筛查心电图上的室性早搏与缺血性中风风险
Premature ventricular complexes on screening electrocardiogram and risk of ischemic stroke.
作者信息
Agarwal Sunil K, Chao Jennifer, Peace Frederick, Judd Suzanne E, Kissela Brett, Kleindorfer Dawn, Howard Virginia J, Howard George, Soliman Elsayed Z
机构信息
From the Division of Cardiology (S.K.A.) and Department of Internal Medicine (J.C.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biostatistics (F.P., S.E.J., G.H.) and Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurology, University of Cincannati, OH (B.K., D.K.); and Division of Epidemiology and Prevention EpiCare, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.).
出版信息
Stroke. 2015 May;46(5):1365-7. doi: 10.1161/STROKEAHA.114.008447. Epub 2015 Apr 14.
BACKGROUND AND PURPOSE
Premature ventricular complexes (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. Whether PVCs seen on routine ECG, commonly used in clinical practice, are associated with an increased risk of ischemic stroke remains unstudied.
METHODS
This analysis included 24 460 participants (aged, 64.5+9.3 years; 55.1% women; 40.0% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment. PVCs were ascertained from baseline ECG (2003-2007), and incident stroke cases through 2011 were confirmed by an adjudication committee.
RESULTS
A total of 1415 (5.8%) participants had at least 1 PVC at baseline, and 591 developed incident ischemic stroke during an average (SD) follow-up of 6.0 (2.0) years. In a cox proportional hazards model adjusted for age, sex, race, geographic region, education, previous heart disease, systolic blood pressure, blood pressure-lowering medications, current smoking, diabetes mellitus, left ventricular hypertrophy by ECG, and aspirin use and warfarin use, the presence of PVCs was associated with 38% increased risk of ischemic stroke (hazard ratio [95% confidence interval], 1.38 [1.05-1.81]).
CONCLUSIONS
PVCs are common on routine screening ECGs and are associated with an increased risk of ischemic stroke.
背景与目的
从长期心电图记录中检测到的室性早搏（PVC）与缺血性中风风险增加相关。临床实践中常用的常规心电图上出现的PVC是否与缺血性中风风险增加相关仍未得到研究。
方法
该分析纳入了来自中风地理和种族差异原因（REGARDS）研究的24460名参与者（年龄64.5±9.3岁；55.1%为女性；40.0%为黑人），这些参与者在入组时无中风。通过基线心电图（2003 - 2007年）确定PVC，并由判定委员会确认截至2011年的缺血性中风发病病例。
结果
共有1415名（5.8%）参与者在基线时有至少1次PVC，在平均（标准差）6.0（2.0）年的随访期间，591人发生了缺血性中风。在调整了年龄、性别、种族、地理区域、教育程度、既往心脏病史、收缩压、降压药物使用、当前吸烟情况、糖尿病、心电图显示的左心室肥厚以及阿司匹林和华法林使用情况的Cox比例风险模型中，PVC的存在与缺血性中风风险增加38%相关（风险比[95%置信区间]，1.38[1.05 - 1.81]）。
结论
PVC在常规筛查心电图中很常见，且与缺血性中风风险增加相关。
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