Electrocardiographic Predictors of Incident Heart Failure in Men and Women Free From Manifest Cardiovascular Disease (from the Atherosclerosis Risk in Communities [ARIC] Study)

Abstract

The risk of incident hospitalized heart failure (HF) was evaluated for 23 electrocardiographic (ECG) variables in men and women free from cardiovascular disease. The hazard ratios with 95% confidence intervals were determined from Cox regression analysis for 13,428 participants 45 to 65 years old in the Atherosclerosis Risk in Communities (ARIC) study. New-onset HF during a 14-year follow-up period occurred in 695 men (11.9%) and 721 women (9.5%). Several ECG variables were significant predictors of incident HF when evaluated as single ECG variables. Predominant among them were spatial angles, reflecting deviations of the direction of the repolarization sequence from the normal reference direction. After controlling for collinearity among the ECG variables, the spatial angle between T peak and normal T reference vectors, Θ(Tp|Tref), was a significant independent predictor in men (HF risk increased 31%) and women (HF risk increased 46%). Other independent predictors in men included epicardial repolarization time (62% increased risk) and T wave peak to T wave end (TpTe) interval, reflecting global dispersion of repolarization (27% increased risk). The independent predictors in women, in addition to Θ(Tp|Tref), were Θ(R|STT) the spatial angle between the mean QRS and STT vectors (54% increased risk) and QRS nondipolar voltage (46% increased risk). In conclusion, wide Θ(Tp|Tref), wide Θ(R|STT), and increased QRS nondipolar voltage in women and wide Θ(Tp|Tref), increased epicardial repolarization time, prolonged TpTe interval and T wave complexity in men were independent predictors of incident HF, and the presence of these abnormal findings could warrant additional diagnostic evaluation for possible preventive action for HF.

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

“…Although several reports have shown that findings on the routine ECG are associated with future HF events,8, 9, 10, 11, 12, 13, 14, 15, 16, 17 few have explored whether ECG predictors vary in their ability to distinguish between HFrEF and HFpEF. A recent examination from the Framingham Heart Study has shown that left ventricular hypertrophy and left bundle‐branch block are associated with HFrEF and that atrial fibrillation is associated with HFpEF 28.…”

A wide QRS/T angle in bundle branch blocks is associated with increased risk for coronary heart disease and all-cause mortality in the Atherosclerosis Risk in Communities (ARIC) Study

“…These in turn were computed from the standard 12-lead ECGs using the Kors transform [15]. The algorithm developed for estimation of the onset of the global (from simultaneous quasi-orthogonal leads) T wave was based on combined use of information of the curvature function and ST segment convexity function described previously [8]. Of special concern was securing a reliable estimate of T wave onset time in LBBB because ST segment spatial magnitude starts increasing right after the end of QRS with no distinct “plateau” period.…”

The Prevalence of Electrocardiographic Indicators Among Men and Women of Older Ages in the Russian Federation

“…Так, в исследовании «Стресс, старение и здоровье в России» (The Study of Stress, Aging and Health in Russia, SAHR) выявлена не-сколько более высокая частота ИМ на ЭКГ мужчин и женщин возрастной категории 55-64 года (6,7% и 4,3%, соответственно) [6]. В исследовании ARIC сре-ди мужчин и женщин частота ИМ составила 1,4% и 3,0%, соответственно, это вполне ожидаемо, по-скольку выборка более молодая [7]. В Тюмени, Томске и Новосибирске регистрировалась меньшая частота зуб-цов QQS у мужчин в этой возрастной категории: 2,5%, 4,5%, и 3,1%, соответственно [4].…”