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Screening entire health system ECG databases to identify patients at increased risk of death.

ABSTRACT: Current methods to identify patients at higher risk for sudden cardiac death, primarily left ventricular ejection fraction ?35%, miss ?80% of patients who die suddenly. We tested the hypothesis that patients with elevated QRS-scores (index of myocardial scar) and wide QRS-T angles (index abnormal depolarization-repolarization relationship) have high 1-year all-cause mortality and could be further risk stratified with clinical characteristics.We screened all 12-lead ECGs over 6 months at 2 large hospital systems and analyzed clinical characteristics and 1-year mortality. Patients with ECGs obtained in hospital areas with known high mortality rates were excluded. At the first hospital, QRS-score ?5 and QRS-T angle ?105° identified 8.0% of patients and was associated with an odds ratio of 2.79 (95% confidence interval, 2.10-3.69) for 1-year mortality compared with patients below both ECG thresholds (13.9% versus 5.5% death rate). Left ventricular ejection fraction was >35% in 82% of the former group of patients, and addition of ECG measures to left ventricular ejection fraction increased the discrimination of death risk (P<0.0001). At the second hospital, the odds ratio was 2.42 (1.95-3.01) for 1-year mortality (8.8% versus 3.8%). Adjustment for patient characteristics eliminated interhospital differences. Multivariable adjusted odds ratio combining data from both hospitals was 1.53 (1.28-1.83). Increasing heart rate and chronic renal impairment further predicted mortality.Screening hospital ECG databases with QRS-scoring and QRS-T angle analysis identifies patients with high 1-year all-cause mortality and predominantly preserved left ventricular ejection fraction. This approach may represent a widely available method to identify patients at increased risk of death.

SUBMITTER: Strauss DG

PROVIDER: S-EPMC3992472 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

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Screening entire health system ECG databases to identify patients at increased risk of death.

Strauss David G DG Mewton Nathan N Verrier Richard L RL Nearing Bruce D BD Marchlinski Francis E FE Killian Tony T Moxley John J Tereshchenko Larisa G LG Wu Katherine C KC Winslow Raimond R Cox Christopher C Spooner Peter M PM Lima João A C JA

Circulation. Arrhythmia and electrophysiology 20131012 6

<h4>Background</h4>Current methods to identify patients at higher risk for sudden cardiac death, primarily left ventricular ejection fraction ≤35%, miss ≈80% of patients who die suddenly. We tested the hypothesis that patients with elevated QRS-scores (index of myocardial scar) and wide QRS-T angles (index abnormal depolarization-repolarization relationship) have high 1-year all-cause mortality and could be further risk stratified with clinical characteristics.<h4>Methods and results</h4>We scre ...[more]

PMID: 24122522

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Screening entire health system ECG databases to identify patients at increased risk of death.

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Screening entire health system ECG databases to identify patients at increased risk of death.

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