Knight Cardiovascular Institute Oregon Health and Science University Portland OR.
Division of Cardiology Department of Medicine Johns Hopkins School of Medicine Baltimore MD.
J Am Heart Assoc. 2020 Feb 4;9(3):e015012. doi: 10.1161/JAHA.119.015012. Epub 2020 Jan 30.
Background Race is an established risk factor for sudden cardiac death (SCD). We sought to determine whether the association of electrophysiological substrate with SCD varies between black and white individuals. Methods and Results Participants from the ARIC (Atherosclerosis Risk in Communities) study with analyzable ECGs (n=14 408; age, 54±6 years; 74% white) were included. Electrophysiological substrate was characterized by ECG metrics. Two competing outcomes were adjudicated: SCD and non-SCD. Interaction of ECG metrics with race was studied in Cox proportional hazards and Fine-Gray competing risk models, adjusted for prevalent cardiovascular disease, risk factors, and incident nonfatal cardiovascular disease. At the baseline visit, adjusted for age, sex, and study center, blacks had larger spatial ventricular gradient magnitude (0.30 mV; 95% CI, 0.25-0.34 mV), sum absolute QRST integral (18.4 mVms; 95% CI, 13.7-23.0 mVms), and Cornell voltage (0.30 mV; 95% CI, 0.25-0.35 mV) than whites. Over a median follow-up of 24.4 years, SCD incidence was higher in blacks (2.86 per 1000 person-years; 95% CI, 2.50-3.28 per 1000 person-years) than whites (1.37 per 1000 person-years; 95% CI, 1.22-1.53 per 1000 person-years). Blacks with hypertension had the highest rate of SCD: 4.26 (95% CI, 3.66-4.96) per 1000 person-years. Race did not modify an association of ECG variables with SCD, except QRS-T angle. Spatial QRS-T angle was associated with SCD in whites (hazard ratio, 1.38; 95% CI, 1.25-1.53) and hypertension-free blacks (hazard ratio, 1.52; 95% CI, 1.09-2.12), but not in blacks with hypertension (hazard ratio, 1.15; 95% CI, 0.99-1.32) (-interaction=0.004). Conclusions Race did not modify associations of electrophysiological substrate with SCD and non-SCD. Electrophysiological substrate does not explain racial disparities in SCD rate.
种族是心脏性猝死（SCD）的既定风险因素。我们旨在确定电生理基质与 SCD 的相关性在黑人和白人之间是否存在差异。
本研究纳入了 ARIC（社区动脉粥样硬化风险）研究中可分析心电图（n=14408；年龄 54±6 岁；74%为白人）的参与者。通过心电图指标来描述电生理基质。两种竞争性结局进行了裁决：SCD 和非 SCD。在 Cox 比例风险和 Fine-Gray 竞争风险模型中研究了心电图指标与种族的交互作用，调整了已患心血管疾病、风险因素和新发非致命性心血管疾病。在基线检查时，根据年龄、性别和研究中心进行调整，与白人相比，黑人的空间心室梯度幅度更大（0.30 mV；95%CI，0.25-0.34 mV）、总和绝对 QRST 积分（18.4 mVms；95%CI，13.7-23.0 mVms）和康奈尔电压（0.30 mV；95%CI，0.25-0.35 mV）。在中位数为 24.4 年的随访中，黑人的 SCD 发生率（2.86/1000 人年；95%CI，2.50-3.28/1000 人年）高于白人（1.37/1000 人年；95%CI，1.22-1.53/1000 人年）。黑人高血压患者的 SCD 发生率最高：4.26（95%CI，3.66-4.96）/1000 人年。种族并未改变心电图变量与 SCD 的关联，除了 QRS-T 角。空间 QRS-T 角与白人（危险比，1.38；95%CI，1.25-1.53）和无高血压黑人（危险比，1.52；95%CI，1.09-2.12）的 SCD 相关，但与黑人高血压患者（危险比，1.15；95%CI，0.99-1.32）无关（-交互作用=0.004）。
种族并未改变电生理基质与 SCD 和非 SCD 的相关性。电生理基质并不能解释 SCD 发生率的种族差异。
