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Erschienen in: Heart and Vessels 11/2022

27.05.2022 | Original Article

QRS transitional zone rotations and the risk of atrial fibrillation: the Suita Study

verfasst von: Ahmed Arafa, Yoshihiro Kokubo, Takashi Kobayashi, Kyoko Honda-Kohmo, Rena Kashima, Haytham A. Sheerah, Kengo Kusano

Erschienen in: Heart and Vessels | Ausgabe 11/2022

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Abstract

ECG screening can detect people at risk of developing atrial fibrillation (AF). Recent literature indicated that QRS transitional zone rotations could predict several cardiovascular events. Herein, we investigated the association between QRS transitional zone rotations and the future risk of AF. This prospective cohort study included 6794 participants (3178 men and 3616 women), aged 30–84 years, from the urban Japanese city of Suita. QRS transitional zone rotations were diagnosed by ECG during baseline, while AF was diagnosed by ECG, hospital records, and checkups during follow-up. The Cox regression was used to compute the sex-specified hazard ratios (HRs) and 95% confidence intervals (CIs) of incident AF for participants with counterclockwise and clockwise QRS transitional zone rotations compared to those with normal rotation. Within a median follow-up period of 14.6 years, 311 participants (206 men and 105 women) developed AF. Counterclockwise rotation was associated with the reduced risk of AF among men, but not women, in the age-adjusted model: HR (95% CI) = 0.66 (0.44, 0.98) and the multivariable-adjusted model: HR (95% CI) = 0.65 (0.43, 0.97). Clockwise rotation was not associated with AF risk in either sex. To the best of our knowledge, this is the first study to indicate that counterclockwise rotation could be associated with the reduced risk of AF in men. More studies are needed to confirm our findings and elucidate possible mechanisms.
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Literatur
1.
Zurück zum Zitat Kornej J, Börschel CS, Benjamin EJ, Schnabel RB (2020) Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res 127:4–20CrossRef Kornej J, Börschel CS, Benjamin EJ, Schnabel RB (2020) Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res 127:4–20CrossRef
2.
Zurück zum Zitat Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014) Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 6:213–220CrossRef Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014) Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 6:213–220CrossRef
3.
Zurück zum Zitat Fujisawa T, Kimura T, Kohsaka S, Ikemura N, Katsumata Y, Miyama H, Nakajima K, Nishiyama T, Aizawa Y, Kanki H, Nagami K, Fukuda K, Takatsuki S (2021) Symptom burden and treatment perception in patients with atrial fibrillation, with and without a family history of atrial fibrillation. Heart Vessel 36(2):267–276CrossRef Fujisawa T, Kimura T, Kohsaka S, Ikemura N, Katsumata Y, Miyama H, Nakajima K, Nishiyama T, Aizawa Y, Kanki H, Nagami K, Fukuda K, Takatsuki S (2021) Symptom burden and treatment perception in patients with atrial fibrillation, with and without a family history of atrial fibrillation. Heart Vessel 36(2):267–276CrossRef
4.
Zurück zum Zitat Emdin CA, Wong CX, Hsiao AJ, Altman DG, Peters SA, Woodward M, Odutayo AA (2016) Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ 532:h7013CrossRef Emdin CA, Wong CX, Hsiao AJ, Altman DG, Peters SA, Woodward M, Odutayo AA (2016) Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: systematic review and meta-analysis of cohort studies. BMJ 532:h7013CrossRef
5.
Zurück zum Zitat Ruddox V, Sandven I, Munkhaugen J, Skattebu J, Edvardsen T, Otterstad JE (2017) Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: a systematic review and meta-analysis. Eur J Prev Cardiol 24:1555–1566CrossRef Ruddox V, Sandven I, Munkhaugen J, Skattebu J, Edvardsen T, Otterstad JE (2017) Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: a systematic review and meta-analysis. Eur J Prev Cardiol 24:1555–1566CrossRef
6.
