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Automated Quantification of Abnormal QRS Peaks From High‐Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5‐Year Prospective Multicenter Study

BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) are at risk of ventricular arrhythmia (VA) attributed to abnormal electrical activation arising from myocardial fibrosis and myocyte disarray. We sought to quantify intra‐QRS peaks (QRSp) in high‐resolution ECGs as a measure of abnormal act...

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Autores principales: Suszko, Adrian M., Chakraborty, Praloy, Viswanathan, Karthik, Barichello, Scott, Sapp, John, Talajic, Mario, Laksman, Zachary, Yee, Raymond, Woo, Anna, Spears, Danna, Adler, Arnon, Rakowski, Harry, Chauhan, Vijay S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851434/
https://www.ncbi.nlm.nih.gov/pubmed/36444865
http://dx.doi.org/10.1161/JAHA.122.026025
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author Suszko, Adrian M.
Chakraborty, Praloy
Viswanathan, Karthik
Barichello, Scott
Sapp, John
Talajic, Mario
Laksman, Zachary
Yee, Raymond
Woo, Anna
Spears, Danna
Adler, Arnon
Rakowski, Harry
Chauhan, Vijay S.
author_facet Suszko, Adrian M.
Chakraborty, Praloy
Viswanathan, Karthik
Barichello, Scott
Sapp, John
Talajic, Mario
Laksman, Zachary
Yee, Raymond
Woo, Anna
Spears, Danna
Adler, Arnon
Rakowski, Harry
Chauhan, Vijay S.
author_sort Suszko, Adrian M.
collection PubMed
description BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) are at risk of ventricular arrhythmia (VA) attributed to abnormal electrical activation arising from myocardial fibrosis and myocyte disarray. We sought to quantify intra‐QRS peaks (QRSp) in high‐resolution ECGs as a measure of abnormal activation to predict late VA in patients with HCM. METHODS AND RESULTS: Prospectively enrolled patients with HCM (n=143, age 53±14 years) with prophylactic implantable cardioverter‐defibrillators had 3‐minute, high‐resolution (1024 Hz), digital 12‐lead ECGs recorded during intrinsic rhythm. For each precordial lead, QRSp was defined as the total number of peaks detected in the QRS complex that deviated from a smoothing filtered version of the QRS. The VA end point was appropriate implantable cardioverter‐defibrillator therapy during 5‐year prospective follow‐up. After 5 years, 21 (16%) patients had VA. Patients who were VA positive had greater QRSp (6.0 [4.0–7.0] versus 4.0 [2.0–5.0]; P<0.01) and lower left ventricular ejection fraction (57±11 versus 62±9; P=0.038) compared with patients who were VA negative, but had similar established HCM risk metrics. Receiver operating characteristic analysis revealed that QRSp discriminated VA (area under the curve=0.76; P<0.001), with a QRSp ≥4 achieving 91% sensitivity and 39% specificity. The annual VA rate was greater in patients with QRSp ≥4 versus QRSp <4 (4.4% versus 0.98%; P=0.012). In multivariable Cox regression, age <50 years (hazard ratio [HR], 2.53; P=0.009) and QRSp (HR per QRS peak, 1.41; P=0.009) predicted VA after adjusting for established HCM risk metrics. In patients aged <50 years, the annual VA rate was 0.0% for QRSp <4 compared with 6.9% for QRSp ≥4 (P=0.012). CONCLUSIONS: QRSp predicted VA in patients with HCM who were eligible for an implantable cardioverter‐defibrillator after adjusting for established HCM risk metrics, such that each additional QRS peak increases VA risk by 40%. QRSp <4 was associated with a <1% annual VA risk in all patients, and no VA risk among those aged <50 years. This novel ECG metric may improve patient selection for prophylactic implantable cardioverter‐defibrillator therapy by identifying those with low VA risk. These findings require further validation in a lower risk HCM cohort. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02560844.
