Having 3 or more ECG changes increased the 2-year risk of new-onset heart failure compared to no ECG changes in patients with atrial fibrillation (HR 1.83; 95% CI 1.58-2.12).
Cohort (n=130,414)
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Does the presence of specific ECG changes during sinus rhythm predict new-onset heart failure in patients with atrial fibrillation?
In patients with atrial fibrillation, the presence of specific ECG changes during sinus rhythm predicts the development of new-onset heart failure in a dose-dependent manner.
Hazard Ratio: 1.83 (95% CI 1.58–2.12)
Tasa de eventos absoluta: 4.2% vs 2.1%
Abstract Background It is well-known that atrial fibrillation (AF) and heart failure (HF) are intertwined and often coexists. This in part because the pathophysiological changes driving the development of HF can be induced by AF. AF induces structural remodeling including tachycardia-related cardiomyopathy, interstitial fibrosis, and atrial enlargement. As a consequence, patients with AF are at an increased risk of developing HF. The coexistence of AF and HF has previously been associated with greater risk of mortality compared to patients with lone AF or HF. Structural changes could introduce changes in the electrical conduction visualized on electrocardiograms (ECGs), yet no evidence of the association between ECG changes and the risk of new-onset HF in patients with AF exist. We hypothesized that remodeling and structural changes in AF could be visualized in ECG changes on a standard 12-lead ECG and that these changes are associated with an increased risk of new-onset heart failure. Purpose We therefore aimed to assess whether ECG changes could predict the risk of new-onset HF in patients with AF. Methods We used nationwide registers to identify AF patients and utilized the Danish Nationwide ECG Cohort to find subsequent sinus rhythm ECGs performed in a hospital setting. Patients were included if they had a sinus rhythm ECG at the time of ECG recording. The ECGs were analyzed to identify the following changes: Prolonged P-wave duration, left ventricle hypertrophy, biphasic P-waves, prolonged PR interval, elevated heart rate at rest, and abnormal P-terminal force in V1. Patients were grouped according to how many of the ECG changes were observed: No ECG changes, 1 ECG change, 2 ECG changes, 3 or more ECG changes. Patients were followed for 2 years to evaluate the risk of new-onset heart failure. Absolute risks were calculated using Aalen Johansen estimator, and relative risks were calculated using adjusted cox regression models. Death from all causes served as competing risk in the analyses. Results We included 130,414 AF patients with subsequent sinus rhythm ECGs. Less than half of the patients (50,300, 38.6%) had none of the ECG changes on their ECG, while the majority of patients (80,114, 61.43%) had at least one. We observed a progressively increasing risk of new-onset heart failure with higher number of ECG changes, Figure 1. Patients with no ECG changes had a 2-year absolute risk of HF of 2.1% (95% Confidence interval (CI) 2.0% to 2.3%), while patients with 3 or more ECG changes had a 2-year absolute risk of new-onset HF of 4.2% (95% CI: 3.7% to 4.8%). Patients with 3 or more ECG changes had an 83% increased risk of HF compared to patients without ECG changes (Hazard ratio: 1.83, 95% CI: 1.58-2.12), Figure 2. Conclusions The risk of new-onset heart failure increased with the number of ECG changes in a dose-response like relationship among patients with AF. ECG changes could be used to identify AF patients at high risk of developing HF.Cumulative incidences, figure 1 Relative risks, figure 2
Binding et al. (Sat,) conducted a cohort in Atrial fibrillation (n=130,414). 3 or more ECG changes vs. No ECG changes was evaluated on new-onset heart failure (HR 1.83, 95% CI 1.58-2.12). Having 3 or more ECG changes increased the 2-year risk of new-onset heart failure compared to no ECG changes in patients with atrial fibrillation (HR 1.83; 95% CI 1.58-2.12).