Zurück zum Zitat He W, Chu Y (2017) Atrial fibrillation as a prognostic indicator of myocardial infarction and cardiovascular death: a systematic review and meta-analysis. Sci Rep 7:3360CrossRef He W, Chu Y (2017) Atrial fibrillation as a prognostic indicator of myocardial infarction and cardiovascular death: a systematic review and meta-analysis. Sci Rep 7:3360CrossRef
7.
Zurück zum Zitat Nakamura H, Niwano S, Fukaya H, Kishihara J, Satoh A, Oikawa J, Yoshizawa T, Ishizue N, Igarashi T, Fujiishi T, Nishinarita R, Horiguchi A, Ako J (2021) Fibrillation cycle length predicts cardiovascular events in patients with long-standing persistent atrial fibrillation. Heart Vessel. https://doi.org/10.1007/s00380-021-01993-xCrossRef Nakamura H, Niwano S, Fukaya H, Kishihara J, Satoh A, Oikawa J, Yoshizawa T, Ishizue N, Igarashi T, Fujiishi T, Nishinarita R, Horiguchi A, Ako J (2021) Fibrillation cycle length predicts cardiovascular events in patients with long-standing persistent atrial fibrillation. Heart Vessel. https://​doi.​org/​10.​1007/​s00380-021-01993-xCrossRef
8.
Zurück zum Zitat Du X, Dong J, Ma C (2017) Is atrial fibrillation a preventable disease? J Am Coll Cardiol 69:1968–1982CrossRef Du X, Dong J, Ma C (2017) Is atrial fibrillation a preventable disease? J Am Coll Cardiol 69:1968–1982CrossRef
9.
Zurück zum Zitat Charron P, Dubourg O, Desnos M, Isnard R, Hagege A, Millaire A, Carrier L, Bonne G, Tesson F, Richard P, Bouhour JB, Schwartz K, Komajda M (1997) Diagnostic value of electrocardiography and echocardiography for familial hypertrophic cardiomyopathy in a genotyped adult population. Circulation 96:214–219CrossRef Charron P, Dubourg O, Desnos M, Isnard R, Hagege A, Millaire A, Carrier L, Bonne G, Tesson F, Richard P, Bouhour JB, Schwartz K, Komajda M (1997) Diagnostic value of electrocardiography and echocardiography for familial hypertrophic cardiomyopathy in a genotyped adult population. Circulation 96:214–219CrossRef
10.
Zurück zum Zitat Nakai M, Watanabe M, Kokubo Y, Nishimura K, Higashiyama A, Takegami M, Nakao YM, Okamura T, Miyamoto Y (2020) Development of a cardiovascular disease risk prediction model using the Suita Study, a population-based prospective cohort study in Japan. J Atheroscler Thromb 27:1160–1175CrossRef Nakai M, Watanabe M, Kokubo Y, Nishimura K, Higashiyama A, Takegami M, Nakao YM, Okamura T, Miyamoto Y (2020) Development of a cardiovascular disease risk prediction model using the Suita Study, a population-based prospective cohort study in Japan. J Atheroscler Thromb 27:1160–1175CrossRef
11.
Zurück zum Zitat Pinto-Filho MM, Brant LC, Dos Reis RP, Giatti L, Duncan BB, Lotufo PA, da Fonseca MJM, Mill JG, de Almeida MDCC, MacFarlane P, Barreto SM, Ribeiro ALP (2021) Prognostic value of electrocardiographic abnormalities in adults from the Brazilian longitudinal study of adults’ health. Heart 107:1560–1566CrossRef Pinto-Filho MM, Brant LC, Dos Reis RP, Giatti L, Duncan BB, Lotufo PA, da Fonseca MJM, Mill JG, de Almeida MDCC, MacFarlane P, Barreto SM, Ribeiro ALP (2021) Prognostic value of electrocardiographic abnormalities in adults from the Brazilian longitudinal study of adults’ health. Heart 107:1560–1566CrossRef
12.
13.
Zurück zum Zitat Rajala S, Haavisto M, Kaltiala K, Mattila K (1987) Electrocardiographic findings and 5-year cardiovascular mortality in very old people. Ann Clin Res 19:324–327PubMed Rajala S, Haavisto M, Kaltiala K, Mattila K (1987) Electrocardiographic findings and 5-year cardiovascular mortality in very old people. Ann Clin Res 19:324–327PubMed
14.
Zurück zum Zitat Nakamura Y, Okamura T, Higashiyama A, Watanabe M, Kadota A, Ohkubo T, Miura K, Kasagi F, Kodama K, Okayama A, Ueshima H, NIPPON DATA80 Research Group (2012) Prognostic values of clockwise and counterclockwise rotation for cardiovascular mortality in Japanese subjects: a 24-year follow-up of the national integrated project for prospective observation of noncommunicable disease and its trends in the aged, 1980-2004 (NIPPON DATA80). Circulation 125:1226–1233CrossRef Nakamura Y, Okamura T, Higashiyama A, Watanabe M, Kadota A, Ohkubo T, Miura K, Kasagi F, Kodama K, Okayama A, Ueshima H, NIPPON DATA80 Research Group (2012) Prognostic values of clockwise and counterclockwise rotation for cardiovascular mortality in Japanese subjects: a 24-year follow-up of the national integrated project for prospective observation of noncommunicable disease and its trends in the aged, 1980-2004 (NIPPON DATA80). Circulation 125:1226–1233CrossRef
