Xiang Kang Rui, Soliman Elsayed Z, Bhave Prashant D, Singleton Matthew J
Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, United States of America; Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
J Electrocardiol. 2021 Jan-Feb;64:18-22. doi: 10.1016/j.jelectrocard.2020.11.011. Epub 2020 Nov 27.
The ability of the Goldberger electrocardiographic (ECG) triad criteria to detect left ventricular dysfunction (LVD) is well-established. However, the prognostic significance of this triad as a predictor of poor outcomes is not known.
We explored the association between the Goldberger ECG-LVD triad with all-cause mortality and cardiovascular mortality in the general population.
This analysis included 8426 participants (60.5 ± 13.6 years, 51.5% women, 50% non-Hispanic white) from the Third National Health and Nutrition Examination Survey. The Goldberger ECG-LVD triad was defined as follows: high precordial QRS voltage (SV1 or SV2 + RV5 or RV6 ≥ 3500 μV); low limb lead QRS voltage (mean QRS amplitude in each of the limb leads ≤800 μV); and poor R wave progression (RV4/SV4 < 1). Mortality was ascertained using the National Death Index.
At baseline, 1384 (47.3%) of the participants had at least one of the criteria of Goldberger triad (1193 had only one and 191 participants had 2 or more). During a median follow up of 13.8 years, 3184 deaths occurred, of which 1405 were cardiovascular. In multivariable-adjusted Cox proportional hazards models, presence of at least one of the Goldberger triad criteria (vs. none) was associated with increased risk of all-cause (HR 1.17, 95% CI 1.08-1.26, p ≤0.0001) and cardiovascular mortality (1.19, 1.06-1.33, p = 0.003).
The Goldberger ECG-LVD triad for left ventricular dysfunction may offer prognostic value in addition to its reported diagnostic utility.
戈德伯格心电图三联征标准检测左心室功能障碍（LVD）的能力已得到充分证实。然而，作为不良预后预测指标的该三联征的预后意义尚不清楚。
我们探讨了一般人群中戈德伯格心电图-LVD三联征与全因死亡率和心血管死亡率之间的关联。
该分析纳入了来自第三次全国健康与营养检查调查的8426名参与者（年龄60.5±13.6岁，51.5%为女性，50%为非西班牙裔白人）。戈德伯格心电图-LVD三联征定义如下：胸前导联QRS波高电压（SV1或SV2 + RV5或RV6≥3500μV）；肢体导联QRS波低电压（每个肢体导联的平均QRS波振幅≤800μV）；以及R波递增不良（RV4/SV4 < 1）。使用国家死亡指数确定死亡率。
在基线时，1384名（47.3%）参与者至少符合戈德伯格三联征的一项标准（1193名仅符合一项，191名参与者符合两项或更多）。在中位随访13.8年期间，发生了3184例死亡，其中1405例为心血管死亡。在多变量调整的Cox比例风险模型中，至少符合一项戈德伯格三联征标准（与无标准相比）与全因死亡风险增加相关（风险比[HR] 1.17，95%置信区间[CI] 1.08 - 1.26，p≤0.0001）和心血管死亡率相关（1.19，1.06 - 1.33，p = 0.003）。
用于左心室功能障碍的戈德伯格心电图-LVD三联征除了其已报道的诊断效用外，可能还具有预后价值。
