| BackgroundResting electrocardiogram (ECG) is a medical procedure commonly used in clinical non-invasive examination methods, it is not only provides most of the heart's electrical activity information but also can be used as diagnostic criteria for certain heart disease, especially in myocardial ischemia and arrhythmias diseases. The Minnesota Code (MC) is wildly used in epidemiologic studies as an ECG classification system. According to Minnesota Code, the electrocardiographic Abnormalities can be divided into 9 categories:1) Q and QS Patterns (MC-1):it usually appears in serious damaged area of heart, indicating the regional myocardial cells without electrophysiological activity; myocardial infarction is the main reason for such pattern.2) QRS Axis Deviation (MC-2):The main direction especially ventricular QRS ECG changes, and is closely related to the size and physiological condition of myocardial cells, as changes of cardiac structure changes with age an important reference index, such as left ventricular hypertrophy often occur QRS left-axis deviation.3) High Amplitude R Waves (MC-3):Refers to the average maximum QRS wave vector direction, appearing in myocardial cells increased or abnormal increase in the number, not synchronized ventricle increases, the relative volume of the chest close to the chest wall and heart enlarged heart and other pathological changes in patients with hypertension often R wave appears high voltage. 4) ST Junction (J) and Segment Depression (MC-4), ST segment is the end of QRS to T wave beginning of a period, starting site for the J point, slow ventricular repolarization process, ST-segment depression often suggest the presence of a relatively stable myocardial ischemia, usually caused by myocardial cell damage or transient hypoxia.5) T-Wave Items (MC-5):T wave present the fast ventricular repolarization, and abnormal showed T amplitude zero (flat), or negative, or diphasic (negative-positive type only), indicating the presence of chronic coronary ischemia.6) A-V Conduction Defect (MC-6):The propagation and delay of impulse from atrial to ventricular, is generally the result of organic heart disease, such as acute myocardial infarction, viral myocarditis and cardiomyopathy.7) Ventricular Conduction Defect (MC-7):The conduction delay or interruption below the bundle of His, included left bundle branch block and right bundle branch block, generally permanent conduction bundle branch block due to organic damage of tissue or distal tip, right bundle branch often occurs in rheumatic heart disease and hypertensive heart disease and left bundle branch block is more common in heart failure and acute myocardial infarction.8) Arrhythmias (MC-8), including heart impulse rate, rhythm, site of origin, conduction velocity or abnormal excitement order, it can be the secondary changes of certain diseases or primary myocardial cells abnormal. Such as premature ventricular occurs often in normal individuals, it may also appear in myocarditis, myocardial ischemia in patients with hypertension; atrial fibrillation can occur in hyperthyroidism and also in young person without heart disease.9) Miscellaneous Items (MC-9), including Low QRS amplitude(hypokalemia), P-wave amplitude^ 2.5 mm (mitral stenosis), T-wave amplitude> 12 mm. Epidemiological studies show that certain abnormal electrocardiogram closely associated with the occurrence of cardiovascular disease events, it can be as a cheap, safe and important indicator of risk stratification in asymptomatic people. The major abnormal (MA) ECG was defined according to Pooling Project, it is an independent risk factor for cardiovascular events; the ischemic ECG abnormalities was defined according to the pathophysiology of myocardial ischemia usually caused by coronary artery stenosis, can be used as diagnostic criteria of coronary heart disease.In our thoughts, the analysis of these different categories of ECG abnormalities distribution in this particular population, exploring the risk factors of these abnormal electrocardiogram and tracking important ECG which is closely associated with cardiovascular events anomalies not only help clarify the situation of heart, but also help us to understand the possible causes leading to abnormal electrocardiogram. More importantly, it can be used to predict important ECG abnormalities which are closely related to cardiovascular events, this can be used for early diagnosis and treatment guidance.Although there are many studies of prevalence of abnormal ECG, most of them are focused on white people and the size of the studies are small. There are few study include black and yellow race. At present, lack