Abstract 13080: Electrocardiographic Strain Pattern as a Predictor for New-Onset Heart Failure, Concentric Hypertrophy, Reduced Function, and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

Abstract

Introduction: Left ventricular hypertrophy (LVH) is associated with incident heart failure (HF), and ECG strain is a marker of LVH. This study sought to evaluate the relationship of baseline ECG strain to the incidence of HF, longitudinal change of left ventricular (LV) geometry and function by cardiac magnetic resonance imaging (CMR). Methods: A total of 4,732 participants (mean age 61 years, 54% women) free of cardiovascular disease (CVD) underwent ECG and CMR. We used univariable and multivariable Cox proportional hazards to evaluate the association of ECG strain with incident HF (n=137). We also examined the association of baseline ECG strain with changes of LV geometry and function in 2,846 participants imaged at baseline and 10 years later using multiple linear regression models. Finally, we evaluated the association between the presence of ECG strain and LV scar defined by late Gadolinium enhancement at year 10 (n=1,650). Results: The presence of ECG strain was significantly associated with incident HF (hazard ratio: 2.53; 95% CI: 1.40 to 4.57; p=0.021) during follow-up (median 11.2 years). Longitudinal analysis revealed that the presence of ECG strain at baseline was significantly associated with an increase in the LV mass index (β=5.54g/m2, p<0.001), LV mass-to-volume ratio (β=0.07g/mL, p=0.009), and a decrease in LV ejection fraction (EF) (β=-2.35%, p=0.015), even when coronary heart disease events were excluded. Moreover, ECG strain was independently associated with LV scar (p=0.004). Conclusions: In a cohort of middle-aged participants without prior CVD, ECG strain was an independent predictor of new-onset HF. In addition, ECG strain was related to development of LV concentric hypertrophy and decline in EF as well as LV scar.