Short-term and long-term changes of select electrocardiogram variables preceding heart failure.

摘要

Background. The association between long-term changes in electrocardiograph (ECG) abnormalities and incident heart failure in healthy populations is unclear. Furthermore, there is a paucity of data on the short-term repeatability of and the long-term changes of ECG abnormalities.;Methods. This study examined the short-term repeatability of ECG measures (QRS/T angle, Cornell voltage, Cornell product, left ventricular mass (LVM), T wave amplitudes in lead V5 and V1, and ST depression) in the ECG Repeatability Study using nested random effects models. In the Atherosclerosis Risk in Communities (ARIC) Study, we described the long-term changes of ECG variables (QRS/T angle, QT interval, Cornell voltage, Cornell product, LVM, T wave amplitudes in leads V5 and V1 and ST depression) over repeat ARIC visits and additionally examined their association with incident heart failure. ECG variables were dichotomized (0 or 1, with "1" indicating increased risk for heart failure) and long-term change was defined as moving from "0" at baseline (1987--1989) to "1" over any ARIC visit. Continuous long-term change variables for ECG measures were created using the number of ECGs available over ARIC visits and time from baseline. Logistic and linear regression models were used to describe the long-term changes of ECG variables by coronary heart disease (CHD), diabetes and hypertension status. Cox regression models were used to assess the associations between long-term changes of ECG variables and incident heart failure.;Results. Short-term repeatability of the ECG measures was excellent. Mean values of the annual rate of change in ECG measures differed by CHD, diabetes and hypertension status and a higher proportion of ECG change was present in persons with these conditions. Finally, continuous and categorical ECG measures were associated with incident heart failure, however stronger associations were observed among the latter.;Conclusions. The long-term changes in select ECG measures may be useful for continuous monitoring of heart failure in the clinical setting. Further research to ascertain whether these select ECGs predict incident heart failure above and beyond traditional risk factors for heart failure is warranted and may provide insight into avenues for the prevention of heart failure.