Increased QRS duration in HCM patients is significantly associated with higher SCD risk scores, ICD implantation, ICD therapy for VAs, and hospitalization for AF or HF.
Is QRS duration associated with sudden cardiac death risk scores and clinical outcomes in patients with hypertrophic cardiomyopathy?
Increased QRS duration is a simple ECG marker that correlates with higher sudden cardiac death risk scores and adverse clinical events in patients with hypertrophic cardiomyopathy.
Absolute Event Rate: 0% vs 0%
Abstract Background Identifying high-risk patients with hypertrophic cardiomyopathy (HCM) is crucial, as an implantable cardioverter defibrillator (ICD) can effectively prevent life-threatening ventricular arrhythmias (VAs) and sudden cardiac death (SCD). 2014 ESC guidelines recommend the use of HCM Risk-SCD score for the risk stratification of patients with HCM. However, the role of the electrocardiogram (ECG) in assessing risk is not as well established. Purpose We investigated the association between the duration of the QRS complex (QRS) and the HCM Risk-SCD score, hospitalization for atrial fibrillation (AF) or heart failure (HF), implantation of an ICD, and ICD therapy for VAs. Methods Patients with a history of HCM, documented by echocardiography, were studied. The 12-lead ECG and echocardiography were performed on the same day. On ECG, we evaluated the QRS duration in milliseconds. A careful personal and family history for unexplained syncope and sudden cardiac death was obtained, respectively. The presence of non-sustained ventricular tachycardia and ICD therapy were assessed either with 48h ECG recording or ICD interrogation. 5-year risk score for SCD was calculated by the corresponding ESC online calculator. Statistical analysis was performed using the SPSS software. Results Forty-six patients with HCM were included (mean age 50±11 years, 78% male). According to the HCM Risk-SCD score, HCM patients were divided into two groups: low to intermediate risk (6, 76%), and high-risk (6, 24%) for SCD. During the study, 46% (21/26) had episodes of NSVT and an ICD, 25% (6/46) had been hospitalized for HF, and 17% (8/46) for AF. QRS duration was significantly prolonged in the high-risk group compared with low to intermediate risk (122±30 vs 101±21, p=0.013). Moreover, HCM patients with an ICD had a higher QRS duration than those without an ICD (117±25 vs 97±21, p=0.005). QRS duration was also significantly prolonged in the group with appropriate ICD therapy for VAs compared with that without ICD therapy (126±31 vs 101±21, p=0.010). Finally, there was a significant positive correlation between QRS duration and HCM risk-SCD score (r=0.316, p=0.032), ICD implantation (r=0.403, p=0.005), ICD therapy (r=0.374, p=0.010) for VAs, hospitalization for AF (r=0.300, p=0.043) and HF (r=0.477, p=0.001). Conclusion Increased QRS duration is associated with HCM risk scores for SCD, ICD implantation, ICD therapy for VAs, and hospitalization for AF or HF in patients with HCM, and it seems to be a novel, easy-to-measure, prognostic ECG marker.
Fragkiadakis et al. (Sat,) reported a other. Increased QRS duration in HCM patients is significantly associated with higher SCD risk scores, ICD implantation, ICD therapy for VAs, and hospitalization for AF or HF.