目的:目前的指南为ANCA相关性血管炎(AAV)的心血管筛查提供了有限的证据。本研究旨在探讨心电图(ECG)异常的患病率及其与无,与匹配的对照组相比,AAV患者的轻微或主要ECG异常与心血管死亡率。
方法:使用风险集匹配的队列设计,从2000-2021年的丹麦登记簿中确定了诊断为肉芽肿性多血管炎或显微镜下多血管炎的患者。患者在年龄上与无AAV的对照组1:3匹配,性别,和心电图测量的年份。根据心电图异常评估心血管死亡的相关危险,在Cox回归模型中进行年龄调整,性别,和合并症,随后计算5年心血管疾病死亡率的风险,标准化为样本的年龄和性别分布。
结果:共纳入1431例AAV患者(中位年龄:69岁,52.3%男性)。中位随访时间为4.8年。AAV与较高的左心室肥厚患病率相关(17.5%vs12.5%),ST-T偏差(10.1%对7.1%),心房颤动(9.6%vs7.5%),QTc延长(5.9%vs3.6%)。与对照组相比,只有具有严重ECG异常的AAV患者显示出心血管死亡风险显着升高[HR1.99(1.49-2.65)]。这相当于5年心血管死亡率的风险为19.14%(16-22%)和9.41%(8-11%)。
结论:AAV患者的主要心电图异常患病率高于对照组。值得注意的是,主要心电图异常与心血管死亡风险显著增加相关.这些结果主张将ECG评估纳入AAV患者的常规临床护理中。
OBJECTIVE: Current guidelines provide limited evidence for cardiovascular screening in ANCA-associated vasculitis (AAV). This study aimed to investigate the prevalence of electrocardiogram (ECG) abnormalities and associations between no, minor or major ECG abnormalities with cardiovascular mortality in AAV patients compared with matched controls.
METHODS: Using a risk-set matched cohort design, patients diagnosed with granulomatosis with polyangiitis or microscopic polyangiitis with digital ECGs were identified from Danish registers from 2000-2021. Patients were matched 1:3 to controls without AAV on age, sex, and year of ECG measurement. Associated hazards of cardiovascular mortality according to ECG abnormalities were assessed in Cox regression models adjusted for age, sex, and comorbidities, with subsequent computation of 5-year risk of cardiovascular mortality standardized to the age- and sex-distribution of the sample.
RESULTS: A total of 1431 AAV patients were included (median age: 69 years, 52.3% male). Median follow-up was 4.8 years. AAV was associated with higher prevalence of left ventricular hypertrophy (17.5% vs 12.5%), ST-T deviations (10.1% vs 7.1%), atrial fibrillation (9.6% vs 7.5%), and QTc prolongation (5.9% vs 3.6%). Only AAV patients with major ECG abnormalities demonstrated significantly elevated risk of cardiovascular mortality [HR 1.99 (1.49-2.65)] compared with controls. This corresponded to a 5-year risk of cardiovascular mortality of 19.14% (16-22%) vs 9.41% (8-11%).
CONCLUSIONS: Patients with AAV demonstrated a higher prevalence of major ECG abnormalities than controls. Notably, major ECG abnormalities were associated with a significantly increased risk of cardiovascular mortality. These results advocate for the inclusion of ECG assessment into routine clinical care for AAV patients.