Electrophysiological ventricular substrate of stroke: a prospective cohort study in the Atherosclerosis Risk in Communities (ARIC) study

ObjectivesThe goal of the study was to determine an association of cardiac ventricular substrate with thrombotic stroke (TS), cardioembolic stroke (ES) and intracerebral haemorrhage (ICH).DesignProspective cohort study.SettingThe Atherosclerosis Risk in Communities (ARIC) study in 1987–1989 enrolled adults (45–64 years), selected as a probability sample from four US communities (Minneapolis, Minnesota; Washington, Maryland; Forsyth, North Carolina; Jackson, Mississippi). Visit 2 was in 1990–1992, visit 3 in 1993–1995, visit 4 in 1996–1998 and visit 5 in 2011–2013.ParticipantsARIC participants with analysable ECGs and no history of stroke were included (n=14 479; age 54±6 y; 55% female; 24% black). Ventricular substrate was characterised by cardiac memory, spatial QRS-T angle (QRS-Ta), sum absolute QRST integral (SAIQRST), spatial ventricular gradient magnitude (SVGmag), premature ventricular contractions (PVCs) and tachycardia-dependent intermittent bundle branch block (TD-IBBB) on 12-lead ECG at visits 1–5.OutcomeAdjudicated TS included a first definite or probable thrombotic cerebral infarction, ES—a first definite or probable non-carotid cardioembolic brain infarction. Definite ICH was included if it was the only stroke event.ResultsOver a median 24.5 years follow-up, there were 899 TS, 400 ES and 120 ICH events. Cox proportional hazard risk models were adjusted for demographics, cardiovascular disease, risk factors, atrial fibrillation, atrial substrate and left ventricular hypertrophy. After adjustment, PVCs (HR 1.72; 95% CI 1.02 to 2.92), QRS-Ta (HR 1.15; 95% CI 1.03 to 1.28), SAIQRST (HR 1.20; 95% CI 1.07 to 1.34) and time-updated SVGmag (HR 1.19; 95% CI 1.08 to 1.32) associated with ES. Similarly, PVCs (HR 1.53; 95% CI 1.03 to 2.26), QRS-Ta (HR 1.08; 95% CI 1.01 to 1.16), SAIQRST (HR 1.07; 95% CI 1.01 to 1.14) and time-updated SVGmag (HR 1.11; 95% CI 1.04 to 1.19) associated with TS. TD-IBBB (HR 3.28; 95% CI 1.03 to 10.46) and time-updated SVGmag (HR 1.23; 95% CI 1.03 to 1.47) were associated with ICH.ConclusionsPVC burden (reflected by cardiac memory) is associated with ischaemic stroke. Transient cardiac memory (likely through TD-IBBB) precedes ICH.

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Does Ventricular Substrate Play a Role in Incident Stroke? The Atherosclerosis Risk in Communities (ARIC) Study

10.1101/2020.05.04.20090910 ◽

2020 ◽

Author(s):

John A. Johnson ◽

Kazi T. Haq ◽

Katherine J. Lutz ◽

Kyle K. Peters ◽

Kevin A. Paternostro ◽

...

Keyword(s):

