PROGNOSTIC IMPLICATIONS OF ASYMPTOMATIC VENTRICULAR ARRHYTHMIAS - THE FRAMINGHAM HEART-STUDY
PROGNOSTIC IMPLICATIONS OF ASYMPTOMATIC VENTRICULAR ARRHYTHMIAS - THE FRAMINGHAM HEART-STUDY
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DOI：
10.7326/0003-4819-117-12-990
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发表时间：
1992-12-15
影响因子：
39.2
通讯作者：
LEVY, D
中科院分区：
文献类型：
--
作者：
BIKKINA, M;LARSON, MG;LEVY, D
目的：评估在动态心电图（ECG）监测中检测到的无症状复杂或频繁室性早搏的患病率和预后意义。设计：随访期为4至6年的队列研究。设置：基于人群。参与者：原始心脏研究队列的存活患者和原始队列成员的后代（2727名男性和3306名女性）。测量：一小时动态心电图。结果：复杂或频繁心律失常的年龄校正患病率（每小时超过30个室性早搏复合波或多种形式的早搏复合波，室性对联，室性心动过速，或R-on-T室性早搏）在2425名无临床明显冠心病的男性中为12%（95% CI，11%至13%），在302名冠心病男性中为33%（CI，24%至42%）。女性（3064例无疾病和242例有疾病）的相应值分别为12%（Cl，11%至13%）和26%（Cl，9%至43%）。在考克斯比例风险模型中校正了年龄和冠心病的传统危险因素后，无冠心病但有复杂或频繁室性心律失常的男性，（相对危险度，2.30;置信区间，1.65 ~ 3.20）与心肌梗死或冠心病死亡的发生率（相对危险度，2.12; CI，1.33至3.38）。在男性冠心病和女性冠心病，复杂或频繁的心律失常与增加的风险，无论是outcome.Conclusions：在男性谁没有临床上明显的冠心病，偶然检测室性心律失常与增加一倍的风险，全因死亡率和心肌梗死或冠心病死亡。这些发现的预防和治疗意义有待进一步研究。
Objective: To evaluate the prevalence and prognostic significance of asymptomatic complex or frequent ventricular premature beats detected during ambulatory electrocardiographic (ECG) monitoring.Design: Cohort study with a follow-up period of 4 to 6 years.Setting: Population-based.Participants: Surviving patients of the original Framingham Heart Study cohort and offspring of original cohort members (2727 men and 3306 women).Measurements: One-hour ambulatory electrocardiography.Results: The age-adjusted prevalence of complex or frequent arrhythmia (more than 30 ventricular premature complexes per hour or multiform premature complexes, ventricular couplets, ventricular tachycardia, or R-on-T ventricular premature complexes) was 12% (95% Cl, 11% to 13%) in the 2425 men without clinically evident coronary heart disease and 33% (Cl, 24% to 42%) in the 302 men with coronary heart disease. The corresponding values in women (3064 without disease and 242 with disease) were 12% (Cl, 11 % to 13%) and 26% (Cl, 9% to 43%). After adjusting for age and traditional risk factors for coronary heart disease in a Cox proportional hazards model, men without coronary heart disease who had complex or frequent ventricular arrhythmias were at increased risk for both all-cause mortality (relative risk, 2.30; Cl, 1.65 to 3.20) and the occurrence of myocardial infarction or death from coronary heart disease (relative risk, 2.12; Cl, 1.33 to 3.38). In men with coronary heart disease and in women with and without coronary heart disease, complex or frequent arrhythmias were not associated with an increased risk for either outcome.Conclusions: In men who do not have clinically apparent coronary heart disease, the incidental detection of ventricular arrhythmias is associated with a twofold increase in the risk for all-cause mortality and myocardial infarction or death due to coronary heart disease. The preventive and therapeutic implications of these findings await further investigation.