TY - JOUR
T1 - A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias
T2 - Sum magnitude of the absolute QRST integral
AU - Tereshchenko, Larisa G.
AU - Cheng, Alan
AU - Fetics, Barry J.
AU - Butcher, Barbara
AU - Marine, Joseph E.
AU - Spragg, David D.
AU - Sinha, Sunil
AU - Dalal, Darshan
AU - Calkins, Hugh
AU - Tomaselli, Gordon F.
AU - Berger, Ronald D.
PY - 2011/3
Y1 - 2011/3
N2 - Objective: We proposed and tested a novel electrocardiogram marker of risk of ventricular arrhythmias (VAs). Methods: Digital orthogonal electrocardiograms were recorded at rest before implantable cardioverter-defibrillator (ICD) implantation in 508 participants of a primary prevention ICDs prospective cohort study (mean ± SD age, 60 ± 12 years; 377 male [74%]). The sum magnitude of the absolute QRST integral in 3 orthogonal leads (SAI QRST) was calculated. A derivation cohort of 128 patients was used to define a cutoff; a validation cohort (n = 380) was used to test a predictive value. Results: During a mean follow-up of 18 months, 58 patients received appropriate ICD therapies. The SAI QRST was lower in patients with VA (105.2 ± 60.1 vs 138.4 ± 85.7 mV - ms, P = .002). In the Cox proportional hazards analysis, patients with SAI QRST not exceeding 145 mV - ms had about 4-fold higher risk of VA (hazard ratio, 3.6; 95% confidence interval, 1.96-6.71; P < .0001) and a 6-fold higher risk of monomorphic ventricular tachycardia (hazard ratio, 6.58; 95% confidence interval, 1.46-29.69; P = .014), whereas prediction of polymorphic ventricular tachycardia or ventricular fibrillation did not reach statistical significance. Conclusion: High SAI QRST is associated with low risk of sustained VA in patients with structural heart disease.
AB - Objective: We proposed and tested a novel electrocardiogram marker of risk of ventricular arrhythmias (VAs). Methods: Digital orthogonal electrocardiograms were recorded at rest before implantable cardioverter-defibrillator (ICD) implantation in 508 participants of a primary prevention ICDs prospective cohort study (mean ± SD age, 60 ± 12 years; 377 male [74%]). The sum magnitude of the absolute QRST integral in 3 orthogonal leads (SAI QRST) was calculated. A derivation cohort of 128 patients was used to define a cutoff; a validation cohort (n = 380) was used to test a predictive value. Results: During a mean follow-up of 18 months, 58 patients received appropriate ICD therapies. The SAI QRST was lower in patients with VA (105.2 ± 60.1 vs 138.4 ± 85.7 mV - ms, P = .002). In the Cox proportional hazards analysis, patients with SAI QRST not exceeding 145 mV - ms had about 4-fold higher risk of VA (hazard ratio, 3.6; 95% confidence interval, 1.96-6.71; P < .0001) and a 6-fold higher risk of monomorphic ventricular tachycardia (hazard ratio, 6.58; 95% confidence interval, 1.46-29.69; P = .014), whereas prediction of polymorphic ventricular tachycardia or ventricular fibrillation did not reach statistical significance. Conclusion: High SAI QRST is associated with low risk of sustained VA in patients with structural heart disease.
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U2 - 10.1016/j.jelectrocard.2010.08.012
DO - 10.1016/j.jelectrocard.2010.08.012
M3 - Article
C2 - 21093871
AN - SCOPUS:79952042919
SN - 0022-0736
VL - 44
SP - 208
EP - 216
JO - Journal of Electrocardiology
JF - Journal of Electrocardiology
IS - 2
ER -