TY - JOUR
T1 - Electrocardiographic amplitudes
T2 - A new risk factor for sudden death in hypertrophic cardiomyopathy
AU - Östman-Smith, Ingegerd
AU - Wisten, Aase
AU - Nylander, Eva
AU - Bratt, Ewa Lena
AU - Granelli, Anne De Wahl
AU - Oulhaj, Abderrahim
AU - Ljungström, Erik
N1 - Funding Information:
The authors express their thanks to Howard Wong-Toi for pointing out some subtle errors in an earlier formulation of CHMs and for very interesting discussions about control of hybrid systems. This research was supported in part by the National Science Foundation under grant ECS-9315344 and NASA under grant NAG2-1043 and in part by the Technion Fund for Promotion of Research. The work by the first author was completed while he was a Senior NRC Research Associate at NASA Ames Research Center, Moffett Field, CA 94035.
PY - 2010/2
Y1 - 2010/2
N2 - AimsAssessment of ECG-features as predictors of sudden death in adults with hypertrophic cardiomyopathy (HCM).Methods and resultsECG-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 ≥7.7 mV (odds ratio 18.8, sensitivity 87, negative predictive value (NPV) 94, P < 0.0001), 12-lead amplitude-duration product ≥2.2 mV s (odds ratio 31.0, sensitivity 92, NPV 97, P < 0.0001), and limb-lead amplitude-duration product ≥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 V4 (P = 0.0048). A risk score is proposed; a score ≥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 ≥6 (odds ratio 345, sensitivity 85, specificity 100, P < 0.0001).ConclusionTwelve-lead ECG is a powerful instrument for risk-stratification in HCM.
AB - AimsAssessment of ECG-features as predictors of sudden death in adults with hypertrophic cardiomyopathy (HCM).Methods and resultsECG-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 ≥7.7 mV (odds ratio 18.8, sensitivity 87, negative predictive value (NPV) 94, P < 0.0001), 12-lead amplitude-duration product ≥2.2 mV s (odds ratio 31.0, sensitivity 92, NPV 97, P < 0.0001), and limb-lead amplitude-duration product ≥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 V4 (P = 0.0048). A risk score is proposed; a score ≥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 ≥6 (odds ratio 345, sensitivity 85, specificity 100, P < 0.0001).ConclusionTwelve-lead ECG is a powerful instrument for risk-stratification in HCM.
KW - Athletes
KW - Electrocardiogram
KW - Gender
KW - Hypertrophic cardiomyopathy
KW - Screening
KW - Sudden death
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U2 - 10.1093/eurheartj/ehp443
DO - 10.1093/eurheartj/ehp443
M3 - Article
C2 - 19897498
AN - SCOPUS:77249144813
SN - 0195-668X
VL - 31
SP - 439
EP - 449
JO - European Heart Journal
JF - European Heart Journal
IS - 4
ER -