Dirschinger Ralf Josef, Müller Alexander, Steger Alexander, Laugwitz Karl-Ludwig, Barthel Petra, Schmidt Georg, Sinnecker Daniel
Department of Internal Medicine I, University Hospital rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany.
Gefäßpraxis im Tal, 80331 Munich, Germany.
J Cardiovasc Dev Dis. 2025 Jan 24;12(2):40. doi: 10.3390/jcdd12020040.
Reduced respiratory sinus arrhythmia, quantified as expiration-triggered sinus arrhythmia (ETA) from simultaneous electrocardiogram and respiration recordings, is a strong long-term mortality predictor in myocardial infarction survivors. Here, we investigated whether ETA also predicts mortality risk in the general elderly population. ETA was quantified from 30-min electrocardiogram and respiration recordings in 1788 general population subjects aged ≥60 years, who were then followed for a median of 4.0 years (median age 72 years, 58% female). Four-year all-cause mortality was 4.6%. Abnormal ETA using a predefined cutoff (≤0.19 ms) was associated with a 4-year mortality of 6.9%, compared to 3.7% in the remaining participants ( = 0.0022). ETA remained a significant mortality predictor in multivariable Cox analysis, also considering a modified Framingham score incorporating sex, age, smoking, cholesterol, blood pressure, antihypertensive medication, family history, diabetes and clinical atherosclerosis (multivariable hazard ratio 1.81; 95% confidence interval 1.17-2.81; = 0.008). Combined risk prediction by ETA (using an optimized cutoff of ≤0.86 ms) and the Framingham score stratified patients into a low-risk (both parameters normal), an intermediate-risk (one parameter abnormal) and a high-risk group (both parameters abnormal), with 4-year mortality rates of 1.9%, 4.4% and 10.1%, respectively. We conclude that in elderly general population subjects, ETA is a mortality risk predictor that complements classical clinical risk stratification.
呼吸性窦性心律不齐减弱，通过同步心电图和呼吸记录以呼气触发的窦性心律不齐（ETA）进行量化，是心肌梗死幸存者长期死亡率的有力预测指标。在此，我们研究了ETA是否也能预测一般老年人群的死亡风险。对1788名年龄≥60岁的一般人群受试者进行30分钟的心电图和呼吸记录，以量化ETA，随后对他们进行了中位数为4.0年的随访（中位年龄72岁，女性占58%）。四年全因死亡率为4.6%。使用预先定义的临界值（≤0.19毫秒）时，异常ETA与4年死亡率6.9%相关，而其余参与者的死亡率为3.7%（P = 0.0022）。在多变量Cox分析中，ETA仍然是一个显著的死亡率预测指标，同时还考虑了纳入性别、年龄、吸烟、胆固醇、血压、抗高血压药物、家族史、糖尿病和临床动脉粥样硬化的改良弗明翰评分（多变量风险比1.81；95%置信区间1.17 - 2.81；P = 0.008）。通过ETA（使用优化后的临界值≤0.86毫秒）和弗明翰评分进行联合风险预测，将患者分为低风险（两个参数均正常）、中风险（一个参数异常）和高风险组（两个参数均异常），4年死亡率分别为1.9%、4.4%和10.1%。我们得出结论，在老年一般人群中，ETA是一种死亡率风险预测指标，可补充经典的临床风险分层。
