Electrocardiographic predictors of incident congestive heart failure and all-cause mortality in postmenopausal women - The women's health initiative
Electrocardiographic predictors of incident congestive heart failure and all-cause mortality in postmenopausal women - The women's health initiative
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DOI：
10.1161/circulationaha.105.537415
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发表时间：
2006-01-31
期刊：
影响因子：
37.8
通讯作者：
LaCroix, A
中科院分区：
文献类型：
--
作者：
Rautaharju, PM;Kooperberg, C;LaCroix, A
背景 - 关于发生充血性心力衰竭 (CHF) 风险的心电图预测因素的信息有限，特别是对于没有明显心血管疾病 (CVD) 表现的女性。方法和结果 - 我们在 9 年随访期间，使用 Cox 回归对妇女健康倡议 (WHI) 的 38 283 名参与者评估了发生 CHF 的风险比和全因死亡率。所有风险模型均根据人口统计和可用的临床和治疗变量进行调整（多变量调整模型）。使用向后选择程序来识别那些作为个体心电图预测因子具有重要意义的主要预测因子。 11 个心电图变量是 CHF 发生的重要预测因素，其中没有一个与基线 CVD 状态存在显着交互作用。从 6 个主要 ECG 预测因子来看，在多变量调整的单 ECG 变量模型中，宽 QRS/T 角的风险增加了近 3 倍。另外两个复极变量（STV5 抑制和高 TV1 振幅）以及 2 个 QRS 相关变量（QRS 非偶极电压和 ECG 测得的心肌梗死 (MI)）均与 CHF 风险增加约 2 倍相关。总体而言，12 个心电图变量中有 11 个是全因死亡率的重要预测因子。四个变量与需要分层的 CVD 状态有显着的相互作用。这 4 项中的 3 项是 CVD 组中强有力的主要预测因子：心电图 MI、宽 QRS/T 角和低 TV5 波幅，其风险从 2 倍以上增加到 3 倍，而在无 CVD 组中风险则显着降低。结论 - 绝经后妇女的几个复极变量是发生 CHF 和全因死亡率的风险的预测因子，与旧心电图 MI 一样重要。
Background - Information is limited about ECG predictors of the risk of incident congestive heart failure (CHF), particularly in women without overt manifestations of cardiovascular disease (CVD).Methods and Results - We evaluated hazard ratios for incident CHF and all-cause mortality using Cox regression in 38 283 participants of the Women's Health Initiative (WHI) during a 9-year follow-up. All risk models were adjusted for demographic and available clinical and therapeutic variables (multivariable-adjusted models). A backward selection procedure was used to identify dominant predictors among those that were significant as individual ECG predictors. Eleven ECG variables were significant predictors of incident CHF, with none of them having a significant interaction with baseline CVD status. From 6 dominant ECG predictors, wide QRS/T angle had a nearly 3-fold increased risk in multivariable-adjusted single ECG variable models. Two other repolarization variables, STV5 depression and high TV1 amplitude, and 2 QRS-related variables, QRS non-dipolar voltage and myocardial infarction (MI) by ECG, were all associated with approximate to 2-fold increase of incident CHF risk. Overall, 11 of the 12 ECG variables were significant predictors of all-cause mortality. Four variables had a significant interaction with CVD status requiring stratification. Three among these 4 were strong, dominant predictors in the CVD group: ECG MI, wide QRS/T angle, and low TV5 amplitude had risk increase from >2-fold to 3-fold, with considerably lower risks in the CVD-free group.Conclusions - Several repolarization variables in postmenopausal women are predictors of the risk of incident CHF and all-cause mortality as important as old ECG MI.