Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.
Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland.
Ann Noninvasive Electrocardiol. 2021 Jan;26(1):e12788. doi: 10.1111/anec.12788. Epub 2020 Aug 17.
Previous population studies have presented conflicting results regarding the prognostic impact of intraventricular conduction delays (IVCD).
We studied long-term prognostic impact and the association with comorbidities of eight IVCDs in a random sample of 6,299 Finnish subjects (2,857 men and 3,442 women, mean age 52.8, SD 14.9 years) aged 30 or over who participated in the health examination including 12-lead ECG. For left bundle branch block (LBBB) and non-specific IVCD (NSIVCD), two different definitions were used.
During 16.5 years' follow-up, 1,309 of the 6,299 subjects (20.8%) died and of these 655 (10.4%) were cardiovascular (CV) deaths. After controlling for known clinical risk factors, the hazard ratio for CV death, compared with individuals without IVCD, was 1.55 for the Minnesota definition of LBBB (95% confidence interval 1.04-2.31, p = .032) and 1.27 (95% confidence interval 0.80-2.02, p = .308) for the Strauss' definition of LBBB. Subjects with NSIVCD were associated with twofold to threefold increase in CV mortality depending on the definition. While right bundle branch block, left anterior fascicular block and incomplete bundle branch blocks were associated with seemingly higher mortality, this was no longer the case after adjustment for age and sex. The presence of R-R' pattern was not associated with any adverse outcome.
In a population study with long-term follow-up, NSIVCD and Minnesota definition of LBBB were independently associated with CV mortality. Other IVCDs had no significant impact on prognosis. The prognostic impact of LBBB and NSIVCD was affected by the definition of the conduction disorder.
先前的人群研究对于室内传导延迟（IVCD）的预后影响提出了相互矛盾的结果。
我们研究了在一个由 6299 名芬兰受试者（2857 名男性和 3442 名女性，平均年龄 52.8 岁，标准差 14.9 岁）组成的随机样本中，八种 IVCD 的长期预后影响及其与合并症的关系。这些受试者年龄在 30 岁以上，参加了包括 12 导联心电图在内的健康检查。对于左束支传导阻滞（LBBB）和非特异性 IVCD（NSIVCD），使用了两种不同的定义。
在 16.5 年的随访期间，6299 名受试者中有 1309 人（20.8%）死亡，其中 655 人（10.4%）为心血管（CV）死亡。在校正了已知的临床危险因素后，与无 IVCD 的个体相比，Minnesota 定义的 LBBB 的 CV 死亡风险比为 1.55（95%置信区间 1.04-2.31，p=0.032），而 Strauss 定义的 LBBB 的风险比为 1.27（95%置信区间 0.80-2.02，p=0.308）。根据定义，NSIVCD 与 CV 死亡率增加两倍至三倍相关。虽然右束支传导阻滞、左前束支传导阻滞和不完全束支传导阻滞与看似更高的死亡率相关，但在校正年龄和性别后，这种情况不再成立。R-R' 模式的存在与任何不良结果无关。
在一项具有长期随访的人群研究中，NSIVCD 和 Minnesota 定义的 LBBB 与 CV 死亡率独立相关。其他 IVCD 对预后没有显著影响。LBBB 和 NSIVCD 的预后影响受到传导障碍定义的影响。