of clarifying the above categories electrocardiogram distribution of anomalies in China large population which is also a lack of large cohort studies to explore these ECG risk factors, and lack of prediction of significant ECG abnormalities closely related to cardiovascular events in large cohort study. Thus, it is hard to objectively evaluate the heart health situation and the distribution in Chinese people; it is difficult to clarify the cause of these major risk factors for abnormal ECG, more difficult to clearly the predictive value of important ECG information on cardiovascular disease. Therefore, it cannot be achieved based on electrocardiogram information on cardiovascular and cerebrovascular diseases early prediction and personalized intervention. In this study, based on the " Multi-healthy center of Shandong longitudinal electrocardiographic monitoring large cohort (sample amounted to 30 million people)", by analysis of cohort baseline of ECG abnormalities distribution in northern Chinese population, in order to clarify the basic heart health situation of this population. Furthermore, establish the cohort (sub-cohort A) based on normal electrocardiogram population follow-up ECG abnormalities occurred (including major ECG abnormalities and ischemic ECG abnormalities), in order to clarify the risk factors of abnormal ECG; the total of cohort are 42,470 people, including 25,891 male,16,579 female. The shortest follow-up time was 1 year; the longest follow-up was 7 years. Baseline information including:age, gender, and other demographic information, smoking, drinking, blood lipids, glucose and blood biochemical biomarkers and many other indicators. Finally, established the sub-cohort B based on non-ischemic ECG abnormalities follow-up of ischemic ECG abnormalities occurring, in order to clarify the cause of ischemic ECG abnormalities important risk factor; a total of 4894 people in the cohort (male 3,561, female 1,333). The minimum follow-up period of cohort is 1 year, the longest follow-up of 7 years, with an average follow-up was 3.24±1.58 years, baseline information in addition to including the sub-cohort A variables, but also includes important non-ischemic ECG abnormalities information.ObjectivesElucidate abnormal electrocardiogram Chinese population distribution and its risk factors. Illuminate the predictive value nonischemic electrocardiogram of ischemic ECG abnormalities, build early prediction model of cardiovascular disease based on electrocardiogram information and implementation personalized early intervention and provide scientific basis.MethodsSubjects are from "Multi-healthy center of Shandong longitudinal ECG monitoring large cohort" which is established by Biostatistics, School of Public Health, Shandong University. The cohort integrates more than a dozen large health examination center, the current sample volume has reached nearly 100 million people (containing more than 800 million people, each person can provide nearly 20,000 information), the longest longitudinal observation has reached 9 years; covering different areas of Shandong, different economic levels of the urban population. It is a typical large longitudinal cohort study. Based on this large cohort, we choose the individuals who first underwent routine healthy check-up from 2004-2014 in multiple cities in Shandong Province. After exclusion of no complete ECG, there are 313,865 people enrolled, included 189,808 male and 124,057 female. The cohort data and information include:Questionnaire (basic information, personal history of the disease and smoking, drinking), physical examination (height, weight and blood pressure measurements), laboratory tests (blood routine, blood chemistry, lipids) and complete ECG screening.1. The prevalence of abnormal ECGs in this population:According to criteria, 313,865 individuals (male 189,808; female 124,057) were selected for the first time with a complete physical examination and electrocardiogram data, of which 219,456 individuals with normal ECG (male 134,404; female)85,052. Then, the remaining 94,409 with abnormal ECG (male 55,404; female 39,005) were analysis using Minnesota coding, the spectrum of prevalence of abnormal ECG, major abnormal ECG and ischemic ECG were further analyzed. The spectrum of abnormal ECG distribution was stratified analysis mainly by sex, age, analysis distribution characteristic of all types of abnormal ECG in various different genders and age. Age divided as follows:<20 years,20-24 years,25-29 years,30-34 years,35-39 years, 40-44 years,45-49 years,50-54 years,55-59 years,60-64 years,65-69 years,70-74 years,75-79 years and?80 years of age (young people?45 years, middle-aged 45-60 years old, the elderly> 60 years). The definition of various types of abnormal ECG as follows:abnormal ECG:An encoding Minnesota 1-9 in any one of the above; major ECG abnormalities:Pooling Project research; ischemic ECG abnormalities; appear MC-1, MC-4, MC-5 in any one of the above.2.The establish of cohort of spectrum of abnormal ECG:Based on the above the population database on the spectrum distribution of abnormal ECG, select all individuals has participated in at least 2 times examination between 2004--2014 to build the sample population cohort. The Construction of the following two sub-cohort:(1) Sub-cohort A:The sub-cohort aimed at observation of ECG abnormalities occurs from the normal electrocardiogram crowd, including abnormal ECG (Minnesota 9 coding class MC-1, MC-2,......, MC-9), and its derived major abnormal ECG (Definition and assignment in table 2) and ischemic ECG abnormalities (as defined and assigned in table 2), in order to clarify the risk factors for ECG abnormalities. The structure of cohort is as follows: ? baseline inclusion criteria: 313,865 baseline crowd with complete ECG information, enrolled individuals at least 2 times examination in 2004--2014 years with normal initial ECG into the cohort baseline, excluding coronary heart disease (including PCI and had coronary artery bypass surgery, diagnosed as myocardial ischemia, myocardial infarction, heart failure) ? Baseline information collection:demographic information (age, gender), habits information (smoking, drinking), biochemical markers information (lipids, blood glucose, liver function). These quantify methods of baseline variables shown in Table 1; ? Definition of outcome and follow-up:follow-up outcomes included abnormal ECG (Minnesota 9 coding class MC-1, MC-2,......, MC-9), and its derived mainly abnormal ECG and ischemic ECG abnormalities, which defines the specific assignment and quantitative methods are shown in Table 2.(2) Sub-cohort B:The purpose of sub-cohort is followed up risk factors for ischemic diseases, and identify whether the non-ischemic ECG abnormalities is the risk factors of ischemic ECG abnormalities closely associated with cardiovascular disease. The structure of cohort is as follows: ? baseline inclusion criteria:313,865 baseline crowd with complete ECG information, enrolled individuals at least 2 times examination in 2004-2014 years with non-ischemic initial ECG(MC 1; MC 4;MC 5) into the cohort baseline, excluding coronary heart disease (including PCI and had coronary artery bypass surgery, diagnosed as myocardial ischemia, myocardial infarction, heart failure).? Above baseline information covering all sub-cohort A baseline information (see Table 1) and non-ischemic ECG information (MC-2:QRS Axis Deviation>MC-3:High Amplitude R Waves?MC-6:A-V Conduction Defects MC-7 Ventricular Conduction Defect MC-8:Arrhythmias. MC-9:Miscellaneous Items)o The non-ischemic ECG information quantify methods of baseline variables shown in Table 3; ? outcome and follow-up assignment quantification method: follow-up to the outcome of ischemic ECG abnormalities (including all types of ischemic ECG abnormalities), quantitative methods are shown in Table 4.3. Statistical analysis:(1) population distribution abnormal ECG analysis spectral analysis: descriptive epidemiology method to analyze the distribution of ECG abnormalities of 9 categories in different genders and age groups (Q/QS wave abnormalities, QRS axis deviation, R-wave high voltage, ST junction (J) and ST segment depression, T wave abnormalities, atrioventricular conduction disorders, ventricular conduction disorders, arrhythmias and ST-segment elevation and other abnormalities); calculate all kinds of various abnormal electrocardiogram frequency; draw different types of sex under the age of various ECG the incidence of abnormal distribution curve; using percentile bar chart, pie chart to describe various sex and age of each ECG abnormalities constituted; incidence of abnormal electrocardiogram test using statistical difference between the groups independent chi-square test abnormalities among groups the rate of change with age trend using statistical tests chi-square test.(2) Cohort statistical Analysis:the statistical analysis of sub-cohort A and B include descriptive analysis and inferential analysis. ? When using human method to estimate the density of various follow-up of the outcome, and then using the K-M method to draw survival curve and statistical significance test to compare each group with the incidence of abnormal outcomes log-rank. ? Comparison of outcomes positive and negative outcomes and significant distribution differences baseline information. For numeric variable data (for example, BMI, etc.) using the t test were statistically significant; data for categorical variables (eg, gender, etc.) using the x test significant difference between the two groups.? The adjustment for age, sex univariate Cox regression model after screening baseline factors on outcomes was statistically associated with ?=0.05 significance level as screening variables.? above adjusted for age, sex univariate Cox regression model after the selected variables statistically significant further integrated multivariate Cox regression models, adjusting for potential confounders, statistical analysis of correlation between various factors and outcomes, using relative risk (RR) and 95% confidence interval associated with the expression of strength.4. Data analysis software:SAS9.0 were used for all of the above statistical analysis supply by Biostatistics, School of Public Health, Shandong University provides.Results1. The spectrum of abnormal ECG in this populationIn general, abnormal ECG (any one of 1 to 9 Minnesota coding), there is no significant difference between men and women mainly positive rate of abnormal. electrocardiogram (Pooling Project Research), while women with ischemic ECG abnormalities (appear MC-1, MC-4, MC-5 in any one or more) positive rate was significantly higher than men (?2=5698.6087, P,0.0001). ECG abnormalities, primarily abnormal ECG and ischemic ECG abnormalities total positive rates were 30.08%,3.97% and 14.06%, and the increasing trend with age.The most common abnormal ECG arrhythmia, accounting for 11.08%; followed by T wave abnormalities, accounting for 8.18%; again for the ST junction (J) and ST segment depression, accounting for 5.34%; other abnormal incidence were:R wave peak voltage 2.96%, ventricular conduction disorders 2.78%, ST segment elevation and other 2.62%, QRS axis deviation 1.47%,1.32% and atrioventricular conduction disturbances Q/QS waves 0.89%. Men most frequently occurring type of abnormal ECG were arrhythmia (12.14%), T wave abnormalities (6.58%) and R-wave high voltage (4.02%); and the most common type of women were abnormal ECG T-wave abnormalities (10.61%), arrhythmia (9.45%) and ST junction (J) and ST segment depression (9.02%).Population occurred major abnormal ECG rate of 3.97%, respectively 3.39% and 4.36% for men and women; the incidence of youth group, middle-aged and elderly groups were 1.78%,4.83% and 14.38%; incidence with age significantly increased.The occurrence of ischemic ECG population was 14.06%, respectively 10.27% and 19.85% of men and women; the incidence of ischemic ECG increases with age, 80 years of age the highest incidence of 39.02%.2. The occurrence density of different type of abnormal ECG occurred in normal ECG cohort and its influencing factorsThere are 42,470 people enrolled in cohort A, including 25,891 male, female 16,579 people; shortest follow-up time of 1 year, the longest follow-up was 7 years; total number of person-years of follow-up were 611,374 person-years, male 382,598 people years, female 228,776 person-yearsThe occurrence density (accumulation rate) of MC-1?MC-9 are various in this cohort. The first is arrhythmia (MC-8), the incidence density up to 57.4/thousand person years, second is T wave abnormalities (MC-5),41.58 cases/thousand person years; ST junction (J) and ST segment depression (MC-4),41.28 cases/thousand person years; other abnormalities (MC-9),16.04 cases/thousand person years; High Amplitude R Waves (MC-3),15.20 cases/thousand person years. These five categories described above are the most popular ECG abnormalities during follow-up.In normal ECG cohort, follow-up its occurrence density and change features of abnormal ECG:occurrence density of abnormal ECG 148.17/thousand person years, With the extended follow-up time, the abnormal ECG occurred level (K-M curve) are similar between men and women (Figure 1-L). Wherein the occurrence density of ischemic electrocardiographic abnormalities (any MC-1, MC-4, MC-5) is 79.27/thousand person years, the female's was significantly higher than male's (Figure 1-J) and this difference was extended rapidly as follow-up time increases, indicating myocardial ischemia high incidence among women. According Pooling Project study defined "major ECG abnormalities", its occurrence density only 5.69/ thousand person years, although there were lower in this cohort density, but density occurs in males than female and the extension of this difference with the follow-up time gradually increases (Figure 1-K). The research results illustrate our population during the development of abnormal ECG provides strong evidence.Gender distribution:ischemic ECG changes Q/QS waves (MC-1) the occurrence of density in men than female, and with prolonged follow-up, and the difference is more obvious. Two other types of ischemic electrocardiographic abnormalities --ST segment depression (MC-4) and T wave abnormalities (MC-5), the occurrence of density females were significantly higher than men, and with prolonged follow-up, this difference increases rapidly large (Figure 1-D and 1-E). The occurrence density of Ischemic ECG changes Q/QS waves (MC-1) is higher in male than female, and with prolonged follow-up, and the difference is more obvious. Two other types of ischemic electrocardiographic abnormalities--ST segment depression (MC-4) and T wave abnormalities (MC-5), the female's occurrence density were significantly higher than men, and with prolonged follow-up, this difference increases-rapidly large (Figure 1-D and 1-E). Non-ischemic electrocardiogram abnormal QRS axis deviation (MC-2) follow-up in men occurs density was significantly higher than the female, but the difference will be with extended follow-up time and more significantly, indicating that compared to women, men are more likely ventricular depolarization has changed direction and this change increases with the age difference between the sexes will become more apparent (Fig.1-B). Follow-up study also found that the occurrence density of High Amplitude R Waves (MC-3) is higher in males than females, and the differences with the extension of follow-up time of rapidly increasing (Fig.1-C). The atrioventricular conduction disorders (MC-6)'s occurrence density of Male and female populations share the similar level, indicating that the incidence of AV conduction disorders did not differ significantly (Figure 1-F) between the genders. Follow-up found that men ventricular conduction disorders (MC-7) occurred density was significantly higher than women, increasing with prolonged follow-up differences between men and women (Figure 1-J). Men arrhythmia (MC-8), and other abnormalities (MC-9) the occurrence of density are also slightly higher than women, with longer follow the same trend of the change, the difference between men and women is not significant (Fig.1-H and Figure 1-1), illustrate the impact of gender anomaly of this kind is not obvious.Multivariate Cox regression analysis revealed that the following factors are influencing factors (risk factors and protective factors) lead to the occurrence of abnormal ECG:1) Age is an independent risk factor of every abnormal ECG, their HR and 95%CI:Q and QS Patterns (MC-1) 1.07 (1.05,1.08); QRS Axis Deviation (MC-2) 1.03(1.02,1.03); High Amplitude R Waves (MC-3) 1.02(1.01,1.02); ST Junction (J) and Segment Depression (MC-4) 1.04(1.04,1.05); T-Wave Items (MC-5) 1.02(1.02,1.03); A-V Conduction Defect (MC-6) 1.03(1.02,1.03); Ventricular Conduction Defect (MC-7) 1.02(1.01,1.03); Arrhythmias (MC-8) 1.02(1.02,1.02). Miscellaneous Items (MC-9) 1.04(1.03,1.04), ischemic ECG abnormalities 1.03(1.03, 1.03), major abnormal (MA) 1.05(1.04,1.06), abnormal ECG 1.02(1.02,1.02)?2) Gender is the risk factor of QRS Axis Deviation(MC-2), High Amplitude R Waves (MC-3)?Ventricular Conduction Defect (MC-7)?Arrhythmias (MC-8) and major abnormal, their HR and 95%CI:2.03(1.57,2.62); 4.36(3.40,5.57); 1.80(1.41,2.32); 1.51(1.36,1.68); 1.11(0.86,1.44). Probable cause is that the protective effect of estrogen; low female smoking rate.3) Systolic pressure is the risk factor of Q and QS Patterns (MC-1), High Amplitude R Waves (MC-3), ST Junction (J) and Segment Depression (MC-4), Arrhythmias (MC-8)?ischemic ECG abnormalities?major abnormal (MA) and abnormal ECG. Diastolic pressure is the risk factor of T-Wave Items (MC-5)? Arrhythmias (MC-8)?ischemic ECG abnormalities. Hypertension effect on many types of abnormal electrocardiogram (risk factors), but there are some differences in HR and 95%CI:Q and QS Patterns (MC-1) 1.85(1.34,2.54), High Amplitude R Waves (MC-3) 1.41 (1.22,1.62), T-Wave Items (MC-5) 1.55 (1.42,1.71), ischemic ECG abnormalities 1.44(1.35,1.54), major abnormal (MA) 1.58(1.25,2.00), abnormal ECG 1.13 (1.08,1.18).4) Fasting blood-glucose is the risk factor of Segment Depression (MC-4), ischemic ECG abnormalities and major abnormal (MA), their HR and 95%CI are 1.04(1.01,1.07),1.02(1.00,1.05) and 1.04(0.97,1.12). Diabetes is the risk factor of Segment Depression (MC-4), HR and 95%CI is 1.26(1.00,1.59).5) In addition, our study also found that:HCT (hematokrit) is the risk factor of Q and QS Patterns (MC-1); TBil(total bilirubin) is the risk factor of QRS Axis Deviation" (MC-2); serum creatinine, albumin and globulin are the risk