Stein Phyllis K, Sanghavi Devang, Sotoodehnia Nona, Siscovick David S, Gottdiener John
Washington University School of Medicine, 4625 Lindell Blvd., St. Louis, MO 63108, USA.
J Electrocardiol. 2010 May-Jun;43(3):251-9. doi: 10.1016/j.jelectrocard.2009.12.009. Epub 2010 Jan 25.
Sudden cardiac death (SCD) can be the first manifestation of cardiovascular disease. Development of screening methods for higher/lower risk is critical.
The Cardiovascular Health Study is a population-based study of risk factors for coronary heart disease and stroke those 65 years or older. Forty-nine (of 1649) with usable Holters and in normal sinus rhythm had SCD during follow-up and were matched with 2 controls, alive at the time of death of the case and not experiencing SCD on follow-up. Univariate and multivariate conditional logistic regression determined the association of Holter-based information and SCD.
In univariate models, the upper half of ventricular premature contraction (VPC) counts, abnormal heart rate turbulence, decreased normalized low-frequency power, increased T-wave alternans (TWA), and decreased the short-term fractal scaling exponent (DFA(1)) were associated with SCD, but time domain heart rate variability was not. In multivariate models, the upper half of VPC counts (odds ratio [OR], 6.6) and having TWA of 37 muV or greater on channel 2 (OR, 4.8) were independently associated with SCD. Also, the upper half of VPC counts (OR, 6.9) and having a DFA(1) of less than 1.05 (OR, 5.0) were independently associated with SCD. When additive effects were explored, having both higher VPCs and higher TWA was associated with an OR of 8.2 for SCD compared with 2.6 for having either. Also, having both higher VPCs and lower DFA(1) was associated with an OR of 9.6 for SCD compared with 3.1 for having either.
Results support a potential role for 24-hour Holter recordings to identify older adults at increased or lower risk of SCD.
心脏性猝死（SCD）可能是心血管疾病的首发表现。开发用于评估高低风险的筛查方法至关重要。
心血管健康研究是一项基于人群的研究，旨在研究65岁及以上人群冠心病和中风的危险因素。在1649名有可用动态心电图且处于正常窦性心律的参与者中，有49人在随访期间发生了SCD，并与2名对照者进行匹配，对照者在病例死亡时存活且随访期间未发生SCD。单因素和多因素条件逻辑回归分析确定了基于动态心电图的信息与SCD之间的关联。
在单因素模型中，室性早搏（VPC）计数的上半部分、异常心率变异性、归一化低频功率降低、T波交替（TWA）增加以及短期分形标度指数（DFA(1)）降低与SCD相关，但时域心率变异性与SCD无关。在多因素模型中，VPC计数的上半部分（比值比[OR]，6.6）以及通道2上TWA为37 μV或更高（OR，4.8）与SCD独立相关。此外，VPC计数的上半部分（OR，6.9）以及DFA(1)小于1.05（OR，5.0）与SCD独立相关。当探索相加效应时，VPC较高且TWA较高者发生SCD的OR为8.2，而单独具有其中一项者为2.6。同样，VPC较高且DFA(1)较低者发生SCD的OR为9.6，而单独具有其中一项者为3.1。
结果支持24小时动态心电图记录在识别SCD风险升高或降低的老年人方面具有潜在作用。