15.
Zurück zum Zitat Patel S, Kwak L, Agarwal SK, Tereshchenko LG, Coresh J, Soliman EZ, Matsushita K (2017) Counterclockwise and clockwise rotation of QRS transitional zone: prospective correlates of change and time-varying associations with cardiovascular outcomes. J Am Heart Assoc 6:e006281CrossRef Patel S, Kwak L, Agarwal SK, Tereshchenko LG, Coresh J, Soliman EZ, Matsushita K (2017) Counterclockwise and clockwise rotation of QRS transitional zone: prospective correlates of change and time-varying associations with cardiovascular outcomes. J Am Heart Assoc 6:e006281CrossRef
16.
Zurück zum Zitat Bradford N, Shah AJ, Usoro A, Haisty WK Jr, Soliman EZ (2015) Abnormal electrocardiographic QRS transition zone and risk of mortality in individuals free of cardiovascular disease. Europace 17:131–136CrossRef Bradford N, Shah AJ, Usoro A, Haisty WK Jr, Soliman EZ (2015) Abnormal electrocardiographic QRS transition zone and risk of mortality in individuals free of cardiovascular disease. Europace 17:131–136CrossRef
17.
Zurück zum Zitat Aro AL, Eranti A, Anttonen O, Kerola T, Rissanen HA, Knekt P, Porthan K, Tikkanen JT, Junttila MJ, Huikuri HV (2014) Delayed QRS transition in the precordial leads of an electrocardiogram as a predictor of sudden cardiac death in the general population. Heart Rhythm 11:2254–2260CrossRef Aro AL, Eranti A, Anttonen O, Kerola T, Rissanen HA, Knekt P, Porthan K, Tikkanen JT, Junttila MJ, Huikuri HV (2014) Delayed QRS transition in the precordial leads of an electrocardiogram as a predictor of sudden cardiac death in the general population. Heart Rhythm 11:2254–2260CrossRef
19.
Zurück zum Zitat Arafa A, Kokubo Y, Sheerah HA, Sakai Y, Watanabe E, Li J, Honda-Kohmo K, Teramoto M, Kashima R, Nakao YM, Koga M (2021) Developing a stroke risk prediction model using cardiovascular risk factors: the Suita Study. Cerebrovasc Dis 29:1–8. https://doi.org/10.1159/000520100CrossRef Arafa A, Kokubo Y, Sheerah HA, Sakai Y, Watanabe E, Li J, Honda-Kohmo K, Teramoto M, Kashima R, Nakao YM, Koga M (2021) Developing a stroke risk prediction model using cardiovascular risk factors: the Suita Study. Cerebrovasc Dis 29:1–8. https://​doi.​org/​10.​1159/​000520100CrossRef
20.
Zurück zum Zitat Kokubo Y, Watanabe M, Higashiyama A, Nakao YM, Kusano K, Miyamoto Y (2017) Development of a basic risk score for incident atrial fibrillation in a Japanese general population- the Suita Study. Circ J 81:1580–1588CrossRef Kokubo Y, Watanabe M, Higashiyama A, Nakao YM, Kusano K, Miyamoto Y (2017) Development of a basic risk score for incident atrial fibrillation in a Japanese general population- the Suita Study. Circ J 81:1580–1588CrossRef
21.
Zurück zum Zitat Arafa A, Kokubo Y, Shimamoto K, Kashima R, Watanabe E, Sakai Y, Li J, Teramoto M, Sheerah HA, Kusano K (2022) Stair climbing and incident atrial fibrillation: a prospective cohort study. Environ Health Prev Med 27:10CrossRef Arafa A, Kokubo Y, Shimamoto K, Kashima R, Watanabe E, Sakai Y, Li J, Teramoto M, Sheerah HA, Kusano K (2022) Stair climbing and incident atrial fibrillation: a prospective cohort study. Environ Health Prev Med 27:10CrossRef
22.
Zurück zum Zitat Arafa A, Kokubo Y, Shimamoto K, Kashima R, Watanabe E, Sakai Y, Li J, Teramoto M, Sheerah HA, Kusano K (2022) Sleep duration and atrial fibrillation risk in the context of predictive, preventive, and personalized medicine: the Suita Study and meta-analysis of prospective cohort studies. EPMA J 13(1):77–86CrossRef Arafa A, Kokubo Y, Shimamoto K, Kashima R, Watanabe E, Sakai Y, Li J, Teramoto M, Sheerah HA, Kusano K (2022) Sleep duration and atrial fibrillation risk in the context of predictive, preventive, and personalized medicine: the Suita Study and meta-analysis of prospective cohort studies. EPMA J 13(1):77–86CrossRef
