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.
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Article Info
Publication History
Received in revised form:
August 29,
2021
Received:
May 17,
2021
Footnotes
The Dallas Heart Study was supported by grant UL1TR001105 from the National Center for Advancing Translational Sciences of the National Institutes of Health (Bethesda, Maryland). Dr. McNamara was supported by grant T32-HL125247 from the National Heart, Lung, and Blood Institute (Bethesda, Maryland).
Identification
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