November 5, 2009Open Access

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

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Hypertrophic cardiomyopathy (HCM) (n=194). Intervention: ECG-amplitude sums and amplitude-duration products vs. HCM-cohort without sudden death/cardiac arrest, normal controls, and athletes. Primary outcome: Sudden death or cardiac arrest (OR 31.5, p=<0.0001).

Resultado clave

Limb-lead amplitude-duration product ≥0.70 mV s strongly separated hypertrophic cardiomyopathy patients with sudden death or cardiac arrest from the general HCM cohort (OR 31.5; P<0.0001).

Diseño del estudio

Tipo

Case-Control (n=194)

PICO estructurado

Does 12-lead ECG amplitude assessment predict sudden death or cardiac arrest in patients with hypertrophic cardiomyopathy?

Población

194 subjects including 44 normals, 34 athletes, 87 hospital-cohort hypertrophic cardiomyopathy (HCM) patients, and 29 HCM patients with sudden death or cardiac arrest (HCM-CA).

Intervención

12-lead ECG assessment of amplitude sums and amplitude-duration products

Comparador

Comparison between HCM patients with sudden death/cardiac arrest, uncomplicated HCM patients, athletes, and normal controls

Resultado

Sudden death or cardiac arresthard clinical

Twelve-lead ECG amplitude sums and amplitude-duration products are strong predictors of sudden death or cardiac arrest in patients with hypertrophic cardiomyopathy.

Resultado numérico

Estimación del efecto: OR 31.5

valor p: p=<0.0001

Resumen

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 or=2.2 mV s (odds ratio 31.0, sensitivity 92%, NPV 97%, P or=0.70 mV s (odds ratio 31.5, sensitivity 93%, NPV 96%, P or=6 gives a sensitivity of 85% but a higher positive predictive value than above measures. Optimal separation between HCM-CA 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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Cite This Study

Östman‐Smith et al. (Thu,) conducted a case-control in Hypertrophic cardiomyopathy (HCM) (n=194). ECG-amplitude sums and amplitude-duration products vs. HCM-cohort without sudden death/cardiac arrest, normal controls, and athletes was evaluated on Sudden death or cardiac arrest (OR 31.5, p=<0.0001). Limb-lead amplitude-duration product ≥0.70 mV s strongly separated hypertrophic cardiomyopathy patients with sudden death or cardiac arrest from the general HCM cohort (OR 31.5; P<0.0001).

synapsesocial.com/papers/6a0f9ddb4fb650da4ffe50b2 https://doi.org/https://doi.org/10.1093/eurheartj/ehp443

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