Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Heart Center, Turku University Hospital, Turku, Finland.
Europace. 2023 Feb 8;25(1):164-174. doi: 10.1093/europace/euac121.
To evaluate the prognostic significance of novel P-wave morphology descriptors in general population.
Novel P-wave morphology variables were analyzed from orthogonal X-, Y-, Z-leads of the digitized electrocardiogram using a custom-made software in 6906 middle-aged subjects of the Mini-Finland Health Survey. A total of 3747 (54.3%) participants died during the follow-up period of 24.3 ± 10.4 years; 379 (5.5%) of the study population succumbed to sudden cardiac death (SCD), 928 (13.4%) to non-SCD (NSCD) and 2440 (35.3%) patients to non-cardiac death (NCD). In univariate comparisons, most of the studied P-wave morphology parameters had a significant association with all modes of death (P from <0.05 to <0.001). After relevant adjustments in the Cox multivariate hazards model, P-wave morphology dispersion (PMD) still tended to predict SCD [hazard ratio (HR): 1.006, 95% confidence interval (CI): 1.000-1.012, P = 0.05) but not NSCD (HR: 0.999, 95% CI: 0.995-1.003, P = 0.68) or NCD (HR: 0.999, 95% CI: 0.997-1.001, P = 0.44). The P-wave maximum amplitude in the lead Z (P-MaxAmp-Z) predicted SCD even after multivariate adjustments (HR: 1.010, 95% CI: 1.005-1.015, P = 0.0002) but also NSCD (HR: 1.005, 95% CI: 1.002-1.009, P = 0.0005) and NCD (HR: 1.002, 95% CI: 1.000-1.005, P = 0.03).
Abnormalities of P-wave morphology are associated with the risk of all modes of death in general population. After relevant adjustments, PMD was still closely associated with the risk of SCD but not with NSCD or NCD. P-MaxAmp-Z predicted SCD even after adjustments, however, it also retained its association with NSCD and NCD.
评估新型 P 波形态指标在普通人群中的预后意义。
使用定制软件对来自数字化心电图的正交 X、Y、Z 导联的新型 P 波形态变量进行分析，共纳入 Mini-Finland 健康调查中的 6906 名中年受试者。在 24.3±10.4 年的随访期间，共有 3747 名（54.3%）参与者死亡；379 名（5.5%）死于心源性猝死（SCD），928 名（13.4%）死于非心源性猝死（NSCD），2440 名（35.3%）死于非心脏性死亡（NCD）。在单变量比较中，大多数研究的 P 波形态参数与所有死亡模式均有显著相关性（P 值从<0.05 到<0.001）。在 Cox 多变量风险模型中进行相关调整后，P 波形态离散度（PMD）仍倾向于预测 SCD[风险比（HR）：1.006，95%置信区间（CI）：1.000-1.012，P=0.05]，但不能预测 NSCD（HR：0.999，95%CI：0.995-1.003，P=0.68）或 NCD（HR：0.999，95%CI：0.997-1.001，P=0.44）。Z 导联中 P 波最大幅度（P-MaxAmp-Z）即使在多变量调整后也能预测 SCD（HR：1.010，95%CI：1.005-1.015，P=0.0002），也能预测 NSCD（HR：1.005，95%CI：1.002-1.009，P=0.0005）和 NCD（HR：1.002，95%CI：1.000-1.005，P=0.03）。
P 波形态异常与普通人群所有死亡模式的风险相关。在相关调整后，PMD 仍与 SCD 风险密切相关，但与 NSCD 或 NCD 无关。P-MaxAmp-Z 即使在调整后也能预测 SCD，但它也与 NSCD 和 NCD 相关。
