Introduction

The association and the racial differences of the electrocardiographic markers of left atrial abnormality (ECG-LAA) with heart failure (HF) are unclear.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

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心电图左心房异常与心力衰竭的风险

介绍

左心房异常 (ECG-LAA) 心电图标记物与心力衰竭 (HF) 的关联和种族差异尚不清楚。

方法

我们检查了来自美国第三国民健康中心的 8460 名参与者（51.5% 女性，60.3 ± 13.5 岁，49.8% 白人）的 ECG-LAA（定义为 V1 中 P 波深末负性（DTNPV1）与心力衰竭）的横断面关联。和营养检查调查。我们排除了心电图无 P 波或心电图结果干扰 P 波测量的参与者。DTNPV1 是根据中心实验室处理的心电图自动测量的。DTNPV1 值≥ 100 μV 视为异常。通过健康访谈确定既往心力衰竭病史。使用多变量逻辑回归分析来检查 DTNPV1 与 HF 的关联。

结果

3.2% ( n  = 271) 的参与者检测到异常 DTNPV1 。与 DTNPV1 正常的个体相比，心力衰竭在异常个体中更为常见（分别为 14.7% 和 4.8%；p值 <0.001）。在针对社会人口统计学和心血管危险因素进行调整的模型中，ECG-LAA 与心力衰竭发生率增加 98% 相关（OR (95% CI)：1.98 (1.30–3.01)，p  < 0.001）。这种关联在非白人（与白人）参与者中更强（OR (95% CI)：分别为 3.14 (1.82–5.43) 与 1.01 (0.51–1.97)；交互作用p值 =0.01），但在按年龄和性别分层的亚组。

结论

ECG-LAA 被定义为异常 DTNPV1，与心力衰竭风险增加相关，强调了心房疾病在心力衰竭发生中的作用。这种关联存在种族差异，这可能表明在心衰风险的个性化评估中考虑使用 ECG-LAA。