Robyns Tomas, Nuyens Dieter, Lu Hua Rong, Gallacher David J, Vandenberk Bert, Garweg Christophe, Ector Joris, Pagourelias Efstathios, Van Cleemput Johan, Janssens Stefan, Willems Rik
Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Belgium; The University Hospitals of Leuven are Member of the European Reference Network for Rare and Complex Diseases of the Heart (ERN GUARD-HEART).
Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.
J Electrocardiol. 2018 Nov-Dec;51(6):1077-1083. doi: 10.1016/j.jelectrocard.2018.09.005. Epub 2018 Sep 12.
Preventing sudden cardiac death (SCD) is one of the main goals in hypertrophic cardiomyopathy (HCM). Many variables have been proposed, however the European and American guidelines do not incorporate any ECG or Holter monitoring derived variables other than the presence of ventricular arrhythmia in their risk stratification models. In the present study we evaluated electrocardiographic parameters in risk stratification of HCM.
Novel electrocardiographic parameters including the index of cardio-electrophysiological balance (iCEB), individualized QT correction (QTi) and QT rate dependence were evaluated along with established risk factors. A composite endpoint of SCD was defined as out of hospital cardiac arrest, appropriate ICD shock and sustained ventricular tachycardia. Cox regression analysis was used to evaluate predictors of SCD. Out of the 466 HCM patients, 31 reached the composite endpoint during a follow up of 75 ± 86 months. In a multivariate model, nor iCEB, QTi or QT rate dependence were predictors of SCD. Only male gender (p < 0.01; OR 13.1; CI 1.74-98.83), negative T waves in the inferior leads (p = 0.04; OR 2.51; CI 1.03-6.13) and familial sudden death (p < 0.01; OR 3.03; CI 1.39-6.59) were significant predictors. On top of either the ESC risk score or the 3 traditional 'American risk factors', only male gender was a significant predictor of SCD.
No ECG or Holter monitoring parameters added in risk stratification for SCD in HCM. However, male gender and negative T waves in the inferior leads are promising novel markers to evaluate in larger cohorts.
预防心脏性猝死（SCD）是肥厚型心肌病（HCM）的主要目标之一。虽然已经提出了许多变量，但欧美指南在其风险分层模型中，除了室性心律失常外，并未纳入任何基于心电图（ECG）或动态心电图监测得出的变量。在本研究中，我们评估了心电图参数在HCM风险分层中的作用。
我们评估了包括心脏电生理平衡指数（iCEB）、个体化QT校正（QTi）和QT频率依赖性在内的新心电图参数以及既定的风险因素。将心脏性猝死的复合终点定义为院外心脏骤停、合适的植入式心律转复除颤器（ICD）电击和持续性室性心动过速。采用Cox回归分析评估心脏性猝死的预测因素。在466例HCM患者中，31例在75±86个月的随访期间达到了复合终点。在多变量模型中，iCEB、QTi或QT频率依赖性均不是心脏性猝死的预测因素。只有男性（p<0.01；比值比[OR]13.1；可信区间[CI]1.74 - 98.83）、下壁导联T波倒置（p = 0.04；OR 2.51；CI 1.03 - 6.13）和家族性猝死（p<0.01；OR 3.03；CI 1.39 - 6.59）是显著的预测因素。在欧洲心脏病学会（ESC）风险评分或3个传统的“美国风险因素”基础上，只有男性是心脏性猝死的显著预测因素。
在HCM心脏性猝死的风险分层中，未发现心电图或动态心电图监测参数有额外作用。然而，男性和下壁导联T波倒置是值得在更大队列中评估的有前景的新标志物。