23.
Zurück zum Zitat Yanagisawa N (1981) Counterclockwise rotation of the heart; correlation of electrocardiography and chest radiography and their clinical significance. J Electrocardiol 14:233–238CrossRef Yanagisawa N (1981) Counterclockwise rotation of the heart; correlation of electrocardiography and chest radiography and their clinical significance. J Electrocardiol 14:233–238CrossRef
24.
Zurück zum Zitat Prineas RJ, Zhang ZM, Stevens CE, Soliman EZ (2018) Distribution and determinants of QRS rotation of black and white persons in the general population. J Electrocardiol 51:316–322CrossRef Prineas RJ, Zhang ZM, Stevens CE, Soliman EZ (2018) Distribution and determinants of QRS rotation of black and white persons in the general population. J Electrocardiol 51:316–322CrossRef
25.
Zurück zum Zitat Seko Y, Kato T, Haruna T, Izumi T, Miyamoto S, Nakane E, Inoko M (2018) Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Sci Rep 8(1):6366CrossRef Seko Y, Kato T, Haruna T, Izumi T, Miyamoto S, Nakane E, Inoko M (2018) Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Sci Rep 8(1):6366CrossRef
26.
Zurück zum Zitat Kavousi M (2020) Differences in epidemiology and risk factors for atrial fibrillation between women and men. Front Cardiovasc Med 7:3CrossRef Kavousi M (2020) Differences in epidemiology and risk factors for atrial fibrillation between women and men. Front Cardiovasc Med 7:3CrossRef
27.
Zurück zum Zitat Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njølstad I, Vartiainen E, Sans S, Pasterkamp G, Hughes M, Costanzo S, Donati MB, Jousilahti P, Linneberg A, Palosaari T, de Gaetano G, Bobak M, den Ruijter HM, Mathiesen E, Jørgensen T, Söderberg S, Kuulasmaa K, Zeller T, Iacoviello L, Salomaa V, Schnabel RB, BiomarCaRE Consortium (2017) Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation 136:1588–1597CrossRef Magnussen C, Niiranen TJ, Ojeda FM, Gianfagna F, Blankenberg S, Njølstad I, Vartiainen E, Sans S, Pasterkamp G, Hughes M, Costanzo S, Donati MB, Jousilahti P, Linneberg A, Palosaari T, de Gaetano G, Bobak M, den Ruijter HM, Mathiesen E, Jørgensen T, Söderberg S, Kuulasmaa K, Zeller T, Iacoviello L, Salomaa V, Schnabel RB, BiomarCaRE Consortium (2017) Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation 136:1588–1597CrossRef
28.
Zurück zum Zitat De Bacquer D, De Backer G, Kornitzer M (2000) Prevalences of ECG findings in large population based samples of men and women. Heart 84:625–633CrossRef De Bacquer D, De Backer G, Kornitzer M (2000) Prevalences of ECG findings in large population based samples of men and women. Heart 84:625–633CrossRef
29.
Zurück zum Zitat Bolijn R, Ter Haar CC, Harskamp RE, Tan HL, Kors JA, Postema PG, Snijder MB, Peters RJG, Kunst AE, van Valkengoed IGM (2020) Do sex differences in the prevalence of ECG abnormalities vary across ethnic groups living in the Netherlands? a cross-sectional analysis of the population-based HELIUS study. BMJ Open 10:e039091CrossRef Bolijn R, Ter Haar CC, Harskamp RE, Tan HL, Kors JA, Postema PG, Snijder MB, Peters RJG, Kunst AE, van Valkengoed IGM (2020) Do sex differences in the prevalence of ECG abnormalities vary across ethnic groups living in the Netherlands? a cross-sectional analysis of the population-based HELIUS study. BMJ Open 10:e039091CrossRef
30.
Zurück zum Zitat Tahara Y, Mizuno H, Ono A, Ishikawa K (1991) Evaluation of the electrocardiographic transitional zone by cardiac computed tomography. J Electrocardiol 24:239–245CrossRef Tahara Y, Mizuno H, Ono A, Ishikawa K (1991) Evaluation of the electrocardiographic transitional zone by cardiac computed tomography. J Electrocardiol 24:239–245CrossRef
Metadaten
Titel
QRS transitional zone rotations and the risk of atrial fibrillation: the Suita Study
verfasst von
Ahmed Arafa
Yoshihiro Kokubo
Takashi Kobayashi
Kyoko Honda-Kohmo
Rena Kashima
Haytham A. Sheerah
Kengo Kusano
Publikationsdatum
27.05.2022
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 11/2022
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-022-02101-3

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