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Electrocardiographic markers of atrial cardiomyopathy and risk of heart failure in the multi-ethnic study of atherosclerosis (MESA) cohort. Front Cardiovasc Med 2023;10:1143338

Date

05/14/2023

Pubmed ID

37180781

Pubmed Central ID

PMC10169752

DOI

10.3389/fcvm.2023.1143338

Scopus ID

2-s2.0-85158969267 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: The association of electrocardiographic (ECG) markers of atrial cardiomyopathy with heart failure (HF) and its subtypes is unclear.

METHODS: This analysis included 6,754 participants free of clinical cardiovascular disease (CVD), including atrial fibrillation (AF), from the Multi-Ethnic Study of Atherosclerosis. Five ECG markers of atrial cardiomyopathy (P-wave terminal force in V1 [PTFV1], deep-terminal negativity in V1 [DTNV1], P-wave duration [PWD], P-wave axis [PWA], advanced intra-atrial block [aIAB]) were derived from digitally recorded electrocardiograms. Incident HF events through 2018 were centrally adjudicated. An ejection fraction (EF) of 50% at the time of HF was used to classify HF as HF with reduced EF (HFrEF), HF with preserved EF (HFpEF), or unclassified HF. Cox proportional hazard models were used to examine the associations of markers of atrial cardiomyopathy with HF. The Lunn-McNeil method was used to compare the associations in HFrEF vs. HFpEF.

RESULTS: 413 HF events occurred over a median follow-up of 16 years. In adjusted models, abnormal PTFV1 (HR (95%CI): 1.56(1.15-2.13), abnormal PWA (HR (95%CI):1.60(1.16-2.22), aIAB (HR (95%CI):2.62(1.47-4.69), DTNPV1 (HR (95%CI): 2.99(1.63-7.33), and abnormal PWD (HR (95%CI): 1.33(1.02-1.73), were associated with increased HF risk. These associations persisted after further adjustments for intercurrent AF events. No significant differences in the strength of association of each ECG predictor with HFrEF and HFpEF were noted.

CONCLUSIONS: Atrial cardiomyopathy defined by ECG markers is associated with HF, with no differences in the strength of association between HFrEF and HFpEF. Markers of atrial Cardiomyopathy may help identify individuals at risk of developing HF.

Author List

Ahmad MI, Mujtaba M, Floyd JS, Chen LY, Soliman EZ

Author

Muhammad Imtiaz Ahmad MBBS Assistant Professor in the Medicine department at Medical College of Wisconsin