title: The Romhilt-Estes electrocardiographic score predicts sudden cardiac arrest independent of left ventricular mass and ejection fraction.
abstract: BACKGROUND
  The Romhilt-Estes point score system (RE) is an established ECG criterion for diagnosing left ventricular hypertrophy (LVH). In this study, we assessed for the first time, whether RE and its components are predictive of sudden cardiac arrest (SCA) independent of left ventricular (LV) mass.
  
  
  METHODS
  Sudden cardiac arrest (SCA) cases occurring between 2002 and 2014 in a Northwestern US metro region (catchment area approx. 1 million) were compared to geographic controls. ECGs and echocardiograms performed prior to the SCA and those of controls were acquired from the medical records and evaluated for the ECG criteria established in the RE score and for LV mass.
  
  
  RESULTS
  Two hundred forty-seven SCA cases (age 68.3 ± 14.6, male 64.4%) and 330 controls (age 67.4 ± 11.5, male 63.6) were included in the analysis. RE scores were greater in cases than controls (2.5 ± 2.1 vs. 1.9 ± 1.7, p < .001), and SCA cases were more likely to meet definite LVH criteria (18.6% vs. 7.9%, p < .001). In a multivariable model including echocardiographic LVH and LV function, definite LVH remained independently predictive of SCA (OR 2.04, 95% CI 1.16-3.59, p = .013). The model was replicated with the individual ECG criteria, and only SV1.2≥ 30 mm and delayed intrinsicoid deflection remained significant predictors of SCA.
  
  
  CONCLUSIONS
  Left ventricular hypertrophy (LVH) as defined by the RE point score system is associated with SCA independent of echocardiographic LVH and reduced LV ejection fraction. These findings support an independent role for purely electrical LVH, in the genesis of lethal ventricular arrhythmias.
authors.affiliation: Cedars-Sinai Medical Center, The Heart Institute, Los Angeles, CA, USA.
authors.forename: Navid
authors.initials: N
authors.lastname: Darouian
authors.affiliation: Cedars-Sinai Medical Center, The Heart Institute, Los Angeles, CA, USA.
authors.forename: Aapo L
authors.initials: AL
authors.lastname: Aro
authors.affiliation: Cedars-Sinai Medical Center, The Heart Institute, Los Angeles, CA, USA.
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: Cedars-Sinai Medical Center, The Heart Institute, Los Angeles, CA, USA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.affiliation: Cedars-Sinai Medical Center, The Heart Institute, Los Angeles, CA, USA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Rusinaru
authors.affiliation: Cedars-Sinai Medical Center, The Heart Institute, Los Angeles, CA, USA.
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.affiliation: Cedars-Sinai Medical Center, The Heart Institute, Los Angeles, CA, USA.
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000503:physiopathology; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology
keywords: electrocardiography; left ventricular hypertrophy; sudden cardiac arrest