Left ventricular hypertrophy on electrocardiogram: Prognostic implications from a 10-year cohort study of older subjects: A report from the Bronx Longitudinal Aging Study
Left ventricular hypertrophy on electrocardiogram: Prognostic implications from a 10-year cohort study of older subjects: A report from the Bronx Longitudinal Aging Study
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DOI：
10.1111/j.1532-5415.1996.tb01437.x
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发表时间：
1996-05-01
影响因子：
6.3
通讯作者：
Aronson, M
中科院分区：
文献类型：
--
作者：
Kahn, S;Frishman, WH;Aronson, M
目的：本研究的目的是报告一组老年人心电图（EGG）显示左心室肥厚（LVH）的患病率、发病率和预后。设计：一项前瞻性、纵向研究，持续10年，基线和每年获得ECG。一项基于社区的队列研究，包括459名受试者（年龄75-85岁，平均年龄79岁）。测定心电图左室肥厚的患病率和发生率以及心电图左室肥厚的消退情况。测量的临床事件发生率为总死亡率、心肌梗死（MI，致死性和非致死性）、心血管死亡率、心血管疾病（致死性和非致死性）、卒中（致死性和非致死性）、全因痴呆和多梗死性痴呆的发生率。比较了两组（有和无LVH的受试者）之间事件发生率的差异，作为比例之间的检验。采用考克斯比例风险回归分析比较年龄、性别、血清胆固醇、洋地黄类药物使用、体重指数、Blessed痴呆量表、吸烟、基线LVH、基线LVH（持续）、新发LVH、新发LVH（持续），新发LVH（消退）、既往心肌梗死病史（ECG）、高血压病史和X线心脏肥大（心胸比率大于或等于50%）。基线时，9.2%的受试者（n = 42）ECG显示LVH，死亡率为11.7/100人年，而基线时无LVH的受试者为4.9/100人年（P < .0001），伴有LVH的MI发生率为7.5/100人年，不伴有LVH的MI发生率为2.6/100人年（P < .0001），伴有LVH的心血管死亡率为7.2/100人年，不伴有LVH的心血管死亡率为2.7/100人年。ECG显示新发LVH的受试者（n = 39）的死亡率为14.4/100人-年，而无LVH的受试者为4.4/100人-年（P < .0001），心血管死亡率为11.1/100人年，而无LVH的心血管死亡率为2.0/100人年MI发生率为6.1/100人年，而无LW时为2.0/100人年（P < .01）。随着时间的推移，ECG LVH模式消失的受试者比持续LVH的受试者发生更少的心血管死亡和病态事件。根据回归分析，从基线开始持续LVH是MI、总体心血管疾病和总死亡率的独立预测因子。新发展的左心室肥厚，没有随后的回归是一个独立的预测整体心血管疾病和death.CONCLUSION：一个增加的患病率和发病率的左心室肥厚的心电图，无论是什么原因，是与一个很老的男性和女性预后不良。老年人ECG LVH的消退，无论原因如何，都可能改善心血管疾病的风险。
OBJECTIVE: The objective of this study was to report on the prevalence, incidence, and prognosis of left ventricular hypertrophy (LVH) on the electrocardiogram (EGG) in a cohort of ambulatory older men and women.DESIGN: A prospective, longitudinal study of 10 years duration with ECGs obtained at baseline and on an annual basis.SETTING AND PATIENTS: A community-based cohort study consisting of 459 subjects (aged 75-85, mean age 79 years).MEASUREMENTS: Baseline and follow up ECGs were interpreted using the Minnesota Code. Prevalence and incidence of LVH on ECG were determined as well as regression of ECG LVH. Clinical event rates measured were incidence of total mortality, myocardial infarction (MI, fatal and nonfatal), cardiovascular mortality, cardiovascular disease (fatal and non-fatal), stroke (fatal and non-fatal), all-cause dementia, and multi-infarct dementia. Differences in event rates between groups (those subjects with and without LVH) were compared as tests between proportions. A Cox Proportional Hazards Regression Analysis was performed to compare the relative independent predictive values of-different competing factors, including age, gender, serum cholesterol, digitalis use, body mass, index, Blessed Dementia Scale, cigarette smoking, LVH at baseline, LVH at baseline (persisting), new LVH, new LVH (persisting), new LVH (regressed), previous MI by history on EGG, hypertension by history, and cardiomegaly by X-ray (cardiothoracic ratio greater than or equal to 50%).RESULTS: At baseline, 9.2% of subjects (n = 42) had LVH on ECG and a mortality rate of 11.7/100 person years versus 4.9/100 person years for subjects without baseline LVH (P < .0001), an MI rate of 7.5/100 person years with LVH versus 2.6/100 person years without LVH (P < .0001), and a cardiovascular mortality rate of 7.2/100 person years with LVH versus 2.7/100 person years without LVH. Subjects who developed new LVH on ECG (n = 39) had a mortality rate of 14.4/100 person-years compared with 4.4/100 person-years for those without LVH (P < .0001), a cardiovascular mortality rate of 11.1/100 person years versus 2.0/100 person years without LVH (P < .0001), and an MI rate of 6.1/100 person years versus 2.0/100 person years without LW (P < .01). Subjects in whom the ECG LVH pattern disappeared over time had fewer cardiovascular mortal and morbid events than those with persistent LVH. According to the regression analyses, persistent LVH from baseline was an independent predictor of MI, overall cardiovascular disease, and total mortality. Newly developing LVH with no subsequent regression was an independent predictor of overall cardiovascular disease and death.CONCLUSION: An increased prevalence and incidence of LVH on EGG, irrespective of cause, is associated with a poor prognosis in very old men and women. Regression of ECG LVH in older people, irrespective of cause, may confer improvement in risk for cardiovascular disease.