Rautaharju Pentti M, Kooperberg Charles, Larson Joseph C, LaCroix Andrea
The EPICARE Center, Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC, USA.
Circulation. 2006 Jan 31;113(4):481-9. doi: 10.1161/CIRCULATIONAHA.105.537415.
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).
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 &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.
Several repolarization variables in postmenopausal women are predictors of the risk of incident CHF and all-cause mortality as important as old ECG MI.
关于充血性心力衰竭（CHF）发病风险的心电图预测指标的信息有限，尤其是在无心血管疾病（CVD）明显表现的女性中。
我们在女性健康倡议（WHI）的38283名参与者的9年随访期间，使用Cox回归评估CHF发病风险和全因死亡率的风险比。所有风险模型均针对人口统计学以及可用的临床和治疗变量进行了调整（多变量调整模型）。采用向后选择程序，在作为个体心电图预测指标具有显著意义的指标中确定主要预测指标。11个心电图变量是CHF发病的显著预测指标，其中没有一个与基线CVD状态存在显著交互作用。在6个主要心电图预测指标中，宽QRS/T角在多变量调整的单心电图变量模型中风险增加近3倍。另外两个复极变量，STV5压低和TV1高振幅，以及两个与QRS相关的变量，QRS非偶极电压和心电图诊断的心肌梗死（MI），均与CHF发病风险增加2倍以上相关。总体而言，12个心电图变量中的11个是全因死亡率的显著预测指标。4个变量与需要分层的CVD状态存在显著交互作用。这4个变量中的3个在CVD组中是强大的主要预测指标：心电图MI、宽QRS/T角和低TV5振幅的风险增加超过2倍至3倍，在无CVD组中的风险则低得多。
绝经后女性的几个复极变量是CHF发病风险和全因死亡率的预测指标，与既往心电图诊断的MI同样重要。
