Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, CA, USA.
Circulation. 2011 Nov 15;124(20):2208-14. doi: 10.1161/CIRCULATIONAHA.111.047191. Epub 2011 Oct 10.
The significance of early repolarization, particularly regarding the morphology of the R-wave downslope, has come under question.
We evaluated 29 281 resting ambulatory ECGs from the VA Palo Alto Health Care System. With PR interval as the isoelectric line and amplitude criteria ≥0.1 mV, ST-segment elevation is defined at the end of the QRS, J wave as an upward deflection, and slur as a conduction delay on the QRS downstroke. Associations of ST-segment elevation patterns, J waves, and slurs with cardiovascular mortality were analyzed with Cox analysis. With a median follow-up of 7.6 years, there were 1995 cardiac deaths. Of 29 281 subjects, 87% were male (55±14 years) and 13% were female (56±17 years); 13% were black, 6% were Hispanic, and 81% were white or other. Six hundred sixty-four (2.3%) had inferior or lateral ST-segment elevation: 185 (0.6%) in inferior leads and 479 (1.6%) in lateral leads, 163 (0.6%) in both, and 0.4% had global elevation. A total of 4041 ECGs were analyzed with enhanced display, and 583 (14%) had J waves or slurring, which were more prevalent in those with than in those without ST-segment elevation (61% versus 13%; P<0.001). ST-segment elevation occurred more in those with than in those without J waves or slurs (12% versus 1.3%; P<0.001). Except when involving only inferior leads, all components of early repolarization were more common in young individuals, male subjects, blacks, and those with bradycardia. All patterns and components of early repolarization were associated with decreased cardiovascular mortality, but this was not significant after adjustment for age.
We found no significant association between any components of early repolarization and cardiac mortality.
早期复极的意义，特别是关于 R 波下降支的形态，已经受到质疑。
我们评估了来自 VA 帕洛阿尔托医疗保健系统的 29281 份静息动态心电图。以 PR 间期为等电线路，幅度标准≥0.1 mV，ST 段抬高定义为 QRS 波终点，J 波为向上偏转，QRS 波下降支传导延迟为浊音。采用 Cox 分析分析 ST 段抬高模式、J 波和浊音与心血管死亡率的关系。中位随访 7.6 年后，共发生 1995 例心脏死亡。在 29281 例患者中，87%为男性（55±14 岁），13%为女性（56±17 岁）；13%为黑人，6%为西班牙裔，81%为白人或其他。664 例（2.3%）存在下壁或侧壁 ST 段抬高：185 例（0.6%）在下壁导联，479 例（1.6%）在侧壁导联，163 例（0.6%）在两者均有，0.4%存在广泛抬高。共有 4041 份心电图进行了增强显示，其中 583 份（14%）存在 J 波或浊音，在存在 ST 段抬高的患者中比不存在 ST 段抬高的患者更为常见（61%比 13%；P<0.001）。存在 J 波或浊音的患者比不存在 J 波或浊音的患者 ST 段抬高更常见（12%比 1.3%；P<0.001）。除仅涉及下壁导联外，早期复极的所有成分在年轻人、男性、黑人以及心动过缓患者中更为常见。早期复极的所有形态和成分均与心血管死亡率降低相关，但在校正年龄后无统计学意义。
我们未发现早期复极的任何成分与心脏死亡率之间存在显著关联。
