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Long-term prognostic value of major and minor ECG abnormalities in latent Keshan disease with suspect chronic Keshan disease.

Zhu Y, Lai B, Niu X, Wei J, Tan W, Wang X - J Epidemiol (2014)

Bottom Line: Four hundred and fourteen new latent KD patients from a monitored population in China were diagnosed and then followed for 10 years.After adjustment for baseline potential confounders, the hazard ratios and 95% confidence intervals (CIs) for progression to chronic KD in latent KD patients with major ECG abnormalities versus those with minor ECG abnormalities was 2.43 (95% CI 1.58-3.93).Major ECG abnormalities and new ventricular premature complex abnormalities that occurred during the follow-up were both associated with an increased risk of progression to chronic KD.

View Article: PubMed Central - PubMed

Affiliation: Institute of Endemic Disease, Key Laboratory of Environment and Gene Related to Diseases of Ministry Education, School of Medicine, Xi'an Jiaotong University.

ABSTRACT

Objective: This study aims to determine whether baseline electrocardiography (ECG) abnormalities, the appearance of new ECG abnormalities, or other clinical characteristics are associated with increased rates of progression to chronic Keshan disease (KD) among patients with latent KD.

Methods: Four hundred and fourteen new latent KD patients from a monitored population in China were diagnosed and then followed for 10 years. Baseline and 10-year ECG abnormalities were classified according to the Minnesota Code as major and minor. Using Cox proportional hazards regression models, the addition of ECG abnormalities to traditional risk factors were examined to predict chronic KD events.

Results: In 414 latent KD patients with ECG abnormalities, 220 (53.1%) had minor and 194 (46.9%) had major ECG abnormalities. During the follow-up, 92 (22.2%) patients experienced chronic KD events; 32 (14.5%) and 60 (30.9%) of these chronic KD events occurred in the minor and major ECG abnormalities groups, respectively. After adjustment for baseline potential confounders, the hazard ratios and 95% confidence intervals (CIs) for progression to chronic KD in latent KD patients with major ECG abnormalities versus those with minor ECG abnormalities was 2.43 (95% CI 1.58-3.93).

Conclusions: Major ECG abnormalities and new ventricular premature complex abnormalities that occurred during the follow-up were both associated with an increased risk of progression to chronic KD. Atrial fibrillation and right bundle branch block with left anterior hemiblock are the most strongly predictive components of major ECG abnormalities. Depending on the model, adding ECG abnormalities to traditional risk factors was associated with improved risk prediction in latent KD.

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Kaplan-Meier estimates of chronic KD cumulative hazard over time of combined major vs minor and isolated major ECG abnormalities.
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fig03: Kaplan-Meier estimates of chronic KD cumulative hazard over time of combined major vs minor and isolated major ECG abnormalities.

Mentions: In the major ECG abnormalities group, 50 latent KD patients with combined ECG abnormalities had higher incidence of progression to chronic KD (23 patients, 46.0%) than those with isolated major abnormalities at baseline. After adjustment for baseline age, sex, family history of KD, initial cardiothoracic ratio, BMI, blood pressure, heart rate, smoking, and plasma selenium level, the HRs and 95% CIs for chronic KD events in latent KD patients with combined major ECG abnormalities and isolated major ECG abnormalities versus those with minor ECG abnormalities were 3.65 (95% CI 2.07–6.36) and 2.07 (95% CI 1.27–3.39), respectively (Figure 3). Using Cox proportional hazards regression models, we also found that atrial fibrillation and right bundle branch block with left anterior hemiblock are the most strongly predictive components of major ECG abnormalities (HR 13.73, 95% CI 5.34–52.33 and HR 26.1, 95% CI 3.52–134.86, respectively). Such results are consistent with previous studies.8 Moreover, some normal ECGs that converted from abnormal ECGs lasted less than 2 years before reverting to abnormal ECGs again. Some of patients who experienced this phenomenon progressed to chronic KD during the follow-up. Thus, latent patients with normal ECGs who previously had abnormal ECGs should have regular follow-up.


