title: High-risk electrocardiographic parameters are ubiquitous in patients with ischemic cardiomyopathy.
abstract: BACKGROUND
  The electrocardiogram (ECG) can be used to predict cardiovascular risk; however, like all risk factors with imperfect specificity, studies in low risk populations have been plagued by poor predictive accuracy. Although predictive accuracy might be improved among cohorts with a higher likelihood of cardiovascular events, this would also affect the prevalence of abnormal parameters and their exclusions.
  
  
  METHODS
  To determine the magnitude of these changes in a cohort with ischemic cardiomyopathy we analyzed 15 previously validated high-risk parameters from the resting and ambulatory ECG in subjects enrolled in the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) study (n = 198).
  
  
  RESULTS
  Using the published exclusion criteria from the validation studies (i.e., atrial fibrillation, persistent pacing, prolonged QRS), only 4 high-risk ECG parameters (27%) could be evaluated in all subjects and only 42% of subjects could have all 15 ECG parameters assessed. Nevertheless, almost every subject (97%) had at least one abnormal parameter. On average, there were 3.4 ± 1.8 (range, 0-8) high-risk ECG parameters per subject among the 11.7 ± 4.5 (range, 4-15) parameters that could be assessed.
  
  
  CONCLUSIONS
  Thus, 34% of all assessable parameters were abnormal. In conclusion, a significant proportion of ECG parameters cannot be assessed in patients with ischemic cardiomyopathy, but high-risk results are ubiquitous. The influence of these issues will be clarified when the results of the PAREPET study are available to actually determine the predictive value of these parameters on cause-specific mortality in a high-risk cohort.
authors: School of Nursing, University at Buffalo, Buffalo, NY 14214, USA.
authors: Mary G
authors: MG
authors: Carey
authors: Salah S
authors: SS
authors: Al-Zaiti
authors: John M
authors: JM
authors: Canty
authors: James A
authors: JA
authors: Fallavollita
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis