Electrocardiographic amplitudes: A new risk factor for sudden death in hypertrophic cardiomyopathy

Abstract

AimsAssessment of ECG-features as predictors of sudden death in adults with hypertrophic cardiomyopathy (HCM).Methods and resultsECG-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 ≥7.7 mV (odds ratio 18.8, sensitivity 87, negative predictive value (NPV) 94, P < 0.0001), 12-lead amplitude-duration product ≥2.2 mV s (odds ratio 31.0, sensitivity 92, NPV 97, P < 0.0001), and limb-lead amplitude-duration product ≥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 V4 (P = 0.0048). A risk score is proposed; a score ≥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 ≥6 (odds ratio 345, sensitivity 85, specificity 100, P < 0.0001).ConclusionTwelve-lead ECG is a powerful instrument for risk-stratification in HCM.