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 language | English (US) |
|---|---|
| Pages (from-to) | 629-635 |
| Number of pages | 7 |
| Journal | Europace |
| Volume | 19 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2017 |
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Keywords
- Clockwise rotation
- Delayed QRS transition
- Electrocardiography
- Population
- Sudden cardiac death
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)
Cite this
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 journal › Article
}
TY - JOUR
T1 - Cardiac structural and functional profile of patients with delayed QRS transition zone and sudden cardiac death
AU - Aro, Aapo L.
AU - Phan, Derek
AU - Teodorescu, Carmen
AU - Uy-Evanado, Audrey
AU - Reinier, Kyndaron
AU - Gunson, Karen
AU - Jui, Jonathan
AU - Huikuri, Heikki V.
AU - Chugh, Sumeet S.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - 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.
AB - 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.
KW - Clockwise rotation
KW - Delayed QRS transition
KW - Electrocardiography
KW - Population
KW - Sudden cardiac death
UR - http://www.scopus.com/inward/record.url?scp=85019144602&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85019144602&partnerID=8YFLogxK
U2 - 10.1093/europace/euw040
DO - 10.1093/europace/euw040
M3 - Article
C2 - 28431059
AN - SCOPUS:85019144602
VL - 19
SP - 629
EP - 635
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
SN - 1099-5129
IS - 4
ER -