Steger Alexander, Barthel Petra, Müller Alexander, Rückert-Eheberg Ina-Maria, Linkohr Birgit, Allescher Julia, Maier Melanie, Hapfelmeier Alexander, Martens Eimo, Heidegger Helene Hildegard, Müller Arne Michael, Rizas Konstantinos D, Kääb Stefan, Sinner Moritz F, Sinnecker Daniel, Laugwitz Karl-Ludwig, Peters Annette, Schmidt Georg
Department of Internal Medicine I, TUM University Hospital, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
Sci Rep. 2024 Dec 19;14(1):30566. doi: 10.1038/s41598-024-83712-w.
In contemporary healthcare, effective risk stratification in the general population is vital amidst rising chronic disease rates and an ageing demographic. Deceleration Capacity of the heart rate (DC), derived from 24-hour Holter electrocardiograms, holds promise in risk stratification for cardiac patients. However, the potential of short-term electrocardiograms of five minutes duration for population screening has not been fully explored. Our study aims to investigate the utility of Deceleration Capacity derived from short-term electrocardiograms as a scalable, fully-automated screening tool for predicting long-term mortality risk in the general population. Within a cohort of a representative population-based survey in Germany (KORA-KMC-study), 823 participants with sinus rhythm aged 27 to 76 years at enrollment (females 47.4%) were followed for a median of 13.4 years (IQR 13.1-13.6). All-cause mortality was defined as the primary endpoint and observed in 159 participants. Deceleration Capacity was calculated from 5-minute 12-lead electrocardiograms by a fully automated approach. Participants were divided into three predefined risk categories: DC - low-risk (> 4.5ms); DC - intermediate-risk (2.5-4.5ms); and DC - high-risk (≤ 2.5ms). More than two-thirds of the participants (n = 564, 68.5%) fell into DC, about one-fifth (n = 168, 20.4%) into DC, and about one-tenth (n = 91, 11.1%) into DC. Estimated 13-years mortality in the risk groups was 16.7%, 23.5%, and 49.1%, respectively (p < 0.001). Adjusting for age, life-style-related risk factors, and comorbidities, increased mortality risk was observed for DC (HR 2.34, 95%-CI 1.56-3.50). Deceleration Capacity, derived automatically from brief 5-minute electrocardiogram recordings, emerges as a robust, feasible, and independent predictor of long-term mortality risk in the general population.
在当代医疗保健领域，随着慢性病发病率上升和人口老龄化，对普通人群进行有效的风险分层至关重要。从24小时动态心电图得出的心率减速能力（DC）在心脏病患者的风险分层中具有前景。然而，时长五分钟的短期心电图用于人群筛查的潜力尚未得到充分探索。我们的研究旨在调查从短期心电图得出的减速能力作为一种可扩展的、全自动筛查工具用于预测普通人群长期死亡风险的效用。在德国一项基于人群的代表性调查队列（KORA-KMC研究）中，823名入组时窦性心律、年龄在27至76岁之间的参与者（女性占47.4%）被随访了中位数13.4年（四分位间距13.1 - 13.6）。全因死亡率被定义为主要终点，在159名参与者中观察到。通过全自动方法从5分钟12导联心电图计算减速能力。参与者被分为三个预先定义的风险类别：DC - 低风险（> 4.5毫秒）；DC - 中风险（2.5 - 4.5毫秒）；以及DC - 高风险（≤ 2.5毫秒）。超过三分之二的参与者（n = 564，68.5%）属于DC低风险，约五分之一（n = 168，20.4%）属于DC中风险，约十分之一（n = 91，11.1%）属于DC高风险。风险组中估计的13年死亡率分别为16.7%、23.5%和49.1%（p < 0.001）。在调整年龄、生活方式相关风险因素和合并症后，观察到DC中风险组的死亡风险增加（风险比2.34，95%置信区间1.56 - 3.50）。从简短的5分钟心电图记录中自动得出的减速能力成为普通人群长期死亡风险的一个稳健、可行且独立的预测指标。
