Younghoon Kwon1,2, Jeffrey R Misialek3, Daniel Duprez1,3, Alvaro Alonso4, David R Jacobs5, Susan R Heckbert6, Susan Redline7, Elsayed Z Soliman8. 1. Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, 55455 MN, USA. 2. Division of Cardiovascular Medicine, University of Virginia, 800158 Charlottesville, VA, USA. 3. Division of Cardiology, University of Minnesota, Minneapolis, 55455 MN, USA. 4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, 30322 GA, USA. 5. School of Public Health, University of Minnesota, Minneapolis, 55455 MN, USA. 6. Department of Epidemiology, University of Washington, Seattle, 98101 WA, USA. 7. Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, 02115 MA, USA. 8. Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, 27157 NC, USA.
Abstract
AIMS: Electrocardiographic (ECG) markers of left atrial (LA) abnormalities have been linked to increased risk of atrial fibrillation (AF). Sleep disordered breathing (SDB) has been associated with increased risk of AF. We aimed to examine the association of ECG markers of LA abnormalities with SDB. METHODS AND RESULTS: 1546 participants (mean age 67.2 years, 53.4% women, and 63.3% non-whites) from the Multi-Ethnic Study of Atherosclerosis Exam 5 Sleep ancillary study were included in this analysis. ECG markers of LA abnormalities (P wave terminal force in V1 (PTFV1), maximum P wave duration, PR interval and heart rate corrected PR interval) were measured from resting standard digital ECG tracings using standardized processing. Linear and logistic regression analyses were utilized to examine the cross-sectional associations of measures of SDB (apnea hypopnea index [AHI] and % time spent with oxygen saturation <90% [%SpO290]) with each ECG marker. In a multivariable analysis adjusting for demographics, cardiovascular risk factors, and comorbidities, AHI was associated with greater PTFV1 but not with other ECG markers of LA abnormalities. A 1-SD increase of AHI (16.6/hr) was associated with higher levels of PTFV1 (175.1 µV.ms, 95% confidence interval [95%CI] 75.4, 274.7) and higher odds of abnormally elevated PTFV1 (≥4000 µV.ms) (Odds Ratio: 1.21 [95%CI 1.05, 1.39]). No association was found between %SpO290 and ECG markers of LA abnormalities. CONCLUSION: Severity of SDB, as measured by AHI, is associated with subclinical LA disease, as indicated by PTFV1. PTFV1 may be an important ECG marker linking SDB and AF. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Electrocardiographic (ECG) markers of left atrial (LA) abnormalities have been linked to increased risk of atrial fibrillation (AF). Sleep disordered breathing (SDB) has been associated with increased risk of AF. We aimed to examine the association of ECG markers of LA abnormalities with SDB. METHODS AND RESULTS: 1546 participants (mean age 67.2 years, 53.4% women, and 63.3% non-whites) from the Multi-Ethnic Study of Atherosclerosis Exam 5 Sleep ancillary study were included in this analysis. ECG markers of LA abnormalities (P wave terminal force in V1 (PTFV1), maximum P wave duration, PR interval and heart rate corrected PR interval) were measured from resting standard digital ECG tracings using standardized processing. Linear and logistic regression analyses were utilized to examine the cross-sectional associations of measures of SDB (apnea hypopnea index [AHI] and % time spent with oxygen saturation <90% [%SpO290]) with each ECG marker. In a multivariable analysis adjusting for demographics, cardiovascular risk factors, and comorbidities, AHI was associated with greater PTFV1 but not with other ECG markers of LA abnormalities. A 1-SD increase of AHI (16.6/hr) was associated with higher levels of PTFV1 (175.1 µV.ms, 95% confidence interval [95%CI] 75.4, 274.7) and higher odds of abnormally elevated PTFV1 (≥4000 µV.ms) (Odds Ratio: 1.21 [95%CI 1.05, 1.39]). No association was found between %SpO290 and ECG markers of LA abnormalities. CONCLUSION: Severity of SDB, as measured by AHI, is associated with subclinical LA disease, as indicated by PTFV1. PTFV1 may be an important ECG marker linking SDB and AF. Published on behalf of the European Society of Cardiology. All rights reserved.
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