女性心源性猝死
Sudden Cardiac Death in Women.
机构信息
From Research Unit of Internal Medicine (M.A.E.H., L.H., J.V., T.K., J.T., J.P., H.H., M.J.J.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland.
Department of Forensic Medicine, Research Unit of Internal Medicine (L.P., M.-L.K.), Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Finland.
出版信息
Circulation. 2019 Feb 19;139(8):1012-1021. doi: 10.1161/CIRCULATIONAHA.118.037702.
BACKGROUND
Despite recent progress in profiling of risk for sudden cardiac death (SCD) and prevention and intervention of cardiac diseases, SCD remains a major cause of death. Among women, the incidence of SCD is significant, but lower than in men, particularly in the premenopausal and early postmenopausal years. Possibly, as a consequence of the difference in population burden, the mechanisms and risk markers of SCD are not as well defined for women. The aim of this study was to determine the autopsy findings and causes of death among women in a large SCD population. Additionally, we sought to classify prior ECG characteristics in male and female subjects with SCD.
METHODS
The Fingesture study has systematically collected clinical and autopsy data from subjects with SCD in Northern Finland between 1998 and 2017. The cohort consists of 5869 subjects with SCD. Previously recorded ECGs were available and analyzed in 1101 subjects (18.8% of total population; and in 25.3% of women).
RESULTS
Female subjects with SCD were significantly older than men: 70.1±13.1 years versus 63.5±11.8 years (mean ± standard deviation, P<0.001). The most frequently identified cause of death was ischemic heart disease in both sexes: 71.7% among women versus 75.7% among men, P=0.005. In contrast, women were more likely to have nonischemic cause of SCD than men (28.3% versus 24.3%, P=0.005). The prevalence of primary myocardial fibrosis was higher among women (5.2%, n=64) than in men (2.6%, n=120; P<0.001). Female subjects with SCD were more likely to have normal prior ECG tracings (22.2% versus 15.3% in men, P<0.001). A normal ECG was even more common among nonischemic female subjects with SCD (27.8% versus 16.2% in men, P=0.009). However, ECG markers of left ventricular hypertrophy, with or without repolarization abnormalities, were more common among women (8.2%; 17.9%) than in men (4.9%; 10.6%, P=0.036; P<0.001, respectively).
CONCLUSIONS
Women were considerably older at the time of SCD and more commonly had nonischemic causes. Women were also more likely to have a prior normal ECG than men, but an increased marker for SCD risk based on ECG criteria for left ventricular hypertrophy with repolarization abnormalities was more commonly observed in women.
背景
尽管在突 发性心 脏死 亡 (SCD) 的风险分析、心脏疾 病的预防和干预方面取得了近 些年的进展，但 SCD 仍是主要的死亡原因之一。在女性中，SCD 的发病率很高，但明显低于男性，尤其是在绝经前和绝经早期。可能由于人群负担的差异，女性的 SCD 机制和风险标志物还没有得到很好的定义。本研究的目的是确定在一个大型 SCD 人群中女性的尸检结果和死因。此外，我们试图对 SCD 男性和女性患者的先前心电图特征进行分类。
方法
芬兰北部的 Fingesture 研究系统地收集了 1998 年至 2017 年 SCD 患者的临床和尸检数据。该队列包括 5869 例 SCD 患者。之前记录的心电图可用于分析 1101 例患者（占总人群的 18.8%；女性占 25.3%）。
结果
女性 SCD 患者的年龄明显大于男性：70.1±13.1 岁 vs. 63.5±11.8 岁（均值±标准差，P<0.001）。两种性别最常识别的死因均为缺血性心脏病：女性为 71.7%，男性为 75.7%，P=0.005。相比之下，女性 SCD 的非缺血性病因更常见于男性（28.3% vs. 24.3%，P=0.005）。女性原发性心肌纤维化的患病率高于男性（5.2%，n=64）vs. 男性（2.6%，n=120；P<0.001）。女性 SCD 患者更有可能出现正常的先前心电图描记（22.2% vs. 男性的 15.3%，P<0.001）。非缺血性女性 SCD 患者的正常心电图更为常见（27.8% vs. 男性的 16.2%，P=0.009）。然而，女性心电图左心室肥厚的标志物，无论是否存在复极异常，更为常见（8.2%；17.9%），而男性为（4.9%；10.6%，P=0.036；P<0.001，分别）。
结论
女性发生 SCD 时的年龄明显较大，更常见的是非缺血性病因。与男性相比，女性先前更可能有正常心电图，但女性心电图左心室肥厚伴复极异常的 SCD 风险标志物更常见。
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