Advertisement

Relations Between Cardiac Magnetic Resonance Imaging-Derived Left Ventricular Mass, Early Repolarization, and Cardiovascular Events (from the Dallas Heart Study)

      Highlights

      • Differences in cardiac structure exist between individuals with and without ERP.
      • ERP associates with increased mortality and non-fatal CVD events.
      • Left ventricular mass may confound associations of ERP and CVD events.
      Early repolarization pattern (ERP) is associated with increased mortality in case-control studies, but the mechanism and role of left ventricular mass (LVM) remain unclear. Our objectives were to understand (1) whether ERP associates with adverse outcomes in a multiethnic population and (2) to explore the role of LVM in these associations. Participants from the Dallas Heart Study with an electrocardiogram interpretable for ERP, defined as J point elevation ≥1 mm in 2 contiguous leads, were included. Combined all-cause mortality and nonfatal cardiovascular disease (CVD) events and individual components were assessed using Cox proportional hazards modeling after adjustment for demographics, traditional CVD risk factors, electrocardiogram intervals, and cardiac magnetic resonance imaging-derived factors. Cardiac magnetic resonance imaging-defined LVM was then added to the most fully adjusted model. Of the 2,686 participants, 240 (8.9%) demonstrated ERP. Participants with ERP were more likely to be male and Black, with lower body mass index, greater left ventricular end-diastolic volumes, and LVM. Over a median follow-up of 11 years, the combined end point occurred in 326 patients. Multivariable modeling demonstrated ERP was associated with the combined end point (HR [95% CI] 1.61 [1.14 to 2.26]), all-cause mortality (1.67 [1.00 to 2.80]). However, further adjusting for LVM attenuated the associations of ERP with the primary end point (HR [95% CI] 1.22 [0.85 to 1.77]) and secondary end points of mortality (1.39 [0.80 to 2.41]) and nonfatal CVD (1.05 [0.68 to 1.64]). ERP was associated with increased mortality and nonfatal CVD events, which was attenuated after adjusting for LVM, a previously under-recognized clinical phenotype. Previous associations of ERP with adverse cardiovascular outcomes may be partially explained by greater LVM in those with ERP.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tikkanen JT
        • Anttonen O
        • Junttila MJ
        • Aro AL
        • Kerola T
        • Rissanen HA
        • Reunanen A
        • Huikuri HV.
        Long-term outcome associated with early repolarization on electrocardiography.
        N Engl J Med. 2009; 361: 2529-2537
        • Sinner MF
        • Reinhard W
        • Müller M
        • Beckmann BM
        • Martens E
        • Perz S
        • Pfeufer A
        • Winogradow J
        • Stark K
        • Meisinger C
        • Wichmann HE
        • Peters A
        • Riegger GA
        • Steinbeck G
        • Hengstenberg C
        • Kääb S
        Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (Monica/KORA).
        PLoS Med. 2010; 7e1000314
        • Kelly JP
        • Greiner M
        • Soliman EZ
        • Randolph TC
        • Thomas KL
        • Dunlay SM
        • Curtis LH
        • O'Brien EC
        • Mentz RJ.
        Relation of Early Repolarization (J Point Elevation) to Mortality in Blacks (from the Jackson Heart Study).
        Am J Cardiol. 2018; 122: 340-346
        • Olson KA
        • Viera AJ
        • Soliman EZ
        • Crow RS
        • Rosamond WD.
        Long-term prognosis associated with J point elevation in a large middle-aged biracial cohort: the ARIC study.
        Eur Heart J. 2011; 32: 3098-3106
        • de Lemos JA
        • Ayers CR
        • Levine BD
        • deFilippi CR
        • Wang TJ
        • Hundley WG
        • Berry JD
        • Seliger SL
        • McGuire DK
        • Ouyang P
        • Drazner MH
        • Budoff M
        • Greenland P
        • Ballantyne CM
        • Khera A.
        Multimodality strategy for cardiovascular risk assessment: performance in 2 population-based cohorts.
        Circulation. 2017; 135: 2119-2132
        • Garg S
        • de Lemos JA
        • Matulevicius SA
        • Ayers C
        • Pandey A
        • Neeland IJ
        • Berry JD
        • McColl R
        • Maroules C
        • Peshock RM
        • Drazner MH.
        Association of concentric left ventricular hypertrophy With subsequent change in left ventricular end-diastolic volume: the Dallas Heart study.
        Circ Heart Fail. 2017; 10e003959
        • Haïssaguerre M
        • Derval N
        • Sacher F
        • Jesel L
        • Deisenhofer I
        • de Roy L
        • Pasquié JL
        • Nogami A
        • Babuty D
        • Yli-Mayry S
        • De Chillou C
        • Scanu P
        • Mabo P
        • Matsuo S
        • Probst V
        • Le Scouarnec S
        • Defaye P
        • Schlaepfer J
        • Rostock T
        • Lacroix D
        • Lamaison D
        • Lavergne T
        • Aizawa Y
        • Englund A
        • Anselme F
        • O'Neill M
        • Hocini M
        • Lim KT
        • Knecht S
        • Veenhuyzen GD
        • Bordachar P
