Predictive values of electrocardiogram P wave dispersion and P wave peak time in lead Ⅱ for new-onset atrial fibrillation in patients with essential hypertension
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摘要:目的
探讨心电图P波离散度(PWD)与Ⅱ导联P波峰值时间(PWPT Ⅱ)对原发性高血压患者新发心房颤动(简称房颤)的预测价值。
方法选择2021年7月—2023年6月在常州市第一人民医院诊断为新发房颤的原发性高血压患者120例为房颤组, 选取年龄、性别相匹配的同期未发房颤的原发性高血压患者240例为对照组。通过电子病历系统收集入选患者近1年内窦性状态下的心电图。比较2组基本临床资料和心电图指标; 采用二元Logistic回归分析探讨PWD、PWPT Ⅱ与原发性高血压患者新发房颤的相关性; 绘制受试者工作特征(ROC)曲线，以组内相关系数(ICC)行观察者内及观察者间测量结果的一致性检验。
结果房颤组的心率(HR)低于对照组，体表面积(BSA)、PR间期、PWD、PWPT Ⅱ均高于对照组，差异有统计学意义(P < 0.05)。校正混杂因素(年龄、性别、HR、体质量指数、BSA)后，二元Logistic回归分析显示, PWD(OR=1.124, 95%CI: 1.095~1.155)和PWPT Ⅱ(OR=1.252, 95%CI: 1.186~1.320)与新发房颤显著相关(P < 0.001)。ROC曲线分析显示, PWD与PWPT Ⅱ预测原发性高血压患者新发房颤的曲线下面积(AUC)分别为0.892、0.797, 二者联合预测的AUC为0.910。观察者内及观察者间测量PWD和PWPT Ⅱ的一致性均极好(ICC>0.9)。
结论心电图PWD联合PWPT Ⅱ预测原发性高血压患者新发房颤具有较高的应用价值。
Abstract:ObjectiveTo investigate the predictive values of electrocardiogram P wave dispersion (PWD) and P wave peak time in lead Ⅱ (PWPT Ⅱ) for new-onset atrial fibrillation in patients with essential hypertension.
MethodsA total of 120 essential hypertension patients diagnosed as new-onset atrial fibrillation in the First People's Hospital of Changzhou City from July 2021 to June 2023 were selected as atrial fibrillation group, and 240 essential hypertension patients without atrial fibrillation in the same period matched by age and gender were selected as control group. Electrocardiograms under sinus rhythm were obtained from the patients in the last year through the electronic medical record system. The basic clinical data and electrocardiogram indexes were compared between the two groups; the correlations of PWD and PWPT Ⅱ with new-onset atrial fibrillation in patients with essential hypertension were analyzed by binary Logistic regression; the receiver operating characteristic (ROC) curve was drawn, and the intra-observer and inter-observer agreement tests were conducted by the intra-class correlation coefficient (ICC).
ResultsHeart rate (HR) of the atrial fibrillation group was significantly lower than that of the control group, while the body surface area (BSA), PR interval, PWD and PWPT Ⅱ were significantly higher than those of the control group (P < 0.05). After adjusting for confounding factors (age, gender, HR, body mass index, BSA), binary Logistic regression analysis showed that PWD (OR=1.124, 95%CI, 1.095 to 1.155) and PWPT Ⅱ (OR=1.252, 95%CI, 1.186 to 1.320) were significantly associated with new-onset atrial fibrillation (P < 0.001). ROC curve analysis showed that the area under the curve (AUC) of PWD and PWPT Ⅱ for predicting new-onset atrial fibrillation in patients with essential hypertension was 0.892 and 0.797 respectively, and the AUC of combined prediction by PWD and PWPT Ⅱ was 0.910. Both the intra-observer and inter-observer agreement for PWD and PWPT Ⅱ measurement were excellent (ICC>0.9).
ConclusionElectrocardiogram PWD combined with PWPT Ⅱ has high application value in predicting new-onset atrial fibrillation in patients with essential hypertension.
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表 1 2组基本临床特征及心电图资料(x±s)
指标 房颤组(n=120) 对照组(n=240) P 年龄/岁 71.03±9.87 71.19±9.48 0.877 BMI/(kg/m2) 24.30±3.76 24.14±2.55 0.673 BSA/m2 1.71±0.18 1.66±0.16 0.019 SBP/mmHg 141.92±22.56 141.35±19.67 0.808 DBP/mmHg 77.83±12.83 77.60±9.92 0.864 HR/(次/min) 70.77±13.04 73.91±11.57 0.021 PD/ms 118.02±15.89 115.10±9.93 0.067 PVL Ⅰ/mV 0.04±0.02 0.05±0.02 0.229 PWPT Ⅱ/ms 62.57±6.25 55.97±4.56 < 0.001 PWD/ms 61.19±24.21 27.81±9.49 < 0.001 PR间期/ms 173.87±37.37 166.26±25.89 0.047 BMI: 体质量指数; BSA: 体表面积; SBP: 收缩压;
DBP: 舒张压; HR: 心率; PD: P波时限;
PVL Ⅰ: Ⅰ导联P波电压;
PWPT Ⅱ: Ⅱ导联P波峰值时间; PWD: P波离散度。
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表 2 新发房颤相关因素的Logistic回归分析
变量 模型1 模型2 OR 95%CI P OR 95%CI P PWD 1.118 1.090~1.146 < 0.001 1.124 1.095~1.155 < 0.001 PWPT Ⅱ 1.251 1.188~1.317 < 0.001 1.252 1.186~1.320 < 0.001 PR间期 1.008 1.001~1.015 0.029 1.007 0.999~1.014 0.076 模型1: 未校正; 模型2: 根据年龄、性别、HR、BMI、BSA校正。PWD: P波离散度; PWPT Ⅱ: Ⅱ导联P波峰值时间; HR: 心率; BMI: 体质量指数; BSA: 体表面积。
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