用于预测心脏手术后房颤的定量心电图检查
Quantitative electrocardiography for predicting postoperative atrial fibrillation after cardiac surgery.
作者信息
Rader Florian, Costantini Otto, Jarrett Craig, Gorodeski Eiran Z, Lauer Michael S, Blackstone Eugene H
机构信息
Heart and Vascular Center, Case Western Reserve University, MetroHealth Campus, Cleveland, OH 44118, USA.
出版信息
J Electrocardiol. 2011 Nov-Dec;44(6):761-7. doi: 10.1016/j.jelectrocard.2010.12.005. Epub 2011 Jan 26.
Abstract
BACKGROUND
Atrial fibrillation (AF) after cardiac surgery is a common marker of poor outcomes. Quantitative electrocardiographic (ECG) measurements may be valuable predictors of postoperative AF.
METHODS
We evaluated clinical and ECG predictors of postoperative AF in 13,356 patients who underwent cardiac surgery in sinus rhythm.
RESULTS
A total of 4724 patients (35%) developed postoperative AF. P-wave amplitude in leads aVR and V(1) were the strongest ECG predictors. A less negative P-wave amplitude in lead aVR was associated with increased risk for postoperative AF (odds ratio, 1.46; 95% confidence interval, 1.32-1.61), as was a more positive or a more negative P-wave amplitude in lead V(1) (odds ratio, 1.25; 95% confidence interval, 1.16-1.36) after adjusting for clinical and procedural predictors of postoperative AF. Reclassification analysis showed a 7% discrimination improvement (P < .0001).
CONCLUSIONS
P-wave amplitude in lead aVR and lead V(1) are powerful predictors of postoperative AF and, in combination with other clinical predictors, can guide application of prophylactic interventions.
摘要
背景
心脏手术后房颤（AF）是预后不良的常见标志。定量心电图（ECG）测量可能是术后房颤的有价值预测指标。
方法
我们评估了13356例窦性心律下接受心脏手术患者术后房颤的临床和心电图预测指标。
结果
共有4724例患者（35%）发生术后房颤。aVR导联和V1导联的P波振幅是最强的心电图预测指标。校正术后房颤的临床和手术预测指标后，aVR导联P波振幅负值减小与术后房颤风险增加相关（比值比，1.46；95%置信区间，1.32 - 1.61），V1导联P波振幅正值增加或负值增加也与术后房颤风险增加相关（比值比，1.25；95%置信区间，1.16 - 1.36）。重新分类分析显示鉴别改善了7%（P <.0001）。
结论
aVR导联和V1导联的P波振幅是术后房颤的有力预测指标，与其他临床预测指标结合可指导预防性干预措施的应用。
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