        • Chauvin M
        • Jais P
        • Coureau G
        • Chene G
        • Klein GJ
        • Clémenty J
        Sudden cardiac arrest associated with early repolarization.
        N Engl J Med. 2008; 358: 2016-2023
        • Patton KK
        • Ellinor PT
        • Ezekowitz M
        • Kowey P
        • Lubitz SA
        • Perez M
        • Piccini J
        • Turakhia M
        • Wang P
        • Viskin S
        American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology and Council on Functional Genomics and Translational Biology. Electrocardiographic early repolarization: a scientific statement from the American Heart Association.
        Circulation. 2016; 133: 1520-1529
        • McNamara DA
        • Bennett AJ
        • Ayers C
        • de Lemos JA
        • Berry JD
        • Link MS.
        Early repolarization pattern is associated with increased left ventricular mass: insights from the Dallas Heart study.
        JACC Clin Electrophysiol. 2019; 5: 395-397
        • Noseworthy PA
        • Tikkanen JT
        • Porthan K
        • Oikarinen L
        • Pietilä A
        • Harald K
        • Peloso GM
        • Merchant FM
        • Jula A
        • Väänänen H
        • Hwang SJ
        • O'Donnell CJ
        • Salomaa V
        • Newton-Cheh C
        • Huikuri HV
        The early repolarization pattern in the general population: clinical correlates and heritability.
        J Am Coll Cardiol. 2011; 57: 2284-2289
        • Perez MV
        • Uberoi A
        • Jain NA
        • Ashley E
        • Turakhia MP
        • Froelicher V
        The prognostic value of early repolarization with ST-segment elevation in African Americans.
        Heart Rhythm. 2012; 9: 558-565
        • Junttila MJ
        • Sager SJ
        • Freiser M
        • McGonagle S
        • Castellanos A
        • Myerburg RJ.
        Inferolateral early repolarization in athletes.
        J Interv Card Electrophysiol. 2011; 31: 33-38
        • Noseworthy PA
        • Weiner R
        • Kim J
        • Keelara V
        • Wang F
        • Berkstresser B
        • Wood MJ
        • Wang TJ
        • Picard MH
        • Hutter AM
        • Jr Newton-Cheh C
        • Baggish AL
        Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training.
        Circ Arrhythm Electrophysiol. 2011; 4: 432-440
        • 3rd Walsh JA
        • L Ilkhanoff
        • Soliman EZ
        • Prineas R
        • Liu K
        • Ning H
        • Lloyd-Jones DM
        Natural history of the early repolarization pattern in a biracial cohort: CARDIA (Coronary artery Risk Development in Young Adults) study.
        J Am Coll Cardiol. 2013; 61: 863-869
        • Biasco L
        • Cristoforetti Y
        • Castagno D
        • Giustetto C
        • Astegiano P
        • Ganzit G
        • Gribaudo CG
        • Gaita F.
        Clinical, electrocardiographic, echocardiographic characteristics and long-term follow-up of elite soccer players with J point elevation.
        Circ Arrhythm Electrophysiol. 2013; 6: 1178-1184
        • Azevedo PMO
        • Guerreiro C
        • Ladeiras-Lopes R
        • Ferreira N
        • Faria R
        • Barbosa R
        • Primo J
        • Braga J.
        Early repolarization pattern and left ventricular mass in hypertrophic cardiomyopathy.
        Cardiology. 2020; 145: 303-308
        • Laukkanen JA
        • Khan H
        • Kurl S
        • Willeit P
        • Karppi J
        • Ronkainen K
        • Di Angelantonio E.
        Left ventricular mass and the risk of sudden cardiac death: a population-based study.
        J Am Heart Assoc. 2014; 3e001285
        • Reinier K
        • Dervan C
        • Singh T
        • Uy-Evanado A
        • Lai S
        • Gunson K
        • Jui J
        • Chugh SS.
        Increased left ventricular mass and decreased left ventricular systolic function have independent pathways to ventricular arrhythmogenesis in coronary artery disease.
        Heart Rhythm. 2011; 8: 1177-1182
        • Bouzas-Mosquera A
        • Broullón FJ
        • Álvarez-García N
        • Peteiro J
        • Mosquera VX
        • Castro-Beiras A.
        Association of left ventricular mass with all-cause mortality, myocardial infarction and stroke.
        PLoS One. 2012; 7: e45570
        • Levy D
        • Garrison RJ
        • Savage DD
        • Kannel WB
        • Castelli WP.
        Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study.
        N Engl J Med. 1990; 322: 1561-1566
        • Aro AL
        • Chugh SS.
        Clinical diagnosis of electrical Versus anatomic left ventricular hypertrophy: prognostic and therapeutic implications.
        Circ Arrhythm Electrophysiol. 2016; 9e003629
        • Ghali JK
        • Kadakia S
        • Cooper RS
        • Liao YL.
        Impact of left ventricular hypertrophy on ventricular arrhythmias in the absence of coronary artery disease.
        J Am Coll Cardiol. 1991; 17: 1277-1282
        • Uberoi A
        • Jain NA
        • Perez M
        • Weinkopff A
        • Ashley E
        • Hadley D
        • Turakhia MP
        • Froelicher V.
        Early repolarization in an ambulatory clinical population.
        Circulation. 2011; 124: 2208-2214