Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, 55455 MN, USA.
Division of Cardiovascular Medicine, University of Virginia, 800158 Charlottesville, VA, USA.
Europace. 2017 Nov 1;19(11):1759-1766. doi: 10.1093/europace/euw328.
Electrocardiographic (ECG) markers of left atrial (LA) abnormalities have been linked to increased risk of atrial fibrillation (AF). Sleep disordered breathing (SDB) has been associated with increased risk of AF. We aimed to examine the association of ECG markers of LA abnormalities with SDB.
1546 participants (mean age 67.2 years, 53.4% women, and 63.3% non-whites) from the Multi-Ethnic Study of Atherosclerosis Exam 5 Sleep ancillary study were included in this analysis. ECG markers of LA abnormalities (P wave terminal force in V1 (PTFV1), maximum P wave duration, PR interval and heart rate corrected PR interval) were measured from resting standard digital ECG tracings using standardized processing. Linear and logistic regression analyses were utilized to examine the cross-sectional associations of measures of SDB (apnea hypopnea index [AHI] and % time spent with oxygen saturation <90% [%SpO290]) with each ECG marker. In a multivariable analysis adjusting for demographics, cardiovascular risk factors, and comorbidities, AHI was associated with greater PTFV1 but not with other ECG markers of LA abnormalities. A 1-SD increase of AHI (16.6/hr) was associated with higher levels of PTFV1 (175.1 µV.ms, 95% confidence interval [95%CI] 75.4, 274.7) and higher odds of abnormally elevated PTFV1 (≥4000 µV.ms) (Odds Ratio: 1.21 [95%CI 1.05, 1.39]). No association was found between %SpO290 and ECG markers of LA abnormalities.
Severity of SDB, as measured by AHI, is associated with subclinical LA disease, as indicated by PTFV1. PTFV1 may be an important ECG marker linking SDB and AF.
心电图（ECG）标记物左心房（LA）异常与心房颤动（AF）风险增加有关。睡眠呼吸障碍（SDB）与 AF 风险增加有关。我们旨在研究 LA 异常的心电图标记物与 SDB 的关系。
这项分析纳入了多民族动脉粥样硬化研究（MESA）第五次睡眠辅助研究的 1546 名参与者（平均年龄 67.2 岁，53.4%为女性，63.3%为非白人）。从静息标准数字 ECG 轨迹中使用标准化处理方法测量 LA 异常的心电图标记物（V1 导联 P 波终末电势（PTFV1）、最大 P 波持续时间、PR 间期和心率校正 PR 间期）。线性和逻辑回归分析用于检查 SDB（呼吸暂停低通气指数 [AHI] 和 %时间血氧饱和度 <90% [%SpO290]）与每个 ECG 标记物的横断面关系。在调整人口统计学、心血管危险因素和合并症的多变量分析中，AHI 与较高的 PTFV1 相关，但与其他 LA 异常的心电图标记物无关。AHI 每增加 1-SD（16.6/hr）与 PTFV1 水平升高相关（175.1 µV.ms，95%置信区间 [95%CI] 75.4，274.7）和异常升高的 PTFV1 （≥4000 µV.ms）的几率升高相关（优势比：1.21 [95%CI 1.05，1.39]）。未发现 %SpO290 与 LA 异常的心电图标记物之间存在关联。
以 AHI 衡量的 SDB 严重程度与 PTFV1 所示的亚临床 LA 疾病有关。PTFV1 可能是连接 SDB 和 AF 的重要 ECG 标记物。
