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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 investigate the effects of left ventricular strain (LV) and left ventricular hypertrophy (LVH) on the prognosis of patients with asymptomatic aortic stenosis. Methods: A total of 766 patients with aortic stenosis were included in our hospital. The values of left ventricular strain and left ventricular hypertrophy were evaluated by Sokolow-Lyon (SL) voltage and Cornell voltage-time (CVDP) Covariate adjustment and evaluation. Results: The cumulative incidence of myocardial infarction in patients with left ventricular strain of electrocardiogram was significantly higher than those without strain of electrocardiogram (HR = 2.7, 95% CI: 1.4-5.3, P = 0.006). Patients with left ventricular hypertrophy diagnosed with SL and CVDP had a significantly increased risk of heart failure (95% CI: 4.7-26.4, P <0.001) compared with non-ECG patients with left ventricular hypertrophy. Patients undergoing aortic valve replacement (95% CI: 1.6-3.2, P <0.001). The composite endpoint of non-fatal infarction, heart failure, or cardiovascular death was also significantly increased (95% CI: 1.2-3.7, P <0.05). Conclusion: ECG LV and LVH are independent predictors of poor prognosis in patients with asymptomatic aortic stenosis.