Darouian Navid, Narayanan Kumar, Aro Aapo L, Reinier Kyndaron, Uy-Evanado Audrey, Teodorescu Carmen, Gunson Karen, Jui Jonathan, Chugh Sumeet S
The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Oregon Health and Science University, Portland, Oregon.
Heart Rhythm. 2016 Apr;13(4):927-32. doi: 10.1016/j.hrthm.2015.12.022. Epub 2015 Dec 14.
Prolongation of initial ventricular depolarization on the 12-lead electrocardiogram (ECG), or delayed intrinsicoid deflection (DID), can indicate left ventricular hypertrophy (LVH). The possibility that this marker could convey distinct risk of sudden cardiac arrest (SCA) has not been evaluated.
To evaluate the association of DID and SCA in the community.
In the ongoing prospective, population-based Oregon Sudden Unexpected Death Study (Oregon SUDS; catchment area approximately 1 million), SCA cases were compared to geographic controls with no SCA. Archived ECGs (closest and unrelated to SCA event for cases) were evaluated for the presence of DID, defined as ≥0.05 second in leads V5 or V6. Left ventricular (LV) mass and function were evaluated from archived echocardiograms.
SCA cases (n = 272, 68.7 ± 14.6 years, 63.6% male) as compared to controls (n = 351, 67.6 ± 11.4 years, 63.3% male) were more likely to have DID on ECG (28.3% vs. 17.1%, P = .001). DID was associated with increased SCA odds (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.31-2.81; P = .001), but showed poor correlation with LV mass and echocardiographic LVH (kappa 0.13). In multivariate analysis adjusted for clinical and ECG markers, reduced LV ejection fraction, and echocardiographic LVH, DID remained an independent predictor of SCA (OR 1.82; 95% CI 1.12-2.97; P = .016). Additionally, in a sensitivity analysis restricted to narrow QRS, DID and ECG LVH by voltage were each independently associated with SCA risk.
DID was associated with increased SCA risk independent of echocardiographic LVH, ECG LVH, and reduced LV ejection fraction, potentially reflecting unique electrical remodeling that warrants further investigation.
12导联心电图（ECG）上初始心室去极化时间延长，即延迟固有心内电位（DID），可提示左心室肥厚（LVH）。这一指标是否能反映心脏骤停（SCA）的独特风险尚未得到评估。
评估社区中DID与SCA的关联。
在正在进行的基于人群的前瞻性俄勒冈州突发意外死亡研究（俄勒冈州SUDS；覆盖区域约100万人口）中，将SCA病例与无SCA的地理对照进行比较。评估存档的心电图（病例为与SCA事件最接近且无关的心电图）是否存在DID，DID定义为V5或V6导联中≥0.05秒。从存档的超声心动图评估左心室（LV）质量和功能。
与对照组（n = 351，67.6±11.4岁，63.3%为男性）相比，SCA病例（n = 272，68.7±14.6岁，63.6%为男性）心电图出现DID的可能性更高（28.3%对17.1%，P = 0.001）。DID与SCA几率增加相关（优势比[OR]1.92；95%置信区间[CI]1.31 - 2.81；P = 0.001），但与LV质量和超声心动图LVH的相关性较差（kappa 0.13）。在对临床和心电图指标、降低的LV射血分数以及超声心动图LVH进行校正的多变量分析中，DID仍然是SCA的独立预测因素（OR 1.82；95% CI 1.12 - 2.97；P = 0.016）。此外，在仅限于窄QRS波的敏感性分析中，DID和电压法心电图LVH均与SCA风险独立相关。
DID与SCA风险增加相关，独立于超声心动图LVH、心电图LVH和降低的LV射血分数，这可能反映了独特的电重构，值得进一步研究。