factor of ST Junction (J) and Segment Depression (MC-4); urea nitrogen and drink are the risk factor of T-Wave Items (MC-5); glutamic-pyruvic transaminase is the risk factor of Ventricular Conduction Defect (MC-7); BMI is the protect factor of muti-abnormal ECG, But the role of these factors in the pathophysiology is still difficult to explain.3. The occurrence density of ischemic ECG abnormalities occurred in non-ischemic ECG cohort and its influencing factors:At baseline among Cohort B were included 45,546 people (28,162 male, female 17,384), of which normal electrocardiogram 35,195 people, non-ischemic ECG abnormalities 10,351 people. In this cohort, the shortest follow-up time of 1 year, the longest follow-up of 7 years, and the total number of person-years of follow-up of 98,645 person-years.(1) The occurrence density of ischemic ECG abnormalities occurred in normal and non-ischemic ECG cohort and its influencing factorsIn general, the occurrence density of ischemic ECG abnormalities is 79.27 cases /thousand person years in normal ECG group,72.11 cases/thousand person years in non-ischemic group, there are no statistic significant difference (P=0.147). After stratification by gender:1) in the male group, there is statistically different (P=0.006) between normal group (57.18 cases/thousand person years) and the non-ischemic ECG group (59.67 cases/thousand person years), but the difference is very small, two KM curve has little difference (Fig.2-A).2) in the female group, there is no statistically significant difference between them (P=0.961), respectively,112.63 cases/thousand person years,108.54 cases/thousand person years, two K-M consistent trend curve (Fig.2-B).3) It is noteworthy that, whether it is a normal ECG group or non-ischemic abnormal ECG group, women has a higher density of ischemic abnormal in the cohort follow-up than male group.There is no significant difference of occurrence density of ischemic ECG abnormalities in Normal group and non-ischemic ECG group, but multivariate Cox regression analysis revealed the relationship of certain non-ischemic ECG abnormalities and ischemic ECG abnormalities, in the sub-cohort B, the occurrence of ischemic ECG abnormalities associated with several risk factors are as follows:1) non-ischemic abnormal High Amplitude R Waves (MC-3) is a risk factor for ischemic ECG abnormalities, its HR and 95%CI is 1.25(1.06,1.47). High Amplitude R Waves usually caused by chronic high pressure in patients with hypertension. The catecholamines and angiotensin ? stimulate the myocardial hypertrophy and interstitial fibrosis, left ventricular electrode increased. It is a sign of target organ damage in patients with hypertension, who are often combined coronary atherosclerosis and microvascular lesions, which are the basis of ischemic electrocardiographic abnormalities.2) Age is a risk factor for ischemic ECG abnormalities, its HR and 95%CI is 1.02(1.02,1.03). With the increase in the age of cell lipid aggregates obvious form more foam cells, smooth muscle cell migration and proliferation of extracellular matrix will affect the size of the lumen of the coronary artery, causing myocardial ischemic changes.3) Systolic blood pressure, diastolic blood pressure, and hypertension in this study were identified as risk factors for ischemic electrocardiographic abnormalities occur, their HR and 95%CI are 1.00 (1.00,1.01)?1.01 (1.01,1.01)?1.41(1.30,1.51). Blood pressure increased left ventricular myocardial pressure, cause myocardial hypertrophy, which will increase the demand for blood supply, blood pressure and coronary artery wall pressure increase will accelerate the development of coronary atherosclerosis, so reducing blood supply, which will increase the likelihood of myocardial ischemia.4) Whether fasting glucose or diabetes are risk factors for ischemic ECG abnormalities, their HR and 95%CI are 1.04(1.01,1.07)?1.22 (1.08,1.37). Hyperglycemia and insulin resistance would undermine the normal arterial function, such as, diabetes can damage the vascular endothelial dilatation function and reduce the biological activity of nitric oxide, resulting in endothelial vasodilatory and anti-inflammatory function decline, unable to maintain a stable environment within the blood vessel, easily It appears intravascular thrombosis, leading to myocardial ischemia.5) In addition, our study found that white blood cell count is abnormal ECG ischemic risk factors, its HR and 95%CI is 1.03(1.01,1.05). Inflammation throughout the various stages of arterial thrombosis, is a key pathophysiological mechanism of plaque formation and rupture, in the early plaque formation occurs by endothelial cells mediated leukocyte aggregation, plaque progression and thromboembolic complications occur frequently accompanied by local and systemic inflammation, white blood cells and therefore can be used as ischemic ECG abnormalities risk factors?6) Gender and ischemic ECG abnormalities have also occurred relevance, male is the protective factor of ischemic abnormalities, possibly because women are more prone to high blood pressure, ST-T changes neurosis associated type. In addition, the study found that creatinine, BMI, total bilirubin and hematocrit and ischemic electrocardiographic abnormalities also statistically relevant, but it is still difficult to give a reasonable explanation.