Cardiac structural and functional profile of patients with delayed QRS transition zone and sudden cardiac death

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http://hdl.handle.net/10138/189053

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Aro , A L A , Phan , D , Teodorescu , C , Uy-Evanado , A , Reinier , K , Gunson , K , Jui , J , Huikuri , H V & Chugh , S S 2017 , ' Cardiac structural and functional profile of patients with delayed QRS transition zone and sudden cardiac death ' , Europace , vol. 19 , no. 4 , pp. 629-635 . https://doi.org/10.1093/europace/euw040

Title: Cardiac structural and functional profile of patients with delayed QRS transition zone and sudden cardiac death
Author: Aro, Aapo Lauri Aleksi; Phan, Derek; Teodorescu, Carmen; Uy-Evanado, Audrey; Reinier, Kyndaron; Gunson, Karen; Jui, Jonathan; Huikuri, Heikki V.; Chugh, Sumeet S.
Contributor: University of Helsinki, Clinicum
Date: 2017-04
Language: eng
Number of pages: 7
Belongs to series: Europace
ISSN: 1099-5129
URI: http://hdl.handle.net/10138/189053
Abstract: Delayed QRS transition zone in the precordial leads of the 12-lead electrocardiogram (ECG) has been recently associated with increased risk of sudden cardiac death (SCD), but the underlying mechanisms are unknown. We correlated echocardiographic findings with ECG and clinical characteristics to investigate how alterations in cardiac structure and function contribute to this risk marker. From the ongoing population-based Oregon Sudden Unexpected Death Study (catchment population similar to 1 million), SCD cases with prior ECG available (n = 627) were compared with controls (n = 801). Subjects with delayed transition at V-5 or later were identified, and clinical and echocardiographic patterns associated with delayed transition were analysed. Delayed transition was present in 31% of the SCD cases and 17% of the controls. These subjects were older and more likely to have cardiovascular risk factors and history of myocardial infarction. Delayed transition was associated with increased left ventricular (LV) mass (122.7 +/- 40.2 vs. 102.9 +/- 33.7 g/m(2); P <0.001), larger LV diameter (53.3 +/- 10.4 vs. 49.2 +/- 8.0 mm; P <0.001), and lower LV ejection fraction (LVEF) (46.4 +/- 15.7 vs. 55.6 +/- 12.5%; P <0.001). In multivariate analysis, delayed transition was independently associated with myocardial infarction, reduced LVEF, and LV hypertrophy. The association between delayed transition and SCD was independent of the LVEF (OR 1.57; 95% CI 1.04-2.38; P = 0.032). The underpinnings of delayed QRS transition zone extend beyond previous myocardial infarction and reduced LVEF. Since the association with sudden death is independent of these factors, this novel marker of myocardial electrical remodelling should be explored as a potential risk predictor of SCD.
Subject: Electrocardiography
Delayed QRS transition
Clockwise rotation
Sudden cardiac death
Population
ELECTROCARDIOGRAPHIC FINDINGS
CARDIOVASCULAR MORTALITY
HEART-ASSOCIATION
NIPPON DATA80
DISEASE
COMMUNITY
FAILURE
RISK
3121 Internal medicine
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