Screening entire healthcare system ECG database: Association of deep terminal negativity of P wave in lead V1 and ECG referral with mortality

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• 作者：Allison Junell^a ; ¹ ; Jason Thomas^b ; ¹ ; Lauren Hawkins^b ; ^c ; Jiri Sklenar^b ; Trevor Feldman^a ; ^b ; Charles A. Henrikson^b ; Larisa G. Tereshchenko^b ; ^{tereshch@ohsu.edu}
• 关键词：Electrocardiogram ; Mortality ; Health system ; Patient education
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：219-224
• 全文大小：581 K
• 卷排序：228

文摘

Each encounter of asymptomatic individuals with the healthcare system presents an opportunity for improvement of cardiovascular disease (CVD) awareness and sudden cardiac death (SCD) risk assessment. ECG sign deep terminal negativity of the P wave in V1 (DTNPV1) was shown to be associated with an increased risk of SCD in the general population.ObjectiveTo evaluate association of DTNPV1 with all-cause mortality and newly diagnosed atrial fibrillation (AFib) in the large tertiary healthcare system patient population.MethodsRetrospective double cohort study compared two levels of exposure (automatically measured amplitude of P-prime (Pp) in V1): DTNPV1 (Pp from − 100 μV to − 200 μV) and ZeroPpV1 (Pp = 0). An entire healthcare system (2010–2014) ECG database was screened. Medical records of children and patients with previously diagnosed AFib/atrial flutter (AFl), implanted pacemaker or cardioverter–defibrillator were excluded. DTNPV1 (n = 3,413) and ZeroPpV1 (n = 3,405) cohorts were matched by age and sex. Primary outcome was all-cause mortality. Secondary outcomes were newly diagnosed AFib/AFl. Median follow-up was 2.5 y.ResultsDTNPV1 was associated with all-cause mortality (HR 1.95(1.64–2.31); P < 0.0001) and newly diagnosed AFib (HR 1.29(1.04–1.59); P = 0.021) after adjustment for CVD, comorbidities, other ECG parameters, medications, and index ECG referral. Index ECG referral by a cardiologist was independently associated with 34% relative risk reduction of mortality (HR 0.66(0.52–0.84); P = 0.001), as compared to ECG referral by a non-cardiologist.ConclusionDTNPV1 is independently associated with twice higher risk of all-cause death, as compared to patients without P prime in V1. Life-saving effect of the index ECG referral by a cardiologist requires further study.