Abstract: Objective To observe ten-year prognosis of patients with latent Keshan disease (KD) and to determine its associated risk factors. Methods A total of 448 patients with newly diagnosed latent KD were monitored and followed up for 10 years. Their ECG abnormalities were classified as major or minor using the Minnesota Code. COX proportional hazards regression models were established to identify risk factors associated with the development of chronic KD. Results A final sample of 414 cases was included in analyses, with an average of (112.9±17.5) months of follow-up. At the end of follow-up, 92 (22.2%) patients developed chronic KD. Older age (>15 years), male, family history of KD, smoking, lower level of blood selenium (r=0.719, P<0.01) between GPx activity and blood selenium concentration was found. Conclusion Major ECG abnormalities, BMI, selenium deficiency, hypertension and VPC abnormalities are associated with the development of chronic KD. 