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Left ventricular geometry and function in early repolarization: results from the population-based Gutenberg Health Study

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Abstract

Aims

The electrocardiographic pattern of early repolarization (ER) is related to increased cardiac mortality in the general population. The pathophysiological basis of ER is largely unknown. We investigated the association of echocardiographic structural and functional parameters of the left ventricle with the presence of ER in the community.

Methods and results

The presence of ER (ER+) was assessed in 13,878 participants (mean age 54.6 years, 51.1% women) of the Gutenberg Health Study and related to left ventricular structure and function derived from standard echocardiography. The prevalence of ER was 5.0% (694/13,878), with higher prevalence in men than women (6.6% vs. 3.5%, p < 0.001). In men baseline characteristics differed including a lower BMI and a lower heart rate in ER+ individuals, whereas in women there were only minor differences. Multivariable-adjusted logistic regression analysis in men showed an association of ER with smaller diameters (left-ventricular end-diastolic diameter: OR 0.77 95% CI 0.69–0.86, p < 0.001; left-ventricular end-systolic diameter: OR 0.86 95% CI 0.78–0.95, p = 0.0035), and lower left-ventricular end-diastolic and end-systolic volume (OR 0.72 95% CI 0.65, 0.80, p < 0.001 and OR 0.80 95% CI 0.72, 0.89, p < 0.001). In women, the associations of ER with left ventricular diameters and volumes showed a similar direction, but were not as pronounced.

Conclusion

In the community, the ER pattern predominantly occurs in men with a low heart rate and a slender habit. Furthermore, ER is not associated with higher left ventricular mass or size but rather with smaller left ventricular diameters and volumes with a regular systolic and diastolic function. Patterns were comparable in women, but less strong.

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Acknowledgements

The Gutenberg Health Study is funded through the government of Rhineland-Palatinate (“Stiftung Rheinland-Pfalz für Innovation”, contract AZ 961-386261/733), the research programs “Wissen schafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim and PHILIPS Medical Systems, including an unrestricted grant for the Gutenberg Health Study. Philipp S. Wild is funded by the Federal Ministry of Education and Research (BMBF 01EO1503) and he is PI of the German Center for Cardiovascular Research (DZHK). We thank all study participants for their willingness to provide data for this research project and we are indebted to all coworkers for their enthusiastic commitment. This project has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 648131) (RBS) and German Research Foundation Emmy Noether Programme (SCHN 1149/3-1) (RBS). This work was performed in the context of the Junior Research Alliance symAtrial project funded by the German Ministry of Research and Education (BMBF 01ZX1408A) e:Med—Systems Medicine program (RBS, TZ).

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Author notes

  1. Wibke Reinhard and Renate Schnabel share senior authorship.

Authors and Affiliations

  1. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany

    Teresa Trenkwalder, Bernhard M. Kaess & Wibke Reinhard

  2. Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany

    Nicole Rübsamen, Christoph R. Sinning, Tanja Zeller, Stefan Blankenberg & Renate Schnabel

  3. Center for Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

    Volker H. Schmitt, Natalie Arnold, Anja Leuschner & Thomas Münzel

  4. Medizinische Klinik I, St. Josefs-Hospital, Wiesbaden, Germany

    Bernhard M. Kaess

  5. Department of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

    Karl J. Lackner

  6. Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria

    Christian Hengstenberg

  7. Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research) Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany

    Stefan Blankenberg & Renate Schnabel

  8. Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

    Philipp S. Wild

  9. Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

    Philipp S. Wild

  10. DZHK (German Center for Cardiovascular Research), Partner Site RhineMain, Mainz, Germany

    Volker H. Schmitt, Thomas Münzel, Karl J. Lackner & Philipp S. Wild

  11. Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

    Volker H. Schmitt, Natalie Arnold, Anja Leuschner, Thomas Münzel & Philipp S. Wild

  12. Department Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

    Manfred E. Beutel

  13. Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

    Irene Schmidtmann

  14. Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

    Stefan Nickels & Norbert Pfeiffer

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  1. Teresa Trenkwalder
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  2. Nicole Rübsamen
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  4. Natalie Arnold
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  13. Thomas Münzel
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  15. Christian Hengstenberg
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  16. Stefan Blankenberg
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  17. Philipp S. Wild
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  18. Wibke Reinhard
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  19. Renate Schnabel
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Correspondence to Renate Schnabel.

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Trenkwalder, T., Rübsamen, N., Schmitt, V.H. et al. Left ventricular geometry and function in early repolarization: results from the population-based Gutenberg Health Study. Clin Res Cardiol 108, 1107–1116 (2019). https://doi.org/10.1007/s00392-019-01445-7

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