Inova Heart and Vascular Institute, Fall Church, Virginia.
Johns Hopkins School of Medicine, Baltimore, Maryland.
Am J Cardiol. 2023 Oct 1;204:287-294. doi: 10.1016/j.amjcard.2023.07.041. Epub 2023 Aug 9.
Abnormalities in myocardial substrate, including diffuse and replacement fibrosis, increase the risk of cardiovascular disease (CVD). Data are sparse on whether electrocardiogram (ECG) measures, coupled with circulating biomarkers, may aid in identifying cardiac fibrosis. This study aimed to determine whether 12-lead ECG and biomarkers together augment the prediction of cardiac fibrosis in participants who are free of known CVD. This is a cross-sectional analysis in the MESA (Multiethnic Study of Atherosclerosis) study at visit 5 (2010 to 2012), with measurements of biomarkers (cardiac troponin T and growth differentiation factor-15), gadolinium-enhanced cardiac magnetic resonance imaging, and ECG. Logistic regression associations of ECG measures with cardiac magnetic resonance surrogates of fibrosis (highest quartile extracellular volume [interstitial fibrosis] and late gadolinium enhancement [replacement fibrosis]) were adjusted for demographics and risk factors. Using the C-statistic, we evaluated whether adding ECG measures and biomarkers to clinical characteristics improved the prediction of either type of fibrosis. There were 1,170 eligible participants (aged 67.1 ± 8.6 years). Among the ECG measures, QRS duration (odds ratio [OR] 1.41 per 10 ms, 95% confidence interval [CI] 1.10 to 1.81), major ST-T abnormalities (OR 3.03, 95%CI 1.20, 7.65), and abnormal QRS-T angle (OR 6.32, 95%CI 3.00, 13.33) were associated with replacement fibrosis, whereas only abnormal QRS-T angle (OR 3.05, 95%CI,1.69, 5.48) was associated with interstitial fibrosis. ECG markers, in addition to clinical characteristics, improved the prediction of replacement fibrosis (p = 0.002) but not interstitial fibrosis. The addition of cardiac troponin T and growth differentiation factor-15 to the ECG findings did not significantly improve the model discrimination for either type of cardiac fibrosis. In CVD free participants, simple ECG measures are associated with replacement fibrosis and interstitial fibrosis. The addition of these measures improves identification of replacement but not interstitial fibrosis. These findings may help refine the identification of myocardial scar in the general population.
心肌底物异常，包括弥漫性和替代性纤维化，增加了心血管疾病（CVD）的风险。关于心电图（ECG）测量值与循环生物标志物结合是否有助于识别心脏纤维化的数据还很有限。本研究旨在确定在没有已知 CVD 的参与者中，12 导联 ECG 和生物标志物是否可以一起增强对心脏纤维化的预测。这是 MESA（动脉粥样硬化多民族研究）研究中的一项横断面分析，在第 5 次访视（2010 年至 2012 年）时测量了生物标志物（心脏肌钙蛋白 T 和生长分化因子 15）、钆增强心脏磁共振成像和心电图。ECG 测量值与心脏磁共振纤维化替代物（最高四分位细胞外容积[间质纤维化]和晚期钆增强[替代纤维化]）的逻辑回归关联根据人口统计学和危险因素进行了调整。使用 C 统计量，我们评估了是否可以通过添加 ECG 测量值和生物标志物来改善对任何一种纤维化的预测。共有 1170 名符合条件的参与者（年龄 67.1±8.6 岁）。在 ECG 测量值中，QRS 持续时间（每增加 10ms 的比值比[OR]为 1.41，95%置信区间[CI]为 1.10 至 1.81）、主要 ST-T 异常（OR 3.03，95%CI 为 1.20 至 7.65）和异常 QRS-T 角（OR 6.32，95%CI 为 3.00 至 13.33）与替代性纤维化相关，而只有异常 QRS-T 角（OR 3.05，95%CI，1.69 至 5.48）与间质纤维化相关。除了临床特征外，心电图标志物还改善了对替代性纤维化（p=0.002）但不是间质纤维化的预测。将心脏肌钙蛋白 T 和生长分化因子 15 添加到 ECG 结果中并没有显著提高对任何类型心脏纤维化的模型区分度。在没有 CVD 的参与者中，简单的 ECG 测量值与替代性纤维化和间质纤维化相关。这些措施的增加可提高对替代性纤维化的识别，但不能提高对间质纤维化的识别。这些发现可能有助于完善对普通人群心肌瘢痕的识别。
