Evaluation of mortality in bundle branch block patients from an electronic cohort: Clinical Outcomes in Digital Electrocardiography (CODE) study
Evaluation of mortality in bundle branch block patients from an electronic cohort: Clinical Outcomes in Digital Electrocardiography (CODE) study
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DOI：
10.1016/j.jelectrocard.2019.09.004
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发表时间：
2019-11-01
影响因子：
1.3
通讯作者：
Ribeiro, Antonio L.
中科院分区：
文献类型：
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作者：
Paixao, Gabriela M. M.;Lima, Emilly M.;Ribeiro, Antonio L.
背景：左束支传导阻滞被认为是死亡风险较高的标志，但右束支传导阻滞在普通人群中的预后价值仍存在争议。我们的目的是在大量巴西患者的电子队列中评估右束支传导阻滞(RBBB)和左束支传导阻滞(LBBB)患者的总体和心血管死亡风险。方法：这项观察性回顾研究利用巴西米纳斯吉拉斯远程医疗网络(TNMG)的数字心电图数据库进行。评估了2010-2017年间对16岁以上的初级保健患者进行的所有心电图检查。电子队列是通过使用标准概率链接方法(FRIL：细粒度记录链接软件，v.2.1.5，佐治亚州亚特兰大)将心电检查(姓名、性别、出生日期、居住城市)的数据与国家死亡信息系统的数据链接起来获得的。只考虑了每个患者的第一次心电图。临床数据自行报告，心电图由心脏病专家手动解释，并由格拉斯哥大学解释软件自动解释。结果：从1,773,689名患者中，1,558,421名16岁以上的初级保健患者在2010-2017年间接受了有效的心电记录。我们排除了格拉斯哥计划中17,359名没有有效QRS测量的患者，以及11,091名QRS等于或大于120ms且不是RBBB或LBBB的对照组患者。因此，纳入了1,529,971人(中位年龄52岁[第一季度：38岁；第三季度：65岁；40.2%是男性])。平均随访3.7年，总死亡率为3.34%。RBBB发生率(2.42%)高于LBBB(1.32%)。在调整性别、年龄和合并症的多因素分析中，RBBB(HR 1.32；CI 95%1.27-1.37)和LBBB(HR 1.69；CI 95%1.62-1.76)患者的总体死亡风险较高。与男性相比，患有RBBB的女性全因死亡的风险更高(p<；0.001)。LBBB患者心血管病死率较高(HR 1.77；CI 95%1.55~2.01)，而RBBB患者无明显差异。结论：RBBB和LBBB患者的总死亡风险较高。患有RBBB的女性比男性有更多的全因死亡风险。LBBB与较高的心血管死亡风险相关。(C)2018 Elsevier Inc.保留所有权利。
Background: Left bundle branch block is recognized as a marker of higher risk of death, but the prognostic value of the right bundle branch block in the general population is still controversial. Our aim is to evaluate the risk of overall and cardiovascular mortality in patients with right (RBBB) and left bundle branch block (LBBB) in a large electronic cohort of Brazilian patients.Methods: This observational retrospective study was developed with the database of digital ECGs from Telehealth Network of Minas Gerais, Brazil (TNMG). All ECGs performed from 2010 to 2017 in primary care patients over 16 years old were assessed. The electronic cohort was obtained by linking data from ECG exams (name, sex, date of birth, city of residence) and those from national mortality information system, using standard probabilistic linkage methods (FRIL: Fine-grained record linkage software, v.2.1.5, Atlanta, GA). Only the first ECG of each patient was considered. Clinical data were self-reported, and ECGs were interpreted manually by cardiologists and automatically by the Glasgow University Interpreter software. Hazard ratio (HR) for mortality was estimated using Cox regression.Results: From a dataset of 1,773,689 patients, 1,558,421 primary care patients over 16 years old underwent a valid ECG recording during 2010 to 2017. We excluded 17,359 patients that didn't have a valid QRS measure from the Glasgow program and 11,091 patients from the control group that had QRS equal or above 120 ms and were not RBBB or LBBB. Therefore, 1,529,971 were included (median age 52 [Q1:38; Q3:65] years; 40.2% were male). In a mean follow-up of 3.7 years, the overall mortality rate was 3.34%. RBBB was more frequent (2.42%) than LBBB (1.32%). In multivariate analysis, adjusting for sex, age and comorbidities, both patients with RBBB (HR 1.32; CI 95% 1.27-1.37) and LBBB (HR 1.69; CI 95% 1.62-1.76) had higher risk of overall mortality. Women with RBBB had an increased risk of all-cause death compared to men (p < 0.001). Cardiovascular mortality was higher in patients with LBBB (HR 1.77; CI 95% 1.55-2.01), but not for RBBB.Conclusions: Patients with RBBB and LBBB had higher risk of overall mortality. Women with RBBB had more risk of all-cause death than men. LBBB was associated with higher risk of cardiovascular mortality. (C) 2018 Elsevier Inc. All rights reserved.