Cardiovascular Department, 'Ospedali Riuniti' and University of Trieste.
Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy.
J Cardiovasc Med (Hagerstown). 2019 Jul;20(7):450-458. doi: 10.2459/JCM.0000000000000804.
The objective was to provide an exhaustive characterization of ECG features in a large cohort of dilated cardiomyopathies (DCMs) and then investigate their possible prognostic role in the long term.
ECG is an accessible, reproducible, low-cost diagnostic and prognostic tool. However, an extensive description of ECG features and their long-term prognostic role in a large cohort of DCM is lacking.
All available baseline ECGs of DCM patients enrolled from 1992 to 2013 were systematically analysed. Patients underwent to a complete clinical-laboratory evaluation. The study outcome measures were death or heart transplant (D/HT) and sudden death or malignant ventricular arrhythmias (SD/MVA).
Four hundred and fourteen DCM patients were enrolled. During a median follow-up of 125 months, 55 and 57 patients experienced D/HT and SD/MVA, respectively. At multivariate analysis, left ventricular hypertrophy (P = 0.017), heart rate (HR, P = 0.005) and anterolateral T-wave inversion (P = 0.041) predicted D/HT. Regarding SD/MVA, S wave amplitude in V2 (P = 0.008), R wave amplitude in DIII (P = 0.007), anterolateral T-wave inversion (P = 0.017) emerged as predictors. At receiver-operating curve analyses, the addition of ECG models to the clinical-laboratory evaluation significantly increased the area under the curve both for D/HT (from 0.68 to 0.74, P = 0.042) and SD/MVA (from 0.70 to 0.77, P = 0.048).
The exhaustive systematic evaluation of ECG has an incremental impact in the prognostication of a large cohort of DCM patients, also regarding the arrhythmic stratification.
本研究旨在对大量扩张型心肌病（DCM）患者的心电图特征进行全面描述，并探讨其在长期随访中的预后价值。
心电图是一种易于获取、可重复、成本低廉的诊断和预后工具。然而，缺乏对大量 DCM 患者心电图特征及其长期预后价值的广泛描述。
系统性分析了 1992 年至 2013 年间纳入的所有 DCM 患者的基线心电图。患者均接受了全面的临床实验室评估。研究的终点事件为死亡或心脏移植（D/HT）和猝死或恶性室性心律失常（SD/MVA）。
共纳入 414 例 DCM 患者。中位随访 125 个月期间，55 例和 57 例患者分别发生了 D/HT 和 SD/MVA。多变量分析显示，左室肥厚（P = 0.017）、心率（HR，P = 0.005）和前外侧 T 波倒置（P = 0.041）预测 D/HT。对于 SD/MVA，V2 导联 S 波振幅（P = 0.008）、DIII 导联 R 波振幅（P = 0.007）和前外侧 T 波倒置（P = 0.017）为预测因子。在受试者工作特征曲线分析中，心电图模型与临床实验室评估相结合，显著提高了 D/HT（从 0.68 增加至 0.74，P = 0.042）和 SD/MVA（从 0.70 增加至 0.77，P = 0.048）的曲线下面积。
对大量 DCM 患者的心电图进行全面系统评估，对预后有额外的影响，对心律失常分层也有影响。
