Association Between Temporal Changes in Early Repolarization Pattern With Long‐Term Cardiovascular Outcome: A Population‐Based Cohort Study

Liu, Lijuan; Tang, Na; Bi, Wen-Tao; Zhang, Ming; Deng, Xue-Qiong; Cheng, Yun‐Jiu

doi:10.1161/jaha.121.022848

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…Interestingly, nicotine-free PG aerosols had a similar effect on J amp and significantly increased VPBs, indicating that PG aerosols also affect both I to and arrhythmia. Of note, several human studies have positively associated increases in J amplitude with fatal arrhythmia 52 .…”

Section: Discussionmentioning

confidence: 99%

E-cigarettes and their lone constituents induce cardiac arrhythmia and conduction defects in mice

et al. 2022

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E-cigarette use has surged, but the long-term health effects remain unknown. E-cigarette aerosols containing nicotine and acrolein, a combustion and e-cigarette byproduct, may impair cardiac electrophysiology through autonomic imbalance. Here we show in mouse electrocardiograms that acute inhalation of e-cigarette aerosols disturbs cardiac conduction, in part through parasympathetic modulation. We demonstrate that, similar to acrolein or combustible cigarette smoke, aerosols from e-cigarette solvents (vegetable glycerin and propylene glycol) induce bradycardia, bradyarrhythmias, and elevations in heart rate variability during inhalation exposure, with inverse post-exposure effects. These effects are slighter with tobacco- or menthol-flavored aerosols containing nicotine, and in female mice. Yet, menthol-flavored and PG aerosols also increase ventricular arrhythmias and augment early ventricular repolarization (J amplitude), while menthol uniquely alters atrial and atrioventricular conduction. Exposure to e-cigarette aerosols from vegetable glycerin and its byproduct, acrolein, diminish heart rate and early repolarization. The pro-arrhythmic effects of solvent aerosols on ventricular repolarization and heart rate variability depend partly on parasympathetic modulation, whereas ventricular arrhythmias positively associate with early repolarization dependent on the presence of nicotine. Our study indicates that chemical constituents of e-cigarettes could contribute to cardiac risk by provoking pro-arrhythmic changes and stimulating autonomic reflexes.

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Section: Discussionmentioning

confidence: 99%

E-cigarettes and their lone constituents induce cardiac arrhythmia and conduction defects in mice

et al. 2022

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“…The methods for ascertainment of SCD events have been described previously. 21 , 22 , 23 , 24 To identify SCD, all fatal cardiovascular events in ARIC study were reviewed by an independent panel of physicians. SCD cases were validated independently by 2 researchers and confirmed by a cardiologist through details from the medical records.…”

Section: Methodsmentioning

confidence: 99%

Dynamic Change of Cardiovascular Health Metrics and Long‐Term Risk of Sudden Cardiac Death: The ARIC Study

Zhai

et al. 2022

JAHA

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Background The change of cardiovascular health (CVH) status has been associated with risk of cardiovascular disease. However, no studies have explored the change patterns of CVH in relation to risk of sudden cardiac death (SCD). We aim to examine the link between baseline CVH and change of CVH over time with the risk of SCD. Methods and Results Analyses were conducted in the prospective cohort ARIC (Atherosclerosis Risk in Communities) study, started in 1987 to 1989. ARIC enrolled 15 792 individuals 45 to 64 years of age from 4 US communities (Forsyth County, North Carolina; Jackson, Mississippi; suburbs of Minneapolis, Minnesota; and Washington County, Maryland). Subjects with 0 to 2, 3 to 4, and 5 to 7 ideal metrics of CVH were categorized as having poor, intermediate, or ideal CVH, respectively. Change in CVH over 6 years between 1987 to 1989 and 1993 to 1995 was considered. The primary study outcome was physician adjudicated SCD. The study population consisted of 15 026 subjects, of whom 12 207 had data about CVH change. Over a median follow‐up of 23.0 years, 583 cases of SCD were recorded. There was a strong inverse association between baseline CVH metrics and time varying CVH metrics with risk of SCD. Compared with subjects with consistently poor CVH, risk of SCD was lower in those changed from poor to intermediate/ideal (hazard ratio [HR], 0.67 [95% CI, 0.48–0.94]), intermediate to poor (HR, 0.73 [95% CI, 0.54–0.99]), intermediate to ideal (HR, 0.49 [95% CI, 0.24–0.99]), ideal to poor/intermediate CVH (HR, 0.23 [95% CI, 0.10–0.52]), or those with consistently intermediate (HR, 0.49 [95% CI, 0.36–0.66]) or consistently ideal CVH (HR, 0.31 [95% CI, 0.13–0.76]). Similar results were also observed for non‐SCD. Conclusions Compared with consistently poor CVH, other patterns of change in CVH were associated with lower risk of SCD. These findings highlight the importance of promotion of ideal CVH in the primordial prevention of SCD.

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“…Relatively high prevalences of early repolarization abnormalities (12.4%) and electrocardiographic left ventricular hypertrophy (8.3%) were also recently reported in the multinational Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) Study [66 & ]. While studies in the general population suggest the association between electrocardiographic early repolarization [72] and left ventricular hypertrophy with SCD [73], long term clinical follow-up is required to determine clinical significance in PLWH (Table 2).…”

Section: Subclinical Disease Measures and Risk Of Ventricular Arrhyth...mentioning

confidence: 99%

Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV

Woldu

Post

et al. 2022

Current Opinion in HIV and AIDS

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Purpose of reviewTo summarize the state-of-the-art literature on the epidemiology, disease progression, and mediators of heart failure, tachyarrhythmias, and sudden cardiac death in people living with HIV (PLWH) to inform prevention strategies.Recent findingsRecent studies corroborate the role of HIV as a risk enhancer for heart failure and arrhythmias, which persists despite adjustment for cardiovascular risk factors and unhealthy behaviors. Immune activation and inflammation contribute to the risk. Heart failure occurs more frequently at younger ages, and among women and ethnic minorities living with HIV, highlighting disparities. Prospective outcome studies remain sparse in PLWH limiting prevention approaches. However, subclinical cardiac and electrophysiologic remodeling and dysfunction detected by noninvasive testing are powerful disease surrogates that inform our mechanistic understanding of HIV-associated cardiovascular disease and offer opportunities for early diagnosis.SummaryAggressive control of HIV viremia and cardiac risk factors and abstinence from unhealthy behaviors remain treatment pillars to prevent heart failure and arrhythmic complications. The excess risk among PLWH warrants heightened vigilance for heart failure and arrhythmic symptomatology and earlier testing as subclinical abnormalities are common. Future research needs include identifying novel therapeutic targets to prevent heart failure and arrhythmias and testing of interventions in diverse groups of PLWH.

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Association Between Temporal Changes in Early Repolarization Pattern With Long‐Term Cardiovascular Outcome: A Population‐Based Cohort Study

Cited by 3 publications

References 36 publications

E-cigarettes and their lone constituents induce cardiac arrhythmia and conduction defects in mice

E-cigarettes and their lone constituents induce cardiac arrhythmia and conduction defects in mice

Dynamic Change of Cardiovascular Health Metrics and Long‐Term Risk of Sudden Cardiac Death: The ARIC Study

Prevention of heart failure, tachyarrhythmias and sudden cardiac death in HIV

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