Dynamic ECG remodelling improved sudden cardiac death risk prediction beyond clinical factors and static ECG, increasing the area under the receiver operating characteristic curve from 0.770 to 0.869.
Case-Control (n=871)
Yes
Does dynamic ECG remodelling improve the prediction of sudden cardiac death compared to static baseline ECG and clinical risk factors?
Dynamic ECG remodelling significantly improves the prediction of sudden cardiac death beyond traditional static ECG and clinical risk factors, introducing a novel marker for SCD risk assessment.
Effect estimate: AUC (95% CI 0.837-0.902)
Absolute Event Rate: 0.869% vs 0.77%
BACKGROUND AND AIMS: Electrocardiogram (ECG) abnormalities have been evaluated as static risk markers for sudden cardiac death (SCD), but the potential importance of dynamic ECG remodelling has not been investigated. In this study, the nature and prevalence of dynamic ECG remodelling were studied among individuals who eventually suffered SCD. METHODS: The study population was drawn from two prospective community-based SCD studies in Oregon (2002, discovery cohort) and California, USA (2015, validation cohort). For this present sub-study, 231 discovery cases (2015-17) and 203 validation cases (2015-21) with ≥2 archived pre-SCD ECGs were ascertained and were matched to 234 discovery and 203 validation controls based on age, sex, and duration between the ECGs. Dynamic ECG remodelling was measured as progression of a previously validated cumulative six-variable ECG electrical risk score. RESULTS: Oregon SCD cases displayed greater electrical risk score increase over time vs. controls +1.06 (95% confidence interval +0.89 to +1.24) vs. -0.05 (-0.21 to +0.11); P < .001. These findings were successfully replicated in California +0.87 (+0.7 to +1.04) vs. -0.11 (-0.27 to 0.05); P < .001. In multivariable models, abnormal dynamic ECG remodelling improved SCD prediction over baseline ECG, demographics, and clinical SCD risk factors in both Oregon area under the receiver operating characteristic curve 0.770 (95% confidence interval 0.727-0.812) increased to area under the receiver operating characteristic curve 0.869 (95% confidence interval 0.837-0.902) and California cohorts. CONCLUSIONS: Dynamic ECG remodelling improved SCD risk prediction beyond clinical factors combined with the static ECG, with successful validation in a geographically distinct population. These findings introduce a novel concept of SCD dynamic risk and warrant further detailed investigation.
Pham et al. (Mon,) conducted a case-control in Sudden cardiac death (n=871). Dynamic ECG remodelling (cumulative six-variable ECG electrical risk score progression) vs. Baseline ECG and clinical risk factors was evaluated on Sudden cardiac death prediction (area under the receiver operating characteristic curve) (AUC, 95% CI 0.837-0.902). Dynamic ECG remodelling improved sudden cardiac death risk prediction beyond clinical factors and static ECG, increasing the area under the receiver operating characteristic curve from 0.770 to 0.869.