Zhang Nixiao, Cheng Sijing, Niu Hongxia, Gu Min, Peng Hui, Sun Zhijun, Liu Xi, Deng Yu, Chen Xuhua, Hua Wei
Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 May 12;9:882662. doi: 10.3389/fcvm.2022.882662. eCollection 2022.
Ventricular arrhythmias in patients with hypertrophic cardiomyopathy (HCM) may lead to sudden cardiac death (SCD). We aimed to investigate the relationship between electrocardiogram (ECG) indicators and the risk of appropriate implantable cardioverter-defibrillator (ICD) therapy in HCM.
The HCM patients receiving ICD implantation were enrolled consecutively. QT interval correction (QTc) was calculated using Bazett's formula. Long or deep S wave in V4 lead was defined as duration time >50 ms and/or voltage amplitude >0.6 mV. The endpoint in our study was at least one ICD appropriate therapy triggered by ventricular tachyarrhythmia (VT) or ventricular fibrillation (VF), including anti-tachyarrhythmia pacing (ATP) and electrical shock.
A total of 149 patients with HCM (mean age 53 ± 14 years, male 69.8%) were studied. Appropriate ICD therapies occurred in 47 patients (31.5%) during a median follow-up of 2.9 years. Cox regression analysis showed that long or deep S wave in V4 lead [hazard ratio (HR) 1.955, 95% confidence interval (CI) 1.017-3.759, = 0.045] and QTc interval (HR 1.014, 95% CI 1.008-1.021, < 0.001) were independent risk factors for appropriate ICD therapy. The ROC showed that the optimal cut-off point value for the QTc interval to predict the appropriate ICD therapy was 464 ms, and the AUC was 0.658 (95% CI 0.544-0.762, = 0.002). The AUC for S wave anomalies in V4 lead was 0.608 (95% CI 0.511-0.706, = 0.034). We developed a new model that combined the QTc interval and S wave anomalies in V4 lead based on four patient groups. Patients with QTc ≥464 ms and long or deep V4-S wave had the highest risk of developing appropriate ICD therapy (log-rank < 0.0001). After adding QTc interval and V4-S wave anomalies into the HCM-risk-SCD model, the prediction effect of the new model was significantly improved, and the NRI was 0.302.
In this HCM cohort, QTc and S wave anomalies in V4 lead were found to be significant and strong predictors of the risk of appropriate ICD therapy. Patients with QTc ≥464 ms and long or deep S wave had the highest risk. After QTc interval and V4-S wave anomalies adding to the HCM-risk-SCD model, the prediction effect is significantly improved.
肥厚型心肌病（HCM）患者的室性心律失常可能导致心源性猝死（SCD）。我们旨在研究心电图（ECG）指标与HCM患者接受合适的植入式心脏复律除颤器（ICD）治疗风险之间的关系。
连续纳入接受ICD植入的HCM患者。使用Bazett公式计算QT间期校正值（QTc）。V4导联中长或深的S波定义为持续时间>50 ms和/或电压幅度>0.6 mV。我们研究的终点是至少一次由室性心动过速（VT）或室颤（VF）触发的合适的ICD治疗，包括抗心动过速起搏（ATP）和电击。
共研究了149例HCM患者（平均年龄53±14岁，男性占69.8%）。在中位随访2.9年期间，47例患者（31.5%）接受了合适的ICD治疗。Cox回归分析显示，V4导联中长或深的S波[风险比（HR）1.955，95%置信区间（CI）1.017 - 3.759，P = 0.045]和QTc间期（HR 1.014，95% CI 1.008 - 1.021，P < 0.001）是合适的ICD治疗的独立危险因素。ROC曲线显示，预测合适的ICD治疗的QTc间期最佳截断点值为464 ms，曲线下面积（AUC）为0.658（95% CI 0.544 - 0.762，P = 0.002）。V4导联S波异常的AUC为0.608（95% CI 0.511 - 0.706，P = 0.034）。我们基于四个患者组开发了一个结合QTc间期和V4导联S波异常的新模型。QTc≥464 ms且V4导联S波长或深的患者发生合适的ICD治疗的风险最高（对数秩检验P < 0.0001）。将QTc间期和V4导联S波异常加入HCM - 风险 - SCD模型后，新模型的预测效果显著改善，净重新分类指数（NRI）为0.302。
在这个HCM队列中，发现QTc和V4导联S波异常是合适的ICD治疗风险的重要且强有力的预测指标。QTc≥464 ms且S波长或深的患者风险最高。将QTc间期和V4导联S波异常加入HCM - 风险 - SCD模型后，预测效果显著改善。