Long-term prognostic value of major and minor ECG abnormalities in latent Keshan disease with suspect chronic Keshan disease.

Zhu Y, Lai B, Niu X, Wei J, Tan W, Wang X - J Epidemiol (2014)

Kaplan-Meier estimates of chronic KD cumulative hazard over time of combined major vs minor and isolated major ECG abnormalities.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150009&req=5

fig03: Kaplan-Meier estimates of chronic KD cumulative hazard over time of combined major vs minor and isolated major ECG abnormalities.
Mentions: In the major ECG abnormalities group, 50 latent KD patients with combined ECG abnormalities had higher incidence of progression to chronic KD (23 patients, 46.0%) than those with isolated major abnormalities at baseline. After adjustment for baseline age, sex, family history of KD, initial cardiothoracic ratio, BMI, blood pressure, heart rate, smoking, and plasma selenium level, the HRs and 95% CIs for chronic KD events in latent KD patients with combined major ECG abnormalities and isolated major ECG abnormalities versus those with minor ECG abnormalities were 3.65 (95% CI 2.07–6.36) and 2.07 (95% CI 1.27–3.39), respectively (Figure 3). Using Cox proportional hazards regression models, we also found that atrial fibrillation and right bundle branch block with left anterior hemiblock are the most strongly predictive components of major ECG abnormalities (HR 13.73, 95% CI 5.34–52.33 and HR 26.1, 95% CI 3.52–134.86, respectively). Such results are consistent with previous studies.8 Moreover, some normal ECGs that converted from abnormal ECGs lasted less than 2 years before reverting to abnormal ECGs again. Some of patients who experienced this phenomenon progressed to chronic KD during the follow-up. Thus, latent patients with normal ECGs who previously had abnormal ECGs should have regular follow-up.

Bottom Line: Four hundred and fourteen new latent KD patients from a monitored population in China were diagnosed and then followed for 10 years.After adjustment for baseline potential confounders, the hazard ratios and 95% confidence intervals (CIs) for progression to chronic KD in latent KD patients with major ECG abnormalities versus those with minor ECG abnormalities was 2.43 (95% CI 1.58-3.93).Major ECG abnormalities and new ventricular premature complex abnormalities that occurred during the follow-up were both associated with an increased risk of progression to chronic KD.

View Article: PubMed Central - PubMed

Affiliation: Institute of Endemic Disease, Key Laboratory of Environment and Gene Related to Diseases of Ministry Education, School of Medicine, Xi'an Jiaotong University.

ABSTRACT

Objective: This study aims to determine whether baseline electrocardiography (ECG) abnormalities, the appearance of new ECG abnormalities, or other clinical characteristics are associated with increased rates of progression to chronic Keshan disease (KD) among patients with latent KD.

Methods: Four hundred and fourteen new latent KD patients from a monitored population in China were diagnosed and then followed for 10 years. Baseline and 10-year ECG abnormalities were classified according to the Minnesota Code as major and minor. Using Cox proportional hazards regression models, the addition of ECG abnormalities to traditional risk factors were examined to predict chronic KD events.

Results: In 414 latent KD patients with ECG abnormalities, 220 (53.1%) had minor and 194 (46.9%) had major ECG abnormalities. During the follow-up, 92 (22.2%) patients experienced chronic KD events; 32 (14.5%) and 60 (30.9%) of these chronic KD events occurred in the minor and major ECG abnormalities groups, respectively. After adjustment for baseline potential confounders, the hazard ratios and 95% confidence intervals (CIs) for progression to chronic KD in latent KD patients with major ECG abnormalities versus those with minor ECG abnormalities was 2.43 (95% CI 1.58-3.93).

Conclusions: Major ECG abnormalities and new ventricular premature complex abnormalities that occurred during the follow-up were both associated with an increased risk of progression to chronic KD. Atrial fibrillation and right bundle branch block with left anterior hemiblock are the most strongly predictive components of major ECG abnormalities. Depending on the model, adding ECG abnormalities to traditional risk factors was associated with improved risk prediction in latent KD.

Show MeSH
Related in: MedlinePlus