Advanced ECG heart age estimation applicable to both sinus and non-sinus rhythm associates with cardiovascular risk, cardiovascular morbidity, and survival

Abstract

BackgroundAn explainable advanced electrocardiography (A-ECG) heart age gap is the difference between A-ECG heart age and chronological age. This gap is an estimate of accelerated cardiovascular ageing expressed in years of healthy human aging, and can intuitively communicate cardiovascular risk to the general population. However, existing A-ECG heart age measures require discernible P waves on the ECG.AimsTo develop and prognostically validate a revised, explainable A-ECG heart age gap without incorporating P-wave measures.MethodsAn A-ECG heart age without P-wave measures (non-P) was derived from the 10-second 12-lead ECG in a derivation cohort using multivariable regression using an existing Bayesian 5-minute 12-lead A-ECG heart age as reference. The non-P heart age was externally validated in a separate cohort of patients referred for cardiovascular magnetic resonance imaging by describing its association with heart failure hospitalization or death using Cox regression, and its association with comorbidities.ResultsIn the derivation cohort (n=2771), A-ECG non-P heart age agreed with the 5-min heart age (R2=0.91, bias 0.0±6.7 years), and increased with increasing co-morbidity. In the validation cohort (n=731, mean age 54±15 years, 43% female, n=139 events over 5.7 [4.8–6.7] years follow-up), increased A-ECG non-P heart age gap (≥10 years) associated with events (hazard ratio [95% confidence interval] 2.04 [1.38–3.00], C-statistic 0.58 [0.54–0.62], and the presence of hypertension, diabetes mellitus, hypercholesterolemia, and heart failure (p≤0.009 for all).ConclusionsAn explainable A-ECG non-P heart age gap applicable to both sinus and non-sinus rhythm associates with cardiovascular risk, cardiovascular morbidity, and survival.