Kelly Jacob P, Greiner Melissa, Soliman Elsayed Z, Randolph Tiffany C, Thomas Kevin L, Dunlay Shannon M, Curtis Lesley H, O'Brien Emily C, Mentz Robert J
Duke Clinical Research Institute, Duke Medicine, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Duke Medicine, Durham, North Carolina.
Am J Cardiol. 2018 Jul 15;122(2):340-346. doi: 10.1016/j.amjcard.2018.04.004. Epub 2018 Apr 12.
Conflicting data exist regarding the associations of early repolarization (ER) with electrocardiogram (ECG) and clinical outcomes in blacks. We examined the association of ER defined by J point elevation (JPE) and all-cause mortality, and heart failure (HF) hospitalization in blacks in the Jackson Heart Study (JHS) cohort. We included JHS participants with ECGs from the baseline visit coding JPE and excluded participants with paced rhythms or QRS duration ≥120 ms. We compared the cumulative incidence of 10-year all-cause mortality and 8-year HF hospitalization by presence of JPE ≥0.1 mV in any ECG lead at baseline using Kaplan-Meier estimates and multivariable Cox models. Of the 4,978 participants, 1,410 (28%) had JPE at baseline: anterior leads 97.8%, lateral leads 8.3%, and inferior leads 2.9%. Compared with participants without JPE, those with JPE were younger, more likely to be male and current smokers, and less likely to have hypertension. Over a median follow-up of 8 years, there were no significant differences in the cumulative incidence or multivariable-adjusted hazards of all-cause mortality or HF hospitalization in participants with and without JPE in any lead (adjusted hazard ratio 0.97, 95% confidence interval 0.89 to 1.52, and adjusted hazard ratio 1.18, 95% confidence interval 0.9 to 1.54, respectively). Of the 2,523 participants who completed Exam 3 without JPE at baseline, 246 (10%) developed JPE over follow-up. In conclusion, JPE on ECG was not associated with long-term mortality or HF hospitalization in a large prospective black community cohort, suggesting that ER may represent a benign ECG finding in blacks.
关于早期复极（ER）与黑人心电图（ECG）及临床结局之间的关联，存在相互矛盾的数据。我们在杰克逊心脏研究（JHS）队列中，研究了由J点抬高（JPE）定义的ER与黑人全因死亡率及心力衰竭（HF）住院之间的关联。我们纳入了基线访视时心电图编码有JPE的JHS参与者，并排除了有起搏心律或QRS时限≥120 ms的参与者。我们使用Kaplan-Meier估计值和多变量Cox模型，比较了基线时任何心电图导联JPE≥0.1 mV者与无JPE者10年全因死亡率和8年HF住院的累积发生率。在4978名参与者中，1410名（28%）在基线时有JPE：前壁导联占97.8%，侧壁导联占8.3%，下壁导联占2.9%。与无JPE的参与者相比，有JPE的参与者更年轻，更可能为男性且是当前吸烟者，患高血压的可能性更小。在中位随访8年期间，任何导联有JPE和无JPE的参与者在全因死亡率或HF住院的累积发生率或多变量调整风险方面均无显著差异（调整后风险比分别为0.97，95%置信区间为0.89至1.52，以及调整后风险比为1.18，95%置信区间为0.9至1.54）。在2523名基线时完成第3次检查且无JPE的参与者中，246名（10%）在随访期间出现了JPE。总之，在一个大型前瞻性黑人社区队列中，心电图上的JPE与长期死亡率或HF住院无关，这表明ER可能是黑人中一种良性的心电图表现。
