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Electrocardiographic amplitudes: a new risk factor for sudden death in hypertrophic cardiomyopathy.

Ostman-Smith I, Wisten A, Nylander E, Bratt EL, Granelli Ad, Oulhaj A, Ljungström E - Eur. Heart J. (2009)

Bottom Line: A risk score is proposed; a score >or=6 gives a sensitivity of 85% but a higher positive predictive value than above measures.Optimal separation between HCM-CA <40 years and athletes is obtained by a risk score >or=6 (odds ratio 345, sensitivity 85%, specificity 100%, P < 0.0001).Twelve-lead ECG is a powerful instrument for risk-stratification in HCM.

View Article: PubMed Central - PubMed

Affiliation: Division of Paediatrics, Department of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Queen Silvia Childreńs Hospital, SE-416 85 Gothenburg, Sweden. ingegerd.ostman-smith@pediat.gu.se

ABSTRACT

Aims: Assessment of ECG-features as predictors of sudden death in adults with hypertrophic cardiomyopathy (HCM).

Methods and results: ECG-amplitude sums were measured in 44 normals, 34 athletes, a hospital-cohort of 87 HCM-patients, and 29 HCM-patients with sudden death or cardiac arrest (HCM-CA). HCM-patients with sudden death or cardiac arrest had substantially higher ECG-amplitudes than the HCM-cohort for limb-lead and 12-lead QRS-amplitude sums, and amplitude-duration products (P = 0.00003-P = 0.000002). Separation of HCM-CA from the HCM-cohort is obtained by limb-lead QRS-amplitude sum >or=7.7 mV (odds ratio 18.8, sensitivity 87%, negative predictive value (NPV) 94%, P < 0.0001), 12-lead amplitude-duration product >or=2.2 mV s (odds ratio 31.0, sensitivity 92%, NPV 97%, P < 0.0001), and limb-lead amplitude-duration product >or=0.70 mV s (odds ratio 31.5, sensitivity 93%, NPV 96%, P < 0.0001). Sensitivity in HCM-patients <40 years is 90, 100, and 100% for those ECG-variables, respectively. Qualitative analysis showed correlation with cardiac arrest for pathological T-wave-inversion (P = 0.0003), ST-depression (P = 0.0010), and dominant S-wave in V(4) (P = 0.0048). A risk score is proposed; a score >or=6 gives a sensitivity of 85% but a higher positive predictive value than above measures. Optimal separation between HCM-CA <40 years and athletes is obtained by a risk score >or=6 (odds ratio 345, sensitivity 85%, specificity 100%, P < 0.0001).

Conclusion: Twelve-lead ECG is a powerful instrument for risk-stratification in HCM.

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Related in: MedlinePlus

The values of different ECG-measures are represented as staple diagrams, with the 95% CI for the mean given as a bracket. F and M indicates female vs. male values, white columns are normals, light grey athletes, medium grey the Gothenburg hypertrophic cardiomyopathy cohort, and dark grey values from the hypertrophic cardiomyopathy patients that had suffered a cardiac arrest. (A) LL QRS, Limb-lead QRS-amplitude sums, SOKLY, Sokolow–Lyon index; ChL QRS, 6 chest-lead QRS-amplitude sums; 12-L, 12-lead QRS-amplitude sums. (B) QRS-dur., QRS-duration; QTc, corrected QT-interval; LL-prod., limb-lead amplitude–duration product; 12-L prod., 12-lead amplitude–duration product.
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EHP443F1: The values of different ECG-measures are represented as staple diagrams, with the 95% CI for the mean given as a bracket. F and M indicates female vs. male values, white columns are normals, light grey athletes, medium grey the Gothenburg hypertrophic cardiomyopathy cohort, and dark grey values from the hypertrophic cardiomyopathy patients that had suffered a cardiac arrest. (A) LL QRS, Limb-lead QRS-amplitude sums, SOKLY, Sokolow–Lyon index; ChL QRS, 6 chest-lead QRS-amplitude sums; 12-L, 12-lead QRS-amplitude sums. (B) QRS-dur., QRS-duration; QTc, corrected QT-interval; LL-prod., limb-lead amplitude–duration product; 12-L prod., 12-lead amplitude–duration product.

Mentions: The results in all comparative groups are illustrated as mean±95% CI in Figure 1A and B in order to facilitate cross-comparisons between groups (the complete summary statistics are given in Supplementary material online, Table S1).


