基于心电图识别慢性阻塞性肺疾病患者房颤风险及其对不良临床结局的影响——前瞻性多中心COSYCONET队列的亚组分析
ECG-based identification of COPD patients at risk for atrial fibrillation and its impact on adverse clinical outcomes-a subgroup analysis of the prospective multicenter COSYCONET cohort.
作者信息
Eichenlaub Martin, Frye Björn Christian, Lehrmann Heiko, Biertz Frank, Jadidi Amir Sherwan, Kaier Klaus, Melzer Thomas, Alter Peter, Watz Henrik, Waschki Benjamin, Weckler Barbara Christine, Trudzinski Franziska Christina, Michels-Zetsche Julia Dorothea, Trinkmann Frederik, Herth Felix Josef-Friedrich, Kauczor Hans-Ulrich, Kahnert Kathrin, Jörres Rudolf, Bals Robert, Westermann Dirk, Arentz Thomas, Vogelmeier Claus Franz, Stolz Daiana, Fähndrich Sebastian
机构信息
Department of Pneumology, Medical Center, Faculty of Medicine, University of Freiburg, Killianstrasse 5, Freiburg, 79106, Germany.
Department of Cardiology and Angiology, Medical Center, Faculty of Medicine, University of Freiburg, Suedring 15, Freiburg, Bad Krozingen, 79189, Germany.
出版信息
Respir Res. 2025 Sep 17;26(1):272. doi: 10.1186/s12931-025-03342-2.
BACKGROUND
Atrial fibrillation (AF) frequently occurs in patients with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes. We aimed to identify patients at risk for AF using amplified p-wave duration (APWD) analysis on electrocardiogram (ECG) as non-invasive tool to diagnose an atrial cardiomyopathy (AtCM) which is an established risk factor for AF.
METHODS
This subgroup analysis of the prospective COSYCONET cohort included 2,385 COPD patients from 31 study centers with baseline sinus rhythm ECG and at least one follow-up examination. Of these, 73 patients showed AF during follow-up and were propensity-score matched to controls. APWD was measured at baseline and future major adverse cardiac and cerebrovascular events (MACCE) and health related outcome were assessed.
RESULTS
219 COPD patients (70 [64-74] years, 79.5% male) were analyzed during a follow-up of 586 (210-1137) days. APWD was significantly longer in patients with AF occurrence compared to controls (132 [125-141] ms vs. 124 [117-133] ms, p < 0.001) and remained significant in multivariate regression analysis (OR: 1.05 [1.01-1.09], p = 0.03). An APWD ≥ 131 ms was identified as best cut-off for AF prediction (62% sensitivity, 70% specificity, OR: 3.91 [2.58 to 5.95], p < 0.001). Patients with AF had a significantly higher MACCE rate (24.7% versus 8.2%, p = 0.001) and a significantly lower physical activity score (1,074 [264-4,776] vs. 2,706 [975-7,339], p = 0.008).
CONCLUSIONS
This study demonstrates that ECG-based AtCM diagnosis identifies COPD patients at risk for AF, which was associated with a substantially elevated MACCE rate and a significantly reduced physical activity. This easy, cost-effective and widely available digital biomarker might enable early therapy initiation and prevention of adverse clinical outcomes.
TRIAL REGISTRATION
NCT01245933 on Clinical-Trials.gov (Registration date: 22.11.2010).
背景
心房颤动（AF）在慢性阻塞性肺疾病（COPD）患者中经常发生，并与不良临床结局相关。我们旨在使用心电图（ECG）上的放大P波时限（APWD）分析作为一种非侵入性工具来识别有AF风险的患者，该工具用于诊断心房心肌病（AtCM），而心房心肌病是AF的既定风险因素。
方法
这项对前瞻性COSYCONET队列的亚组分析纳入了来自31个研究中心的2385例COPD患者，这些患者有基线窦性心律心电图且至少进行了一次随访检查。其中，73例患者在随访期间出现AF，并与对照组进行倾向评分匹配。在基线时测量APWD，并评估未来主要不良心脑血管事件（MACCE）和健康相关结局。
结果
在586（210 - 1137）天的随访期间，对219例COPD患者（70 [64 - 74]岁，79.5%为男性）进行了分析。与对照组相比，发生AF的患者APWD明显更长（132 [125 - 141]毫秒对124 [117 - 133]毫秒，p < 0.001），并且在多变量回归分析中仍然显著（OR：1.05 [1.01 - 1.09]，p = 0.03）。APWD≥131毫秒被确定为预测AF的最佳切点（敏感性62%，特异性70%，OR：3.91 [2.58至5.95]，p < 0.001）。发生AF的患者MACCE发生率显著更高（24.7%对8.2%，p = 0.001），身体活动评分显著更低（1074 [264 - 4776]对2706 [975 - 7339]，p = 0.008）。
结论
本研究表明，基于心电图的AtCM诊断可识别有AF风险的COPD患者，这与MACCE发生率大幅升高和身体活动显著降低相关。这种简单、经济有效且广泛可用的数字生物标志物可能有助于早期开始治疗并预防不良临床结局。
试验注册
ClinicalTrials.gov上的NCT01245933（注册日期：2010年11月22日）。
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