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spelling pubmed-98514342023-01-24 Automated Quantification of Abnormal QRS Peaks From High‐Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5‐Year Prospective Multicenter Study Suszko, Adrian M. Chakraborty, Praloy Viswanathan, Karthik Barichello, Scott Sapp, John Talajic, Mario Laksman, Zachary Yee, Raymond Woo, Anna Spears, Danna Adler, Arnon Rakowski, Harry Chauhan, Vijay S. J Am Heart Assoc Original Research BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) are at risk of ventricular arrhythmia (VA) attributed to abnormal electrical activation arising from myocardial fibrosis and myocyte disarray. We sought to quantify intra‐QRS peaks (QRSp) in high‐resolution ECGs as a measure of abnormal activation to predict late VA in patients with HCM. METHODS AND RESULTS: Prospectively enrolled patients with HCM (n=143, age 53±14 years) with prophylactic implantable cardioverter‐defibrillators had 3‐minute, high‐resolution (1024 Hz), digital 12‐lead ECGs recorded during intrinsic rhythm. For each precordial lead, QRSp was defined as the total number of peaks detected in the QRS complex that deviated from a smoothing filtered version of the QRS. The VA end point was appropriate implantable cardioverter‐defibrillator therapy during 5‐year prospective follow‐up. After 5 years, 21 (16%) patients had VA. Patients who were VA positive had greater QRSp (6.0 [4.0–7.0] versus 4.0 [2.0–5.0]; P<0.01) and lower left ventricular ejection fraction (57±11 versus 62±9; P=0.038) compared with patients who were VA negative, but had similar established HCM risk metrics. Receiver operating characteristic analysis revealed that QRSp discriminated VA (area under the curve=0.76; P<0.001), with a QRSp ≥4 achieving 91% sensitivity and 39% specificity. The annual VA rate was greater in patients with QRSp ≥4 versus QRSp <4 (4.4% versus 0.98%; P=0.012). In multivariable Cox regression, age <50 years (hazard ratio [HR], 2.53; P=0.009) and QRSp (HR per QRS peak, 1.41; P=0.009) predicted VA after adjusting for established HCM risk metrics. In patients aged <50 years, the annual VA rate was 0.0% for QRSp <4 compared with 6.9% for QRSp ≥4 (P=0.012). CONCLUSIONS: QRSp predicted VA in patients with HCM who were eligible for an implantable cardioverter‐defibrillator after adjusting for established HCM risk metrics, such that each additional QRS peak increases VA risk by 40%. QRSp <4 was associated with a <1% annual VA risk in all patients, and no VA risk among those aged <50 years. This novel ECG metric may improve patient selection for prophylactic implantable cardioverter‐defibrillator therapy by identifying those with low VA risk. These findings require further validation in a lower risk HCM cohort. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02560844. John Wiley and Sons Inc. 2022-12-06 /pmc/articles/PMC9851434/ /pubmed/36444865 http://dx.doi.org/10.1161/JAHA.122.026025 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Suszko, Adrian M.
Chakraborty, Praloy
Viswanathan, Karthik
Barichello, Scott
Sapp, John
Talajic, Mario
Laksman, Zachary
Yee, Raymond
Woo, Anna
Spears, Danna
Adler, Arnon
Rakowski, Harry
Chauhan, Vijay S.
Automated Quantification of Abnormal QRS Peaks From High‐Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5‐Year Prospective Multicenter Study
title Automated Quantification of Abnormal QRS Peaks From High‐Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5‐Year Prospective Multicenter Study
title_full Automated Quantification of Abnormal QRS Peaks From High‐Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5‐Year Prospective Multicenter Study
title_fullStr Automated Quantification of Abnormal QRS Peaks From High‐Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5‐Year Prospective Multicenter Study
title_full_unstemmed Automated Quantification of Abnormal QRS Peaks From High‐Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5‐Year Prospective Multicenter Study
title_short Automated Quantification of Abnormal QRS Peaks From High‐Resolution ECGs Predicts Late Ventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 5‐Year Prospective Multicenter Study
title_sort automated quantification of abnormal qrs peaks from high‐resolution ecgs predicts late ventricular arrhythmias in hypertrophic cardiomyopathy: a 5‐year prospective multicenter study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851434/
https://www.ncbi.nlm.nih.gov/pubmed/36444865
http://dx.doi.org/10.1161/JAHA.122.026025
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