Background--Atrial fibrillation and heart failure are 2 of the most common diseases, yet ready means to identify individuals at risk are lacking. The 12-lead ECG is one of the most accessible tests in medicine. Our objective was to determine whether a premature atrial contraction observed on a standard 12-lead ECG would predict atrial fibrillation and mortality and whether a premature ventricular contraction would predict heart failure and mortality. Methods and Results--We utilized the CHS (Cardiovascular Health) Study, which followed 5577 participants for a median of 12 years, as the primary cohort. The ARIC (Atherosclerosis Risk in Communities Study), the replication cohort, captured data from 15 792 participants over a median of 22 years. In the CHS, multivariable analyses revealed that a baseline 12-lead ECG premature atrial contraction predicted a 60% increased risk of atrial fibrillation (hazard ratio, 1.6; 95% CI, 1.3-2.0; P < 0.001) and a premature ventricular contraction predicted a 30% increased risk of heart failure (hazard ratio, 1.3; 95% CI, 1.0-1.6; P=0.021). In the negative control analyses, neither predicted incident myocardial infarction. A premature atrial contraction was associated with a 30% increased risk of death (hazard ratio, 1.3; 95% CI, 1.1-1.5; P=0.008) and a premature ventricular contraction was associated with a 20% increased risk of death (hazard ratio, 1.2; 95% CI, 1.0-1.3; P=0.044). Similarly statistically significant results for each analysis were also observed in ARIC. Conclusions--Based on a single standard ECG, a premature atrial contraction predicted incident atrial fibrillation and death and a premature ventricular contraction predicted incident heart failure and death, suggesting that this commonly used test may predict future disease.
Bibliographical noteFunding Information:
This work was made possible by the Joseph Drown Foundation (Marcus), R25MD00683, the National Institute on Minority Health and Health Disparities (Nguyen), and grant 16EIA26410001 from the American Heart Association (Alonso). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Grants and contracts for the Cardiovascular Health Study include: contracts HHSN268201200036C, HHSN268200800007C, N01HC 55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grant
U01HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with an additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. These grants and contracts supported the data collection and management of CHS data. The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by NHLBI contracts (HHSN268201100005C, HHSN268201100006C, HHSN2682 01100007C, HHSN268201100008C, HHSN26820110000 9C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). These grants and contracts supported the data collection and management of ARIC data.
Marcus receives research support from the NIH, PCORI, Medtronic, Pfizer, and Rhythm Diagnostic Systems and is a consultant and equity holder of InCarda. None of the other authors have any competing interests.
- Atrial fibrillation
- Heart failure
- Premature atrial contractions
- Premature ventricular contractions