Electrocardiographic amplitudes: a new risk factor for sudden death in hypertrophic cardiomyopathy.
OBJECTIVE
Assessment of ECG-features as predictors of sudden death in adults with hypertrophic cardiomyopathy (HCM).


RESULTS
ECG-amplitude sums were measured in 44 normals, 34 athletes, a hospital-cohort of 87 HCM-patients, and 29 HCM-patients with sudden death or cardiac arrest (HCM-CA). HCM-patients with sudden death or cardiac arrest had substantially higher ECG-amplitudes than the HCM-cohort for limb-lead and 12-lead QRS-amplitude sums, and amplitude-duration products (P = 0.00003-P = 0.000002). Separation of HCM-CA from the HCM-cohort is obtained by limb-lead QRS-amplitude sum >or=7.7 mV (odds ratio 18.8, sensitivity 87%, negative predictive value (NPV) 94%, P < 0.0001), 12-lead amplitude-duration product >or=2.2 mV s (odds ratio 31.0, sensitivity 92%, NPV 97%, P < 0.0001), and limb-lead amplitude-duration product >or=0.70 mV s (odds ratio 31.5, sensitivity 93%, NPV 96%, P < 0.0001). Sensitivity in HCM-patients <40 years is 90, 100, and 100% for those ECG-variables, respectively. Qualitative analysis showed correlation with cardiac arrest for pathological T-wave-inversion (P = 0.0003), ST-depression (P = 0.0010), and dominant S-wave in V(4) (P = 0.0048). A risk score is proposed; a score >or=6 gives a sensitivity of 85% but a higher positive predictive value than above measures. Optimal separation between HCM-CA <40 years and athletes is obtained by a risk score >or=6 (odds ratio 345, sensitivity 85%, specificity 100%, P < 0.0001).


CONCLUSIONS
Twelve-lead ECG is a powerful instrument for risk-stratification in HCM.
Ostman-Smith
Ingegerd
I
Division of Paediatrics, Department of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Queen Silvia Childreńs Hospital, SE-416 85 Gothenburg, Sweden. ingegerd.ostman-smith@pediat.gu.se
Wisten
Aase
A
Nylander
Eva
E
Bratt
Ewa-Lena
EL
Granelli
Anne de-Wahl
Ad
Oulhaj
Abderrahim
A
Ljungström
Erik
E
D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D042241:Early Diagnosis; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012420:Running; D013550:Swimming; D014463:Ultrasonography