ECG Features Associated With Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation: A Combined AFFIRM and AF-CHF Analysis

被引:6
作者
Andrade, Jason G. [1 ]
Roy, Denis [1 ]
Wyse, D. George [2 ]
Dorian, Paul [3 ]
Talajic, Mario [1 ]
Leduc, Hugues [4 ]
Cadrin-Tourigny, Julia [1 ]
Shohoudi, Azadeh [4 ]
Macle, Laurent [1 ]
Thibault, Bernard [1 ]
Guerra, Peter G. [1 ]
Rivard, Lena [1 ]
Dubuc, Marc [1 ]
Khairy, Paul [1 ,4 ]
机构
[1] Univ Montreal, Montreal Heart Inst, Electrophysiol Serv, Montreal, PQ, Canada
[2] Libin Cardiovasc Inst, Calgary, AB, Canada
[3] Univ Toronto, St Michaels Hosp, Toronto, ON, Canada
[4] Montreal Heart Inst, Coordinating Ctr, Montreal, PQ H1T 1C8, Canada
基金
加拿大健康研究院;
关键词
AFFIRM trial; AF-CHF trial; atrial fibrillation; electrocardiography; hospitalization; mortality; CONGESTIVE-HEART-FAILURE; 1ST-DEGREE ATRIOVENTRICULAR-BLOCK; CORONARY-ARTERY-DISEASE; PROLONGED QRS DURATION; APPARENTLY HEALTHY-MEN; QT INTERVAL; PROGNOSTIC VALUE; EJECTION FRACTION; CARDIAC MORTALITY; CONDUCTION DELAY;
D O I
10.1111/jce.12934
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
ECG and Cardiovascular Outcomes in AF. Background: The association between standard parameters from a simple 12-lead ECG (i.e., QRS duration and PR, JT, and QT intervals) and adverse cardiovascular outcomes (cardiovascular mortality, all-cause mortality, arrhythmic mortality, and hospitalizations) in patients with a history of atrial fibrillation (AF) has not been previously studied. Methods and Results: A pooled analysis of patient-level data was conducted on 5,436 patients, age 68.2 +/- 8.3 years, 34.8% female, with a history of non-permanent AF randomized in AFFIRM and AF-CHF trials. The predictive value of ECG parameters was assessed in AF and sinus rhythm in multivariate Cox regression models. During a follow-up of 40.8 +/- 16.3 months, QRS duration >120 milliseconds was independently associated with all-cause mortality (hazard ratio [HR] 1.46, 95% confidence interval [CI; 1.21-1.76] in AF, P < 0.001), cardiovascular mortality (HR 1.75, 95% CI (1.15-2.65) in sinus rhythm, P = 0.009; HR 1.56, 95% CI [1.27-1.93] in AF, P < 0.001), arrhythmic mortality (HR 1.90, 95% CI [1.09-3.32] in sinus, P = 0.024; HR 1.84, 95% CI [1.35-2.51] in AF, P < 0.001), any hospitalization (HR 1.15, 95% CI [1.02-1.29] in AF, P = 0.027), and cardiovascular hospitalization (HR 1.21, 95% CI [1.06-1.37] in AF; P = 0.004). Increased PR interval (>200 milliseconds) was independently associated with cardiovascular (HR 1.56, 95% CI [1.11-2.21], P = 0.010) and arrhythmic (HR 1.91, 95% CI [1.14-3.18], P = 0.004) mortality. The JT and QTc intervals were not predictive of mortality. Conclusions: Simple parameters from standard ECGs are significantly and independently associated with adverse cardiovascular outcomes in patients with a history of AF.
引用
收藏
页码:404 / 413
页数:10
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