Automatically assessed P-wave predicts cardiac events independently of left atrial enlargement in patients with cardiovascular risks: The Japan Morning Surge-Home Blood Pressure Study.
Automatically assessed P-wave predicts cardiac events independently of left atrial enlargement in patients with cardiovascular risks: The Japan Morning Surge-Home Blood Pressure Study.
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自动评估的p波预测心血管风险患者独立于左房扩张的心脏事件：日本晨间手术-家庭血压研究
DOI：
10.1111/jch.14136
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Kario K
中科院分区：
文献类型：
--
作者：
Yokota A;Kabutoya T;Hoshide S;Kario K
心电图（ECG）中P波延长反映心房重构并预测心房颤动（AF）的发展。作者在日本晨涌家庭血压（J - HOP）研究中招募了810名具有≥1个心血管（CV）危险因素的受试者。采用标准12导联心电图自动分析P波持续时间。超声心动图测量左房（LA）增大和左室肥厚（LVH）。主要终点是致死性/非致死性心脏事件：心肌梗死、猝死和因心力衰竭住院。选取12根导联的最大P波持续时间（Pmax）进行分析。作者比较了四个延长的P波截止时间（Pmax = 120,130,140,150 ms）和心脏事件。左室直径和左室质量指数（LVMI）与Pmax有显著相关性（r = 0.08, P = 0.02和r = 0.17, P < 0.001）。当截断水平为Pmax 120或130 ms时，延长的P波与心脏事件无关（P = 0.45和P = 0.10），但当延长的P波定义为Pmax≥140 ms （n = 50）或Pmax≥150 ms （n = 19）时，这两组患者的心脏事件发生率显著高于其他组（P < 0.001和P = 0.03）。Cox比例风险模型包括年龄、性别、体重指数、吸烟、经常饮酒、高血压、血脂异常、糖尿病、办公室收缩压、心率、LA增大和LVH，结果显示Pmax≥140 ms的延长P波与心脏事件独立相关（风险比：4.23；95%可信区间：1.30-13.77;P = 0.02）。综上所述，在日本有CV风险的患者中，自动评估的延长P波与心脏事件无关，与LA增大和LVH有关。
A prolonged P‐wave in electrocardiography (ECG) reflects atrial remodeling and predicts the development of atrial fibrillation (AF). The authors enrolled 810 subjects in the Japan Morning Surge Home Blood Pressure (J‐HOP) study who had ≥1 cardiovascular (CV) risk factor. The duration of P‐wave was automatically analyzed by standard 12‐lead electrocardiogram. Left atrial (LA) enlargement and left ventricular hypertrophy (LVH) were measured on echocardiography. The primary end points were fatal/nonfatal cardiac events: myocardial infarction, sudden death, and hospitalization for heart failure. The maximum P‐wave duration (Pmax) from the 12 leads was selected for analysis. The authors compared four prolonged P‐wave cutoffs (Pmax = 120, 130, 140, 150 ms) and cardiac events. LA diameter and left ventricular mass index (LVMI) were significantly associated with Pmax (r = 0.08, P = .02 and r = 0.17, P < .001, respectively). When the cutoff level was Pmax 120 or 130 ms, prolonged P‐wave was not associated with cardiac events (P = .45 and P = .10), but when a prolonged P‐wave was defined as Pmax ≥ 140 ms (n = 50) or Pmax ≥ 150 ms (n = 19), the patients in those groups had significantly higher incidence of cardiac events than others (P < .001 and P = .03). A Cox proportional hazards model including age, gender, body mass index, smoking, regular drinker, hypertension, dyslipidemia, diabetes, office systolic blood pressure, heart rate, LA enlargement, and LVH revealed that prolonged P‐wave defined as Pmax ≥ 140 ms was independently associated with cardiac events (hazard ratio: 4.23; 95% confidence interval: 1.30–13.77; P = .02). In conclusion, the automatically assessed prolonged P‐wave was associated with cardiac events independently of LA enlargement and LVH in Japanese patients with CV risks.
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