Okin Peter M, Roman Mary J, Lee Elisa T, Galloway James M, Best Lyle G, Howard Barbara V, Devereux Richard B
Greenberg Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, New York, New York, USA.
Am J Cardiol. 2007 Jul 1;100(1):94-8. doi: 10.1016/j.amjcard.2007.02.059. Epub 2007 May 15.
The qualitative electrocardiographic strain pattern of ST depression (STD) and T-wave inversion is strongly associated with coronary heart disease and left ventricular hypertrophy and is an independent predictor of new-onset heart failure in hypertensive participants. However, whether quantitative measures of STD in the lateral precordial leads predict new heart failure is unclear. Digital electrocardiograms were examined in 2,059 American-Indian participants in the second Strong Heart Study examination with no history of heart failure. The absolute magnitude of ST segment deviation was measured using computer to the nearest 5 microV in leads V(5) and V(6). During 5.7 +/-1.4 years of follow-up, heart failure developed in 77 participants (3.7%). Participants who developed heart failure had greater STD in leads V(5) or V(6) (-11 +/- 35 vs 12 +/- 27 microV; p <0.001) than those who did not. In univariate Cox analyses, STD was a significant predictor of new heart failure, with each 10-microV greater STD associated with a 31% greater risk of heart failure (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.24 to 1.39). Increasing STD grouped according to quartiles was strongly associated with the development of heart failure, with stepwise increasing risk of heart failure compared with the lowest quartile of STD for the second (HR 2.39, 95% CI 0.77 to 7.40), third (HR 3.01, 95% CI 1.00 to 9.08), and fourth quartiles of STD (HR 9.06, 95% CI 3.26 to 25.16). In Cox multivariate analyses controlling for age, gender, diabetes, coronary heart disease, albuminuria, and other baseline risk factors, STD remained a significant predictor of incident heart failure (HR 1.22, 95% CI 1.13 to 1.32 per 10-muV increment in STD; p <0.001). In conclusion, increasing STD in lateral precordial leads is strongly associated with increased risk of developing heart failure independent of other risk factors for new heart failure.
ST段压低（STD）和T波倒置的定性心电图应变模式与冠心病和左心室肥厚密切相关，并且是高血压患者新发心力衰竭的独立预测指标。然而，前侧壁心前导联STD的定量测量是否能预测新发心力衰竭尚不清楚。在第二次强心脏研究检查中，对2059名无心力衰竭病史的美国印第安参与者的数字心电图进行了检查。使用计算机测量V（5）和V（6）导联中ST段偏移的绝对幅度，精确到最接近的5微伏。在5.7±1.4年的随访期间，77名参与者（3.7%）发生了心力衰竭。发生心力衰竭的参与者在V（5）或V（6）导联中的STD更大（-11±35微伏对12±27微伏；p<0.001）。在单变量Cox分析中，STD是新发心力衰竭的显著预测指标，STD每增加10微伏，心力衰竭风险增加31%（风险比[HR]1.31，95%置信区间[CI]1.24至1.39）。根据四分位数分组的STD增加与心力衰竭的发生密切相关，与STD最低四分位数相比，第二（HR 2.39，95%CI 0.77至7.40）、第三（HR 3.01，95%CI 1.00至9.08）和第四四分位数的STD发生心力衰竭的风险逐步增加（HR 9.06，95%CI 3.26至25.16）。在控制年龄、性别、糖尿病、冠心病、蛋白尿和其他基线风险因素的Cox多变量分析中，STD仍然是新发心力衰竭的显著预测指标（STD每增加10微伏，HR 1.22，95%CI 1.13至1.32；p<0.001）。总之，前侧壁心前导联STD增加与新发心力衰竭风险增加密切相关，独立于其他新发心力衰竭风险因素。
