Okin Peter M
Greenberg Division of Cardiology, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10021, USA.
J Electrocardiol. 2009 Nov-Dec;42(6):584-8. doi: 10.1016/j.jelectrocard.2009.06.020. Epub 2009 Jul 24.
Although the presence and severity of electrocardiographic (ECG) left ventricular hypertrophy (LVH) have been associated with an increased risk of cardiovascular (CV) morbidity and mortality, the relationship of regression of ECG LVH during antihypertensive therapy to CV risk has only recently been examined.
Electrocardiographic LVH was evaluated over time in 9193 hypertensive patients enrolled in the Losartan Intervention for Endpoint Reduction in Hypertension study. Patients were treated with losartan- or atenolol-based regimens and followed with serial ECGs at 6 months and then yearly until death or study end. Electrocardiographic LVH was measured using gender-adjusted Cornell product (RaVL + SV3 [+6 mm in women]) QRS duration) and Sokolow-Lyon voltage (SV1 + RV5/6).
After mean (SD) follow-up of 4.8 (0.9) years, the Losartan Intervention for Endpoint Reduction in Hypertension study composite end point of CV death, nonfatal myocardial infarction, or stroke occurred in 1096 patients. In Cox regression models controlling for treatment type, baseline Framingham risk score, baseline, and in-treatment blood pressure and for severity of baseline ECG LVH by Cornell product and Sokolow-Lyon voltage, lower in-treatment ECG LVH by Cornell product and Sokolow-Lyon voltage were associated with 14% and 17% lower rates, respectively, of the composite CV end point: adjusted hazard ratios (HRs) of 0.86 (95% confidence interval [CI], 0.82-0.90; P < .001) for every 1050 mm . ms (1 SD) decrease in Cornell product and 0.83 (95% CI, 0.78-0.88; P < .001) for every 10.5 mm (1 SD) decrease in Sokolow-Lyon voltage. In parallel analyses, lower Cornell product and Sokolow- Lyon voltage were each independently associated with lower risks of CV mortality (HR, 0.78; 95% CI, 0.73-0.83; P < .001; HR, 0.80; 95% CI, 0.73-0.87; P < .001), of myocardial infarction (HR, 0.90; 95% CI, 0.82-0.98; P = .011; HR, 0.90; 95% CI, 0.81-1.00; P = .043), and of stroke (HR, 0.90; 95% CI, 0.84-0.96; P = .002; HR, 0.81; 95% CI, 0.75-0.89; P < .001). Regression of ECG LVH was also associated with significantly reduced risks of sudden cardiac death, new-onset atrial fibrillation, hospitalization for heart failure, and new-onset diabetes mellitus.
Regression of ECG LVH by Cornell product and/or Sokolow-Lyon voltage criteria during antihypertensive therapy is associated with lower likelihoods of CV morbidity and mortality, all-cause mortality, and new-onset diabetes, independent of blood pressure lowering and treatment modality in essential hypertension. These findings suggest that antihypertensive therapy targeted at regression or prevention of ECG LVH may improve prognosis.
尽管心电图（ECG）左心室肥厚（LVH）的存在及严重程度与心血管（CV）疾病发病率和死亡率的增加相关，但抗高血压治疗期间ECG LVH消退与CV风险之间的关系直到最近才得到研究。
在“氯沙坦降低高血压终点事件干预研究”纳入的9193例高血压患者中，对ECG LVH进行了长期评估。患者接受基于氯沙坦或阿替洛尔的治疗方案，并在6个月时进行系列心电图检查，之后每年检查一次，直至死亡或研究结束。使用性别校正的康奈尔乘积（RaVL + SV3[女性为+6 mm]）QRS时限）和索科洛夫 - 里昂电压（SV1 + RV5/6）测量ECG LVH。
在平均（标准差）4.8（0.9）年的随访后，“氯沙坦降低高血压终点事件干预研究”的CV死亡、非致死性心肌梗死或中风的复合终点事件发生在1096例患者中。在控制治疗类型、基线弗雷明汉风险评分、基线和治疗期间血压以及通过康奈尔乘积和索科洛夫 - 里昂电压评估的基线ECG LVH严重程度的Cox回归模型中，康奈尔乘积和索科洛夫 - 里昂电压在治疗期间降低的ECG LVH分别与复合CV终点事件发生率降低14%和17%相关：康奈尔乘积每降低1050 mm·ms（1个标准差），校正风险比（HR）为0.86（95%置信区间[CI]，0.82 - 0.90；P <.001）；索科洛夫 - 里昂电压每降低10.5 mm（1个标准差），校正风险比（HR）为0.83（95%CI，0.78 - 0.88；P <.001）。在平行分析中，康奈尔乘积和索科洛夫 - 里昂电压降低各自独立与CV死亡率降低（HR，0.78；95%CI，0.73 - 0.83；P <.001；HR，0.80；95%CI，0.73 - 0.87；P <.001）、心肌梗死风险降低（HR，0.90；95%CI，0.82 - 0.98；P =.011；HR，0.90；95%CI，0.81 - 1.00；P =.043）以及中风风险降低（HR，0.90；95%CI，0.84 - 0.96；P =.002；HR，0.81；95%CI，0.75 - 0.89；P <.001）相关。ECG LVH的消退还与心脏性猝死、新发房颤、因心力衰竭住院以及新发糖尿病的风险显著降低相关。
在抗高血压治疗期间，根据康奈尔乘积和/或索科洛夫 - 里昂电压标准使ECG LVH消退与CV疾病发病率和死亡率、全因死亡率以及新发糖尿病的可能性降低相关，独立于原发性高血压患者的血压降低和治疗方式。这些发现表明，旨在使ECG LVH消退或预防的抗高血压治疗可能改善预后。
