Abstract 15924: Ectopy on a Single 12-lead Electrocardiogram and Incident Cardiac Myopathy in the Community
Introduction: Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) quantified by 24-hour ambulatory electrocardiogram (ECG) monitoring predict incident atrial fibrillation (AF) and heart failure (HF), respectively. More commonly used standard 12-lead ECGs often capture premature beats, yet their clinical significance remains unknown.
Methods: We sought to determine if the presence of at least one PAC would predict AF and at least one PVC would predict HF using a single standard (10-second) ECG in two observational cohort studies: the Cardiovascular Health Study (CHS) and the Atherosclerosis Risk in Communities Study (ARIC). Incident events were analyzed using Cox proportional hazards models. Covariates were identified a priori based on biological plausibility and previous literature and included: age, sex, race (white/non-white), body mass index, hypertension, diabetes, coronary disease, myocardial infarction, and study center.
Results: Among 5,577 CHS participants followed for a median 12 years, a 12-lead ECG PAC (4%) was associated with 60% increased risk of AF (HR 1.6; 95% CI 1.3-2.0; P < 0.001; Figure) and a PVC (5%) with a 30% increased risk of HF (HR 1.3; 95% CI 1.0-1.6; P = 0.021) and a decline in left ventricular ejection fraction (OR 2.8, 95% CI 1.3-6.1, p=0.008) after multivariable adjustment. As a negative control, neither type of ectopy predicted incident myocardial infarction. Similarly, among 15,792 ARIC participants, one ECG-detected PAC was associated with AF (HR 2.4; 95% CI 1.9-3.1; P < 0.001) and one ECG-detected PVC with HF (HR 2.0; 95% CI 1.4-2.8; P < 0.001).
Conclusions: Based on a single standard ECG, the presence of any atrial ectopy predicted AF and any ventricular ectopy predicted HF. This commonly used test may be useful in guiding subsequent monitoring and preventive therapies.
Author Disclosures: K.T. Nguyen: Research Grant; Modest; NIH. T.A. Dewland: None. J.W. Dukes: None. E. Vittinghoff: None. E.Z. Soliman: None. P.K. Stein: None. J.S. Gottdiener: None. A. Alonso: None. L.Y. Chen: None. B.M. Psaty: None. S.R. Heckbert: None. G.M. Marcus: Research Grant; Significant; MedTronic Inc., Pfizer Inc., PCORI. Ownership Interest; Modest; Incarda Therapuetics Inc..
- © 2016 by American Heart Association, Inc.