Use of hundreds of electrocardiographic biomarkers for prediction of mortality in postmenopausal women: the Women's Health Initiative.
Use of hundreds of electrocardiographic biomarkers for prediction of mortality in postmenopausal women: the Women's Health Initiative.
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DOI：
10.1161/circoutcomes.110.959023
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发表时间：
2011-09
期刊：
影响因子：
--
通讯作者：
Lauer MS
中科院分区：
文献类型：
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作者：
Gorodeski EZ;Ishwaran H;Kogalur UB;Blackstone EH;Hsich E;Zhang ZM;Vitolins MZ;Manson JE;Curb JD;Martin LW;Prineas RJ;Lauer MS
Simultaneous contribution of hundreds of electrocardiographic biomarkers to prediction of long-term mortality in post-menopausal women with clinically normal resting electrocardiograms (ECGs) is unknown. We analyzed ECGs and all-cause mortality in 33,144 women enrolled in Women’s Health Initiative trials, who were without baseline cardiovascular disease or cancer, and had normal ECGs by Minnesota and Novacode criteria. Four hundred and seventy seven ECG biomarkers, encompassing global and individual ECG findings, were measured using computer algorithms. During a median follow-up of 8.1 years (range for survivors 0.5–11.2 years), 1,229 women died. For analyses cohort was randomly split into derivation (n=22,096, deaths=819) and validation (n=11,048, deaths=410) subsets. ECG biomarkers, demographic, and clinical characteristics were simultaneously analyzed using both traditional Cox regression and Random Survival Forest (RSF), a novel algorithmic machine-learning approach. Regression modeling failed to converge. RSF variable selection yielded 20 variables that were independently predictive of long-term mortality, 14 of which were ECG biomarkers related to autonomic tone, atrial conduction, and ventricular depolarization and repolarization. We identified 14 ECG biomarkers from amongst hundreds that were associated with long-term prognosis using a novel random forest variable selection methodology. These were related to autonomic tone, atrial conduction, ventricular depolarization, and ventricular repolarization. Quantitative ECG biomarkers have prognostic importance, and may be markers of subclinical disease in apparently healthy post-menopausal women.
