Havranek Edward P, Esler Anne, Estacio Raymond O, Mehler Philip S, Schrier Robert W
Division of Cardiology, University of Colorado Health Sciences Center, Department of Medicine, Denver, USA.
Am Heart J. 2003 Jun;145(6):993-8. doi: 10.1016/S0002-8703(02)94780-0.
Serial decline in electrocardiographic voltage in patients with increased left ventricular mass has been associated with a lower risk of cardiovascular events.
We studied 468 patients with diabetes mellitus and hypertension in the Appropriate Blood Pressure Control in Diabetes (ABCD) trial. Patients were randomized in a stratified design to receive initial treatment with either enalapril or nisoldipine and to either intensive or moderate treatment goals. We measured an electrocardiographic index for increased left ventricular mass, the adjusted Cornell voltage, serially by treatment group. The association between changes in electrocardiographic voltage and cardiovascular events was defined with Cox proportional hazards analysis.
In 5 years of follow-up, the decline in adjusted Cornell voltage was significantly greater for patients treated with enalapril than for patients treated with nisoldipine (repeated measures analysis of variance P =.002). In the Cox proportional hazards model, treatment assignment (enalapril vs nisoldipine) was the strongest predictor of cardiovascular events, but the presence of coronary disease at baseline, the duration of diabetes mellitus, and change in voltage were also independent predictors of cardiovascular events.
In the ABCD study, enalapril treatment was associated with a lower risk of myocardial infarction. The reduction in left ventricular mass as reflected by diminished electrocardiographic voltage may explain some, but not all, of the effect of enalapril in this study.
左心室质量增加的患者中，心电图电压的连续下降与较低的心血管事件风险相关。
我们在糖尿病患者血压适当控制（ABCD）试验中研究了468例糖尿病和高血压患者。患者采用分层设计随机分组，接受依那普利或尼索地平初始治疗，并设定强化或中度治疗目标。我们按治疗组连续测量了反映左心室质量增加的心电图指标——校正康奈尔电压。通过Cox比例风险分析确定心电图电压变化与心血管事件之间的关联。
在5年的随访中，依那普利治疗的患者校正康奈尔电压的下降幅度显著大于尼索地平治疗的患者（重复测量方差分析P = 0.002）。在Cox比例风险模型中，治疗分配（依那普利与尼索地平）是心血管事件的最强预测因素，但基线时冠心病的存在、糖尿病病程以及电压变化也是心血管事件的独立预测因素。
在ABCD研究中，依那普利治疗与较低的心肌梗死风险相关。心电图电压降低所反映的左心室质量减轻可能解释了依那普利在本研究中的部分而非全部作用。
