Electrocardiographic abnormalities that predict coronary heart disease events and mortality in postmenopausal women - The women's health initiative
Electrocardiographic abnormalities that predict coronary heart disease events and mortality in postmenopausal women - The women's health initiative
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DOI：
10.1161/circulationaha.104.496091
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发表时间：
2006-01-31
期刊：
影响因子：
37.8
通讯作者：
LaCroix, A
中科院分区：
文献类型：
--
作者：
Rautaharju, PM;Kooperberg, C;LaCroix, A
背景-关于女性复极异常的独立预后价值的信息有限。方法和结果-我们在长达9.2年的随访中，使用COX回归评估了38,283名女性健康倡议(WHI)参与者的心电变量对致命性和非致命性冠心病(CHD)事件和CHD死亡率的风险比。所有的风险模型都根据人口统计学、临床和治疗变量进行了调整。作为单变量评价，宽QRS/T角和心电图显示的心肌梗死对冠心病事件的预测作用最强，危险比(95%CI)分别为1.90(1.50~2.42)和1.62(1.29~2.03)。其他六个复极变量也是CHD事件的重要、强有力的预测因子。在多因素调整的风险模型中，当与其他心电图变量同时评估时，宽QRS/T角、心电图MI和QT延长似乎是主要的预测因素。QRS/T角、心电图-MI和高QRS非偶极电压是冠心病死亡率的最强预测因子，其危险比分别为2.70、2.41和2.18。对于其他4个显著预测因素，风险增加从63%到95%不等。QRS/T角宽、心电-MI、QRS非偶极电压升高、心率变异性降低、QT延长(仅限于无心血管病变组)是主要的死亡危险预测因素。结论：绝经后妇女的心室复极异常与心电-MI及其他QRS异常一样，是预测冠心病事件和死亡率的重要指标。复极变量和QRS非偶极电压在未来的研究中值得关注。
Background - Information is limited about the independent prognostic value of repolarization abnormalities in women.Methods and Results - We evaluated hazard ratios for ECG variables for combined fatal and nonfatal coronary heart disease (CHD) events and for CHD mortality using Cox regression in 38 283 Women's Health Initiative (WHI) participants during up to 9.2 years of follow-up. All risk models were adjusted for demographic, clinical, and therapeutic variables. Evaluated as single ECG variables, wide QRS/T angle and ECG-demonstrated myocardial infarction ( ECG-MI) were the strongest predictors of CHD events, with hazard ratios (95% CI) of 1.90 (1.50 to 2.42) and 1.62 (1.29 to 2.03), respectively. Six other repolarization variables were also significant, strong predictors of CHD events. Wide QRS/T angle, ECG-MI, and QT prolongation appeared as dominant predictors when evaluated simultaneously with other ECG variables in a multiadjusted risk model. QRS/T angle, ECG-MI, and high QRS nondipolar voltage were the strongest predictors of CHD mortality, with hazard ratios of 2.70, 2.41, and 2.18, respectively. The risk increase ranged from 63% to 95% for the other 4 significant predictors. Five ECG abnormalities were identified as dominant mortality risk predictors: wide QRS/T angle, ECG- MI, high QRS nondipolar voltage, reduced heart rate variability, and QT prolongation ( in the cardiovascular disease - free group only).Conclusions - Ventricular repolarization abnormalities in postmenopausal women are as important predictors of CHD events and CHD mortality as ECG- MI and other QRS abnormalities. Repolarization variables and QRS nondipolar voltage warrant attention in future investigations.