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Electrocardiographic amplitudes: a new risk factor for sudden death in hypertrophic cardiomyopathy
Gothenburg University.
Sunderby Hospital.
Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
Gothenburg University.
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2010 (English)In: EUROPEAN HEART JOURNAL, ISSN 0195-668X, Vol. 31, no 4, 439-449 p.Article in journal (Refereed) Published
Abstract [en]

Assessment of ECG-features as predictors of sudden death in adults with hypertrophic cardiomyopathy (HCM). 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 andgt;= 7.7 mV (odds ratio 18.8, sensitivity 87%, negative predictive value (NPV) 94%, P andlt; 0.0001), 12-lead amplitude-duration product andgt;= 2.2 mV s (odds ratio 31.0, sensitivity 92%, NPV 97%, P andlt; 0.0001), and limb-lead amplitude-duration product andgt;= 0.70 mV s (odds ratio 31.5, sensitivity 93%, NPV 96%, P andlt; 0.0001). Sensitivity in HCM-patients andlt; 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 andgt;= 6 gives a sensitivity of 85% but a higher positive predictive value than above measures. Optimal separation between HCM-CA andlt; 40 years and athletes is obtained by a risk score andgt;= 6 (odds ratio 345, sensitivity 85%, specificity 100%, P andlt; 0.0001). Twelve-lead ECG is a powerful instrument for risk-stratification in HCM.

Place, publisher, year, edition, pages
2010. Vol. 31, no 4, 439-449 p.
Keyword [en]
Hypertrophic cardiomyopathy, Sudden death, Electrocardiogram, Screening, Athletes, Gender
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54261DOI: 10.1093/eurheartj/ehp443ISI: 000274787100012OAI: oai:DiVA.org:liu-54261DiVA: diva2:302284
Available from: 2010-03-05 Created: 2010-03-05 Last updated: 2010-03-05

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Nylander, Eva

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Clinical Physiology Faculty of Health SciencesDepartment of Clinical Physiology
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