Accelerated ECG-age (>8.45 years higher than chronological age) predicted a 3-fold increased stroke risk and 5-fold increased heart failure risk in Brazilian adults.
Does accelerated ECG-age predict cardiovascular outcomes and improve ASCVD risk discrimination in adults without prevalent CVD?
Accelerated ECG-age is a significant predictor of stroke, heart failure, and cardiovascular mortality in Brazilian adults, though it does not improve ASCVD risk discrimination beyond the WHO HEARTS score.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction Chronological age is a key risk factor for cardiovascular disease (CVD), although its effects on cardiovascular health are heterogeneous across individuals. Premature biological aging results in higher CVD risk. Recognizing individuals with accelerated cardiovascular aging could help enhance primary prevention strategies. Electrocardiographic interpretation based on deep neural networks (DNN) can estimate electrocardiographic age (ECG-age), a potential indicator of biological and cardiovascular aging. However, the ability of ECG-age to predict cardiovascular outcomes, as well as its potential clinical utility, is still a subject of study. Purpose To evaluate the association between accelerated ECG-age and cardiovascular outcomes in Brazilian adults using data from the ELSA-Brasil community-based cohort. Additionally, we aimed to evaluate the ability of ECG-age to discriminate atherosclerotic cardiovascular events (ASCVD) risk, comparing its performance to the WHO HEARTS risk prediction score for tropical Latin America, recommended by national guidelines. Methods From 15.115 participants, we excluded those with prevalent CVD and incomplete outcome data. ECG-age was categorized based on the difference (Δage) between DNN-predicted ECG-age and chronological age. A Δage greater than 8.45 years, the model’s mean absolute error, was classified as "accelerated ECG-age". Cox proportional hazards models hierarchically adjusted for age, sex, level of education and traditional cardiovascular risk factors were used to examine the association of accelerated ECG-age with cardiovascular outcomes stroke, acute coronary syndrome (ACS), heart failure (HF), cardiovascular mortality, and composite outcomes including ASCVD and major adverse cardiac events (MACE). To account for the competing risk of mortality, we used Fine-Gray models. Additionally, we assessed whether ECG-age could improve the WHO risk score discrimination for ASCVD using the c-statistics. Results The study sample included 12,854 individuals (mean age 52 ± 9 years; 55% women; 46% Black race), of which 7.4% had accelerated ECG-age. In the fully adjusted models, accelerated ECG-age was associated with a 5-year increase in risk for stroke HR=3.04 (95%CI 1.54-6.00), HF HR 5.13 (95%CI 2.50-14.70), cardiovascular mortality HR= 3.82 (95%CI 1.59-9.17), ASCVD HR=1.92 (95%CI 1.22-3.04) and MACE HR=2.27 (95%CI 1.49-3.45). No significant association was observed between accelerated ECG-age and ACS. The incidence curves derived from the age and sex-adjusted Cox proportional models for stroke and HF are depicted in Figures 1 and 2, respectively. In the discrimination analysis ECG-age had an AUC of 0.71 for ASCVD, and no incremental benefit when compared to AUC=0.76 for the WHO score. Conclusion Accelerated ECG-age is a significant predictor of stroke and HF in Brazilian adults, but its addition to the WHO score did not enhance its discriminatory ability.Incidence curve for stroke Incidence curve for heart failure
Ciminelli et al. (Sat,) reported a other. Accelerated ECG-age (>8.45 years higher than chronological age) predicted a 3-fold increased stroke risk and 5-fold increased heart failure risk in Brazilian adults.