Department of Cardiology, Cardinal Tien Hospital, Fu-Jen Catholic University, Hsintien, Taipei, Taiwan.
Cardiovasc Toxicol. 2010 Mar;10(1):17-26. doi: 10.1007/s12012-009-9059-x.
Chronic arsenic poisoning is a major worldwide public health problem. Recently, we had reported chronic arsenic poisoning was dose-dependently associated with ventricular abnormalities quantified by electrocardiographic QT prolongation linking to atherosclerotic diseases. An association of chronic arsenic poisoning with ventricular repolarization inhomogeneity quantified by QT dispersion (QTD) is of particular interest from a theoretical and practical perspective. We aimed to further elucidate (1) the association of chronic arsenic exposure with ventricular abnormalities quantified by QTD, (2) the association of QTD with atherosclerotic diseases and (3) the predictability of QTD for long-term mortality in subjects with chronic arsenic poisoning. We followed up 280 men and 355 women living in arseniasis-endemic area in southwestern coast in Taiwan for 17 years. QTD in electrocardiogram and carotid intima-media thickness by ultrasonography were measured. Coronary artery disease was diagnosed by an abnormal electrocardiogram and a definite history. Cumulative arsenic exposure was significantly associated with QTD showing a dose-response relationship (P < 0.001). Significant associations of the QTD with coronary artery disease and carotid atherosclerosis existed after adjustment for potential confounders in the multiple linear regression analysis (all P values < 0.05). In the multivariate Cox regression analyses, the hazard ratios (95% confidence interval, P value) of cumulative cardiovascular and all-cause mortality were 3.9 (2.1-6.2, P = 0.002) and 1.4 (0.9-2.3, P = 0.10), respectively, for QTD > or = 65 ms compared with QTD < 65. QTD may be indicated as an early biomarker for atherosclerotic diseases and a significant and strong predictor of cardiovascular mortality in population with chronic arsenic exposure.
慢性砷中毒是一个全球性的主要公共卫生问题。最近，我们报道慢性砷中毒与心电图 QT 延长相关联的心室异常呈剂量依赖性，而 QT 延长与动脉粥样硬化疾病有关。从理论和实践的角度来看，慢性砷中毒与 QT 离散度（QTD）量化的心室复极不均匀性的关联特别有趣。我们旨在进一步阐明：（1）慢性砷暴露与 QTD 量化的心室异常的关系；（2）QTD 与动脉粥样硬化疾病的关系；（3）QTD 对慢性砷中毒患者长期死亡率的预测能力。我们对居住在台湾西南沿海砷病流行区的 280 名男性和 355 名女性进行了 17 年的随访。通过心电图和超声测量 QTD 和颈动脉内膜中层厚度。通过异常心电图和明确的病史诊断冠心病。累积砷暴露与 QTD 呈显著剂量反应关系（P < 0.001）。在多元线性回归分析中，校正潜在混杂因素后，QTD 与冠心病和颈动脉粥样硬化显著相关（所有 P 值均 < 0.05）。在多变量 Cox 回归分析中，累积心血管和全因死亡率的风险比（95%置信区间，P 值）分别为 3.9（2.1-6.2，P = 0.002）和 1.4（0.9-2.3，P = 0.10），与 QTD > 65 相比，QTD < 65。QTD 可能是动脉粥样硬化疾病的早期生物标志物，也是慢性砷暴露人群心血管死亡率的显著和强有力的预测指标。