(2) The occurrence density of ischemic ECG abnormalities occurred in non-ischemic ECG cohort and its influencing factorsIn non-ischemic ECG cohort, our follow-up study found that the occurrence of a density of the overall ischemic ECG abnormalities (any MC-1, MC-4 and MC-5) is 79.27 cases/thousands person of years, but the the occurrence density of T wave abnormalities (MC-5) (39.55 cases/thousands person of years) and ST segment depression (MC-4) (32.08 cases/thousands person of years) was significantly higher than Q/QS wave (MC-1) (7.05 cases/thousands person of years). The Results of this study provide strong evidence to understand China's population of ischemic ECG abnormalities occurred level.On gender distribution, the occurrence density of the overall ischemic ECG abnormalities in female (108.54 cases/thousands person of years) is much higher than male (59.67 cases/thousands person of years). However, female's occurrence density of T wave abnormalities (MC-5) (35.99 cases/thousands person of years) and ST segment depression (MC-4) (20.70 cases/thousands person of years) were lower than that of female (50.07 cases/thousand years and 65.86 cases/thousands person of years). Male's occurrence density of Q and QS pattern (MC-1) (7.90 cases/ thousands person of years s) is higher than female's (4.30 cases/thousands person of years). The possible reason for this gender differences is due to the lack of estrogen protection, male are more prone to get severe ischemic heart disease than female, such as acute myocardial infarction, etc. (This is the Q/QS waves mainly cause), while female got more non-specific ST-T changes, leading to follow-up these two types of abnormal high.In non-ischemic ECG cohort, the multivariate Cox regression analysis revealed that the following factors are influencing factors (risk factors and protective factors) ischemic ECG abnormalities occurred:1) non-ischemic abnormal High Amplitude R Waves (MC-3) is a risk factor for ischemic ECG abnormalities, T wave abnormalities (MC-5) and ST segment depression (MC-4) its HR and 95%CI are 1.47 (1.26,1.72)?1.35(1.05,1.73) and 1.67(1.25,2.24) separately. The R-wave high voltage common in patients with hypertension, in long-term pressure overload, such patients are often combined coronary atherosclerosis and micro-vascular disease, vascular disease can lead to such varying degrees of stable sub-endocardial ischemia, such as myocardial ischemia often presents ST segment depression and T wave abnormalities.2) Age is also a risk factor for all types of ischemic ECG abnormalities (ischemic ECG abnormalities, Q/QS waves, ST segment depression and T wave abnormalities for each additional 1 year of age, their risk increased by approximately 3%, respectively,5%,4% and 2%). This shows that, with increasing age, the incidence of myocardial ischemia increases, also confirmed the pathophysiological changes with age, increasing coronary artery lipid deposition occurs, the blood vessel wall, thickening, decreased elasticity, these It can cause changes in the lumen of the coronary artery, causing myocardial ischemia occurs.3) Diastolic blood pressure is the risk factors of total ischemic abnormalities and T wave abnormalities (MC-5), its HR and 95% CI were 1.01 (1.00,1.01) and 1.01 (1.00,1.03), and hypertension is all kinds of risk factors of ischemic abnormalities, the HR and 95% CI were:ischemic abnormalities:1.32 (1.16,1.49), Q/QS waves (MC-1):1.48 (1.03,2.14), ST segment depression (MC-4):1.38 (1.12,1.70), T wave abnormalities (MC-5):1.41 (1.14,1.74). Effect of blood pressure on the cardiovascular system of the above, indicating whether it is a normal ECG or non-ischemic electrocardiogram population groups, the impact of hypertension on the cardiovascular system are enormous.4) In addition, it was observed in the present study, gender, red blood cell count, hematocrit, ventricular conduction disorders (MC-7) and BMI... |
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