Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
BMJ Open. 2020 Nov 4;10(11):e033553. doi: 10.1136/bmjopen-2019-033553.
To examine the association between polarity of atrial premature complexes (APCs) and stroke.
A prospective study.
A total of 11 092 participants in the Jichi Medical School cohort study were included after excluding patients with atrial fibrillation. We analysed stroke events in patients with (n=136) and without (n=10 956) APCs. With regard to polarity of APCs, patients were subcategorised into having (1) negative (n=39) or non-negative (n=97) P waves in augmented vector right (aVR), and (2) positive (n=28) or non-positive (n=108) P waves in augmented vector left (aVL).
The primary endpoint was stroke.
Patients with APCs were significantly older than those without APCs (64.1±9.2 vs 55.1±11.6 years, p<0.001). The mean follow-up period was 11.8±2.4 years. Stroke events were observed in patients with (n=13 events) and without (n=411 events) APCs. This difference was significant (log-rank 12.9, p<0.001); however, APCs were not an independent predictor of stroke after adjusting for age, sex, height, body mass index, current drinking, diabetes, systolic blood pressure, prior myocardial infarction, prior stroke and high-density lipoprotein-cholesterol (p=0.15). The incidence of stroke in patients with APCs and non-negative P wave in aVR was significantly higher than in patients without APCs (log-rank 20.1, p<0.001), and non-negative P wave in aVR was revealed to be an independent predictor of stroke (HR 1.84, 95% CI 1.02 to 3.30). The incidence of stroke in patients with APC with non-positive P wave in aVL was also significantly higher than in patients without APC (log-rank 15.3, p<0.001), and non-positive P wave in aVL was an independent predictor of stroke (HR 1.92, 95% CI 1.05 to 3.54).
The presence of APCs with non-negative P wave in aVR or non-positive P wave in aVL on 12-lead ECG was associated with a higher risk of incident stroke.
探讨房性期前收缩（APCs）极性与中风的关系。
前瞻性研究。
在排除房颤患者后，共纳入 11092 名参加日本顺天堂医学院队列研究的患者。我们分析了有（n=136）和无 APCs（n=10956）的患者的中风事件。根据 APCs 的极性，患者分为（1）aVR 中具有（n=39）或不具有（n=97）负 P 波，以及（2）aVL 中具有（n=28）或不具有（n=108）正 P 波。
主要终点为中风。
有 APCs 的患者比无 APCs 的患者年龄更大（64.1±9.2 岁 vs 55.1±11.6 岁，p<0.001）。平均随访时间为 11.8±2.4 年。有 APCs 的患者（n=13 例）和无 APCs 的患者（n=411 例）均观察到中风事件。这一差异具有统计学意义（对数秩检验 12.9，p<0.001）；然而，在调整年龄、性别、身高、体重指数、当前饮酒、糖尿病、收缩压、既往心肌梗死、既往中风和高密度脂蛋白胆固醇后，APCs 不是中风的独立预测因素（p=0.15）。在 aVR 中具有非负 P 波的 APCs 患者的中风发生率明显高于无 APCs 的患者（对数秩检验 20.1，p<0.001），并且 aVR 中的非负 P 波被证明是中风的独立预测因素（HR 1.84，95%CI 1.02 至 3.30）。在 aVL 中具有非正 P 波的 APCs 患者的中风发生率也明显高于无 APCs 的患者（对数秩检验 15.3，p<0.001），并且 aVL 中的非正 P 波是中风的独立预测因素（HR 1.92，95%CI 1.05 至 3.54）。
12 导联心电图上 aVR 中具有非负 P 波或 aVL 中具有非正 P 波的 APCs 存在与中风的发生风险增加相关。
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