Panikkath Ragesh, Reinier Kyndaron, Uy-Evanado Audrey, Teodorescu Carmen, Gunson Karen, Jui Jonathan, Chugh Sumeet S
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Ann Noninvasive Electrocardiol. 2013 May;18(3):225-9. doi: 10.1111/anec.12003. Epub 2012 Nov 22.
Left ventricular hypertrophy (LVH) has been associated with increased risk of sudden cardiac death (SCD), and improvements in risk stratification methodology are warranted.
We evaluated electrocardiographic intervals as potential markers of SCD risk in LVH. Corrected QT, QRS, and JT intervals were evaluated in consecutive cases with SCD and LVH from the ongoing Oregon Sudden Unexpected Death study who underwent a 12-lead electrocardiogram (EKG) and echocardiogram prior to and unrelated to the SCD event. Comparisons of age, gender, body mass index, LV ejection fraction, and EKG intervals together with clinical conditions (hypertension and diabetes) were conducted with geographically matched controls that had coronary artery disease but no history of ventricular arrhythmias or cardiac arrest. LVH was determined using the modified American Society of Echocardiography equation for LV mass. Independent samples t-test, Pearson's chi-square test, and multiple logistic regression were used for statistical comparisons.
Of the 109 cases and 49 controls who met study criteria, age, gender, and comorbidities were similar among cases and controls. The mean LV mass index was not significantly different in cases compared to controls. However mean QTc (470.6 ± 53.6 ms vs 440.7 ± 38.7 ms; P < 0.0001) and QRS duration (113.6 ± 30.0 ms vs 104.9 ± 18.7 ms; P = 0.03) were significantly higher in cases than controls. In logistic regression analysis, prolonged QTc was the only EKG interval significantly associated with SCD (OR 1.72 [1.23-2.40]).
Prolonged QTc was independently associated with SCD among subjects with LVH and merits further evaluation as a predictor of SCD in LVH.
左心室肥厚（LVH）与心脏性猝死（SCD）风险增加相关，因此有必要改进风险分层方法。
我们评估心电图间期作为LVH中SCD风险的潜在标志物。在俄勒冈州突发意外死亡研究中，对连续发生SCD且患有LVH的病例进行校正QT、QRS和JT间期评估，这些病例在SCD事件之前且与之无关时接受了12导联心电图（EKG）和超声心动图检查。将年龄、性别、体重指数、左心室射血分数、EKG间期以及临床情况（高血压和糖尿病）与地理位置匹配的患有冠状动脉疾病但无室性心律失常或心脏骤停病史的对照组进行比较。使用改良的美国超声心动图学会左心室质量方程确定LVH。采用独立样本t检验、Pearson卡方检验和多元逻辑回归进行统计学比较。
在符合研究标准的109例病例和49例对照中，病例组和对照组的年龄、性别及合并症相似。与对照组相比，病例组的平均左心室质量指数无显著差异。然而，病例组的平均校正QTc（470.6±53.6毫秒对440.7±38.7毫秒；P<0.0001）和QRS时限（113.6±30.0毫秒对104.9±18.7毫秒；P = 0.03）显著高于对照组。在逻辑回归分析中，校正QTc延长是唯一与SCD显著相关的EKG间期（比值比1.72[1.23 - 2.40]）。
校正QTc延长在LVH患者中与SCD独立相关，作为LVH中SCD的预测指标值得进一步评估。
