Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland
Department of Internal Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
BMJ Open. 2022 Feb 28;12(2):e053477. doi: 10.1136/bmjopen-2021-053477.
ECG left ventricular hypertrophy (ECG-LVH) has been associated with left ventricular dysfunction and adverse prognosis, but little is known about the prevalence and prognostic significance of different levels of QRS duration in the presence of ECG-LVH in a general population.
Population-based observational prospective cohort study.
Nationally representative random cluster of Finnish adult population.
We assessed the prevalence and long-term (median 15.9 years) prognostic significance of QRS duration in ECG-LVH, and compared the risk to individuals without ECG-LVH in a predominantly middle-aged random sample of 6033 Finnish subjects aged over 30 years (mean age 52.2, SD 14.6 years), who participated in a health examination including a 12-lead ECG.
Cardiovascular and all-cause mortality, incidence of heart failure (HF).
ECG-LVH was present in 1337 (22.2%) subjects; 403 of these (30.1%) had QRS duration ≥100 ms and 100 (7.5%) had ≥110 ms. The increased risk of mortality in ECG-LVH became evident after a QRS threshold of ≥100 ms. After controlling for known clinical risk factors, QRS 100-109 ms was associated with increased cardiovascular (HR 1.38, 95% CI 1.01 to 1.88, p=0.045) and QRS≥110 ms with cardiovascular (1.74, 95% CI 1.07 to 2.82, p=0.025) and all-cause mortality (1.52, 95% CI 1.02 to 2.25, p=0.039) in ECG-LVH. The risk of new-onset HF was two-fold in subjects with QRS 100-109 ms and threefold in subjects with QRS ≥110 ms, even after adjustment for incident myocardial infarction within the follow-up. When the prognosis was compared with subjects without ECG-LVH, subjects with ECG-LVH but QRS duration <100 ms displayed similar mortality rates with or without ECG-LVH but higher rates of incident HF.
In ECG-LVH, the risk of excess mortality and new-onset HF markedly increases with longer QRS duration, but even QRS duration within normal limits in ECG-LVH carried a risk of HF compared with the risk in individuals without ECG-LVH.
心电图左心室肥厚（ECG-LVH）与左心室功能障碍和不良预后相关，但在一般人群中，ECG-LVH 存在时不同 QRS 时限水平的患病率和预测意义知之甚少。
基于人群的观察性前瞻性队列研究。
芬兰成年人群的全国代表性随机聚类。
我们评估了心电图左心室肥厚中 QRS 时限的患病率和长期（中位数 15.9 年）预后意义，并在一个由 6033 名年龄超过 30 岁（平均年龄 52.2，SD 14.6 岁）的芬兰受试者的随机样本中，比较了 QRS 时限在心电图左心室肥厚中的风险，这些受试者均参加了健康检查，包括 12 导联心电图。
心血管和全因死亡率、心力衰竭（HF）发生率。
心电图左心室肥厚存在于 1337 名（22.2%）受试者中；其中 403 名（30.1%）的 QRS 时限≥100 ms，100 名（7.5%）的 QRS 时限≥110 ms。在 QRS 阈值≥100 ms 后，心电图左心室肥厚的死亡风险增加变得明显。在控制了已知的临床危险因素后，QRS 100-109 ms 与心血管疾病（HR 1.38，95%CI 1.01 至 1.88，p=0.045）相关，QRS≥110 ms 与心血管疾病（1.74，95%CI 1.07 至 2.82，p=0.025）和全因死亡率（1.52，95%CI 1.02 至 2.25，p=0.039）相关。在心电图左心室肥厚患者中，QRS 100-109 ms 患者的新发 HF 风险增加了一倍，QRS≥110 ms 患者的风险增加了两倍，即使在随访期间发生心肌梗死的情况下也进行了调整。与无心电图左心室肥厚的患者相比，当预后比较时，QRS 时限＜100 ms 的心电图左心室肥厚患者的死亡率与有或无心电图左心室肥厚患者相似，但新发 HF 的发生率更高。
在心电图左心室肥厚中，QRS 时限延长与死亡率和新发 HF 风险显著增加相关，但即使心电图左心室肥厚的 QRS 时限在正常范围内，与无心电图左心室肥厚的患者相比，HF 的风险也会增加。
