目的:探究心电图异常P波额面电轴对不同疾病死亡风险的预测价值。方法:纳入第三次美国健康与营养调查（1988年1月至1994年12月）中行心电图检查时心律为窦性心律的成年人，排除生存数据缺失者。异常P波额面电轴定义为除0°~75°以外的任何数值。主要结局为ICD-9定义的各种原因的死亡。将异常P波电轴作为暴露变量纳入多因素Cox回归模型中评估全因死亡风险，使用竞争风险模型探究不同疾病的死亡风险。结果:共纳入8 220名参与者，年龄（60.10±13.50）岁，其中女占52%（4 276/8 220）。73.3%（6 025/8 220）的参与者为白种人，随访259［131，328］个月，共死亡5 169人。进行多因素调整后，P波额面电轴与全因死亡风险呈非线性相关，风险最低点位于50°，异常P波额面电轴与全因死亡风险增加相关（HR 1.37，95% CI 1.29~1.45，P<0.001）。多因素调整的竞争风险模型中，异常P波额面电轴主要与慢性肺部疾病死亡风险增加相关（校正后模型：HR 1.99，95% CI 1.51~2.63），风险约增加1倍。结论:异常P波额面电轴增加全因死亡风险，尤其与慢性肺部疾病死亡风险增加相关性显著。
The predictive value of abnormal P-wave frontal electrical axis for death risk of different diseases
Objective:To investigate the association between abnormal P-wave frontal axis in electrocardiogram (ECG) and the risk of death from various diseases.Methods:The study enrolled adults who had sinus rhythm at the time of ECG examination in the Third American Health and Nutrition Survey (from January,1988 to December,1994) and excluded those with missing survival data. An abnormal P-wave frontal axis was defined as any value other than 0° to 75°. The primary outcome was death from all causes as defined by ICD-9. The abnormal P-wave axis was included as an exposure variable into the multivariate Cox regression model to evaluate the relationship with the risk of all-cause mortality. The competitive risk model was used to explore the relationship with the risk of death from different diseases.Results:A total of 8 220 participants with average age of (60.10±13.50) years were included in this study, 52% of the participants were female and 73.3% were white. The median follow-up was 259[131,328] months and there were 5 169 deaths. After multivariate adjustment, the frontal axis of P wave was found to be nonlinearly related to the risk of all-cause mortality, and the lowest risk point was 50°. Abnormal P-wave frontal axis was associated with an increased risk of all-cause mortality. In the multivariate adjusted competitive risk model, abnormal P-wave frontal axis was mainly associated with a one-fold increased risk of death from chronic lung disease.Conclusion:The frontal axis of P wave is repeatable and non-invasive measurement that can predict the risk of death. Abnormal P-wave frontal axis is associated with an increased risk of death, particularly from chronic lung disease. Therefore, screening for lung diseases should be focused on people with abnormal frontal P-wave axis.
万方数据
