Abnormal P-Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients
Abnormal P-Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients
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DOI：
10.1111/j.1542-474x.2009.00341.x
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发表时间：
2010-01-01
影响因子：
1.9
通讯作者：
Moss, Arthur J.
中科院分区：
文献类型：
--
作者：
Holmqvist, Fredrik;Platonov, Pyotr G.;Moss, Arthur J.
背景：在对充血性心力衰竭患者进行风险分层时，几种基于心电的方法已被证明是有价值的，但在这一背景下，很少有人关注异常心房除极的预后价值。本研究的目的是对有严重充血性心力衰竭和急性心肌梗死病史的高危人群的心房除极相进行无创性分析，以确定与死亡风险增加、心力衰竭恶化和心房颤动(AF)发生相关的标志物。方法：研究对象包括在基础状态为窦性心律的多中心自动除颤器植入试验II(MADIT II)中的患者(n=802)。对未经滤波和带通滤波的信号平均P波进行分析，以确定正交P波形态(预先指定的类型1、2和3/非典型)、P波持续时间和均方根20。结果：P波持续时间为139+/-23ms，RMS20为1.9+/-1.1mV，这些参数与心脏预后不良或房颤的发生无明显相关性。调整临床协变量后，P波形态异常可独立预测非心源性死亡(HR2.66；95%CI1.41~5.04，P=0.0027)和房颤发生(HR1.75；95%CI1.10~2.79，P=0.019)。结论：体表心电图正交导联P波形态异常可独立预测心源性非猝死和房颤发生的风险。《人工神经网络无创性心电》2010；15(1)：63-72
Background: Several ECG-based approaches have been shown to add value when risk-stratifying patients with congestive heart failure, but little attention has been paid to the prognostic value of abnormal atrial depolarization in this context. The aim of this study was to noninvasively analyze the atrial depolarization phase to identify markers associated with increased risk of mortality, deterioration of heart failure, and development of atrial fibrillation (AF) in a high-risk population with advanced congestive heart failure and a history of acute myocardial infarction.Methods: Patients included in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) with sinus rhythm at baseline were studied (n = 802). Unfiltered and band-pass filtered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology (prespecified types 1, 2, and 3/atypical), P-wave duration, and RMS20. The association between P-wave parameters and data on the clinical course and cardiac events during a mean follow-up of 20 months was analyzed.Results: P-wave duration was 139 +/- 23 ms and the RMS20 was 1.9 +/- 1.1 mu V. None of these parameters was significantly associated with poor cardiac outcome or AF development. After adjustment for clinical covariates, abnormal P-wave morphology was found to be independently predictive of nonsudden cardiac death (HR 2.66; 95% CI 1.41-5.04, P = 0.0027) and AF development (HR 1.75; 95% CI 1.10-2.79, P = 0.019).Conclusion: Abnormalities in P-wave morphology recorded from orthogonal leads in surface ECG are independently predictive of increased risk of nonsudden cardiac death and AF development in MADIT II patients. Ann Noninvasive Electrocardiol 2010;15(1):63-72