Latent profiles of global electrical heterogeneity: the Hispanic Community Health Study/Study of Latinos

Larisa G Tereshchenko; Kazi T Haq; Stacey J Howell; Evan C Mitchell; Jesús Martínez; Jessica Hyde; Genesis Briceno; Jose Pena; Edvinas Pocius; Akram Khan; Elsayed Z Soliman; João A C Lima; Samir R Kapadia; Anita D Misra-Hebert; Michael W Kattan; Mayank M Kansal; Martha L Daviglus; Robert Kaplan

doi:10.1093/ehjdh/ztae048

Latent profiles of global electrical heterogeneity: the Hispanic Community Health Study/Study of Latinos

Eur Heart J Digit Health. 2024 Jul 8;5(5):611-621. doi: 10.1093/ehjdh/ztae048. eCollection 2024 Sep.

Authors

Larisa G Tereshchenko^{1

2

3}, Kazi T Haq⁴, Stacey J Howell⁵, Evan C Mitchell⁶, Jesús Martínez⁷, Jessica Hyde⁷, Genesis Briceno⁷, Jose Pena⁷, Edvinas Pocius⁷, Akram Khan⁷, Elsayed Z Soliman⁸, João A C Lima³, Samir R Kapadia², Anita D Misra-Hebert¹, Michael W Kattan¹, Mayank M Kansal⁹, Martha L Daviglus⁹, Robert Kaplan^{10

11}

Affiliations

¹ Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, JJN3-01, Cleveland, OH 44195, USA.
² Heart, Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, JJN3-01, Cleveland, OH 44195, USA.
³ Department of Medicine, Cardiovascular Division, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴ Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA.
⁵ Section of Electrophysiology, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA.
⁶ Department of Surgery, Brown University School of Medicine, Providence, RI, USA.
⁷ School of Medicine, Oregon Health & Science University, Portland, OR, USA.
⁸ Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC, USA.
⁹ Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
¹⁰ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
¹¹ Public Health Sciences Division, Fred Hutch Cancer Center, Seattle, WA, USA.

Abstract

Aims: Despite the highest prevalence of stroke, obesity, and diabetes across races/ethnicities, paradoxically, Hispanic/Latino populations have the lowest prevalence of atrial fibrillation and major Minnesota code-defined ECG abnormalities. We aimed to use Latent Profile Analysis in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) population to obtain insight into epidemiological discrepancies.

Methods and results: We conducted a cross-sectional analysis of baseline HCHS/SOL visit. Global electrical heterogeneity (GEH) was measured as spatial QRS-T angle (QRSTa), spatial ventricular gradient azimuth (SVGaz), elevation (SVGel), magnitude (SVGmag), and sum absolute QRST integral (SAIQRST). Statistical analysis accounted for the stratified two-stage area probability sample design. We fitted a multivariate latent profile generalized structural equation model adjusted for age, sex, ethnic background, education, hypertension, diabetes, smoking, dyslipidaemia, obesity, chronic kidney disease, physical activity, diet quality, average RR' interval, median beat type, and cardiovascular disease (CVD) to gain insight into the GEH profiles. Among 15 684 participants (age 41 years; 53% females; 6% known CVD), 17% had an increased probability of likely abnormal GEH profile (QRSTa 80 ± 27°, SVGaz -4 ± 21°, SVGel 72 ± 12°, SVGmag 45 ± 12 mVms, and SAIQRST 120 ± 23 mVms). There was a 23% probability for a participant of being in Class 1 with a narrow QRSTa (40.0 ± 10.2°) and large SVG (SVGmag 108.3 ± 22.6 mVms; SAIQRST 203.4 ± 39.1 mVms) and a 60% probability of being in intermediate Class 2.

Conclusion: A substantial proportion (17%) in the Hispanic/Latino population had an increased probability of altered, likely abnormal GEH profile, whereas 83% of the population was resilient to harmful risk factors exposures.

Keywords: Cardiovascular risk; ECG; Electrophysiology; Hispanic or Latino ethnicity; Latent class analysis; Vectorcardiogram.