Ann Intern Med. 2015 Nov 17;163(10):747-55. doi: 10.7326/M15-0598. Epub 2015 Oct 27.
The prognostic value of early repolarization with J waves and QRS slurs remains controversial. Although these findings are more prevalent in patients with idiopathic ventricular fibrillation, their ability to predict cardiovascular death has varied across studies.
To test the hypothesis that J waves and QRS slurs on electrocardiograms (ECGs) are associated with increased risk for cardiovascular death.
Retrospective cohort.
Veterans Affairs Palo Alto Health Care System.
Veterans younger than 56 years who had resting 12-lead electrocardiography, 90.5% of whom were men.
Electrocardiograms were manually measured and visually coded using criteria of 0.1 mV or greater in at least 2 contiguous leads. J waves were measured at the peak of an upward deflection or notch at the end of QRS, and QRS slurs were measured at the top of conduction delay on the QRS downstroke. Absolute risk differences at 10 years were calculated to study the associations between J waves or QRS slurs and the primary outcome of cardiovascular death.
Over a median follow-up of 17.5 years, 859 cardiovascular deaths occurred. Of 20 661 ECGs, 4219 (20%) had J waves or QRS slurs in the inferior and/or lateral territories; of these, 3318 (78.6%) had J waves or QRS slurs in inferior leads and 1701 (40.3%) in lateral leads. The upper bound of differences in risk for cardiovascular death from any of the J-wave or QRS slur patterns suggests that an increased risk can be safely ruled out (inferior, -0.77% [95% CI, -1.27% to -0.27%]; lateral, -1.07% [CI, -1.72% to -0.43%]).
The study consisted of predominantly men, and deaths could be classified as cardiovascular but not arrhythmic.
J waves and QRS slurs did not exhibit a clinically meaningful increased risk for cardiovascular death in long-term follow-up.
None.
早期复极伴有 J 波和 QRS 切迹的预后价值仍存在争议。虽然这些发现更常见于特发性心室颤动患者，但它们预测心血管死亡的能力在不同的研究中有所不同。
检验心电图（ECG）上 J 波和 QRS 切迹与心血管死亡风险增加相关的假设。
回顾性队列。
退伍军人事务部帕洛阿尔托医疗保健系统。
年龄小于 56 岁的退伍军人，接受静息 12 导联心电图检查，其中 90.5%为男性。
心电图由手动测量，并使用至少 2 个连续导联中 0.1 mV 或更大的标准进行视觉编码。J 波在 QRS 结束时的向上偏转或切迹的峰值处测量，QRS 切迹在 QRS 下传的传导延迟处的顶部测量。计算 10 年内的绝对风险差异，以研究 J 波或 QRS 切迹与心血管死亡的主要结局之间的关联。
在中位随访 17.5 年期间，发生了 859 例心血管死亡。在 20661 份心电图中，4219 份（20%）下壁和/或侧壁有 J 波或 QRS 切迹；其中，3318 份（78.6%）在下壁导联有 J 波或 QRS 切迹，1701 份（40.3%）在侧壁导联有 J 波或 QRS 切迹。任何 J 波或 QRS 切迹模式的心血管死亡风险差异的上限表明，可以安全排除风险增加（下壁，-0.77%[95%CI，-1.27%至-0.27%]；侧壁，-1.07%[CI，-1.72%至-0.43%]）。
该研究主要由男性组成，死亡可归类为心血管疾病，但不一定是心律失常。
在长期随访中，J 波和 QRS 切迹并未表现出与心血管死亡风险增加的临床相关关系。
无。
