高血压患者中心电图左心室肥厚逆转与新发房颤发病率降低的关系分析  

Regression of electrocardiographic left ventricular hypertrophy and decreased incidence of new-onset atrial fibrillation in patients with hypertension

作　　者：Okin P.M. Wachtell K. Devereux R.B. 任付先 

机构地区：[1]Weill Medical College of Cornell University, 525 E 68th St, New York, NY 10021, United States.Dr

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2007年第2期6-7,共2页

摘　　要：背景:房颤(AF)与死亡和心血管事件(尤其是卒中)的风险增高相关,使得预防新发AF成为临床实践中的首要任务。尽管心电图上呈现的左心室肥厚(LVH)及其严重程度可以预测AF的发展,但是心电图上LVH逆转是否与AF发病率降低相关仍不清楚。Context: Atrial fibrillation(AF) is associated with increased risk of mortality and cardiovascular events, particularly stroke, making prevention of new-onset AF a clinical priority. Although the presence and severity of electrocardiographic left ventricular hypertrophy(LVH) appear to predict development of AF, whether regression of electrocardiographic LVH is associated with a decreased incidence of AF is unclear. Objective: To test the hypothesis that in-treatment regression or continued absence of electrocardiographic LVH during antihypertensive therapy is associated with a decreased incidence of AF, independent of blood pressure and treatment modality. Design, Setting, and Participants: Double-blind, randomized, parallel-group study conducted in 1995-2001 among 8831 men and women with hypertension, aged 55-80 years(median, 67 years), with electrocardiographic LVH by Cornell voltage-duration product or Sokolow-Lyon voltage, with no history of AF, without AF on the baseline electrocardiogram, and enrolled in the Losartan Intervention for Endpoint Reduction in Hypertension Study. Interventions: Losartan-or atenolol-based treatment regimens, with follow-up assessments at 6 months and then yearly until death or study end. Main Outcome Measure: New-onset AF in relation to electrocardiographic LVH determined at baseline and subsequently. Electrocardiographic LVH was measured using sex-adjusted Cornell product criteria({RaVL+SV3[+6 mm in women]}×QRS duration). Results: After a mean(SD) follow-up of 4.7(1.1) years, new-onset AF occurred in 290 patients with in-treatment regression or continued absence of Cornell product LVH for a rate of 14.9 per 1000 patient-years and in 411 patients with in-treatment persistence or development of LVH by Cornell product criteria for a rate of 19.0 per 1000 patient-years. In time-dependent Cox analyses adjusted for treatment effects, baseline differences in risk factors for AF, baseline and in-treatment blood pressure, and baseline severity of electrocardiographic LVH, lower in-treat

关 键 词：心室肥厚 心血管事件 抗高血压治疗 临床实践 Cornell 终点事件 洛沙坦 阿替洛尔 缺如 随访 

分 类 号：R541.3[医药卫生—心血管疾病]