Zong Yanan, Maanja Maren, Chaireti Roza, Schlegel Todd T, Ugander Martin, Antovic Jovan P
Coagulation & Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Physiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
J Electrocardiol. 2020 Jan-Feb;58:171-175. doi: 10.1016/j.jelectrocard.2019.12.008. Epub 2019 Dec 12.
Patients with hemophilia A (PWHA) have reportedly lower mortality due to cardiovascular disease (CVD) compared to the general population.
To evaluate signs of CVD in asymptomatic PWHA using advanced electrocardiography (A-ECG).
PWHA (n = 29, median [interquartile range] age 57 [47-70] years) and age-matched male controls (n = 29, 59 [48-68] years) were evaluated. Digital resting 12‑lead ECGs were retrospectively analysed using both conventional and A-ECG techniques including derived vectorcardiography and waveform complexity. Previously validated multivariate A-ECG scores designed to detect: 1) cardiac disease in general, 2) left ventricular systolic dysfunction (LVSD), 3) coronary artery disease or coronary microvascular disease (CAD/CMVD), or 4) left ventricular hypertrophy defined as left ventricular electrical remodelling (LVH/LVER), were quantified and compared between PWHA and controls.
Compared to controls, PWHA had a higher probability of having cardiac disease (median [interquartile range] 84.6 [32.5-99.5] vs. 0.6 [0.2-8.2]%), LVSD (4.1 [1.3-12.9] vs. 0.9 [0.5-3.2]%), CAD/CMVD (84.3 [35.6-96.6] vs. 6.7 [0.8-24.4]%), and LVH/LVER (17 [5/29] vs. 0 [0/29]%). Compared to patients with non-severe HA (n = 20), patients with severe HA (n = 9) showed a non-significant trend towards lower probability of cardiac disease, CAD/CMVD, LVSD and LVH/LVER.
In PWHA, A-ECG exhibits changes more indicative of overt or subclinical CVD compared to controls, and there is a tendency for lower scores for CVD in patients with severe compared to non-severe HA. These results suggest that PWHA ≥ 40 years could be at higher risk for CVD than age-matched controls and that A-ECG could potentially be used for early detection.
据报道，与普通人群相比，甲型血友病患者（PWHA）因心血管疾病（CVD）导致的死亡率较低。
使用高级心电图（A-ECG）评估无症状PWHA的CVD体征。
对PWHA（n = 29，年龄中位数[四分位间距]57[47 - 70]岁）和年龄匹配的男性对照者（n = 29，59[48 - 68]岁）进行评估。使用包括衍生向量心电图和波形复杂性分析的传统及A-ECG技术，对数字化静息12导联心电图进行回顾性分析。对先前验证的多变量A-ECG评分进行量化，这些评分旨在检测：1）一般心脏病，2）左心室收缩功能障碍（LVSD），3）冠状动脉疾病或冠状动脉微血管疾病（CAD/CMVD），或4）定义为左心室电重构（LVH/LVER）的左心室肥厚，并在PWHA和对照者之间进行比较。
与对照者相比，PWHA患心脏病的概率更高（中位数[四分位间距]84.6[32.5 - 99.5]%对0.6[0.2 - 8.2]%）、LVSD（4.1[1.3 - 12.9]%对0.9[0.5 - 3.2]%）、CAD/CMVD（84.3[35.6 - 96.6]%对6.7[0.8 - 24.4]%）以及LVH/LVER（17[5/29]对0[0/29]）。与非重度HA患者（n = 20）相比，重度HA患者（n = 9）在患心脏病、CAD/CMVD、LVSD和LVH/LVER方面的概率有降低趋势，但差异无统计学意义。
与对照者相比，在PWHA中，A-ECG表现出更多提示显性或亚临床CVD的变化，且与非重度HA患者相比，重度HA患者的CVD评分有降低趋势。这些结果表明，≥40岁的PWHA患CVD的风险可能高于年龄匹配的对照者，且A-ECG可能潜在地用于早期检测。
