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患有和未患有注意力缺陷多动障碍的儿童及青少年的心脏早期复极模式异常:一项社区观察性研究

Cardiac Early Repolarization Pattern Anomalies Among Children and Adolescents With and Without Attention-Deficit Hyperactivity Disorder: A Community Observational Study.

作者信息

Isart Fernando A, Ramos Faustino G, Isart-Infante Fernando

机构信息

Kids 'N Teen Clinics, Houston, TX, USA.

The University of Texas Health Sciences Center at Houston, TX, USA.

出版信息

Glob Pediatr Health. 2019 Feb 6;6:2333794X19828311. doi: 10.1177/2333794X19828311. eCollection 2019.

Abstract

Our research had 2 aims, first, to determine if electrocardiographic early repolarization pattern anomalies (ERPAs) were more likely present among children and adolescents diagnosed with attention-deficit hyperactivity disorder (ADHD; n = 416) when compared with non-ADHD children (n = 187), and second, to asses if ADHD patients whose parents report severe ADHD psychometric scores were more likely to have ERPA in their surface ECG (electrocardiography) when compared with other ADHD patients with mild to moderate dysfunction or no dysfunction. In our unmatched case-control study, ERPA was recognized when there was an end QRS notch (J wave) or slur on the downslope of a prominent R wave with and without ST-segment elevation and the peak of the notch or J wave (Jp) ≥0.1 mV in ≥2 contiguous leads, excluding V1-V3 anterior lead, and QRS duration (measured in leads in which a notch or slur is absent) <120 ms or ST-segment elevation >0.1 mV in ≥2 contiguous leads, excluding V1-V3, and QRS duration <120 ms. The (, 4th edition) criteria were used to diagnose ADHD. Our data analysis suggested a significant association between ERPA presence and ADHD (n = 603, = .020). Our logistic regression model suggests that patients with ERPA (n = 167) were 2.778 times more likely to have a diagnosis of ADHD after controlling for age, gender, and ethnicity (95% confidence interval for odds ratio 1.087-7.100, = .033). Multiple regression models suggested that age, < .001; gender, < .001; ERPA, = .004; and ERPA leads number, = .022, were significant predictors of global parental ADHD worry scale. Hispanic and black ethnicity were not significant predictors. Consequently, the presence of ERPA should be reported in all ECGs done in children and adolescents for prospective behavioral phenotype and/or arrhythmia risk stratification analysis.

摘要

我们的研究有两个目的,其一,确定与未患注意力缺陷多动障碍(ADHD;n = 416)的儿童相比,被诊断为注意力缺陷多动障碍的儿童和青少年(n = 187)是否更有可能出现心电图早期复极模式异常(ERPAs);其二,评估父母报告ADHD心理测量分数严重的ADHD患者与其他轻度至中度功能障碍或无功能障碍的ADHD患者相比,是否更有可能在其体表心电图(心电图)中出现ERPA。在我们的非匹配病例对照研究中,当在≥2个连续导联(不包括V1 - V3前壁导联)中出现终末QRS切迹(J波)或明显R波下降支的顿挫,且切迹或J波(Jp)≥0.1 mV,同时QRS时限(在无切迹或顿挫的导联中测量)<120 ms,或者在≥2个连续导联(不包括V1 - V3)中ST段抬高>0.1 mV且QRS时限<120 ms时,即识别为ERPA。采用(《精神障碍诊断与统计手册》,第4版)标准诊断ADHD。我们的数据分析表明ERPA的存在与ADHD之间存在显著关联(n = 603,P = .020)。我们的逻辑回归模型表明,在控制年龄、性别和种族后,有ERPA的患者(n = 167)被诊断为ADHD的可能性是其他患者的2.778倍(优势比的95%置信区间为1.087 - 7.100,P = .033)。多元回归模型表明,年龄,P < .001;性别,P < .001;ERPA,P = .004;以及ERPA导联数量,P = .022,是全球父母ADHD担忧量表的显著预测因素。西班牙裔和黑人种族不是显著预测因素。因此,对于儿童和青少年进行的所有心电图检查,都应报告ERPA的存在情况,以便进行前瞻性行为表型和/或心律失常风险分层分析。

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