May Ole, Graversen Christina Boesgaard, Johansen Mia Østergaard, Arildsen Hanne
Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark.
Cardiovasc. Res. Unit, Dept. of Med., Regional Hospital West Jutland, Aarhus University, Denmark.
J Diabetes Complications. 2017 Mar;31(3):551-555. doi: 10.1016/j.jdiacomp.2016.12.001. Epub 2016 Dec 16.
A large angle between the QRS vector and the T-wave vector (QRS-T angle) in electrocardiograms (ECGs) has recently been introduced as a marker of poor prognosis. The prognostic value in diabetes is unknown. We assessed the long-term predictive power of the frontal plane QRS-T angle in the diabetic population.
In 1992-93, the diabetic population of the municipality of Horsens, Denmark, was delineated by the prescription method, and an age- and gender-stratified sample of 240 diabetic persons was randomly selected. In 2015, 12-lead ECGs taken in 1993-94 were analyzed. Vital statistics were obtained from the Danish Civil Registration System and data regarding hospitalizations taken from The National Patient Registry in July 2015.
In total, 178 people agreed to participate (74%) in the study, with the mean (sd) age being 58.9 (10.2) years and 56% being male. The total observation time was 21.5 (0.18) years, during which time 122 (69%) persons died, 32 (18%) suffered a myocardial infarction (MI) and 126 (71%) reached the composite endpoint of non-fatal MI or all-cause death. In Cox regression multivariate analysis a QRS-T angle above 90° was found to be an independent predictor of all-cause death (HR=2.2 (95% CI: 1.3-3.8)), MI (HR=2.95 (95% CI: 1.1-7.7)) and MI or all-cause death (HR=2.0 (95% CI: 1.2-3.5)) (all p<0.05), when adjusting for the effects of co-variates (gender, age, length of diabetes, BMI, total cholesterol, diabetes type, hemoglobin A1c, smoking, hypertension and previous MI).
A large QRS-T angle is a strong, independent long-term predictor of all-cause mortality, MI and MI or all-cause death in the diabetic population.
心电图（ECG）中QRS向量与T波向量之间的大角度（QRS-T角）最近被引入作为预后不良的标志物。其在糖尿病中的预后价值尚不清楚。我们评估了额面QRS-T角在糖尿病患者中的长期预测能力。
1992 - 1993年，采用处方方法确定丹麦霍森斯市的糖尿病患者群体，并随机选取240名按年龄和性别分层的糖尿病患者样本。2015年，对1993 - 1994年采集的12导联心电图进行分析。从丹麦民事登记系统获取人口统计数据，并于2015年7月从国家患者登记处获取住院数据。
共有178人同意参与（74%）该研究，平均（标准差）年龄为58.9（10.2）岁，男性占56%。总观察时间为21.5（0.18）年，在此期间122人（69%）死亡，32人（18%）发生心肌梗死（MI），126人（71%）达到非致命性MI或全因死亡的复合终点。在Cox回归多变量分析中，当调整协变量（性别、年龄、糖尿病病程、体重指数、总胆固醇、糖尿病类型、糖化血红蛋白、吸烟、高血压和既往MI）的影响时，发现QRS-T角大于90°是全因死亡（HR = 2.2（95%CI：1.3 - 3.8））、MI（HR = 2.95（95%CI：1.1 - 7.7））和MI或全因死亡（HR = 2.0（95%CI：1.2 - 3.5））的独立预测因子（所有p<0.05）。
大的QRS-T角是糖尿病患者全因死亡率、MI以及MI或全因死亡的强有力的独立长期预测因子。
