Abstract
ObjectiveThis 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.MethodsFour 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.ResultsIn 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).ConclusionsMajor 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.
Highlights
Keshan disease (KD) is an endemic cardiomyopathy with unknown etiology that was first found in Keshan County, Heilongjiang Province, China, during winter in 1935, when a violent and tragic outbreak that resembled a plague[1] occurred
KD has been proven to be closely associated with selenium deficiency,[21,22] which is associated with decreased activities of selenium-dependent antioxidant enzymes such as glutathione peroxidase (GPx)
Selenium deficiency was shown to be correlated with a decrease in GPx activity and was associated with the progression of latent KD to chronic KD (HR 0.95, 95% confidence intervals (CIs) 0.94–0.96)
Summary
Keshan disease (KD) is an endemic cardiomyopathy with unknown etiology that was first found in Keshan County, Heilongjiang Province, China, during winter in 1935, when a violent and tragic outbreak that resembled a plague[1] occurred. KD patients are divided into four categories on the basis of the onset of attack, clinical features, and heart function.[4,5,6] These categories are acute, subacute, chronic, and latent. Few cases of acute or subacute KD have been reported in recent years, and chronic and latent KD patients are mainly found in KD endemic areas.[7] Chronic KD is characterized by severe cardiomyopathy, which is usually manifested by congestive heart failure and varying degrees of pathological changes. The identification of latent KD cases, Long-term Prognostic of Latent Keshan Disease which have a high risk of developing into chronic KD, is crucial
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