Department of Clinical Sciences, Lund University, Skåne University Hospital, Inga-Marie Nilssons väg 49, S-20502 Malmö, Sweden.
Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Europace. 2018 Mar 1;20(3):429-434. doi: 10.1093/europace/eux032.
ST-depression at 24hECG has not been studied in relation to atrial fibrillation (AF) risk. We aimed to determine whether ST-depression at 24hECG was associated with incident AF in two Swedish population-based cohorts - a sub-cohort of the Malmö Diet and Cancer study (MDCS), and the cohort 'Men born in 1914', and to determine whether 24hECG could be used to predict AF development.
There were 378 acceptable 24hECG recordings in the MDCS (mean age 64.5 years, 43% men) and 394 acceptable recordings in 'Men born in 1914' (mean age 68.8 years). Incidence of AF was monitored using national registers of hospitalizations and outpatient visits in Sweden. Mean follow-up ± SD (cumulative incidence) was 10.4 ± 2 years (11.3%) in MDCS, and 10.9 ± 4 years (7.3%) in 'Men born in 1914'. ST-depressions were independently associated with incident AF; hazard ratio (HR) (95% CI) 2.41 (1.29-4.50, P = 0.006) and 2.28 (1.05-4.95, P = 0.038) after adjustment [age, sex, height, weight, systolic blood pressure, smoking, anti-hypertensive drugs, LDL/total cholesterol, and HOMA-IR (in MDCS)]. AF incidence was substantially lower in individuals who had neither ST-depressions or high supraventricular activity (SVA, negative predictive value 0.97 and 0.94, in MDCS and 'Men born in 1914', respectively), and similar in men and women.
ST-depression at 24h-ECG is independently associated with incident AF, and incidence is substantially lower in individuals with neither ST-depression or high SVA. 24hECG can be used not only to diagnose AF but also to identify individuals at high and low AF risk.
24 小时心电图上的 ST 段压低与心房颤动（AF）风险的关系尚未得到研究。我们旨在确定在两个瑞典人群队列 - 马尔默饮食和癌症研究（MDCS）的一个子队列和“1914 年出生的男性”队列中，24 小时心电图上的 ST 段压低是否与 AF 事件相关，并确定 24 小时心电图是否可用于预测 AF 的发生。
MDCS 中有 378 份可接受的 24 小时心电图记录（平均年龄 64.5 岁，43%为男性），“1914 年出生的男性”中有 394 份可接受的记录（平均年龄 68.8 岁）。AF 的发生率通过瑞典的住院和门诊就诊国家登记处进行监测。MDCS 的平均随访时间±SD（累积发生率）为 10.4±2 年（11.3%），“1914 年出生的男性”为 10.9±4 年（7.3%）。ST 段压低与 AF 事件独立相关；调整年龄、性别、身高、体重、收缩压、吸烟、降压药、LDL/总胆固醇和 HOMA-IR（在 MDCS 中）后，风险比（HR）（95%CI）为 2.41（1.29-4.50，P=0.006）和 2.28（1.05-4.95，P=0.038）。在既没有 ST 段压低也没有高室上性活动（SVA）的个体中，AF 的发生率显著降低（阴性预测值分别为 0.97 和 0.94，在 MDCS 和“1914 年出生的男性”中），且在男性和女性中相似。
24 小时心电图上的 ST 段压低与 AF 事件独立相关，在既没有 ST 段压低也没有高 SVA 的个体中，AF 的发生率显著降低。24 小时心电图不仅可用于诊断 AF，还可用于识别 AF 风险高低的个体。
