Division Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy.
Division Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy.
Int J Cardiol. 2022 Nov 1;366:42-47. doi: 10.1016/j.ijcard.2022.06.066. Epub 2022 Jun 30.
Predictors of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM) do not include ECG variables. Intrinsicoid deflection (ID) represents the early ventricular depolarization on surface ECG. Delayed ID (DID) has been associated with sudden cardiac arrest (SCA) in the community. In a cohort of consecutive patients with HCM, we assessed whether DID predicts SCA or its surrogates.
We reviewed ECG, clinical and follow-up data of 344 consecutive HCM patients. DID (ID ≥50 ms) was classified as lateral (leads I or aVL), inferior (leads II, III or aVF), and precordial (leads V5 or V6). The endpoint was a combination of SCD, resuscitated SCA or appropriate ICD intervention.
The SCA group was composed by 2 secondary prevention ICD recipients and 23 patients that reached the endpoint during follow-up (108 ± 73 months). SCA patients had more frequently massive LV hypertrophy (LVH) or end-stage HCM. ECG indexes of LVH were comparable between SCA and controls. SCA patients were more likely to have DID on ECG lateral leads I/aVL (72% vs 44%; p = 0.008). A non significant trend was observed for inferior and V5/V6 leads. DID I/aVL was associated with SCA in multivariate analysis after correction for massive LVH and end-stage disease (HR: 2.86; 95%CI: 1.14-7.13; p = 0.02).
In HCM patients DID is associated with increased risk of SCA. Its prognostic value extends beyond that of LVH. If confirmed in prospective studies, the prognostic power of this ECG marker could be used to refine risk prediction.
肥厚型心肌病（HCM）患者发生心源性猝死（SCD）的预测因素不包括心电图变量。固有偏转（ID）代表体表心电图上的早期心室除极。延迟 ID（DID）与社区中的心脏骤停（SCA）有关。在连续的 HCM 患者队列中，我们评估 DID 是否可预测 SCA 或其替代终点。
我们回顾了 344 例连续 HCM 患者的心电图、临床和随访数据。将 DID（ID≥50ms）分为外侧（I 或 aVL 导联）、下壁（II、III 或 aVF 导联）和前壁（V5 或 V6 导联）。终点是 SCD、复苏性 SCA 或适当的 ICD 干预的组合。
SCA 组由 2 例二级预防 ICD 受者和 23 例在随访期间达到终点的患者组成（108±73 个月）。SCA 患者更常伴有巨大左室肥厚（LVH）或终末期 HCM。SCA 和对照组的心电图 LVH 指标相似。SCA 患者更有可能在心电图外侧导联 I/aVL 上出现 DID（72%比 44%；p=0.008）。下壁和 V5/V6 导联也有观察到非显著趋势。在多变量分析中，校正巨大 LVH 和终末期疾病后，DID I/aVL 与 SCA 相关（HR：2.86；95%CI：1.14-7.13；p=0.02）。
在 HCM 患者中，DID 与 SCA 风险增加相关。其预后价值超出了 LVH。如果在前瞻性研究中得到证实，这种心电图标志物的预后价值可用于改善风险预测。
