Ectopy on a Single 12-Lead ECG, Incident Cardiac Myopathy, and Death in the Community
Kaylin T Nguyen1, Eric Vittinghoff2, Thomas A Dewland3
1Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, CA.
Insights
Premature atrial contractions on a 12-lead ECG predict atrial fibrillation and death, while premature ventricular contractions predict heart failure and death. This accessible test identifies individuals at risk for these common cardiovascular diseases.
Area of Science:
- Cardiology
- Preventive Medicine
- Electrocardiography
Background:
- Atrial fibrillation and heart failure are prevalent cardiovascular diseases with limited early identification methods.
- The standard 12-lead electrocardiogram (ECG) is a widely accessible diagnostic tool in clinical practice.
Purpose of the Study:
- To investigate if premature atrial contractions (PACs) on a 12-lead ECG predict future atrial fibrillation and mortality.
- To determine if premature ventricular contractions (PVCs) on a 12-lead ECG predict future heart failure and mortality.
Main Methods:
- Utilized the Cardiovascular Health (CHS) Study (n=5577, median 12-year follow-up) as the primary cohort.
- Employed the Atherosclerosis Risk in Communities (ARIC) Study (n=15792, median 22-year follow-up) as a replication cohort.
- Performed multivariable analyses to assess the predictive value of PACs and PVCs for incident diseases and mortality.
Main Results:
- A baseline PAC predicted a 60% increased risk of atrial fibrillation (HR, 1.6; 95% CI, 1.3-2.0) and a 30% increased risk of death (HR, 1.3; 95% CI, 1.1-1.5).
- A baseline PVC predicted a 30% increased risk of heart failure (HR, 1.3; 95% CI, 1.0-1.6) and a 20% increased risk of death (HR, 1.2; 95% CI, 1.0-1.3).
- Neither PACs nor PVCs predicted incident myocardial infarction; similar significant results were observed in the ARIC cohort.
Conclusions:
- A single standard 12-lead ECG finding of PACs predicts incident atrial fibrillation and mortality.
- A single standard 12-lead ECG finding of PVCs predicts incident heart failure and mortality.
- The 12-lead ECG is a valuable tool for predicting future cardiovascular disease risk.
Background:
Atrial fibrillation and heart failure are 2 of the most common diseases, yet ready means to identify individuals at risk are lacking. The 12-lead ECG is one of the most accessible tests in medicine. Our objective was to determine whether a premature atrial contraction observed on a standard 12-lead ECG would predict atrial fibrillation and mortality and whether a premature ventricular contraction would predict heart failure and mortality.
Methods And Results:
We utilized the CHS (Cardiovascular Health) Study, which followed 5577 participants for a median of 12 years, as the primary cohort. The ARIC (Atherosclerosis Risk in Communities Study), the replication cohort, captured data from 15 792 participants over a median of 22 years. In the CHS, multivariable analyses revealed that a baseline 12-lead ECG premature atrial contraction predicted a 60% increased risk of atrial fibrillation (hazard ratio, 1.6; 95% CI, 1.3-2.0; P<0.001) and a premature ventricular contraction predicted a 30% increased risk of heart failure (hazard ratio, 1.3; 95% CI, 1.0-1.6; P=0.021). In the negative control analyses, neither predicted incident myocardial infarction. A premature atrial contraction was associated with a 30% increased risk of death (hazard ratio, 1.3; 95% CI, 1.1-1.5; P=0.008) and a premature ventricular contraction was associated with a 20% increased risk of death (hazard ratio, 1.2; 95% CI, 1.0-1.3; P=0.044). Similarly statistically significant results for each analysis were also observed in ARIC.
Conclusions:
Based on a single standard ECG, a premature atrial contraction predicted incident atrial fibrillation and death and a premature ventricular contraction predicted incident heart failure and death, suggesting that this commonly used test may predict future disease.
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