Key result
Fragmented QRS is linked to ~6-fold greater risk of major arrhythmic events in HCM.
Why the study?
Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy remains challenging, and the prognostic value of non-invasive ECG markers remains unclear.
Do specific electrocardiographic markers predict major arrhythmic events in patients with hypertrophic cardiomyopathy?
Meta-Analysis (n=3,807)
Do specific electrocardiographic markers predict major arrhythmic events in patients with hypertrophic cardiomyopathy?
Answers are grounded in this paper and cite their sources.
Specific ECG markers, particularly fragmented QRS and repolarization abnormalities, may serve as useful non-invasive tools for stratifying arrhythmic risk in patients with hypertrophic cardiomyopathy.
Background/Introduction Hypertrophic cardiomyopathy (HCM) is a primary genetic myocardial disorder associated with sudden cardiac death (SCD) due to ventricular arrhythmias, however risk stratification remains challenging. Electrocardiographic (ECG) markers may offer non-invasive tools for improved risk assessment, but their prognostic value remains unclear. Purpose The purpose of this study is to systematically evaluate the association between ECG markers and the risk of major arrhythmic events (MAEs) in HCM patients. Methods We conducted a systematic search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Clinical Trials from inception to December 2024, including studies providing data on ECG variables and MAEs in patients with HCM. Pooled effect estimates were calculated using Der Simonian-Laird random-effects model. Results 15 studies with 3,807 HCM patients were included. Pooled results demonstrated that the presence of fragmented QRS (fQRS) was significantly associated with MAEs (OR: 6.42, 95% CI: 3.07; 13.4) with moderate diagnostic performance [AUC=0.76, sensitivity 59% (95% CI: 37%; 78%), specificity 80% (95% CI: 64%; 90%)]. Prolonged QTc interval (MD: 8.76 ms; 95% CI: 0.98; 16.54), T-wave peak-to-end (Tp-e) interval (MD: 13.01 ms, 95% CI: 7.42; 18.59) and QT dispersion (QTd) (SMD: 0.48; 95% CI: 0.19; 0.77) were also associated with MAEs. In contrast, PR interval, P-wave, QRS duration and the presence of right bundle branch block (RBBB) demonstrated no significant associations. Conclusions This meta-analysis highlights the potential prognostic utility of specific ECG markers, particularly fQRS and repolarization abnormalities in stratifying arrhythmic risk in HCM.
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Chiotis et al. (2026) conducted a meta-analysis in Hypertrophic cardiomyopathy (HCM) (n=3,807). Fragmented QRS (fQRS) and other ECG markers vs. Absence of specific ECG markers was evaluated on Major arrhythmic events (MAEs) (OR 6.42, 95% CI 3.07-13.4). The presence of fragmented QRS on ECG was significantly associated with an increased risk of major arrhythmic events in patients with hypertrophic cardiomyopathy (OR 6.42; 95% CI 3.07-13.4).
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