Background: A number of studies have shown usefulness of the electrocardiogram (ECG) in predicting heart failure (HF). However, whether these ECG predictors can distinguish between the risk of heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction is unknown.
Methods: We analyzed data of 6,638 participants (53% female; mean age 62±10 years) from the Multi-Ethnic Study of Atherosclerosis who were free of cardiovascular disease at the time of enrollment. Digital ECGs were collected and centrally read at baseline (2000-2002) while HF was classified by an adjudication committee during a median follow-up of 11.2 years. A Cox competing risks analysis was used to compare the association of several ECG predictors with HFpEF and HFrEF.
Results: A total of 226 HF events occurred during follow up, of which 116 events were HFrEF. Most of the ECG predictors of HF showed stronger associations with HFrEF than HFpEF. However, only a few showed a difference that reached statistical significance including prolonged QT, ST/T abnormalities and delayed QRS intrinsicoid deflection time (Table).
Conclusion: Repolarization abnormalities and delayed ventricular activation may have the potential to distinguish between participants at future risk of HFrEF and HFpEF.