Faculty Collaboration Database

Electrocardiographic Strain Pattern Is Associated With Left Ventricular Concentric Remodeling, Scar, and Mortality Over 10 Years: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2017 Sep 20;6(9)

Date

09/22/2017

Pubmed ID

28931529

Pubmed Central ID

PMC5634304

DOI

10.1161/JAHA.117.006624

Scopus ID

2-s2.0-85029744606 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

BACKGROUND: Both ECG strain pattern and QRS measured left ventricular (LV) hypertrophy criteria are associated with LV hypertrophy and have been used for risk stratification. However, the independent predictive value of ECG strain in apparently healthy individuals in predicting mortality and adverse cardiovascular events is unclear.

METHODS AND RESULTS: MESA (Multi-Ethnic Study of Atherosclerosis) is a multicenter, prospective cohort of 6441 participants (mean age, 62 years; 54% women). In 2847 of these participants, cardiac magnetic resonance imaging was repeated ≈10 years later (Year-10). At Year-10, 1759 participants underwent cardiac magnetic resonance imaging with gadolinium to detect myocardial scar. During a median follow-up of 11.7 years, ECG strain (n=168, 2.6%) was significantly associated with all-cause death (adjusted hazard ratio, 1.33; 95% confidence interval, 1.01-1.77; P=0.045), heart failure (2.62; 1.73-3.97; P<0.001), myocardial infarction (1.86; 1.09-3.18; P=0.024), and incident cardiovascular disease (1.45; 1.06-2.00; P=0.022). ECG strain was also associated with an increase in LV mass (β=9.29 g; P<0.001) and LV mass-to-volume ratio (β=0.07 g/mL; P=0.007) and a decline in LV ejection fraction (β=-3.30%; P<0.001). Moreover, ECG strain either at baseline and Year-10 was associated with LV scar (odds ratio, 4.93 and 5.22; P=0.002 and <0.001, respectively), whereas these associations were not observed in ECG LV hypertrophy.

CONCLUSIONS: ECG strain is independently associated with all-cause mortality, adverse cardiovascular events, development of LV concentric remodeling and systolic dysfunction, and myocardial scar over 10 years in multiethnic participants without past cardiovascular disease. ECG strain may be an early marker of LV structural remodeling that contributes to development of adverse cardiovascular events.

CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00005487.

Author List

Inoue YY, Soliman EZ, Yoneyama K, Ambale-Venkatesh B, Wu CO, Sparapani R, Bluemke DA, Lima JAC, Ashikaga H

Author

Rodney Sparapani PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Atherosclerosis
Cause of Death
Electrocardiography
Follow-Up Studies
Forecasting
Heart Ventricles
Humans
Magnetic Resonance Imaging, Cine
Middle Aged
Morbidity
Myocardium
Prospective Studies
Survival Rate
United States
Ventricular Function, Left
Ventricular Remodeling