Electrical risk score beyond the left ventricular ejection fraction: Prediction of sudden cardiac death in the Oregon Sudden Unexpected Death Study and the Atherosclerosis Risk in Communities Study

Aapo L. Aro, Kyndaron Reinier, Carmen Rusinaru, Audrey Uy-Evanado, Navid Darouian, Derek Phan, Wendy J. Mack, Jonathan Jui, Elsayed Z. Soliman, Larisa Tereshchenko, Sumeet S. Chugh

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Aims There is an urgent need to extend sudden cardiac death (SCD) risk stratification beyond the left ventricular ejection fraction (LVEF). We evaluated whether a cumulative electrocardiogram (ECG) risk score would improve identification of individuals at high risk of SCD. Methods and results In the community-based Oregon Sudden Unexpected Death Study (catchment population 1/41 million), 522 SCD cases with archived 12-lead ECG available (65.3 ± 14.5 years, 66% male) were compared with 736 geographical controls to assess the incremental value of multiple ECG parameters in SCD prediction. Heart rate, LV hypertrophy, QRS transition zone, QRS-T angle, QTc, and Tpeak-to-Tend interval remained significant in the final model, which was externally validated in the Atherosclerosis Risk in Communities (ARIC) Study. Sixteen percent of cases and 3% of controls had ≥4 abnormal ECG markers. After adjusting for clinical factors and LVEF, increasing ECG risk score was associated with progressively greater odds of SCD. Overall, subjects with ≥4 ECG abnormalities had an odds ratio (OR) of 21.2 for SCD [95% confidence interval (CI) 9.4-47.7; P < 0.001]. In the LVEF >35% subgroup, the OR was 26.1 (95% CI 9.9-68.5; P < 0.001). The ECG risk score increased the C-statistic from 0.625 to 0.753 (P < 0.001), with net reclassification improvement of 0.319 (P < 0.001). In the ARIC cohort validation, risk of SCD associated with ≥4 ECG abnormalities remained significant after multivariable adjustment (hazard ratio 4.84; 95% CI 2.34-9.99; P < 0.001; C-statistic improvement 0.759-0.774; P = 0.019). Conclusion This novel cumulative ECG risk score was independently associated with SCD and was particularly effective for LVEF >35% where risk stratification is currently unavailable. These findings warrant further evaluation in prospective clinical investigations.

Original languageEnglish (US)
Pages (from-to)3017-3025
Number of pages9
JournalEuropean Heart Journal
Volume38
Issue number40
DOIs
StatePublished - Oct 21 2017

Keywords

  • Death
  • Electrocardiography
  • Left ventricular ejection fraction
  • Prevention
  • Risk stratification
  • Sudden cardiac

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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