PROGNOSTIC IMPLICATIONS OF BASE-LINE ELECTROCARDIOGRAPHIC FEATURES AND THEIR SERIAL CHANGES IN SUBJECTS WITH LEFT-VENTRICULAR HYPERTROPHY
PROGNOSTIC IMPLICATIONS OF BASE-LINE ELECTROCARDIOGRAPHIC FEATURES AND THEIR SERIAL CHANGES IN SUBJECTS WITH LEFT-VENTRICULAR HYPERTROPHY
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DOI：
10.1161/01.cir.90.4.1786
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发表时间：
1994-10-01
期刊：
影响因子：
37.8
通讯作者：
KANNEL, WB
中科院分区：
文献类型：
--
作者：
LEVY, D;SALOMON, M;KANNEL, WB
背景在过去的半个世纪里，心电图被广泛用于左心室肥厚的诊断。人与心电图证据的左心室肥厚的心血管疾病的发展风险增加。方法和结果受试者从心脏研究的心电图证据的左心室肥厚有资格进行这项调查，如果他们是免费的心血管疾病，并没有完全的肌支传导阻滞或沃尔夫-帕金森-白色综合征。使用汇总的两年一次检查的逻辑回归分析来确定心血管疾病的风险，作为基线电压（aVL中R波加V-3中S波之和）和复极的函数，以及作为这些心电图特征的一系列变化的函数肥大。合格样本包括274名男性（平均年龄60岁）和250名女性（平均年龄64岁），他们提供了2660次个人检查。在随访期间，有269例新发心血管事件。与基线电压第一个警戒值的受试者相比，第四个四分位数的受试者中，男性和女性心血管疾病的年龄校正比值比分别为3.08（95%置信区间[CI]，1.87 - 5.07）和3.29（95% CI，1.78 - 6.09）。与正常复极模式相比，严重复极异常的存在与年龄校正的比值比男性为5.84（95%CI，3.55至9.62），女性为2.47（95%CI，1.38至4.42）。电压连续下降的受试者发生心血管疾病的风险低于无连续变化的受试者（男性：校正年龄和基线电压后的比值比，0.46; 95%CI，0.26 - 0.84;女性：比值比，0.56; 95%CI，0.30 - 1.04）。相比之下，那些电压连续增加的人患心血管疾病的风险更大（男性：比值比，1.86; 95%CI，1.14至3.03;女性：比值比，1.61; 95%CI，0.91至2.84）。与无系列变化的患者相比，复极改善与男性心血管风险的轻微显著降低相关（校正年龄和基线复极后的比值比为0.45; 95%CI为0.20 ~ 1.01）。复极恶化与男女心血管疾病风险增加相关（男性：比值比，1.89; 95% CI，1.05 ~ 3.40;女性：比值比，2.02; 95%可信区间，1.07至3.81）结论本研究结果提示，左心室肥厚心电图特征的消退可改善心血管疾病的风险。疾病，而连续恶化会增加风险。左心室肥厚消退的益处必须在其他临床环境中得到证实。
Background During the past half-century, the ECG has been used extensively for the diagnosis of left ventricular hypertrophy. Persons with ECG evidence of left ventricular hypertrophy are at increased risk for the development of cardiovascular disease.Methods and Results Subjects from the Framingham Heart Study with ECG evidence of left ventricular hypertrophy were eligible for this investigation if they were free of cardiovascular disease and did not have complete bundle-branch block or Wolff-Parkinson-White syndrome. Logistic regression analyses of pooled biennial examinations were used to determine risk for cardiovascular disease as a function of baseline voltage (sum of R wave in aVL plus S wave in V-3) and repolarization and as a function of serial changes in these ECG features of hypertrophy. The eligible sample consisted of 274 men (mean age, 60 years) and 250 women (mean age, 64 years) who contributed 2660 person-examinations. During follow-up, there were 269 new cardiovascular events. Compared with subjects in the first guartile of voltage at baseline, the age-adjusted odds ratio for cardiovascular disease among subjects in the fourth quartile was 3.08 (95% confidence interval [CI], 1.87 to 5.07) in men and 3.29 (95% CI, 1.78 to 6.09) in women. Compared with a normal repolarization pattern, the presence of severe repolarization abnormalities was associated with an age-adjusted odds ratio of 5.84 (95% CI, 3.55 to 9.62) in men and 2.47 (95% CI, 1.38 to 4.42) in women. Subjects with a serial decline in voltage were at lower risk for cardiovascular disease than were those with no serial change (men: odds ratio after adjusting for age and baseline voltage, 0.46; 95% CI, 0.26 to 0.84; women: odds ratio, 0.56; 95% CI, 0.30 to 1.04). In contrast, those with a serial increase in voltage were at greater risk for cardiovascular disease (men: odds ratio, 1.86; 95% CI, 1.14 to 3.03; women: odds ratio, 1.61; 95% CI, 0.91 to 2.84). Compared with those with no serial change, an improvement in repolarization was associated with a marginally significant reduction in cardiovascular risk in men (odds ratio after adjusting for age and baseline repolarization, 0.45; 95% CI, 0.20 to 1.01). Worsening of repolarization was associated with increased risk for cardiovascular disease in both sexes (men: odds ratio, 1.89; 95% CI, 1.05 to 3.40; women: odds ratio, 2.02; 95% CI, 1.07 to 3.81).Conclusions The results of this investigation suggest that regression of ECG features of left ventricular hypertrophy confers an improvement in risk for cardiovascular disease, whereas serial worsening imposes increased risk. The benefits to be derived from regression of left ventricular hypertrophy must be confirmed in other clinical settings.