Abstract MP09: Deep Terminal Negativity of the P Wave in V1 is Associated with Sudden Cardiac Death in the Community: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Larisa G Tereshchenko ◽  
Yiyi Zhang ◽  
Dan E Arking ◽  
Nona Sotoodehnia ◽  
David S Siscovick ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Left Ventricular ◽  
P Wave ◽  
Baseline Risk ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Qrs Duration ◽  
Cornell Product

Background: Deep terminal negativity of the P wave in V1 (P prime in V1, PPV1) defined as PPV1 ≤ -0.1mV in amplitude and ≥40 ms in duration (one small box on ECG grid) is sign of a left atrium enlargement, and a component in the Romhilt-Estes score of left ventricular hypertrophy (LVH). LVH is known to be associated with the risk of sudden cardiac death (SCD). Deep PPV1 negativity is also associated with atrial fibrillation (AF) and stroke; both have been linked to SCD as well. However, it is unknown whether or not PPV1 negativity is independently associated with SCD. Method: Baseline resting digital 12-lead ECGs of 13232 ARIC cohort participants (mean age 53.9±5.7 y; 5760 [43.5%] men; 9747 [73.7%] white) were analyzed. Individuals with prevalent baseline coronary heart disease (CHD), heart failure (HF), or QRS ≥ 120 ms were excluded. The ECGs were analyzed using a 12SL TM algorithm (GE Healthcare, Wauwatosa, WI, USA). Amplitude and duration of PPV1 was automatically measured. Results: Deep PPV1 negativity was observed in 97 (0.73%) participants. During a median follow-up of 14 years, 182 participants had SCD. In multivariable competing risks regression analysis, deep PPV1 negativity was significantly associated with SCD after adjustment for baseline risk factors of CHD and SCD (age, sex, race, diabetes, smoking, alcohol consumption, cholesterol, triglycerides, body mass index, serum creatinine, albumin, systolic blood pressure, use of antihypertensive, QT-prolonging medications, level of physical activity, mean heart rate, QTc, QRS duration, ECG-LVH by Cornell product), and incident HF, AF, stroke [subHR 3.8 (95%CI 1.88-7.69); P<0.0001]. Deep PPV1 negativity showed 7% sensitivity and 99% specificity for SCD prediction. Conclusion: In apparently CV healthy, middle-aged individuals, deep terminal negativity of P-wave in V1 is associated with about 4-times higher risk of SCD during 14 years of follow-up. Further studies should explore the cardiac substrate underlying presence of this marker and its use for risk stratification.

Abstract P027: Time-updated Premature Ventricular Contractions on 12-lead ECG Are Associated With the Risk of Sudden Cardiac Death: Atherosclerosis Risk in Communities Study and Cardiovascular Health Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Abhishek Maan ◽  
David M German ◽  
Aron Bender ◽  
Srini V Mukundan ◽  
Colleen Sitlani ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Cardiovascular Health ◽  
Competing Risk ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Premature Ventricular Contractions ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk

Introduction: The association between premature ventricular contractions (PVCs) and Sudden Cardiac Death (SCD) remains controversial. Hypothesis: We hypothesized that PVCs are associated with SCD. Methods: Presence of PVCs was detected on 12-lead ECG recorded at baseline or any of 4 follow-up visits in 15,667 participants (pts) (mean age: 54.2 + 5.8 Yrs; 55% female; 73% Whites) of the Atherosclerosis Risk in Communities (ARIC) study. For validation cohort, we included baseline and 9 follow-up visits ECG data in 5,846 pts (mean age: 72.8+ 5.6 yrs; 57.7% female, 84.2% whites) from Cardiovascular Health Study (CHS). Competing risk analyses models were constructed to test the association between time-updated PVCs and SCD risk. Model 1 was adjusted for age, sex, race and study center. Model 2 in addition was adjusted for time-updated coronary heart disease, heart failure, atrial fibrillation, stroke, and hypertension. Results: In ARIC pts, across all study visits, PVCs were observed in 2.6% of the ECGs; 99.7% of pts were PVC-free at least once; 8.8% of pts had PVC at least once. 97.7% of pts without PVCs remained PVC-free at the next visit; 19.1% of pts with detected PVC had PVC at the next visit; 2.4% of pts who were PVC-free on previous ECG, transitioned to having PVC on subsequent visit ECG. In CHS, across all 10 yearly study visits, on average, PVC was observed on 4.85% of ECG recordings; 99.4% of participants were PVC-free at least once; 21.9% of pts had PVC at least once. 96.4% of PVC-free pts remained free from PVC at the next visit. 30.6% of pts with detected PVC on a given ECG had PVC at the next visit. 3.6% of pts who did not have PVC on previous ECG, transitioned to having PVC at the next visit. 69.4% of pts with PVC on a given ECG transitioned to being PVC-free next year. In adjusted competing risk analysis PVC was associated with SCD, but not with non-sudden cardiac death or non-cardiac death (Table). Conclusions: Time-updated presence of PVC on a short 10-sec resting 12-lead ECG is associated with SCD.