Risk Factors ◽

Hemorrhagic Stroke ◽

Cox Model ◽

Left Ventricular ◽

Premature Ventricular Contractions ◽

Atherosclerosis Risk In Communities ◽

Cardiac Memory ◽

Atherosclerosis Risk ◽

History Of ◽

Aric Study

AbstractBackground—The goal of the study was to determine an association of ventricular substrate with thrombotic, cardioembolic, and hemorrhagic stroke.Methods—Participants from the Atherosclerosis Risk in Communities study with analyzable ECGs and no history of stroke were included (n=14,479; age 54±6 y; 55% female; 24% black). Ventricular substrate was characterized by cardiac memory [spatial QRS-T angle (QRS-Ta), sum absolute QRST integral (SAIQRST), spatial ventricular gradient magnitude (SVGmag)], premature ventricular contractions (PVC) and tachycardia-dependent intermittent bundle branch block (TD-IBBB) on 12-lead ECG recorded at visits 1-5. Incident strokes were adjudicated by physician reviewers. Cox proportional hazard risk models were constructed.Results—Over a median 24.5 y follow-up, there were 899 thrombotic, 400 cardioembolic, and 187 hemorrhagic strokes. After adjustment for cardiovascular disease (CVD) and its risk factors, atrial fibrillation / atrial substrate, and ECG-left ventricular hypertrophy, PVC (HR 1.72; 95%CI 1.02-2.92), QRS-Ta (HR 1.15; 95%CI 1.03-1.28), SAIQRST (HR 1.20; 95%CI 1.07-1.34) and time-updated SVGmag (HR 1.19; 95%CI 1.08-1.32) associated with cardioembolic stroke. After adjustment for CVD and its risk factors, PVC (HR 1.53; 95%CI 1.03-2.26), QRS-Ta (HR 1.08; 95%CI 1.01-1.16), SAIQRST (HR 1.07; 95%CI 1.01-1.14), and time-updated SVGmag (HR 1.11; 95%CI 1.04-1.19) associated with thrombotic stroke. In fully adjusted time-updated Cox model QRS-Ta (HR 1.20; 95%CI 1.04-1.38), SAI QRST (HR 1.23; 95%CI 1.06-1.43), SVGmag (HR 1.23; 95%CI 1.06-1.43) associated with hemorrhagic stroke, whereas TD-IBBB trended (HR 1.84; 95%CI 0.25-13.33).Conclusions—PVC burden reflected by cardiac memory is associated with ischemic stroke. Transient cardiac memory (likely through TD-IBBB) precedes hemorrhagic stroke.

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Faculty Opinions recommendation of Contrast echocardiography for assessing left ventricular vortex strength in heart failure: a prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718250477.793490113 ◽

2014 ◽

Author(s):

Gerald Maurer ◽

Georg Goliasch

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Contrast Echocardiography ◽

Left Ventricular ◽

Vortex Strength

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Vital exhaustion and sudden cardiac death in the Atherosclerosis Risk in Communities Study

Heart ◽

10.1136/heartjnl-2017-311825 ◽

2017 ◽

Vol 104 (5) ◽

pp. 423-429 ◽

Cited By ~ 2

Author(s):

Brittany M Bogle ◽

Nona Sotoodehnia ◽

Anna M Kucharska-Newton ◽

Wayne D Rosamond

Keyword(s):

Risk Factors ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Disease Risk ◽

Ventricular Tachyarrhythmia ◽

Atherosclerosis Risk In Communities ◽

Vital Exhaustion ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Aric Study

ObjectiveVital exhaustion (VE), a construct defined as lack of energy, increased fatigue and irritability, and feelings of demoralisation, has been associated with cardiovascular events. We sought to examine the relation between VE and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) Study.MethodsThe ARIC Study is a predominately biracial cohort of men and women, aged 45–64 at baseline, initiated in 1987 through random sampling in four US communities. VE was measured using the Maastricht questionnaire between 1990 and 1992 among 13 923 individuals. Cox proportional hazards models were used to examine the hazard of out-of-hospital SCD across tertiles of VE scores.ResultsThrough 2012, 457 SCD cases, defined as a sudden pulseless condition presumed due to a ventricular tachyarrhythmia in a previously stable individual, were identified in ARIC by physician record review. Adjusting for age, sex and race/centre, participants in the highest VE tertile had an increased risk of SCD (HR 1.48, 95% CI 1.17 to 1.87), but these findings did not remain significant after adjustment for established cardiovascular disease risk factors (HR 0.94, 95% CI 0.73 to 1.20).ConclusionsAmong participants of the ARIC study, VE was not associated with an increased risk for SCD after adjustment for cardiovascular risk factors.

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