Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA.
Eur J Prev Cardiol. 2013 Dec;20(6):1035-41. doi: 10.1177/2047487312460017. Epub 2012 Sep 5.
Isolated minor non-specific ST-segment and T-wave abnormalities (NSSTTAs) are common and known to be independent electrocardiographic risk markers for future cardiovascular disease (CVD) events. The association of NSSTTA with subclinical atherosclerosis is not well defined, but has been postulated as a potential mechanism of association with future clinical events.
We studied participants from the Year 20 examination of the middle-aged, biracial CARDIA cohort. This examination included measurement of traditional risk factors, 12-lead electrocardiograms (ECGs), coronary artery calcium (CAC) measurement and common carotid intima-media thickness (CC-IMT). ECGs were coded using both Minnesota Code (MC) and Novacode (NC) criteria. Isolated minor STTA was defined by MC as presence of MC 4-3, 4-4, 5-3, or 5-4, and by NC as presence of NC 5.8. ECGs with secondary causes of STTA (i.e., LVH) were excluded. Multivariable logistic regression was used to determine the cross-sectional association of isolated minor NSSTTAs with CAC and CC-IMT. The study sample consisted of 2175 participants with an average age of 45 years (57% female and 43% Black). Isolated NSSTTAs were present in 5.1% of males and 6.3% of females. No association was observed between NSSTTA and CAC. After multivariable-adjustment for traditional CVD risk factors, the presence of isolated minor NSSTTAs remained significantly associated with the extent of CC-IMT (odds ratio 1.25 (1.06-1.48), p < 0.01). This association remained significant after further adjustment for CAC.
Isolated minor NSSTTAs were associated with the extent of CC-IMT, but not with CAC, in this middle-aged biracial cohort. Further study is needed to elucidate potential mechanisms for these findings.
孤立的非特异性小 ST 段和 T 波异常（NSSTTA）很常见，已知是未来心血管疾病（CVD）事件的独立心电图风险标志物。NSSTTA 与亚临床动脉粥样硬化的关联尚未明确，但被认为是与未来临床事件相关的潜在机制。
我们研究了来自中年、双种族 CARDIA 队列 2 年检查的参与者。该检查包括测量传统危险因素、12 导联心电图（ECG）、冠状动脉钙（CAC）测量和颈总动脉内膜中层厚度（CC-IMT）。ECG 使用明尼苏达州编码（MC）和 Novacode（NC）标准进行编码。孤立的小 STTA 按照 MC 标准定义为存在 MC 4-3、4-4、5-3 或 5-4，按照 NC 标准定义为存在 NC 5.8。排除了心电图有 STTA 继发性原因（即 LVH）的患者。多变量逻辑回归用于确定孤立的小 NSSTTA 与 CAC 和 CC-IMT 的横断面关联。研究样本包括 2175 名平均年龄为 45 岁（57%为女性，43%为黑人）的参与者。男性中有 5.1%存在孤立性 NSSTTA，女性中有 6.3%存在孤立性 NSSTTA。NSSTTA 与 CAC 之间没有观察到关联。在对传统 CVD 危险因素进行多变量调整后，存在孤立的小 NSSTTA 与 CC-IMT 的程度仍然显著相关（比值比 1.25（1.06-1.48），p<0.01）。在进一步调整 CAC 后，这种关联仍然显著。
在这个中年双种族队列中，孤立的小 NSSTTA 与 CC-IMT 的程度相关，但与 CAC 无关。需要进一步研究阐明这些发现的潜在机制。
