Ishikawa Joji, Ishikawa Shizukiyo, Kario Kazuomi
From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (J.I., K.K.); and Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan (S.I.).
Hypertension. 2015 Mar;65(3):554-60. doi: 10.1161/HYPERTENSIONAHA.114.04722. Epub 2014 Dec 22.
We attempted to evaluate whether subjects who exhibit prolonged corrected QT (QTc) interval (≥440 ms in men and ≥460 ms in women) on ECG, with and without ECG-diagnosed left ventricular hypertrophy (ECG-LVH; Cornell product, ≥244 mV×ms), are at increased risk of stroke. Among the 10 643 subjects, there were a total of 375 stroke events during the follow-up period (128.7±28.1 months; 114 142 person-years). The subjects with prolonged QTc interval (hazard ratio, 2.13; 95% confidence interval, 1.22-3.73) had an increased risk of stroke even after adjustment for ECG-LVH (hazard ratio, 1.71; 95% confidence interval, 1.22-2.40). When we stratified the subjects into those with neither a prolonged QTc interval nor ECG-LVH, those with a prolonged QTc interval but without ECG-LVH, and those with ECG-LVH, multivariate-adjusted Cox proportional hazards analysis demonstrated that the subjects with prolonged QTc intervals but not ECG-LVH (1.2% of all subjects; incidence, 10.7%; hazard ratio, 2.70, 95% confidence interval, 1.48-4.94) and those with ECG-LVH (incidence, 7.9%; hazard ratio, 1.83; 95% confidence interval, 1.31-2.57) had an increased risk of stroke events, compared with those with neither a prolonged QTc interval nor ECG-LVH. In conclusion, prolonged QTc interval was associated with stroke risk even among patients without ECG-LVH in the general population.
我们试图评估心电图显示校正QT(QTc)间期延长(男性≥440毫秒,女性≥460毫秒)且伴有或不伴有心电图诊断的左心室肥厚(ECG-LVH;康奈尔乘积,≥244 mV×ms)的受试者是否中风风险增加。在10643名受试者中,随访期间共有375例中风事件(128.7±28.1个月;114142人年)。即使在校正ECG-LVH后,QTc间期延长的受试者(风险比,2.13;95%置信区间,1.22 - 3.73)中风风险仍增加(风险比,1.71;95%置信区间,1.22 - 2.40)。当我们将受试者分为既无QTc间期延长也无ECG-LVH、有QTc间期延长但无ECG-LVH以及有ECG-LVH三组时,多变量校正的Cox比例风险分析表明,有QTc间期延长但无ECG-LVH的受试者(占所有受试者的1.2%;发病率,10.7%;风险比,2.70,95%置信区间,1.48 - 4.94)和有ECG-LVH的受试者(发病率,7.9%;风险比,1.83;95%置信区间,1.31 - 2.57)与既无QTc间期延长也无ECG-LVH的受试者相比,中风事件风险增加。总之,在一般人群中,即使在无ECG-LVH的患者中,QTc间期延长也与中风风险相关。