Electrocardiographic markers of structural heart disease and predictors of death in 2332 unselected patients undergoing outpatient Holter recording.
OBJECTIVE
To test the hypothesis that the QS interval of ventricular ectopic beats (VEBs) (ventricular ectopic QS interval, VEQSI) would provide a marker for the presence of structural heart disease and a predictor of mortality.


RESULTS
We interviewed and examined 2332 patients undergoing Holter ECG monitoring for clinical indications. In persons with VEBs, the morphologies were counted and the QS interval was measured for each of these morphologies. The duration of the broadest VEB, measured from the QRS onset in the derivation showing the earliest onset to its end in the derivation showing the latest termination, was taken as that patient's VEQSI. Survival was ascertained from public health records. Of 15 electrocardiographic variables pre-selected as potential prognostic indicators, VEQSI demonstrated the strongest association with the presence of structural heart disease (P = 0.013). Thirty-four persons died in 16 +/- 4 months follow-up. Univariate predictors of mortality are age, history of myocardial infarction, maximum heart rate, QS interval, the number of VEB morphologies, and the VEQSI. On multivariate analysis, only age (P < 0.001) and the number of VEB morphologies (P = 0.02) predicted mortality.


CONCLUSIONS
VEQSI predicts the presence of structural heart disease. The number of VEB morphologies in a Holter recording predicts all-cause mortality.
Gallagher
Mark M
MM
Department of Cardiology, Policlinico Tor Vergata, Viale Oxford 81, Rome 00133, Italy. mark_m_gallagher@hotmail.com
Padula
Mina
M
Sgueglia
Marianna
M
Santini
Luca
L
Voci
Paolo
P
Mahon
Niall G
NG
Yap
Yee Guan
YG
Romeo
Francesco
F
D000328:Adult; D000368:Aged; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology*; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000503:physiopathology*