The presence of fragmented QRS was significantly associated with major arrhythmic events in hypertrophic cardiomyopathy patients (OR 7.03; 95% CI 3.19-15.48).
Meta-Analysis (n=3,419)
Does the presence of specific ECG markers predict major arrhythmic events in patients with hypertrophic cardiomyopathy?
Fragmented QRS and repolarization abnormalities on ECG are significantly associated with major arrhythmic events in patients with hypertrophic cardiomyopathy, offering potential non-invasive risk stratification.
Effect estimate: OR 7.03 (95% CI 3.19-15.48)
BACKGROUND: 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. 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: 12 studies with 3,419 HCM patients were included. Pooled results demonstrated that the presence of fragmented QRS (fQRS) was significantly associated with MAEs (OR: 7.03, 95% CI: 3.19; 15.48) with moderate diagnostic performance AUC = 0.76, sensitivity 59% (95% CI: 37%; 78%), specificity 80% (95% CI: 64%; 90%). Prolonged QTc interval (MD: 10.57 ms, 95% CI: 1-20.15), T-wave peak-to-end (Tp-e) interval (MD: 15.35 ms, 95% CI: 9.45; 21.26) 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. CONCLUSION: This meta-analysis highlights the potential prognostic utility of specific ECG markers, particularly fQRS and repolarization abnormalities in stratifying arrhythmic risk in HCM. PROSPERO REGISTRATION NUMBER: CRD42025635276.
Chiotis et al. (Thu,) conducted a meta-analysis in Hypertrophic cardiomyopathy (n=3,419). Electrocardiographic (ECG) markers was evaluated on Major arrhythmic events (MAEs) (OR 7.03, 95% CI 3.19-15.48). The presence of fragmented QRS was significantly associated with major arrhythmic events in hypertrophic cardiomyopathy patients (OR 7.03; 95% CI 3.19-15.48).