Sex differences in vectorcardiogram of African-Americans with and without cardiovascular disease: a cross-sectional study in the Jackson Heart Study cohort

Latent profiles of global electrical heterogeneity: the Hispanic Community Health Study/Study of Latinos

Aims

Despite the highest prevalence of stroke, obesity, and diabetes across races/ethnicities, paradoxically, Hispanic/Latino populations have the lowest prevalence of atrial fibrillation and major Minnesota code-defined ECG abnormalities. We aimed to use Latent Profile Analysis in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) population to obtain insight into epidemiological discrepancies.

Methods and results

We conducted a cross-sectional analysis of baseline HCHS/SOL visit. Global electrical heterogeneity (GEH) was measured as spatial QRS-T angle (QRSTa), spatial ventricular gradient azimuth (SVGaz), elevation (SVGel), magnitude (SVGmag), and sum absolute QRST integral (SAIQRST). Statistical analysis accounted for the stratified two-stage area probability sample design. We fitted a multivariate latent profile generalized structural equation model adjusted for age, sex, ethnic background, education, hypertension, diabetes, smoking, dyslipidaemia, obesity, chronic kidney disease, physical activity, diet quality, average RR' interval, median beat type, and cardiovascular disease (CVD) to gain insight into the GEH profiles. Among 15 684 participants (age 41 years; 53% females; 6% known CVD), 17% had an increased probability of likely abnormal GEH profile (QRSTa 80 ± 27°, SVGaz -4 ± 21°, SVGel 72 ± 12°, SVGmag 45 ± 12 mVms, and SAIQRST 120 ± 23 mVms). There was a 23% probability for a participant of being in Class 1 with a narrow QRSTa (40.0 ± 10.2°) and large SVG (SVGmag 108.3 ± 22.6 mVms; SAIQRST 203.4 ± 39.1 mVms) and a 60% probability of being in intermediate Class 2.

Conclusion

A substantial proportion (17%) in the Hispanic/Latino population had an increased probability of altered, likely abnormal GEH profile, whereas 83% of the population was resilient to harmful risk factors exposures.

Exploring vectorcardiography: An extensive vectocardiogram analysis across age, sex, BMI, and cardiac conditions

BACKGROUND

The vectocardiogram (VCG) offers a three-dimensional view of the heart's electrical activity, yet many VCG parameters remain unexplored in diverse clinical contexts.

OBJECTIVES

This study aims to explore the relationships between various VCG parameters and specific patient characteristics.

METHODS

ECG signals from adults were transformed into VCGs utilizing the Kors matrix, yielding 315 parameters per patient from the P, QRS and T loops. Univariable analysis, circular statistics, and stepwise logistic regression were employed to examine the relationships between VCG parameters and factors such as age, sex, BMI, hypertension, echocardiographic ischemic heart disease (Echo-IHD), and left ventricular hypertrophy (Echo-LVH).

RESULTS

We included 664 adults and considered an alpha value of 0.05 and a power of 90%. The study revealed significant associations, such as age with P loop roundness index (RI) (OR = 3.825, 95% confidence interval [95%CI] = 2.079-7.04), male sex with QRS loop RI (OR = 6.08, 95%CI = 1.835-20.153), abnormal BMI with the T loop's RI (OR = 0.544, 95%CI = 0.325-0.909), hypertension with the T loop planarity index (PI) (OR = 8.01, 95%CI = 2.134-30.117), Echo-IHD with QRS loop curvature at the 4/10th segment (OR = 7.58, 95%CI = 1.954-29.458), and Echo-LVH with the T loop lag-1/10 dihedral angle (OR = 10.3, 95%CI = 1.822-58.101). In the study, several additional VCG parameters demonstrated statistically significant, albeit smaller, associations with patient demographics and cardiovascular conditions.

CONCLUSIONS

The findings enhance our understanding of the intricate relationships between VCG parameters and patient characteristics, emphasizing the potential role of VCG analysis in assessing cardiovascular diseases. These insights may guide future research and clinical applications in cardiology.

Reproducibility of global electrical heterogeneity measurements on 12-lead ECG: The Multi-Ethnic Study of Atherosclerosis

OBJECTIVE

Vectorcardiographic (VCG) global electrical heterogeneity (GEH) metrics showed clinical usefulness. We aimed to assess the reproducibility of GEH metrics.

METHODS

GEH was measured on two 10-s 12‑lead ECGs recorded on the same day in 4316 participants of the Multi-Ethnic Study of Atherosclerosis (age 69.4 ± 9.4 y; 2317(54%) female, 1728 (40%) white, 1138(26%) African-American, 519(12%) Asian-American, 931(22%) Hispanic-American). GEH was measured on a median beat, comprised of the normal sinus (N), atrial fibrillation/flutter (S), and ventricular-paced (VP) beats. Spatial ventricular gradient's (SVG's) scalar was measured as sum absolute QRST integral (SAIQRST) and vector magnitude QT integral (VMQTi).

RESULTS

Two N ECGs with heart rate (HR) bias of -0.64 (95% limits of agreement [LOA] -5.68 to 5.21) showed spatial area QRS-T angle (aQRST) bias of -0.12 (95%LOA -14.8 to 14.5). Two S ECGs with HR bias of 0.20 (95%LOA -15.8 to 16.2) showed aQRST bias of 1.37 (95%LOA -33.2 to 35.9). Two VP ECGs with HR bias of 0.25 (95%LOA -3.0 to 3.5) showed aQRST bias of -1.03 (95%LOA -11.9 to 9.9). After excluding premature atrial or ventricular beat and two additional beats (before and after extrasystole), the number of cardiac beats included in a median beat did not affect the GEH reproducibility. Mean-centered log-transformed values of SAIQRST and VMQTi demonstrated perfect agreement (Bias 0; 95%LOA -0.092 to 0.092).

CONCLUSION

GEH measurements on N, S, and VP median beats are reproducible. SVG's scalar can be measured as either SAIQRST or VMQTi.

SIGNIFICANCE

Satisfactory reproducibility of GEH metrics supports their implementation.