AUTHOR=Ahmad Muhammad Imtiaz , Mujtaba Mohammadtokir , Floyd James S. , Chen Lin Y. , Soliman Elsayed Z. 

TITLE=Electrocardiographic markers of atrial cardiomyopathy and risk of heart failure in the multi-ethnic study of atherosclerosis (MESA) cohort

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1143338

DOI=10.3389/fcvm.2023.1143338

ISSN=2297-055X

ABSTRACT=Background: The association of electrocardiographic markers of atrial cardiomyopathy with heart failure (HF) and its subtypes is unclear.
Methods: This analysis included 6,754 participants free of clinical cardiovascular disease (CVD), including atrial fibrillation (AF), from the Multi-Ethnic Study of Atherosclerosis. Five ECG markers of atrial cardiomyopathy (P-wave terminal force in V1 [PTFV1], deep-terminal negativity in V1 [DTNV1], P-wave duration [PWD], P-wave axis [PWA], advanced intra-atrial block [aIAB]) were derived from digitally recorded electrocardiograms. Incident HF events through 2018 were centrally adjudicated. An ejection fraction (EF) of 50% at the time of HF was used to classify HF as HF with reduced EF (HFrEF), HF with preserved EF (HFpEF), or unclassified HF. Cox proportional hazard models were used to examine the associations of markers of atrial cardiomyopathy with HF.  The Lunn-McNeil method was used to compare the associations in HFrEF versus HFpEF.
Results: Over a median follow-up of 16 years, 413 HF events occurred.  In adjusted models, abnormal PTFV1 (HR (95%CI): 1.56(1.15-2.13), abnormal PWA (HR (95%CI):1.60(1.16-2.22), aIAB (HR (95%CI):2.62(1.47-4.69), DTNPV1 (HR (95%CI): 2.99(1.63-7.33), and abnormal PWD (HR (95%CI): 1.33(1.02-1.73), were associated with increased HF risk. These associations persisted after further adjustments for intercurrent AF events. There were no significant differences in the strength of association of each ECG predictor with HFrEF and HFpEF.  
Conclusions: Atrial cardiomyopathy defined by ECG markers is associated with HF, with no
significant difference in the strength of association among its subtypes. Markers of atrial
Cardiomyopathy may help identify individuals at risk of developing HF.