Subclinical coronary atherosclerosis and resting ECG abnormalities in an unselected general population
Stefan Möhlenkamp1, Axel Schmermund, Nils Lehmann
1Clinic of Cardiology, West-German Heart Center Essen, University Clinic Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. stefan.moehlenkamp@uk-essen.de
Insights
Cardiovascular risk factors are linked to coronary artery calcification (CAC) and ECG abnormalities. Elevated CAC burden often indicates myocardial disease, suggesting shared pathways from risk factor exposure.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Imaging
Background:
- Cardiovascular (CV) risk factors can lead to coronary atherosclerosis and myocardial disease.
- Coronary artery calcification (CAC) reflects atherosclerosis, while resting ECG abnormalities indicate myocardial disease.
- Understanding the relationship between CAC and ECG findings is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between coronary artery calcification (CAC) and resting ECG abnormalities in a general population.
- To explore this association in individuals with and without established cardiovascular disease (CVD) or treated risk factors (tRF).
Main Methods:
- A cohort of 4814 subjects (45-75 years) from the Heinz Nixdorf Recall Study was analyzed.
- Standard CV risk factors, digitized resting ECGs, and EBT-based Agatston CAC scores were obtained.
- Subjects were categorized based on the presence of CVD or tRF.
Main Results:
- Higher CAC scores and positive CAC were more frequent in individuals with ECG abnormalities than those with normal ECGs (p<0.05).
- In subjects without CVD/tRF, CAC > or =75th percentile was associated with LVH and prolonged QTc.
- In subjects with CVD/tRF, elevated CAC was linked to atrial fibrillation, borderline-LVH, signs of MI, and major ECG abnormalities.
Conclusions:
- ECG evidence of myocardial disease is frequently associated with increased CAC burden.
- This suggests a common link between epicardial (atherosclerosis) and myocardial (disease) manifestations of CV risk factors.
- The association patterns have implications for interpreting resting ECG and CAC burden in risk stratification.
Objectives:
Exposure to cardiovascular (CV) risk factors may result in coronary atherosclerosis and myocardial disease, which is reflected in the extent of coronary artery calcification (CAC) and resting ECG abnormalities, respectively. We studied the association of CAC with ECG abnormalities in a general population without myocardial infarction or revascularization.
Methods:
The total cohort of 4814 subjects (45-75 years) were randomly selected from the general population for the Heinz Nixdorf Recall Study, an ongoing study designed to assess the prognostic value of modern risk stratification methods. In addition to measuring standard risk factors, digitized resting ECGs and the EBT-based Agatston score were obtained. Subjects were separated into those without (n=1929) and with CV disease (CVD) or treated risk factors (tRF) (n=2558).
Results:
In both groups, a positive CAC-score was more frequent and CAC-scores were higher in men and women with ECG abnormalities as compared to those with normal ECGs (p<0.05 each). In persons without CVD/tRF, a CAC > or =75th percentile was more frequent in those with LVH (42.4%) and QTc >440 ms (34.2%) as compared to normal ECGs (23.0%, p<0.01 for both). In persons with CVD/tRF, a CAC-score > or =75th percentile was found in subjects with A-Fib (46.3%), borderline-LVH (39.1%), ECG signs of MI (40.5%) and major ECG abnormalities (40.3%) versus 31.2% in those with normal ECGs (p<0.03 for all). In multivariate analysis, LVH (p=0.025) and major ECG abnormalities (p=0.04) remained independently associated with CAC in subjects without and with CVD/tRF, respectively.
Conclusions:
ECG-based evidence of myocardial disease is often associated with an elevated CAC burden, suggesting a link between epicardial and myocardial manifestations of risk factor exposure. The association of CAC burden with different ECG abnormalities in different clinical groups may have implications for the interpretation of the resting ECG and CAC burden in risk stratification.
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