Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Department of Internal Medicine, Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Am J Cardiol. 2019 May 1;123(9):1443-1447. doi: 10.1016/j.amjcard.2019.01.050. Epub 2019 Feb 10.
Although minor electrocardiographic (ECG) abnormalities are common findings in clinical practice, their prognostic significance remains unclear due to inconsistent reports. We hypothesized that this inconsistency is due to the traditional focus on examining their prognostic significance as a binary variable (i.e., presence vs absence of any abnormality) ignoring the number of abnormalities. We tested this hypothesis in 6,467 participants (mean age 59 years, 53% women) from the Third National Health and Nutrition Examination Survey who were free of baseline cardiovascular disease (CVD) and major ECG abnormalities. ECG abnormalities were defined from digitally recorded and centrally processed standard electrocardiograms using the Minnesota ECG Classification. CVD mortality was ascertained using National Death Index. About 38% of participants (n = 2,438) had at least 1 minor ECG abnormality at baseline. During a median follow-up of 13.9 years, 755 CVD deaths occurred. In a multivariable Cox model, presence of at least 1 minor ECG abnormality was marginally associated with increased risk of CVD mortality (hazard ratio (95% confidence interval):1.15(1.00,1.34), p-value = 0.04)). However, as the number of ECG abnormalities increases, the association with CVD mortality showed a dose-response relation (event rate per 1,000 person-year of 7.3, 10.1, and 16.7 in participants with 0, 1, and ≥2 ECG abnormalities, respectively; p-value for trend <0.01). Also, each additional minor ECG abnormality was associated with a 13% increased risk of CVD mortality (hazard ratio (95% confidence interval): 1.13(1.04, 1.24)). In conclusion, the number, not only the mere presence of minor ECG abnormalities should be taken into account to understand the prognostic significance of these common findings.
尽管在临床实践中常见到轻微的心电图（ECG）异常，但由于报告结果不一致，其预后意义仍不清楚。我们假设这种不一致是由于传统上侧重于检查其作为二元变量（即是否存在任何异常）的预后意义，而忽略了异常的数量。我们在第三项全国健康和营养检查调查中检验了这一假设，该调查共纳入了 6467 名无基线心血管疾病（CVD）和主要 ECG 异常的参与者（平均年龄 59 岁，53%为女性）。使用明尼苏达州心电图分类法，从数字化记录和集中处理的标准心电图中定义 ECG 异常。使用国家死亡索引确定 CVD 死亡率。大约 38%的参与者（n=2438）在基线时至少存在 1 种轻微的 ECG 异常。在中位随访 13.9 年后，发生了 755 例 CVD 死亡。在多变量 Cox 模型中，存在至少 1 种轻微的 ECG 异常与 CVD 死亡风险增加相关（风险比（95%置信区间）：1.15（1.00，1.34），p 值=0.04））。然而，随着 ECG 异常数量的增加，与 CVD 死亡率的关联呈剂量反应关系（参与者中每 1000 人年的事件发生率分别为 7.3、10.1 和 16.7；趋势检验 p 值<0.01）。此外，每增加 1 个轻微的 ECG 异常与 CVD 死亡率增加 13%相关（风险比（95%置信区间）：1.13（1.04，1.24））。总之，数量，而不仅仅是轻微 ECG 异常的存在，应该被考虑在内，以了解这些常见发现的预后意义。
