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Electrocardiographic amplitudes: a new risk factor for sudden death in hypertrophic cardiomyopathy.
Gothenburg University, Division of Paediatrics, Department of Clinical Sciences, Sahlgrenska Academy.
Sunderby Hospital, Luleå, Department of Internal Medicine.
Linköping University, Department of Clinical Physiology/CVM, Faculty of Health Science.
Gothenburg University, Division of Paediatrics, Department of Clinical Sciences, Sahlgrenska Academy.
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2010 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 31, no 4, 439-449 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Oxford University Press, 2010. Vol. 31, no 4, 439-449 p.
Keyword [en]
Hypertrophic cardiomyopathy, Sudden death, Electrocardiogram, Screening, Athletes, Gender
National Category
Nursing Cardiac and Cardiovascular Systems
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-4369DOI: 10.1093/eurheartj/ehp443PubMedID: 19897498OAI: oai:DiVA.org:hv-4369DiVA: diva2:533035
Available from: 2012-06-12 Created: 2012-06-12 Last updated: 2015-02-03Bibliographically approved

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