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

Heart ◽  
2017 ◽  
Vol 104 (5) ◽  
pp. 423-429 ◽  
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.

Abstract MP083: Autonomic Imbalance at the Level of Atrioventricular Node, but Not at the Level of Sinus Node, is Associated With Sudden Cardiac Death: The Atherosclerosis Risk in Community Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Srini V Mukundan ◽  
Muammar M Kabir ◽  
Jason Thomas ◽  
Golriz Sedaghat ◽  
Jonathan W Waks ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Cox Regression ◽  
Sinus Node ◽  
Atrioventricular Node ◽  
Av Node ◽  
Atherosclerosis Risk In Communities ◽  
Autonomic Imbalance ◽  
Summary Effect ◽  
Atherosclerosis Risk

Introduction: Autonomic imbalance, quantified by decreased heart rate variability (HRV), is associated with increased cardiovascular mortality. It is unknown if autonomic influences on sinus and atrioventricular (AV) nodes are equally important for the risk of sudden cardiac death (SCD). Hypothesis: Autonomic influences on sinus and AV node are equally strongly associated with increased SCD, non-sudden cardiac death (non-SCD), and non-cardiac death. Methods: Baseline visit 10-second ECGs (n=14,250) of the Atherosclerosis Risk in Communities (ARIC) cohort were analyzed. Normalized variance of P-onset to P-onset intervals (PPVN) and QRS-onset to QRS-onset intervals (QQVN) was calculated to assess autonomic influence on sinus and AV node respectively. Normalized variance of Rpeak - Rpeak intervals was determined as HRV measure. Values were log-transformed to normalize distribution. SCD served as primary outcome. Secondary outcomes were non-SCD and non-cardiac death. Three Cox regression models were constructed for dichotomized at 20 th percentile predictor variables. Results: Over median follow-up of 24.4 years, there were 497 SCDs (incidence 1.66 [95%CI 1.52-1.82], 742 non-SCDs (incidence 2.48 [95%CI 2.31-2.67], and 3,753 non-cardiac deaths (incidence 12.6 [95%CI 12.1-13.0]) per 1,000 person-years. In paired analysis, LogPPVN was significantly larger than LogQQVN (-7.28±1.06 vs. -7.72±1.24; P<0.0001). There was no difference between LogQQVN and Log RRVN (-7.72±1.24 vs -7.72±1.23; P=0.364). After full adjustment, LogRRVN and LogQQVN were significantly associated with non-SCD and SCD. Association with non-SCD was stronger. LogPPVN was independently associated with non-SCD but not SCD. No value was associated with non-cardiac death. Conclusion: Autonomic imbalance at the AV node, with likely summary effect at the bundle of His, is associated with SCD and non-SCD. Autonomic imbalance at the SA node is associated with non-SCD only. Autonomic input to SA and AV node should be further studied.

scholarly journals The Metabolic Syndrome and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study

2017 ◽  
Vol 6 (8) ◽  
Author(s):  
Paul L. Hess ◽  
Hussein R. Al‐Khalidi ◽  
Daniel J. Friedman ◽  
Hillary Mulder ◽  
Anna Kucharska‐Newton ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Atherosclerosis Risk In Communities ◽  
The Metabolic Syndrome ◽  
Atherosclerosis Risk
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