Section of General Internal Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.
School of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas.
Am J Cardiol. 2022 Oct 1;180:17-23. doi: 10.1016/j.amjcard.2022.06.043. Epub 2022 Jul 29.
Identifying ischemic etiology of cardiomyopathy carries prognostic and therapeutic significance. Clinical and electrocardiographic parameters can predict ischemic cardiomyopathy. Positive T wave polarity in lead aVR (TPaVR) has been associated with adverse cardiac events and severity of coronary artery disease. Medical records of adults evaluated in an advanced heart failure referral clinic for cardiomyopathy with systolic dysfunction (ejection fraction ≤ 40%) were retrospectively reviewed. Patients with ventricular pacing were excluded. Significant predictors of ischemic cardiomyopathy from a univariate logistic regression model were entered simultaneously into a multivariate logistic regression model. A total of 180 patients met study inclusion criteria. Mean age of the population was 52.5 ± 15.3 years old and 65% were men. Ischemic cardiomyopathy was present in 52 patients (29%). Positive TPaVR was present in 57 patients (32%). Ischemic cardiomyopathy was more common in patients with positive TPaVR (63% vs 13%, p < 0.001). Ischemic cardiomyopathy was independently predicted by male gender, diabetes, hyperlipidemia, absence of family history of cardiomyopathy, echocardiographic regional wall motion abnormality, and positive TPaVR. The strongest association was with positive TPaVR (odds ratio 30.5, 95% confidence interval 6.47 to 214; p < 0.001). T wave amplitude of +0.025 mV in lead aVR was the optimal cutoff to distinguish ischemic and nonischemic cardiomyopathy in receiver operating characteristic analysis (sensitivity 69.2%, specificity 83.6%, area under curve = 0.747, 95% confidence interval 0.658 to 0.836). In conclusion, positive TPaVR was a strong predictor of ischemic etiology of cardiomyopathy.
确定心肌病的缺血性病因具有预后和治疗意义。临床和心电图参数可以预测缺血性心肌病。aVR 导联 T 波正向（TPaVR）已与不良心脏事件和冠状动脉疾病的严重程度相关。回顾性分析了在高级心力衰竭转诊诊所因收缩功能障碍（射血分数≤40%）接受心肌病评估的成年人的病历。排除了心室起搏的患者。单变量逻辑回归模型中的缺血性心肌病的显著预测因素同时被纳入多变量逻辑回归模型。共有 180 名患者符合研究纳入标准。人群的平均年龄为 52.5±15.3 岁，65%为男性。52 名患者（29%）存在缺血性心肌病。57 名患者（32%）存在 TPaVR 阳性。TPaVR 阳性患者中缺血性心肌病更为常见（63% vs. 13%，p < 0.001）。缺血性心肌病独立预测因素为男性、糖尿病、血脂异常、无心肌病家族史、超声心动图区域性壁运动异常和 TPaVR 阳性。与 TPaVR 阳性的相关性最强（优势比 30.5，95%置信区间 6.47 至 214；p < 0.001）。在接受者操作特征分析中，aVR 导联 T 波振幅为+0.025 mV 是区分缺血性和非缺血性心肌病的最佳截断值（灵敏度 69.2%，特异性 83.6%，曲线下面积为 0.747，95%置信区间为 0.658 至 0.836）。总之，TPaVR 是缺血性心肌病的一个强有力的预测因子。
