Ethnic distribution of ECG predictors of atrial fibrillation and its impact on understanding the ethnic distribution of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) study.
Ethnic distribution of ECG predictors of atrial fibrillation and its impact on understanding the ethnic distribution of ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) study.
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DOI：
10.1161/strokeaha.108.534735
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发表时间：
2009-04
期刊：
影响因子：
8.3
通讯作者：
Goff DC Jr
中科院分区：
文献类型：
--
作者：
Soliman EZ;Prineas RJ;Case LD;Zhang ZM;Goff DC Jr
与白人相比，黑人房颤（AF）患病率较低，尽管前者卒中发生率较高，这一矛盾可能与目前用于基于人群的研究中诊断房颤的方法的局限性有关。因此，本研究旨在利用心房颤动ECG预测因子的民族分布作为不同民族心房颤动倾向的衡量指标。对来自社区动脉粥样硬化风险（ARIC）研究的15429名参与者（27%为黑人）的p波终点力、p波持续时间、p波面积和PR持续时间（被称为AF预测因子）的基线测量值的分布进行非配对t检验、χ2和logistic回归分析。采用Cox比例风险分析分别检查房颤预测因子与房颤和缺血性卒中的相关性。尽管与白人相比，黑人AF的发生率明显较低（0.24% vs 0.95%， P<0.0001），与之前的研究报告相似，但黑人AF预测因子的异常值明显更高（所有比较的P<0.0001）。与白人相比，黑人与异常房颤预测因子显著相关；不同房颤预测因子的比值比为2.1 ~ 3.1。房颤预测因子与房颤和缺血性卒中具有显著且独立的相关性，而种族与房颤预测因子之间没有显著的相互作用，研究结果进一步证明将房颤预测因子作为房颤和卒中未来风险的早期指标是合理的。房颤预测因子的种族分布与房颤的种族分布之间存在脱节，可能是因为前者不像后者，不会受到低灵敏度的影响。这些结果提高了黑人实际上可能有更高的房颤患病率的可能性，这可能是由于以前的研究方法有限而被遗漏的，这一差异可以部分解释黑人中风风险更高的原因。
The paradox of the reported low prevalence of atrial fibrillation (AF) in blacks compared with whites despite higher stroke rates in the former could be related to limitations in the current methods used to diagnose AF in population-based studies. Hence, this study aimed to use the ethnic distribution of ECG predictors of AF as measures of AF propensity in different ethnic groups. The distribution of baseline measures of P-wave terminal force, P-wave duration, P-wave area, and PR duration (referred to as AF predictors) were compared by ethnicity in 15 429 participants (27% black) from the Atherosclerosis Risk in Communities (ARIC) study by unpaired t test, χ2, and logistic-regression analysis, as appropriate. Cox proportional-hazards analysis was used to separately examine the association of AF predictors with incident AF and ischemic stroke. Whereas AF was significantly less common in blacks compared with whites (0.24% vs 0.95%, P<0.0001), similar to what has been reported in previous studies, blacks had significantly higher and more abnormal values of AF predictors (P<0.0001 for all comparisons). Black ethnicity was significantly associated with abnormal AF predictors compared with whites; odds ratios for different AF predictors ranged from 2.1 to 3.1. AF predictors were significantly and independently associated with AF and ischemic stroke with no significant interaction between ethnicity and AF predictors, findings that further justify using AF predictors as an earlier indicator of future risk of AF and stroke. There is a disconnect between the ethnic distribution of AF predictors and the ethnic distribution of AF, probably because the former, unlike the latter, do not suffer from low sensitivity. These results raise the possibility that blacks might actually have a higher prevalence of AF that might have been missed by previous studies owing to limited methodology, a difference that could partially explain the greater stroke risk in blacks.