Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan.
Am J Hypertens. 2018 Jul 16;31(8):895-901. doi: 10.1093/ajh/hpy055.
The appearance of left ventricular hypertrophy on 12-lead electrocardiography (ECG-LVH) has been clarified to be associated with the risk of incidence of cardiovascular events (CVEs) in hypertensive individuals and the general population, but not enough in non-hypertensive individuals.
A total of 4,927 non-hypertensive individuals ≥40 years of age who were free of CVE in the general population were followed for the incidence of CVE. ECG-LVH was defined according to criteria of the Sokolow-Lyon (SL) voltage, Cornell voltage (CV), or Cornell voltage product (CP).
During the average 9.8 ± 2.0 years of follow-up, 267 individuals (5.4%) had their first CVE. The hazard ratio (HR) for the incidence of CVE after full adjustment by potential confounders significantly increased in the individuals with ECG-LVH by any criteria of the SL voltage, CV, and CP (HR = 1.77, P < 0.001) compared to those with no ECG-LVH. This association was also significant in individuals without any of obesity, dyslipidemia, and diabetes mellitus or those with systolic blood pressure (BP) <120 mm Hg and diastolic BP <80 mm Hg. Furthermore, ECG-LVH by each criteria provided the reclassification improvement for the CVE risk prediction model by the Framingham 10-year risk score (the net reclassification improvement = 0.17-0.22, each P value < 0.010).
In the absence of hypertension, ECG-LVH parameters are associated with the increased risk of developed CVEs independent of the established risk factors and provide the additional prognostic value in an assessment of the CVE risk using the traditional risk factors.
12 导联心电图（ECG-LVH）上出现左心室肥厚已被明确与高血压个体和普通人群中心血管事件（CVE）的发病风险相关，但在非高血压个体中则不然。
共有 4927 名年龄≥40 岁且无 CVE 的非高血压普通人群进行了 CVE 的发病随访。根据 Sokolow-Lyon（SL）电压、Cornell 电压（CV）或 Cornell 电压乘积（CP）标准定义 ECG-LVH。
在平均 9.8±2.0 年的随访期间，267 名（5.4%）患者发生了首次 CVE。经潜在混杂因素充分校正后，任何 SL 电压、CV 和 CP 标准的 ECG-LVH 患者的 CVE 发病风险 HR（危险比）均显著高于无 ECG-LVH 患者（HR=1.77，P<0.001）。这种关联在无肥胖、血脂异常和糖尿病且收缩压（BP）<120mmHg 和舒张压（BP）<80mmHg 的患者中也是显著的。此外，每个标准的 ECG-LVH 均为Framingham 10 年风险评分的 CVE 风险预测模型提供了再分类改善（净再分类改善=0.17-0.22，P 值均<0.010）。
在没有高血压的情况下，ECG-LVH 参数与已建立的危险因素独立相关，增加了 CVE 的发病风险，并在使用传统危险因素评估 CVE 风险时提供了额外的预后价值。
