高危心力衰竭患者基线心电图测量与预后的关系：射血分数降低的心力衰竭患者VerICiguaT全球研究（VICTORIA）试验的见解
Relationship between baseline electrocardiographic measurements and outcomes in patients with high-risk heart failure: Insights from the VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial.
作者信息
Yogasundaram Haran, Zheng Yinggan, Ly Eric, Ezekowitz Justin, Ponikowski Piotr, Lam Carolyn S P, O'Connor Christopher, Blaustein Robert O, Roessig Lothar, Temple Tracy, Westerhout Cynthia M, Armstrong Paul W, Sandhu Roopinder K
机构信息
Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada.
Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
出版信息
Eur J Heart Fail. 2023 Oct;25(10):1822-1830. doi: 10.1002/ejhf.3021. Epub 2023 Sep 10.
AIMS
Whether electrocardiographic (ECG) measurements predict mortality in chronic heart failure with reduced ejection fraction (HFrEF) is unknown.
METHODS AND RESULTS
We studied 4880 patients from the Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial with a baseline 12-lead ECG. Associations between ECG measurements and mortality were estimated as hazard ratios (HR) and adjusted for the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score, N-terminal pro-B-type natriuretic peptide, and index event. Select interactions between ECG measurements, patient characteristics and mortality were examined. Over a median of 10.8 months, there were 824 cardiovascular (CV) deaths (214 sudden) and 1005 all-cause deaths. Median age was 68 years (interquartile range [IQR] 60-76), 24% were women, median ejection fraction was 30% (IQR 23-35), 41% had New York Heart Association class III/IV, and median MAGGIC score was 24 (IQR 19-28). After multivariable adjustment, significant associations existed between heart rate (per 5 bpm: HR 1.02), QRS duration (per 10 ms: HR 1.02), absence of left ventricular hypertrophy (HR 0.64) and CV death, and similarly so with all-cause death (HR 1.02; HR 1.02; HR 0.61, respectively). Contiguous pathologic Q waves were significantly associated with sudden death (HR 1.46), and right ventricular hypertrophy with all-cause death (HR 1.44). The only sex-based interaction observed was for pathologic Q waves on CV (men: HR 1.05; women: HR 1.64, p = 0.024) and all-cause death (men: HR 0.99; women: HR 1.57; p = 0.010). Whereas sudden death doubled in females, it did not differ among males (male: HR 1.25, 95% confidence interval [CI] 0.87-1.79; female: HR 2.50, 95% CI 1.23-5.06; p = 0.141).
CONCLUSION
Routine ECG measurements provide additional prognostication of mortality in high-risk HFrEF patients, particularly in women with contiguous pathologic Q waves.
目的
心电图（ECG）测量能否预测射血分数降低的慢性心力衰竭（HFrEF）患者的死亡率尚不清楚。
方法与结果
我们在射血分数降低的心力衰竭患者的维立西呱全球研究（VICTORIA）试验中，对4880例有基线12导联心电图的患者进行了研究。心电图测量与死亡率之间的关联以风险比（HR）估计，并根据慢性心力衰竭荟萃分析全球组（MAGGIC）风险评分、N末端B型利钠肽原和索引事件进行调整。研究了心电图测量、患者特征与死亡率之间的特定相互作用。在中位时间10.8个月内，有824例心血管（CV）死亡（214例猝死）和1005例全因死亡。中位年龄为68岁（四分位间距[IQR]60 - 76），24%为女性，中位射血分数为30%（IQR 23 - 35），41%有纽约心脏协会III/IV级，中位MAGGIC评分为24（IQR 19 - 28）。多变量调整后，心率（每5次心跳/分钟：HR 1.02）、QRS波时限（每10毫秒：HR 1.02）、无左心室肥厚（HR 0.64）与CV死亡之间存在显著关联，全因死亡情况类似（分别为HR 1.02；HR 1.02；HR 0.61）。连续性病理性Q波与猝死显著相关（HR 1.46），右心室肥厚与全因死亡显著相关（HR 1.44）。观察到的唯一基于性别的相互作用是关于CV上的病理性Q波（男性：HR 1.05；女性：HR 1.64，p = 0.024）和全因死亡（男性：HR 0.99；女性：HR 1.57；p = 0.010）。猝死在女性中增加了一倍，而在男性中无差异（男性：HR 1.25，95%置信区间[CI]0.87 - 1.79；女性：HR 2.50，95%CI 1.23 - 5.06；p = 0.141）。
结论
常规心电图测量可为高危HFrEF患者的死亡率提供额外的预后评估，特别是对于有连续性病理性Q波的女性患者。
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