Ectopy on a Single 12-Lead ECG, Incident Cardiac Myopathy, and Death in the Community

Abstract

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.

Keywords: atrial fibrillation; heart failure; mortality; premature atrial contractions; premature ventricular contractions.

Figure 1

Probability of incident outcomes by the presence of ectopy on the baseline standard ECG. Ectopy was defined as the presence of at least 1 PAC (in the AF analysis) and at least 1 PVC (in the HF analysis). Models were adjusted for age, sex, race, hypertension, diabetes mellitus, myocardial infarction, coronary artery disease, body mass index, study center, and heart failure (in AF outcome analyses) and AF, baseline left ventricular ejection fraction, and beta‐blocker use (in heart failure outcome analyses). AF indicates atrial fibrillation; ARIC, Atherosclerosis Risk in Communities study; CHS, Cardiovascular Health Study; HF, heart failure; PAC, premature atrial contraction; PVC, premature ventricular contraction.

Figure 2

Multivariate‐adjusted hazard ratios for the association between baseline characteristics and incident outcomes. Models were adjusted for study center and atrial fibrillation (in HF analyses) and baseline ejection fraction (in HF analyses in CHS) in addition to the listed covariates. *For every 10‐year increase in age. ^†Risk in individuals with abnormal BMI (≥25 kg/m²) compared to normal (<25 kg/m²). Error bars represent 95% CI. ARIC indicates Atherosclerosis Risk in Communities study; BMI, body mass index; CAD, coronary artery disease; CHS, Cardiovascular Health Study; HF, heart failure; MI, myocardial infarction; PAC, premature atrial contraction; PVC, premature ventricular contraction.