Schillaci Giuseppe, Pirro Matteo, Ronti Tiziana, Gemelli Fabio, Pucci Giacomo, Innocente Salvatore, Porcellati Carlo, Mannarino Elmo
Unit of Internal Medicine, Angiology and Arteriosclerosis, Department of Clinical and Experimental Medicine, University of Perugia Medical School, Hospital Santa Maria della Misericordia, Piazzale Menghini, 1, 06132 Perugia, Italy.
Arch Intern Med. 2006 Apr 24;166(8):909-13. doi: 10.1001/archinte.166.8.909.
QT interval prolongation on the surface electrocardiogram (ECG) predicts cardiovascular complications in high-risk subjects, but its prognostic role in uncomplicated hypertension has been understudied.
For up to 13 years (average, 5.3 years), we followed up 2110 white patients with initially untreated essential hypertension (mean +/- SD age, 49 +/- 12 years; 55% men) without prevalent cardiovascular or renal disease who underwent 12-lead ECG before therapy. We excluded patients with ECG abnormalities including ischemia, necrosis, complete bundle branch block, atrial fibrillation, arrhythmias, and ventricular preexcitation.
Heart rate-corrected QT interval (QTc) showed a weak but significant direct association with systolic blood pressure (r = 0.07; P<.001), diastolic blood pressure (r = 0.11; P<.001), and Cornell voltage (r = 0.06; P = .006). During follow-up, 84 patients developed new-onset ischemic heart disease (0.75 event per 100 patient-years). After adjustment (Cox model) for the effects of age, sex, diabetes mellitus, serum cholesterol level, serum creatinine level, smoking, left ventricular hypertrophy, and 24-hour systolic blood pressure, patients with a prolonged QTc (>or=450 milliseconds in women and >or=440 milliseconds in men) had a nearly 2-fold increase in risks of coronary events (hazard ratio, 1.95; 95% confidence interval, 1.12-3.42; P = .02) and cardiovascular death (hazard ratio, 2.05; 95% confidence interval, 1.03-4.37; P = .04). Coronary heart disease risk was independently higher by 33% (95% confidence interval, +7% to +66%; P = .01) for each 32-millisecond increase in QTc.
Prolonged ventricular repolarization is a risk factor for ischemic heart disease and cardiovascular mortality in subjects with uncomplicated hypertension. Its prognostic significance adds to that of several traditional cardiovascular risk factors, including left ventricular hypertrophy.
体表心电图（ECG）上的QT间期延长可预测高危患者的心血管并发症，但其在无并发症高血压患者中的预后作用尚未得到充分研究。
我们对2110例初治原发性高血压白人患者进行了长达13年（平均5.3年）的随访，这些患者（平均年龄±标准差为49±12岁；55%为男性）无心血管或肾脏疾病史，在治疗前接受了12导联心电图检查。我们排除了有心电图异常的患者，包括缺血、坏死、完全性束支传导阻滞、心房颤动、心律失常和心室预激。
心率校正QT间期（QTc）与收缩压（r = 0.07；P<0.001）、舒张压（r = 0.11；P<0.001）和康奈尔电压（r = 0.06；P = 0.006）呈弱但显著的正相关。随访期间，84例患者发生了新发缺血性心脏病（每100患者年0.75例事件）。在对年龄、性别、糖尿病、血清胆固醇水平、血清肌酐水平、吸烟、左心室肥厚和24小时收缩压的影响进行调整（Cox模型）后，QTc延长（女性≥450毫秒，男性≥440毫秒）的患者发生冠状动脉事件的风险增加近2倍（风险比，1.95；95%置信区间，1.12 - 3.42；P = 0.02），心血管死亡风险增加2.05倍（风险比，2.05；95%置信区间，1.03 - 4.37；P = 0.04）。QTc每增加32毫秒，冠心病风险独立升高33%（95%置信区间，+7%至+66%；P = 0.01）。
心室复极延长是无并发症高血压患者发生缺血性心脏病和心血管死亡的危险因素。其预后意义补充了包括左心室肥厚在内的几种传统心血管危险因素的预后意义。
