Epidemiological Cardiology Research Center, Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America.
Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, WI, United States of America.
J Electrocardiol. 2024 Jan-Feb;82:7-10. doi: 10.1016/j.jelectrocard.2023.11.006. Epub 2023 Nov 19.
The association and the racial differences of the electrocardiographic markers of left atrial abnormality (ECG-LAA) with heart failure (HF) are unclear.
We examined the cross-sectional association of ECG-LAA, defined as deep terminal negativity of P wave in V1 (DTNPV1) with HF in 8460 participants (51.5% women, 60.3 ± 13.5 age and 49.8% Whites) from the US Third National Health and Nutrition Examination Survey. We excluded participants without P-wave in their ECG or with ECG findings that interfere with measurements of P-wave. DTNPV1 was automatically measured from ECGs processed at a central lab. Values of DTNPV1 ≥ 100 μV were considered abnormal. Past medical history of HF was identified through health interviews. Multivariable logistic regression analysis was used to examine the associations of DTNPV1 with HF.
Abnormal DTNPV1 was detected in 3.2% (n = 271) of the participants. HF was significantly more common in individuals with abnormal, compared to those with normal, DTNPV1 (14.7% vs. 4.8%, respectively; p-value <0.001). In a model adjusted for socio-demographics and cardiovascular risk factors, ECG-LAA was associated with 98% increased odds of HF (OR (95% CI): 1.98 (1.30-3.01), p < 0.001). This association was stronger in non-White (vs. White) participants (OR (95% CI): 3.14 (1.82-5.43) vs. 1.01 (0.51-1.97), respectively; interaction p-value =0.01), but consistent in subgroups stratified by age and sex.
ECG-LAA, defined as abnormal DTNPV1, is associated with an increased risk of HF, underscoring the role of atrial disease in developing HF. Racial differences in this association exist, possibly suggesting considering ECG-LAA in personalized assessments of HF risk.
心电图左房异常（ECG-LAA）标记物与心力衰竭（HF）的关联及其种族差异尚不清楚。
我们在美国第三次国家健康和营养检查调查（NHANES III）中检查了 8460 名参与者（51.5%为女性，年龄 60.3±13.5 岁，49.8%为白人）的 ECG-LAA（V1 中 P 波的终末深负性 DTNPV1）与 HF 的横断面关联。我们排除了心电图中无 P 波或心电图检查结果干扰 P 波测量的参与者。DTNPV1 是从中央实验室处理的心电图中自动测量的。DTNPV1 值≥100μV 被认为异常。HF 的既往病史是通过健康访谈确定的。多变量逻辑回归分析用于检查 DTNPV1 与 HF 的相关性。
3.2%（n=271）的参与者存在异常 DTNPV1。与正常 DTNPV1 相比，异常 DTNPV1 者 HF 更为常见（分别为 14.7%和 4.8%；p 值<0.001）。在调整了社会人口统计学和心血管危险因素的模型中，ECG-LAA 与 HF 的几率增加 98%相关（比值比（95%置信区间）：1.98（1.30-3.01），p<0.001）。这种相关性在非白人（与白人相比）参与者中更强（比值比（95%置信区间）：3.14（1.82-5.43）与 1.01（0.51-1.97）；交互 p 值=0.01），但在按年龄和性别分层的亚组中一致。
心电图左房异常（ECG-LAA），定义为异常 DTNPV1，与 HF 风险增加相关，强调了心房疾病在 HF 发生中的作用。这种相关性在种族之间存在差异，这可能表明在 HF 风险的个体化评估中考虑 ECG-LAA。
