Bringing Critical Race Praxis into the Study of Electrophysiological Substrate of Sudden Cardiac Death: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Race is an established risk factor for sudden cardiac death (SCD). We sought to determine whether the association of electrophysiological (EP) substrate with SCD varies between black and white individuals. Participants from the Atherosclerosis Risk in Communities study with analyzable ECGs (n=14,408; age 54±6 y; 74% white) were included. EP substrate was characterized by traditional 12-lead ECG and vectorcardiographic metrics. Two competing outcomes were adjudicated SCD and non-sudden cardiac death (nonSCD). Interaction of ECG metrics with race was studied in Cox proportional hazards and Fine-Gray competing risk models, adjusted for prevalent cardiovascular disease (CVD), risk factors, and incident non-fatal CVD. At the baseline visit linear regression analysis, adjusted for age, sex, and study center, showed black participants had larger Spatial Ventricular Gradient magnitude by 0.30 (95%CI 0.25-0.34) mV, SAI QRST by 18.4 (13.7-23.0) mV*ms, Cornell voltage by 0.30 (95%CI 0.25-0.35) mV than white participants. Over a median follow-up of 24.4 years, SCD incidence was higher in black (2.86; 95%CI 2.50-3.28 per 1000 person-years) than white participants (1.37; 95%CI 1.22-1.53 per 1000 person-years). Black participants with hypertension had the highest rate of SCD: 4.26; 95%CI 3.66-4.96 per 1000 person-years. Race did not modify associations of EP substrate with SCD and nonSCD. EP substrate does not explain racial disparities in SCD rate.

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

“…Vectorcardiographic (VCG) global electrical heterogeneity (GEH) metrics showed their clinical usefulness in heart failure patients with implanted primary prevention cardioverterdefibrillators [1][2][3][4] and in the general population. [5][6][7][8][9][10] GEH metrics represent comprehensive characterization of spatial ventricular gradient (SVG) magnitude, direction (azimuth and elevation), spatial QRS-T angle, and SVG's scalar value, sum absolute QRST integral (SAIQRST). [11,12] Spatial QRS-T angle is a well-recognized and extensively studied marker of cardiovascular risk.…”

“…Extensive previous studies support the need to implement GEH in clinical practice. [1][2][3][4][5][6][7][8][9][10][11][12][18][19][20][21][22][23][24] For successful implementation in clinical practice, it is necessary to assess the reproducibility of GEH metrics.…”

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

“…Vectorcardiographic (VCG) global electrical heterogeneity (GEH) metrics showed their clinical usefulness in heart failure patients with implanted primary prevention cardioverterdefibrillators [1][2][3][4] and in the general population. [5][6][7][8][9][10] GEH metrics represent comprehensive characterization of spatial ventricular gradient (SVG) magnitude, direction (azimuth and elevation), spatial QRS-T angle, and SVG's scalar value, sum absolute QRST integral (SAIQRST). [11,12] Spatial QRS-T angle is a well-recognized and extensively studied marker of cardiovascular risk.…”

“…Extensive previous studies support the need to implement GEH in clinical practice. [1][2][3][4][5][6][7][8][9][10][11][12][18][19][20][21][22][23][24] For successful implementation in clinical practice, it is necessary to assess the reproducibility of GEH metrics.…”