Ostrowska Bozena, Lind Lars, Sciaraffia Elena, Blomström-Lundqvist Carina
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
School of Medical Science, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
J Geriatr Cardiol. 2022 Sep 28;19(9):643-650. doi: 10.11909/j.issn.1671-5411.2022.09.008.
Early identification of patients at risk of congestive heart failure (HF) may alter their poor prognosis. The aim was therefore to test whether simple electrocardiographic variables, the P-wave and PR-interval, could predict incident HF.
The PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (1016 individuals all aged 70 years, 50% women) was used to identify predictors of HF. Subjects with prevalent HF, QRS duration ≥ 130 ms, atrial tachyarrhythmias, implanted pacemaker/defibrillator, second- and third-degree atrioventricular block or delta waves at baseline were excluded. Cox proportional hazard analysis was used to relate the PR interval, P-wave duration (Pdur) and amplitude (Pamp), measured in lead V1, to incident HF. Adjustment was performed for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index and smoking.
Out of 836 subjects at risk, 107 subjects were diagnosed with HF during a follow-up of 15 years. In the multivariate analysis, there was a strong U-shaped correlation between Pdur in lead V1 and incident HF ( = 0.0001) which was significant for a Pdur < 60 ms [HR = 2.75; 95% CI: 1.87-4.06, at Pdur 40 ms] but not for prolonged Pdur. There was no significant relationship between incident HF and the PR-interval or the Pamp. A Pdur < 60 ms improved discrimination by 3.7% when added to the traditional risk factors including sex, RR-interval, beta-blocking agents, systolic blood pressure, BMI and smoking ( = 0.048).
A short Pdur, an easily measured parameter on the ECG, may potentially be a useful marker of future HF, enabling its early detection and prevention, thus improving outcomes.
早期识别有充血性心力衰竭（HF）风险的患者可能会改变其不良预后。因此，本研究旨在检验简单的心电图变量，即P波和PR间期，是否能够预测HF的发生。
采用乌普萨拉老年人血管前瞻性研究（PIVUS）（1016名均为70岁的个体，50%为女性）来确定HF的预测因素。排除基线时患有HF、QRS时限≥130 ms、房性快速性心律失常、植入起搏器/除颤器、二度和三度房室传导阻滞或δ波的受试者。采用Cox比例风险分析，将V1导联测量的PR间期、P波时限（Pdur）和振幅（Pamp）与HF的发生相关联。对性别、RR间期、β受体阻滞剂、收缩压、体重指数和吸烟进行了校正。
在836名有风险的受试者中，107名受试者在15年的随访期间被诊断为HF。在多变量分析中，V1导联的Pdur与HF的发生之间存在强烈的U型相关性（P = 0.0001），对于Pdur < 60 ms具有显著性[HR = 2.75；95%CI：1.87 - 4.06，Pdur为40 ms时]，但对于Pdur延长则无显著性。HF的发生与PR间期或Pamp之间无显著关系。当将Pdur < 60 ms添加到包括性别、RR间期、β受体阻滞剂、收缩压、BMI和吸烟在内的传统危险因素中时，辨别能力提高了3.7%（P = 0.048）。
Pdur短是心电图上一个易于测量的参数，可能是未来HF的一个有用标志物，能够实现HF的早期检测和预防，从而改善预后。
