A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias

Sum magnitude of the absolute QRST integral

Larisa Tereshchenko, Alan Cheng, Barry J. Fetics, Barbara Butcher, Joseph E. Marine, David D. Spragg, Sunil Sinha, Darshan Dalal, Hugh Calkins, Gordon F. Tomaselli, Ronald D. Berger

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)208-216
Number of pages9
JournalJournal of Electrocardiology
Volume44
Issue number2
DOIs
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Tachycardia
Electrocardiography
Cardiac Arrhythmias
Implantable Defibrillators
Ventricular Tachycardia
Confidence Intervals
Predictive Value of Tests
Ventricular Fibrillation
Primary Prevention
Heart Diseases
Cohort Studies
Prospective Studies
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias : Sum magnitude of the absolute QRST integral. / Tereshchenko, Larisa; Cheng, Alan; Fetics, Barry J.; Butcher, Barbara; Marine, Joseph E.; Spragg, David D.; Sinha, Sunil; Dalal, Darshan; Calkins, Hugh; Tomaselli, Gordon F.; Berger, Ronald D.

In: Journal of Electrocardiology, Vol. 44, No. 2, 03.2011, p. 208-216.

Research output: Contribution to journalArticle

Tereshchenko, L, Cheng, A, Fetics, BJ, Butcher, B, Marine, JE, Spragg, DD, Sinha, S, Dalal, D, Calkins, H, Tomaselli, GF & Berger, RD 2011, 'A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias: Sum magnitude of the absolute QRST integral', Journal of Electrocardiology, vol. 44, no. 2, pp. 208-216. https://doi.org/10.1016/j.jelectrocard.2010.08.012
Tereshchenko, Larisa ; Cheng, Alan ; Fetics, Barry J. ; Butcher, Barbara ; Marine, Joseph E. ; Spragg, David D. ; Sinha, Sunil ; Dalal, Darshan ; Calkins, Hugh ; Tomaselli, Gordon F. ; Berger, Ronald D. / A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias : Sum magnitude of the absolute QRST integral. In: Journal of Electrocardiology. 2011 ; Vol. 44, No. 2. pp. 208-216.
@article{e17deef78d65478382a93f0b3d8243c6,
title = "A new electrocardiogram marker to identify patients at low risk for ventricular tachyarrhythmias: Sum magnitude of the absolute QRST integral",
abstract = "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.",
author = "Larisa Tereshchenko and Alan Cheng and Fetics, {Barry J.} and Barbara Butcher and Marine, {Joseph E.} and Spragg, {David D.} and Sunil Sinha and Darshan Dalal and Hugh Calkins and Tomaselli, {Gordon F.} and Berger, {Ronald D.}",
year = "2011",
month = "3",
doi = "10.1016/j.jelectrocard.2010.08.012",
language = "English (US)",
volume = "44",
pages = "208--216",
journal = "Journal of Electrocardiology",
issn = "0022-0736",
publisher = "Churchill Livingstone",
number = "2",

}

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

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.

UR - http://www.scopus.com/inward/record.url?scp=79952042919&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952042919&partnerID=8YFLogxK

U2 - 10.1016/j.jelectrocard.2010.08.012

DO - 10.1016/j.jelectrocard.2010.08.012

M3 - Article

VL - 44

SP - 208

EP - 216

JO - Journal of Electrocardiology

JF - Journal of Electrocardiology

SN - 0022-0736

IS - 2

ER -