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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; 6(9)JA

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.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.Division of Public Health Sciences, Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC. Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC.Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.Office of Biostatistics Research, National Heart Lung and Blood Institute, Bethesda, MD.Division of Biostatistics, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI.Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD. Department of Radiology, School of Medicine and Public Health University of Wisconsin, Madison, WI.Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD hashika1@jhmi.edu. Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28931529

Citation

Inoue, Yuko Y., et al. "Electrocardiographic Strain Pattern Is Associated With Left Ventricular Concentric Remodeling, Scar, and Mortality Over 10 Years: the Multi-Ethnic Study of Atherosclerosis." Journal of the American Heart Association, vol. 6, no. 9, 2017.
Inoue YY, Soliman EZ, Yoneyama K, et al. 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;6(9).
Inoue, Y. Y., Soliman, E. Z., Yoneyama, K., Ambale-Venkatesh, B., Wu, C. O., Sparapani, R., ... Ashikaga, H. (2017). Electrocardiographic Strain Pattern Is Associated With Left Ventricular Concentric Remodeling, Scar, and Mortality Over 10 Years: The Multi-Ethnic Study of Atherosclerosis. Journal of the American Heart Association, 6(9), doi:10.1161/JAHA.117.006624.
Inoue YY, et al. 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) PubMed PMID: 28931529.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Electrocardiographic Strain Pattern Is Associated With Left Ventricular Concentric Remodeling, Scar, and Mortality Over 10 Years: The Multi-Ethnic Study of Atherosclerosis. AU - Inoue,Yuko Y, AU - Soliman,Elsayed Z, AU - Yoneyama,Kihei, AU - Ambale-Venkatesh,Bharath, AU - Wu,Colin O, AU - Sparapani,Rodney, AU - Bluemke,David A, AU - Lima,João A C, AU - Ashikaga,Hiroshi, Y1 - 2017/09/20/ PY - 2017/9/22/entrez PY - 2017/9/22/pubmed PY - 2018/6/12/medline KW - ECG KW - cardiovascular magnetic resonance imaging KW - cardiovascular outcomes KW - remodeling KW - repolarization JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 6 IS - 9 N2 - 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. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/28931529/Electrocardiographic_Strain_Pattern_Is_Associated_With_Left_Ventricular_Concentric_Remodeling_Scar_and_Mortality_Over_10_Years:_The_Multi_Ethnic_Study_of_Atherosclerosis_ L2 - http://www.ahajournals.org/doi/full/10.1161/JAHA.117.006624?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -