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

Aapo L. Aro, Derek Phan, Carmen Teodorescu, Audrey Uy-Evanado, Kyndaron Reinier, Karen Gunson, Jonathan Jui, Heikki V. Huikuri, Sumeet S. Chugh

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Aims 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 echocardiography findings with ECG and clinical characteristics to investigate how alterations in cardiac structure and function contribute to this risk marker. Methods and results From the ongoing population-based Oregon Sudden Unexpected Death Study (catchment population ~1 million), SCD cases with prior ECG available (n = 627) were compared with controls (n = 801). Subjects with delayed transi- tion at V5 or later were identified, and clinical and echocardiography 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/m2; 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). Conclusion 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.

Original languageEnglish (US)
Pages (from-to)629-635
Number of pages7
JournalEuropace
Volume19
Issue number4
DOIs
StatePublished - Apr 1 2017

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Sudden Cardiac Death
Electrocardiography
Myocardial Infarction
Sudden Death
Echocardiography
Atrial Remodeling
Left Ventricular Hypertrophy
Stroke Volume
Population
Multivariate Analysis

Keywords

  • Clockwise rotation
  • Delayed QRS transition
  • Electrocardiography
  • Population
  • Sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Aro, A. L., Phan, D., Teodorescu, C., Uy-Evanado, A., Reinier, K., Gunson, K., ... Chugh, S. S. (2017). Cardiac structural and functional profile of patients with delayed QRS transition zone and sudden cardiac death. Europace, 19(4), 629-635. https://doi.org/10.1093/europace/euw040

Cardiac structural and functional profile of patients with delayed QRS transition zone and sudden cardiac death. / Aro, Aapo L.; Phan, Derek; Teodorescu, Carmen; Uy-Evanado, Audrey; Reinier, Kyndaron; Gunson, Karen; Jui, Jonathan; Huikuri, Heikki V.; Chugh, Sumeet S.

In: Europace, Vol. 19, No. 4, 01.04.2017, p. 629-635.

Research output: Contribution to journalArticle

Aro, AL, Phan, D, Teodorescu, C, Uy-Evanado, A, Reinier, K, Gunson, K, Jui, J, Huikuri, HV & Chugh, SS 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
Aro, Aapo L. ; Phan, Derek ; Teodorescu, Carmen ; Uy-Evanado, Audrey ; Reinier, Kyndaron ; Gunson, Karen ; Jui, Jonathan ; Huikuri, Heikki V. ; Chugh, Sumeet S. / Cardiac structural and functional profile of patients with delayed QRS transition zone and sudden cardiac death. In: Europace. 2017 ; Vol. 19, No. 4. pp. 629-635.
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abstract = "Aims 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 echocardiography findings with ECG and clinical characteristics to investigate how alterations in cardiac structure and function contribute to this risk marker. Methods and results From the ongoing population-based Oregon Sudden Unexpected Death Study (catchment population ~1 million), SCD cases with prior ECG available (n = 627) were compared with controls (n = 801). Subjects with delayed transi- tion at V5 or later were identified, and clinical and echocardiography 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/m2; 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). Conclusion 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.",
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