心电图左心室劳损和左心室肥厚对主动脉瓣狭窄患者预后的影响

Impact of Electrocardiographic Left Ventricular Strain and Left Ventricular Hypertrophy on Prognosis of Patients with Aortic Stenosis

目的:探讨心电图左心室劳损(LV)和左心室肥厚(LVH)对无症状主动脉瓣狭窄患者预后的影响。方法:到我院治疗的主动脉瓣狭窄患者766例,心电图左心室劳损和左心室肥厚的预测值用Sokolow-Lyon(SL)电压标准和Cornell电压-时间(CVDP)标准评估,通过对其他预后协变量调整并进行评价。结果:心电图左心室劳损患者的心肌梗死的累计发生率显著高于非心电图劳损的患者(HR=2.7,95%CI:1.4-5.3,P=0.006)。与非心电图左心室肥厚的患者比较,SL标准与CVDP标准联用诊断的左心室肥厚患者心力衰竭的风险显著增加(95%CI:4.7-26.4,P<0.001);行主动脉瓣置换术风险显著增加(95%CI:1.6-3.2,P<0.001);非致死性梗死、心力衰竭或心血管死亡的复合终点风险也显著增加(95%CI:1.2-3.7,P<0.05)。结论:心电图LV和LVH是无症状主动脉瓣狭窄患者预后不良的独立预测因子。

Objective： To evaluate the impact of electrocardiographic left ventricular strain（LV） and left ventricular hypertrophy（LVH） on the prognosis of patients with asymptomatic aortic stenosis. Methods： In our hospital, 776 cases SEAS patients were included.Predictive value of ECG left ventricular strain and left ventricular hypertrophy were evaluated with Sokolow-Lyon（SL） and Cornell voltage standard voltage-Standard evaluation time（CVDP）, through adjustment of other prognostic covariates and evaluated. Results： Multivariate analysis showed that the cumulative incidence of myocardial infarction in patients with electrocardiographic left ventricular strain was significantly higher than that of patients without left ventricular strain（HR=2.7, 95% CI： 1.4-5.3, P=0.006）. Univariate analysis showed that, compared with patients without electrocardiographic left ventricular hypertrophy, risk of heart failure increased significantly for left ventricular hypertrophy patients by SL and CVDP standard diagnostic criteria（95% CI： 4.7-26.4, P〈0.001）, and so did the risk of main line aortic valve replacement surgery（95% CI： 1.6-3.2, P〈0.001）, and the risk of the composite endpoint of nonfatal infarction,heart failure or cardiovascular death（95% CI： 1.2-3.7, P〈0.05）. Conclusion： ECG LV and LVH are independent predictors of poor prognosis of patients with asymptomatic aortic stenosis.