title: Early repolarization pattern associated with sudden cardiac death: long-term follow-up in patients with chronic heart failure.
abstract: BACKGROUND
  Identification of patients with chronic heart failure (CHF) at a risk for sudden cardiac death (SCD) is an important objective. Early repolarization pattern (ERP) is associated with ventricular fibrillation in patients without structural heart diseases. Moreover, ERP was reported to be associated with SCD in patients with old myocardial infarction in a case-control study. However, little information is available on the prognostic significance of ERP in CHF patients. Thus, we aimed to investigate whether ERP is associated with SCD in CHF patients.
  
  
  RESULTS
  The study population consisted of 132 consecutive outpatients with NYHA class I, II and III congestive heart failure and radionuclide left ventricular ejection fraction less than 40%. All patients underwent the standard 12-lead electrocardiogram at enrollment, where we assessed the presence of ERP using the criteria of J-point elevation ≥ 0.1 mV in at least 2 inferior or lateral leads. The primary endpoint of this study was SCD. At enrollment, 16 patients had ERP. During the follow-up period of 6.7 ± 3.5 years, 26 patients had SCD. Kaplan-Meier analysis showed that SCD was observed significantly more frequently in patients with ERP than in those without ERP (63% [10/16] vs 14% [16/116], P < 0.0001]. A multivariate Cox analysis revealed that ERP was significantly and independently associated with SCD (hazard ratio, 3.7; 95% confidence interval, 1.6-8.6; P = 0.002).
  
  
  CONCLUSIONS
  ERP in inferior leads would be associated with an increased risk of SCD in CHF patients.
authors: Division of Cardiology, Osaka General Medical Center, Osaka, Japan. frkwyso@hotmail.com
authors: Yoshio
authors: Y
authors: Furukawa
authors: Takahisa
authors: T
authors: Yamada
authors: Takashi
authors: T
authors: Morita
authors: Yusuke
authors: Y
authors: Iwasaki
authors: Masato
authors: M
authors: Kawasaki
authors: Atsushi
authors: A
authors: Kikuchi
authors: Takashi
authors: T
authors: Naito
authors: Tadao
authors: T
authors: Fujimoto
authors: Kentaro
authors: K
authors: Ozu
authors: Takumi
authors: T
authors: Kondo
authors: Kaoruko
authors: K
authors: Sengoku
authors: Hironori
authors: H
authors: Yamamoto
authors: Tohru
authors: T
authors: Masuyama
authors: Masatake
authors: M
authors: Fukunami
mesh_terms: D000368:Aged; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011875:Radionuclide Angiography; D013318:Stroke Volume