Martínez-Sellés Manuel, Martínez-Larrú M Esther, Ibarrola Martin, Santos Alba, Díez-Villanueva Pablo, Bayés-Genis Antoni, Baranchuk Adrian, Bayés-de-Luna Antonio, Elosua Roberto
Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain; CIBERCV, Madrid, Spain.
Departamento de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Int J Cardiol. 2020 Dec 15;321:95-98. doi: 10.1016/j.ijcard.2020.08.006. Epub 2020 Aug 15.
An association between interatrial block (IAB) (P wave duration ≥120 ms) and dementia has been suggested. Our objective was to assess the association of IAB with cognitive impairment (CI).
The prospective BAYES registry included 552 patients ≥70 years with structural heart disease without documented atrial fibrillation. Cognitive ability was assessed at baseline and every 6 months with the Pfeiffer test. The median follow-up was 22 months.
Thirty patients (5.4%) had baseline CI, 20 patients with mild CI and 10 with moderate CI. Compared to patients without CI, patients with CI had higher mean age (80.4 ± 6.5 vs. 76.8 ± 5.4 years) and higher prevalence of advanced IAB (with biphasic P-wave ± in inferior leads) (14 [46.7%] vs. 122 [23.4%], p < .01). The prevalence of baseline CI was 2.7% in normal P-wave, 5.1% in partial IAB, and 10.3% in advanced IAB, p < .001. Advanced IAB was independently associated with baseline CI (odds ratio 4.9, 95% confidence interval 1.4-16.5), this was not the case with partial IAB (odds ratio 2.1, 95% confidence interval 0.5-7.4). The independent association with CI at follow-up existed both for partial IAB (hazard ratio 1.98, 95% confidence interval 1.18-3.33) and advanced IAB (hazard ratio 2.04, 95% confidence interval 1.19-3.51).
In patients aged 70 years or more with structural heart disease who are in sinus rhythm advanced IAB is associated with baseline CI. There is also an association of partial and advanced IAB with CI during follow-up.
已有研究表明心房传导阻滞（IAB）（P波时限≥120毫秒）与痴呆之间存在关联。我们的目的是评估IAB与认知障碍（CI）之间的关联。
前瞻性BAYES注册研究纳入了552例年龄≥70岁、患有结构性心脏病且无房颤记录的患者。在基线时以及每6个月使用 Pfeiffer 测试评估认知能力。中位随访时间为22个月。
30例患者（5.4%）有基线CI，其中20例为轻度CI，10例为中度CI。与无CI的患者相比，有CI的患者平均年龄更高（80.4±6.5岁 vs. 76.8±5.4岁），晚期IAB（下壁导联P波呈双相±）的患病率更高（14例[46.7%] vs. 122例[23.4%]，p<0.01）。正常P波时基线CI的患病率为2.7%，部分IAB时为5.1%，晚期IAB时为10.3%，p<0.001。晚期IAB与基线CI独立相关（比值比4.9，95%置信区间1.4 - 16.5），部分IAB则不然（比值比2.1，95%置信区间0.5 - 7.4）。部分IAB（风险比1.98，95%置信区间1.18 - 3.33）和晚期IAB（风险比2.04，95%置信区间1.19 - 3.51）在随访时均与CI独立相关。
在年龄≥70岁、患有结构性心脏病且为窦性心律的患者中，晚期IAB与基线CI相关。部分IAB和晚期IAB在随访期间也与CI相关。
