Limits...
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.

Show MeSH

Related in: MedlinePlus

The ECG of a 25 year-old female with hypertrophic cardiomyopathy, who suffered a cardiac arrest while rushing to catch a train but was successfully rescuscitated. Echocardiographically she has moderate hypertrophy with septal thickness 2.5 cm, posterior left ventricular wall 0.8 cm, and maximal wall thickness of 2.6 cm on short-axis and apical views, and there is no dynamic left ventricular outflow tract obstruction, nevertheless there are extensive ST-T-wave abnormalities. Her values on important ECG-measures on her first ECG were: limb-lead amplitude sum = 10.9 mV; limb-lead amplitude–duration product = 0.89 mV s; 12-lead amplitude–duration product = 2.29 mV s; risk score = 8 points; all above high-risk cut-offs. Sokolow–Lyon index on the other hand is normal, 3.8 mV.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2821628&req=5

EHP443F2: The ECG of a 25 year-old female with hypertrophic cardiomyopathy, who suffered a cardiac arrest while rushing to catch a train but was successfully rescuscitated. Echocardiographically she has moderate hypertrophy with septal thickness 2.5 cm, posterior left ventricular wall 0.8 cm, and maximal wall thickness of 2.6 cm on short-axis and apical views, and there is no dynamic left ventricular outflow tract obstruction, nevertheless there are extensive ST-T-wave abnormalities. Her values on important ECG-measures on her first ECG were: limb-lead amplitude sum = 10.9 mV; limb-lead amplitude–duration product = 0.89 mV s; 12-lead amplitude–duration product = 2.29 mV s; risk score = 8 points; all above high-risk cut-offs. Sokolow–Lyon index on the other hand is normal, 3.8 mV.

Mentions: Supplementary material online, Table S2 shows the relative frequency of abnormalities in ECG morphology. The HCM-CA group shows a significantly increased occurrence of pathological T-wave inversion in any lead (P = 0.0003), precordial T-wave inversion (P < 0.0001), ST-depression (P = 0.0010), and a dominant S-wave in V4 (P = 0.0048) compared with the Gothenburg HCM-cohort. QRS-axis deviation is possibly increased (P = 0.05). On the other hand, the frequency of bundle-branch block, pathological Q-waves, or giant negative or giant positive T-waves were not significantly different between the groups. Figure 2 illustrates the repolarization abnormalities often present in young HCM-patients with cardiac arrest.


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 ECG of a 25 year-old female with hypertrophic cardiomyopathy, who suffered a cardiac arrest while rushing to catch a train but was successfully rescuscitated. Echocardiographically she has moderate hypertrophy with septal thickness 2.5 cm, posterior left ventricular wall 0.8 cm, and maximal wall thickness of 2.6 cm on short-axis and apical views, and there is no dynamic left ventricular outflow tract obstruction, nevertheless there are extensive ST-T-wave abnormalities. Her values on important ECG-measures on her first ECG were: limb-lead amplitude sum = 10.9 mV; limb-lead amplitude–duration product = 0.89 mV s; 12-lead amplitude–duration product = 2.29 mV s; risk score = 8 points; all above high-risk cut-offs. Sokolow–Lyon index on the other hand is normal, 3.8 mV.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

EHP443F2: The ECG of a 25 year-old female with hypertrophic cardiomyopathy, who suffered a cardiac arrest while rushing to catch a train but was successfully rescuscitated. Echocardiographically she has moderate hypertrophy with septal thickness 2.5 cm, posterior left ventricular wall 0.8 cm, and maximal wall thickness of 2.6 cm on short-axis and apical views, and there is no dynamic left ventricular outflow tract obstruction, nevertheless there are extensive ST-T-wave abnormalities. Her values on important ECG-measures on her first ECG were: limb-lead amplitude sum = 10.9 mV; limb-lead amplitude–duration product = 0.89 mV s; 12-lead amplitude–duration product = 2.29 mV s; risk score = 8 points; all above high-risk cut-offs. Sokolow–Lyon index on the other hand is normal, 3.8 mV.
Mentions: Supplementary material online, Table S2 shows the relative frequency of abnormalities in ECG morphology. The HCM-CA group shows a significantly increased occurrence of pathological T-wave inversion in any lead (P = 0.0003), precordial T-wave inversion (P < 0.0001), ST-depression (P = 0.0010), and a dominant S-wave in V4 (P = 0.0048) compared with the Gothenburg HCM-cohort. QRS-axis deviation is possibly increased (P = 0.05). On the other hand, the frequency of bundle-branch block, pathological Q-waves, or giant negative or giant positive T-waves were not significantly different between the groups. Figure 2 illustrates the repolarization abnormalities often present in young HCM-patients with cardiac arrest.

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