Levy D, Salomon M, D'Agostino R B, Belanger A J, Kannel W B
Framingham Heart Study, MA 01701.
Circulation. 1994 Oct;90(4):1786-93. doi: 10.1161/01.cir.90.4.1786.
During the past half-century, the ECG has been used extensively for the diagnosis of left ventricular hypertrophy. Persons with ECG evidence of left ventricular hypertrophy are at increased risk for the development of cardiovascular disease.
Subjects from the Framingham Heart Study with ECG evidence of left ventricular hypertrophy were eligible for this investigation if they were free of cardiovascular disease and did not have complete bundle-branch block or Wolff-Parkinson-White syndrome. Logistic regression analyses of pooled biennial examinations were used to determine risk for cardiovascular disease as a function of baseline voltage (sum of R wave in aVL plus S wave in V3) and repolarization and as a function of serial changes in these ECG features of hypertrophy. The eligible sample consisted of 274 men (mean age, 60 years) and 250 women (mean age, 64 years) who contributed 2660 person-examinations. During follow-up, there were 269 new cardiovascular events. Compared with subjects in the first quartile of voltage at baseline, the age-adjusted odds ratio for cardiovascular disease among subjects in the fourth quartile was 3.08 (95% confidence interval [CI], 1.87 to 5.07) in men and 3.29 (95% CI, 1.78 to 6.09) in women. Compared with a normal repolarization pattern, the presence of severe repolarization abnormalities was associated with an age-adjusted odds ratio of 5.84 (95% CI, 3.55 to 9.62) in men and 2.47 (95% CI, 1.38 to 4.42) in women. Subjects with a serial decline in voltage were at lower risk for cardiovascular disease than were those with no serial change (men: odds ratio after adjusting for age and baseline voltage, 0.46; 95% CI, 0.26 to 0.84; women: odds ratio, 0.56; 95% CI, 0.30 to 1.04). In contrast, those with a serial increase in voltage were at greater risk for cardiovascular disease (men: odds ratio, 1.86; 95% CI, 1.14 to 3.03; women: odds ratio, 1.61; 95% CI, 0.91 to 2.84). Compared with those with no serial change, an improvement in repolarization was associated with a marginally significant reduction in cardiovascular risk in men (odds ratio after adjusting for age and baseline repolarization, 0.45; 95% CI, 0.20 to 1.01). Worsening of repolarization was associated with increased risk for cardiovascular disease in both sexes (men: odds ratio, 1.89; 95% CI, 1.05 to 3.40; women: odds ratio, 2.02; 95% CI, 1.07 to 3.81).
The results of this investigation suggest that regression of ECG features of left ventricular hypertrophy confers an improvement in risk for cardiovascular disease, whereas serial worsening imposes increased risk. The benefits to be derived from regression of left ventricular hypertrophy must be confirmed in other clinical settings.
在过去的半个世纪里，心电图被广泛用于诊断左心室肥厚。有心电图证据显示左心室肥厚的人患心血管疾病的风险增加。
来自弗雷明汉心脏研究的有心电图证据显示左心室肥厚的受试者，若没有心血管疾病、没有完全性束支传导阻滞或预激综合征，则符合本研究的条件。对汇总的两年一次的检查进行逻辑回归分析，以确定心血管疾病风险与基线电压（aVL导联R波与V3导联S波之和）及复极的关系，以及与这些肥厚心电图特征的系列变化的关系。符合条件的样本包括274名男性（平均年龄60岁）和250名女性（平均年龄64岁），共进行了2660人次检查。在随访期间，发生了269例新的心血管事件。与基线电压处于第一四分位数的受试者相比，第四四分位数的男性受试者患心血管疾病的年龄调整后比值比为3.08（95%置信区间[CI]，1.87至5.07），女性为3.29（95%CI，1.78至6.09）。与正常复极模式相比，严重复极异常的存在与男性年龄调整后比值比5.84（95%CI，3.55至9.62）及女性2.47（95%CI，1.38至4.42）相关。电压呈系列下降的受试者患心血管疾病的风险低于无系列变化者（男性：年龄和基线电压调整后的比值比为0.46；95%CI，0.26至0.84；女性：比值比为0.56；95%CI，0.30至1.04）。相反，电压呈系列升高的受试者患心血管疾病的风险更高（男性：比值比为1.86；95%CI，1.14至3.03；女性：比值比为1.61；95%CI，0.91至2.84）。与无系列变化者相比，复极改善与男性心血管风险略有显著降低相关（年龄和基线复极调整后的比值比为0.45；95%CI，0.20至1.01）。复极恶化与两性心血管疾病风险增加相关（男性：比值比为1.89；95%CI，1.05至3.40；女性：比值比为2.02；95%CI，1.07至3.81）。
本研究结果表明，左心室肥厚心电图特征的消退可使心血管疾病风险得到改善，而系列恶化则会增加风险。左心室肥厚消退带来的益处必须在其他临床环境中得到证实。
