Prognostic value electrocardiographic criteria for left ventricular hypertrophy
Prognostic value electrocardiographic criteria for left ventricular hypertrophy
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DOI：
10.1016/j.ahj.2004.08.041
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发表时间：
2005-07-01
影响因子：
4.8
通讯作者：
Froelicher, VF
中科院分区：
文献类型：
--
作者：
Hsieh, BP;Pham, MX;Froelicher, VF
背景 存在许多左心室肥厚 (LVH) 心电图 (ECG) 标准，但很少有研究比较它们在预测心血管 (CV) 方面的相对预后价值。死亡率。方法 我们分析了 46950 名连续退伍军人的第一次心电图。我们以体重指数 >20 的男性门诊患者为目标，以避免使分解代谢疾病复杂化而造成混淆，并进一步排除传导异常的患者。使用针对年龄、心率和体重指数进行调整的 Cox 回归模型，我们比较了从 17 种常用心电图获得的心血管死亡风险比 (HR)，即 LVH 的标准。结果 在平均随访 7-4 年期间，在总共 1;9434 名患者（平均年龄 54-14 岁）中，1254 名患者 (6%) 死于心血管原因。在各种标准中，CV 死亡率的调整 HR 范围为 1.4 (95% Cl 1.2-1.6) 至 3.7 (95% Cl 2.7-5.0)。与仅电压标准相比，复合标准定义的左心室肥大通常与更高的调整 HR 相关。在 ECG-LVH 患者中，左心室应变模式或负 P 端力增加最能预测 CV 死亡率（HR 3.9 和 3.5，95% Cl 3.3-4.6 和 2.8-4.2）。结论 与检测 LVH 的仅电压标准相比，复合 ECG 标准更能预测 CV 死亡率。通过将这些心电图标准应用到常规临床实践中，可以识别出心血管死亡风险较高的 LVH 患者并进行适当治疗。
Background Many electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) exist, but few studies have compared their relative prognostic value for predicting cardiovascular (CV). mortality.Methods We analyzed the first ECG on 46950 consecutive veterans. We targeted male outpatients with a body mass index >20 to avoid confounding by complicating catabolic illnesses and further excluded those with conduction abnormalities. Using Cox regression models adjusted for age, heart rate, and body mass index, we compared the hazard ratios (HRs) for CV mortality obtained from seventeen commonly used ECG,criteria foe LVH.Results During a mean follow-up of 7 4 years, in a total population of 1;9434 patients (mean age 54, 14 years), 1254 (6%) patients died of CV causes. The adjusted HR for CV mortality ranged from 1.4 (95% Cl 1.2-1.6) to 3.7 (95% Cl 2.7-5.0) among the various criteria. Left ventricular hypertrophy defined by composite criteria was generally associated with higher adjusted HRs compared with voltage-only criteria. Among patients with ECG-LVH, the presence of a left ventricular strain pattern or increased negative P-terminal force were most predictive of CV mortality (HR 3.9 and 3.5, 95% Cl 3.3-4.6 and 2.8-4.2).Conclusions Compared with voltage-only criteria for detecting LVH,composite ECG criteria are more strongly predictive of CV mortality. By applying these ECG criteria into routine clinical practice, individuals with LVH who a re at higher risk for CV mortality can be identified and appropriately treated.