Matsushima Shouji, Kaku Hidetaka, Enzan Nobuyuki, Ide Tomomi, Higo Taiki, Tsuchihashi-Makaya Miyuki, Tsutsui Hiroyuki
Department of Cardiovascular Medicine, Kyushu University Hospital Fukuoka Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University Fukuoka Japan.
Circ Rep. 2019 May 30;1(6):248-254. doi: 10.1253/circrep.CR-19-0025.
Electrocardiogram (ECG) findings of left ventricular hypertrophy (LVH; ECG-LVH) are observed in patients with dilated cardiomyopathy (DCM), but the prognostic importance is unclear. The present study assessed the impact of QRS voltage on long-term outcomes, including mortality and rehospitalization, in patients with DCM using a database of patients hospitalized for worsening heart failure (HF). We analyzed a total of 261 patients with DCM in the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD), a prospective cohort studying the characteristics and treatments in a broad sample of HF patients. ECG-LVH were diagnosed according to the Sokolow-Lyon voltage criteria. A total of 81 patients (31.0%) had ECG-LVH. During a mean follow-up period of 1.8 years, patients with ECG-LVH had a lower rate of all-cause death (9.0% vs. 20.3%, P=0.029) and composite of all-cause death and rehospitalization due to worsening HF (26.9% vs. 45.9%, P=0.007) than those without it. After multivariable adjustment, ECG-LVH was an independent negative predictor for the risk of composite all-cause death and rehospitalization (hazard ratio, 0.358; 95% CI: 0.157-0.857, P=0.049). ECG-LVH were independently associated with better long-term outcome in patients with DCM.
在扩张型心肌病（DCM）患者中可观察到左心室肥厚（LVH；心电图LVH）的心电图表现，但这种表现对预后的重要性尚不清楚。本研究利用因心力衰竭（HF）加重而住院的患者数据库，评估了QRS波电压对DCM患者长期预后（包括死亡率和再次住院率）的影响。我们分析了日本心脏病学会心力衰竭注册研究（JCARE-CARD）中总共261例DCM患者，这是一项前瞻性队列研究，旨在研究广泛样本的HF患者的特征和治疗情况。根据Sokolow-Lyon电压标准诊断心电图LVH。共有81例患者（31.0%）存在心电图LVH。在平均1.8年的随访期内，与无心电图LVH的患者相比，有心电图LVH的患者全因死亡率较低（9.0%对20.3%，P=0.029），因HF加重导致的全因死亡和再次住院的复合发生率也较低（26.9%对45.9%，P=0.007）。经过多变量调整后，心电图LVH是全因死亡和再次住院复合风险的独立阴性预测因素（风险比，0.358；95%置信区间：0.157 - 0.857，P=0.049）。心电图LVH与DCM患者更好的长期预后独立相关。
