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.
J Am Heart Assoc. 2017 Sep 20;6(9):e006624. doi: 10.1161/JAHA.117.006624.
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.
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; =0.045), heart failure (2.62; 1.73-3.97; <0.001), myocardial infarction (1.86; 1.09-3.18; =0.024), and incident cardiovascular disease (1.45; 1.06-2.00; =0.022). ECG strain was also associated with an increase in LV mass (β=9.29 g; <0.001) and LV mass-to-volume ratio (β=0.07 g/mL; =0.007) and a decline in LV ejection fraction (β=-3.30%; <0.001). Moreover, ECG strain either at baseline and Year-10 was associated with LV scar (odds ratio, 4.93 and 5.22; =0.002 and <0.001, respectively), whereas these associations were not observed in ECG LV hypertrophy.
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.
URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00005487.
心电图应变模式和 QRS 测量的左心室（LV）肥厚标准均与 LV 肥厚相关，并已用于危险分层。然而，在无既往心血管疾病的多民族参与者中，心电图应变在预测死亡率和不良心血管事件方面的独立预测价值尚不清楚。
MESA（动脉粥样硬化的多民族研究）是一项多中心、前瞻性队列研究，纳入了 6441 名参与者（平均年龄 62 岁；54%为女性）。其中 2847 名参与者在大约 10 年后（第 10 年）重复进行了心脏磁共振成像检查。在第 10 年，1759 名参与者接受了心脏磁共振成像加钆造影检查以检测心肌瘢痕。在中位随访 11.7 年期间，心电图应变（n=168，2.6%）与全因死亡（校正后的危险比，1.33；95%置信区间，1.01-1.77；=0.045）、心力衰竭（2.62；1.73-3.97；<0.001）、心肌梗死（1.86；1.09-3.18；=0.024）和心血管疾病事件（1.45；1.06-2.00；=0.022）显著相关。心电图应变还与 LV 质量增加（β=9.29g；<0.001）和 LV 质量/容积比增加（β=0.07g/mL；=0.007）以及 LV 射血分数下降（β=-3.30%；<0.001）相关。此外，基线和第 10 年的心电图应变与 LV 瘢痕（比值比，4.93 和 5.22；=0.002 和 <0.001）相关，而在心电图 LV 肥厚中则未观察到这些相关性。
在无既往心血管疾病的多民族参与者中，心电图应变独立于其他因素与全因死亡率、不良心血管事件、LV 向心性重构和收缩功能障碍以及 10 年内心肌瘢痕的发生相关。心电图应变可能是 LV 结构重构的早期标志物，可导致不良心血管事件的发生。
