Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

Abstract

Purpose:To examine the associations of myocardial diffuse fibrosis and scar with surface electrocardiographic (ECG) parameters in individuals free of prior coronary heart disease in four different ethnicities. Materials and Methods:This prospective cross-sectional study was approved by the institutional review boards, and all participants gave informed consent. A total of 1669 participants in the Multi-Ethnic Study of Atherosclerosis, or MESA, who were free of prior myocardial infarction underwent both ECG and cardiac magnetic resonance imaging. In individuals without a late gadolinium enhancement-defined myocardial scar (n = 1131), T1 mapping was used to assess left ventricular (LV) interstitial diffuse fibrosis. The associations of LV diffuse fibrosis or myocardial scar with ECG parameters (QRS voltage, QRS duration, and corrected QT interval [QTc]) were evaluated by using multivariable regression analyses adjusted for demographic data, risk factors for scar, LV end-diastolic volume, and LV mass. Results:The mean age of the 1669 participants was 67.4 years 6 8.7 (standard deviation); 49.8% were women. Lower postcontrast T1 time at 12 minutes was significantly associated with lower QRS Sokolow-Lyon voltage (b = 15.1 µV/10 msec, P = .004), lower QRS Cornell voltage (b = 9.2 µV/10 msec, P = .031), and shorter QRS duration (b = 0.16 msec/10 msec, P = .049). Greater extracellular volume (ECV) fraction was also significantly associated with lower QRS Sokolow-Lyon voltage (b = 235.2 µV/1% ECV increase, P , .001) and Cornell voltage (b = 223.7 µV/1% ECV increase, P , .001), independent of LV structural indexes. In contrast, the presence of LV scar (n = 106) was associated with longer QTc (b = 4.3 msec, P = .031). Conclusion:In older adults without prior coronary heart disease, underlying greater LV diffuse fibrosis is associated with lower QRS voltage and shorter QRS duration at surface ECG, whereas clinically unrecognized myocardial scar is associated with a longer QT interval.q RSNA, 2016

How are ECG parameters related to cardiac magnetic resonance images? Electrocardiographic predictors of left ventricular hypertrophy and myocardial fibrosis in hypertrophic cardiomyopathy

“…The diagnostic value of the different ECG voltage criteria for HCM is mainly investigated using echocardiography (Chen et al, 2014;Erice et al, 2009;Grossman, Prokupetz, Koren-Morag, Grossman, & Shamiss, 2012 (Inoue et al, 2017). It is also known that end-stage HCM with extensive fibrosis is associated with low voltage on ECGs (Konno et al, 2016).…”

Association of myocardial fibrosis and cardiovascular events: the multi-ethnic study of atherosclerosis

“…Prior articles have explored in the same population (1840 participants), the association of fibrosis with ageing, 9 identifying correlates of myocardial scar, 10 association of fibrosis with ventricular 2,11 and atrial 12 remodelling, and the association with electrocardiographic parameters. 13 However, our study is unique in trying to identify the association between CV events and myocardial fibrosis, introducing a formula for estimation of haematocrit (and consequently ECV) from T1 images without the need for a blood draw based on a large multicentre sample, and elucidating the association of CV risk factors with diffuse myocardial fibrosis.…”

T‐wave and its association with myocardial fibrosis on cardiovascular magnetic resonance examination

“…Conduction delay has been associated with LGE‐evident fibrosis in several cohorts (Cheema et al., 2012; Raman et al., 2007). More recently, the impact of diffuse myocardial fibrosis on the ECG has been evaluated (Inoue et al., 2017; Rodrigues et al., 2017). These studies highlight the ongoing clinical impact of the ECG and the need for further investigation.…”