Kowal Jamie, Ahmad Muhammad Imtiaz, Li Yabing, Soliman Elsayed Z
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
J Electrocardiol. 2019 May-Jun;54:49-53. doi: 10.1016/j.jelectrocard.2019.03.008. Epub 2019 Mar 13.
Echocardiographically detected right ventricular hypertrophy (RVH) is associated with cardiovascular disease (CVD) and mortality. However, the prognostic significance of electrocardiographic (ECG)RVH criteria as predictors of poor outcomes in the general population is unclear.
This study included 7857 participants (59.8 ± 13.4 years, 52.6% women) from the Third National Health and Nutrition Examination Survey. Sixteen different ECG-RVH criteria were created from digitally recorded and centrally processed electrocardiograms. All-cause mortality was ascertained using the National Death Index. Cox proportional hazards analysis was used to examine the association between baseline ECG-RVH criteria and all-cause mortality.
The prevalence of RVH varied widely among the criteria. The lowest ECG-RVH prevalence was 0.09% (using S > R in I, II, III) while the highest prevalence was 20.7% (using (R I + S III) - (S I + R III) < 15 mm). During a median follow-up of 14 years, 2812 deaths occurred. The mortality rate was highest among participants with ECG-RVH defined as R:S ratio V < 0.75. In multivariable adjusted models, 9 out of the 16 ECG-RVH criteria were significantly associated with all-cause mortality. When ECG-RVH was defined as the presence of any ECG-RVH criteria, each additional ECG-RVH criteria was associated with 6% increased risk of all-cause mortality (HR (95% CI):1.06(1.03,1.10)).
There is a wide variation in the prevalence of ECG-RVH when different criteria are applied in the general population. However, the presence of ECG-RVH by most criteria regardless of prevalence was associated with poor prognosis suggesting that appropriate choice of criteria may enhance the utilization of these ECG markers in risk stratification.
超声心动图检测到的右心室肥厚（RVH）与心血管疾病（CVD）及死亡率相关。然而，在普通人群中，心电图（ECG）RVH标准作为不良预后预测指标的预后意义尚不清楚。
本研究纳入了来自第三次全国健康与营养检查调查的7857名参与者（年龄59.8±13.4岁，女性占52.6%）。通过数字记录并集中处理的心电图创建了16种不同的ECG-RVH标准。使用国家死亡指数确定全因死亡率。采用Cox比例风险分析来检验基线ECG-RVH标准与全因死亡率之间的关联。
不同标准下RVH的患病率差异很大。ECG-RVH患病率最低为0.09%（采用I、II、III导联中S＞R），而最高患病率为20.7%（采用（RI+SIII）-（SI+RIII）＜15mm）。在中位随访14年期间，发生了2812例死亡。在定义为V导联R:S比值＜0.75的ECG-RVH参与者中，死亡率最高。在多变量调整模型中，1666种ECG-RVH标准中有9种与全因死亡率显著相关。当将ECG-RVH定义为存在任何一种ECG-RVH标准时，每增加一种ECG-RVH标准，全因死亡风险增加6%（风险比（95%置信区间）：1.06（1.03，1.10））。
在普通人群中应用不同标准时，ECG-RVH的患病率差异很大。然而，无论患病率如何，大多数标准下ECG-RVH的存在都与不良预后相关，这表明适当选择标准可能会提高这些ECG标记物在风险分层中的应用。