Electrocardiographic amplitudes: a new risk factor for sudden death in hypertrophic cardiomyopathy.

Ostman-Smith I, Wisten A, Nylander E, Bratt EL, Granelli Ad, Oulhaj A, Ljungström E - Eur. Heart J. (2009)

The values of different ECG-measures are represented as staple diagrams, with the 95% CI for the mean given as a bracket. F and M indicates female vs. male values, white columns are normals, light grey athletes, medium grey the Gothenburg hypertrophic cardiomyopathy cohort, and dark grey values from the hypertrophic cardiomyopathy patients that had suffered a cardiac arrest. (A) LL QRS, Limb-lead QRS-amplitude sums, SOKLY, Sokolow–Lyon index; ChL QRS, 6 chest-lead QRS-amplitude sums; 12-L, 12-lead QRS-amplitude sums. (B) QRS-dur., QRS-duration; QTc, corrected QT-interval; LL-prod., limb-lead amplitude–duration product; 12-L prod., 12-lead amplitude–duration product.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2821628&req=5

EHP443F1: The values of different ECG-measures are represented as staple diagrams, with the 95% CI for the mean given as a bracket. F and M indicates female vs. male values, white columns are normals, light grey athletes, medium grey the Gothenburg hypertrophic cardiomyopathy cohort, and dark grey values from the hypertrophic cardiomyopathy patients that had suffered a cardiac arrest. (A) LL QRS, Limb-lead QRS-amplitude sums, SOKLY, Sokolow–Lyon index; ChL QRS, 6 chest-lead QRS-amplitude sums; 12-L, 12-lead QRS-amplitude sums. (B) QRS-dur., QRS-duration; QTc, corrected QT-interval; LL-prod., limb-lead amplitude–duration product; 12-L prod., 12-lead amplitude–duration product.
Mentions: The results in all comparative groups are illustrated as mean±95% CI in Figure 1A and B in order to facilitate cross-comparisons between groups (the complete summary statistics are given in Supplementary material online, Table S1).

Bottom Line: A risk score is proposed; a score >or=6 gives a sensitivity of 85% but a higher positive predictive value than above measures.Optimal separation between HCM-CA <40 years and athletes is obtained by a risk score >or=6 (odds ratio 345, sensitivity 85%, specificity 100%, P < 0.0001).Twelve-lead ECG is a powerful instrument for risk-stratification in HCM.

View Article: PubMed Central - PubMed

Affiliation: Division of Paediatrics, Department of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Queen Silvia Childreńs Hospital, SE-416 85 Gothenburg, Sweden. ingegerd.ostman-smith@pediat.gu.se

ABSTRACT

Aims: Assessment of ECG-features as predictors of sudden death in adults with hypertrophic cardiomyopathy (HCM).

Methods and results: ECG-amplitude sums were measured in 44 normals, 34 athletes, a hospital-cohort of 87 HCM-patients, and 29 HCM-patients with sudden death or cardiac arrest (HCM-CA). HCM-patients with sudden death or cardiac arrest had substantially higher ECG-amplitudes than the HCM-cohort for limb-lead and 12-lead QRS-amplitude sums, and amplitude-duration products (P = 0.00003-P = 0.000002). Separation of HCM-CA from the HCM-cohort is obtained by limb-lead QRS-amplitude sum >or=7.7 mV (odds ratio 18.8, sensitivity 87%, negative predictive value (NPV) 94%, P < 0.0001), 12-lead amplitude-duration product >or=2.2 mV s (odds ratio 31.0, sensitivity 92%, NPV 97%, P < 0.0001), and limb-lead amplitude-duration product >or=0.70 mV s (odds ratio 31.5, sensitivity 93%, NPV 96%, P < 0.0001). Sensitivity in HCM-patients <40 years is 90, 100, and 100% for those ECG-variables, respectively. Qualitative analysis showed correlation with cardiac arrest for pathological T-wave-inversion (P = 0.0003), ST-depression (P = 0.0010), and dominant S-wave in V(4) (P = 0.0048). A risk score is proposed; a score >or=6 gives a sensitivity of 85% but a higher positive predictive value than above measures. Optimal separation between HCM-CA <40 years and athletes is obtained by a risk score >or=6 (odds ratio 345, sensitivity 85%, specificity 100%, P < 0.0001).

Conclusion: Twelve-lead ECG is a powerful instrument for risk-stratification in HCM.

Show MeSH
Related in: MedlinePlus