Venkatesh Sanjay, O'Neal Wesley T, Broughton Stephen T, Shah Amit J, Soliman Elsayed Z
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Am J Cardiol. 2017 Mar 15;119(6):856-861. doi: 10.1016/j.amjcard.2016.11.039. Epub 2016 Dec 18.
The lack of abnormalities found on noninvasive cardiac testing possibly improves cardiovascular disease (CVD) risk stratification efforts and conveys reduced risk despite the presence of traditional risk factors. This analysis included 3,805 (95% white and 61% women) participants from the Cardiovascular Health Study (CHS) without baseline CVD. The combination of a normal electrocardiogram (ECG) and echocardiogram was assessed for the development of CVD. A normal ECG was defined as the absence of major or minor Minnesota code abnormalities. A normal echocardiogram was defined as the absence of contractile dysfunction, wall motion abnormalities, or abnormal left ventricular mass. Cox regression was used to compute the 10-year risk of developing coronary heart disease, stroke, and heart failure events. There were 1,555 participants (41%) with normal findings on both measures. After accounting for traditional CVD risk factors, a protective benefit was observed for all outcomes among participants who had normal ECG and echocardiographic findings (coronary heart disease: hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.46, 0.69; stroke: HR 0.57, 95% CI 0.43, 0.76; heart failure: HR 0.36, 95% CI 0.29, 0.41). The addition of this normal profile resulted in significant net reclassification improvement of the Framingham risk score for heart failure (net reclassification improvement 4.3%, 95% CI 1.0, 8.0). In conclusion, normal findings on routine noninvasive cardiac assessment identify subjects in whom CVD risk is low.
在无创心脏检查中未发现异常，这可能会改善心血管疾病（CVD）风险分层工作，并表明尽管存在传统风险因素，但风险降低。该分析纳入了心血管健康研究（CHS）中3805名（95%为白人，61%为女性）无基线CVD的参与者。评估了正常心电图（ECG）和超声心动图联合检查对CVD发生情况的影响。正常ECG定义为无明尼苏达编码的主要或次要异常。正常超声心动图定义为无收缩功能障碍、室壁运动异常或左心室质量异常。采用Cox回归计算发生冠心病、中风和心力衰竭事件的10年风险。两项检查结果均正常的参与者有1555名（41%）。在考虑传统CVD风险因素后，观察到ECG和超声心动图检查结果正常的参与者在所有结局方面均有保护作用（冠心病：风险比[HR]0.56，95%置信区间[CI]0.46，0.69；中风：HR 0.57，95%CI 0.43，0.76；心力衰竭：HR 0.36，95%CI 0.29，0.41）。增加这一正常情况显著改善了心力衰竭弗明翰风险评分的净重新分类（净重新分类改善4.3%，95%CI 1.0，8.0）。总之，常规无创心脏评估结果正常可识别出CVD风险较低的受试者。
