Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Am J Cardiol. 2019 Sep 15;124(6):886-891. doi: 10.1016/j.amjcard.2019.06.003. Epub 2019 Jun 25.
Left ventricular hypertrophy (LVH) and left atrial abnormality (LAA) are common correlated complications of hypertension. It is unclear how common for electrocardiographic markers of LAA (ECG-LAA) to coexist with ECG-LVH and how their coexistence impacts their prognostic significance. This analysis included 4,077 participants (61.2 ± 13.0 years, 51.2% women, 48.6% whites) with hypertension from the Third National Health and Nutrition Examination Survey. ECG-LVH was defined by Cornell voltage criteria. ECG-LAA was defined as deep terminal negativity of P wave in V1 >100 µV. Cox proportional hazard analysis was used to examine the associations between various combinations of ECG-LAA and ECG-LVH with all-cause mortality over a median follow-up of 14 years. The baseline prevalence of ECG-LVH, ECG-LAA, and the concomitant presence of both was 3.6%, 2.7%, and 0.34%, respectively. In a multivariable-adjusted model, mortality risk was highest in the group with concomitant ECG-LAA and ECG-LVH (hazard ratio [HR; 95% confidence interval {CI}] 2.69 [1.51, 4.80]), followed by isolated ECG-LAA (HR [95% CI] 1.63 [1.26, 2.12]), and then isolated ECG-LVH (HR [95% CI] 1.40 [1.08, 1.81]), compared with the group without ECG-LAA or ECG-LVH. Effect modification of these results by age and diabetes but not by gender or race was observed. In models with similar adjustment where ECG-LVH and ECG-LAA were entered as 2 separate variables and subsequently additionally adjusted for each other, the mortality risk was essentially unchanged for both variables. In conclusion, in participants with hypertension, ECG-LAA and ECG-LVH are independent markers of poor outcomes, and their concomitant presence carries a higher risk than either marker alone.
左心室肥厚（LVH）和左心房异常（LAA）是高血压常见的相关并发症。尚不清楚心电图 LAA 标志物（ECG-LAA）与 ECG-LVH 共存的频率，以及它们的共存对预后意义的影响。本分析纳入了来自第三次全国健康和营养调查的 4077 名高血压患者（61.2±13.0 岁，51.2%为女性，48.6%为白人）。ECG-LVH 通过 Cornell 电压标准定义。ECG-LAA 定义为 V1 中 P 波终末深负性＞100µV。使用 Cox 比例风险分析来检查 ECG-LAA 和 ECG-LVH 与各种组合与全因死亡率之间的相关性，中位随访时间为 14 年。ECG-LVH、ECG-LAA 以及同时存在这两者的基线患病率分别为 3.6%、2.7%和 0.34%。在多变量调整模型中，同时存在 ECG-LAA 和 ECG-LVH 的组死亡率最高（风险比[HR；95%置信区间{CI}]2.69[1.51，4.80]），其次是孤立的 ECG-LAA 组（HR[95%CI]1.63[1.26，2.12]），然后是孤立的 ECG-LVH 组（HR[95%CI]1.40[1.08，1.81]），与无 ECG-LAA 或 ECG-LVH 的组相比。观察到这些结果在年龄和糖尿病方面存在效应修饰，但在性别或种族方面没有。在具有类似调整的模型中，将 ECG-LVH 和 ECG-LAA 作为 2 个独立变量输入，随后相互进一步调整，这两个变量的死亡率风险基本不变。总之，在高血压患者中，ECG-LAA 和 ECG-LVH 是预后不良的独立标志物，它们的共存比任何单一标志物的存在风险更高。
