants (N=14 609) with measured GEH at visits 1 to 4. GEH was quantified by spatial ventricular gradient, QRS-T angle, and sum absolute QRS-T integral. Cross-sectional and longitudinal regressions were adjusted for manifest and subclinical cardiovascular disease. Having 4 abnormal GEH parameters was associated with a 6.4% (95% confidence interval, 5.5-7.3) LV ejection fraction decline, a 24.2 g/m (95% confidence interval, 21.5-26.9) increase in LV mass index, a 10.3 mL/m (95% confidence interval, 8.9-11.7) increase in LV end-diastolic volume index, and a 7.8 mL/m (95% confidence interval, 6.9-8.6) increase in LV end-systolic volume index. Altogether, clinical and ECG parameters accounted for approximately one third of LV volume and 20% of systolic function variability. The associations were significantly stronger in cardiovascular disease. Sum absolute QRS-T integral increased by 20 mV*ms for each 3-year period in participants who demonstrated LV dilatation at visit 5. Sudden cardiac death victims demonstrated rapid GEH worsening, whereas those with LV dysfunction demonstrated slow GEH worsening. Healthy aging was associated with a distinct pattern of spatial ventricular gradient azimuth decrement.

CONCLUSIONS: GEH is a marker of subclinical abnormalities in cardiac structure and function.

Alternate JournalCirc Arrhythm Electrophysiol
PubMed ID29496680
PubMed Central IDPMC5836803
Grant ListT15 LM007442 / LM / NLM NIH HHS / United States
R01 HL118277 / HL / NHLBI NIH HHS / United States
HHSN268201700001I / HL / NHLBI NIH HHS / United States
HHSN268201700004I / HL / NHLBI NIH HHS / United States
HHSN268201000021C / HL / NHLBI NIH HHS / United States
HHSN268201700002I / HL / NHLBI NIH HHS / United States
HHSN268201700005I / HL / NHLBI NIH HHS / United States
HHSN268201700003I / HL / NHLBI NIH HHS / United States