The Romhilt-Estes electrocardiographic score predicts sudden cardiac arrest independent of left ventricular mass and ejection fraction

Navid Darouian, Aapo L. Aro, Kumar Narayanan, Audrey Uy-Evanado, Carmen Rusinaru, Kyndaron Reinier, Karen Gunson, Jonathan Jui, Sumeet S. Chugh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The Romhilt-Estes point score system (RE) is an established ECG criterion for diagnosing left ventricular hypertrophy (LVH). In this study, we assessed for the first time, whether RE and its components are predictive of sudden cardiac arrest (SCA) independent of left ventricular (LV) mass. Methods: Sudden cardiac arrest (SCA) cases occurring between 2002 and 2014 in a Northwestern US metro region (catchment area approx. 1 million) were compared to geographic controls. ECGs and echocardiograms performed prior to the SCA and those of controls were acquired from the medical records and evaluated for the ECG criteria established in the RE score and for LV mass. Results: Two hundred forty-seven SCA cases (age 68.3 ± 14.6, male 64.4%) and 330 controls (age 67.4 ± 11.5, male 63.6) were included in the analysis. RE scores were greater in cases than controls (2.5 ± 2.1 vs. 1.9 ± 1.7, p < .001), and SCA cases were more likely to meet definite LVH criteria (18.6% vs. 7.9%, p < .001). In a multivariable model including echocardiographic LVH and LV function, definite LVH remained independently predictive of SCA (OR 2.04, 95% CI 1.16-3.59, p = .013). The model was replicated with the individual ECG criteria, and only SV1.2 ≥ 30 mm and delayed intrinsicoid deflection remained significant predictors of SCA. Conclusion: Left ventricular hypertrophy (LVH) as defined by the RE point score system is associated with SCA independent of echocardiographic LVH and reduced LV ejection fraction. These findings support an independent role for purely electrical LVH, in the genesis of lethal ventricular arrhythmias.

Original languageEnglish (US)
JournalAnnals of Noninvasive Electrocardiology
DOIs
StateAccepted/In press - 2017

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Sudden Cardiac Death
Left Ventricular Hypertrophy
Stroke Volume
Electrocardiography
Left Ventricular Function
Medical Records
Cardiac Arrhythmias

Keywords

  • Electrocardiography
  • Left ventricular hypertrophy
  • Sudden cardiac arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

The Romhilt-Estes electrocardiographic score predicts sudden cardiac arrest independent of left ventricular mass and ejection fraction. / Darouian, Navid; Aro, Aapo L.; Narayanan, Kumar; Uy-Evanado, Audrey; Rusinaru, Carmen; Reinier, Kyndaron; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S.

In: Annals of Noninvasive Electrocardiology, 2017.

Research output: Contribution to journalArticle

Darouian, Navid ; Aro, Aapo L. ; Narayanan, Kumar ; Uy-Evanado, Audrey ; Rusinaru, Carmen ; Reinier, Kyndaron ; Gunson, Karen ; Jui, Jonathan ; Chugh, Sumeet S. / The Romhilt-Estes electrocardiographic score predicts sudden cardiac arrest independent of left ventricular mass and ejection fraction. In: Annals of Noninvasive Electrocardiology. 2017.
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abstract = "Background: The Romhilt-Estes point score system (RE) is an established ECG criterion for diagnosing left ventricular hypertrophy (LVH). In this study, we assessed for the first time, whether RE and its components are predictive of sudden cardiac arrest (SCA) independent of left ventricular (LV) mass. Methods: Sudden cardiac arrest (SCA) cases occurring between 2002 and 2014 in a Northwestern US metro region (catchment area approx. 1 million) were compared to geographic controls. ECGs and echocardiograms performed prior to the SCA and those of controls were acquired from the medical records and evaluated for the ECG criteria established in the RE score and for LV mass. Results: Two hundred forty-seven SCA cases (age 68.3 ± 14.6, male 64.4{\%}) and 330 controls (age 67.4 ± 11.5, male 63.6) were included in the analysis. RE scores were greater in cases than controls (2.5 ± 2.1 vs. 1.9 ± 1.7, p < .001), and SCA cases were more likely to meet definite LVH criteria (18.6{\%} vs. 7.9{\%}, p < .001). In a multivariable model including echocardiographic LVH and LV function, definite LVH remained independently predictive of SCA (OR 2.04, 95{\%} CI 1.16-3.59, p = .013). The model was replicated with the individual ECG criteria, and only SV1.2 ≥ 30 mm and delayed intrinsicoid deflection remained significant predictors of SCA. Conclusion: Left ventricular hypertrophy (LVH) as defined by the RE point score system is associated with SCA independent of echocardiographic LVH and reduced LV ejection fraction. These findings support an independent role for purely electrical LVH, in the genesis of lethal ventricular arrhythmias.",
keywords = "Electrocardiography, Left ventricular hypertrophy, Sudden cardiac arrest",
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T1 - The Romhilt-Estes electrocardiographic score predicts sudden cardiac arrest independent of left ventricular mass and ejection fraction

AU - Darouian, Navid

AU - Aro, Aapo L.

AU - Narayanan, Kumar

AU - Uy-Evanado, Audrey

AU - Rusinaru, Carmen

AU - Reinier, Kyndaron

AU - Gunson, Karen

AU - Jui, Jonathan

AU - Chugh, Sumeet S.

PY - 2017

Y1 - 2017

N2 - Background: The Romhilt-Estes point score system (RE) is an established ECG criterion for diagnosing left ventricular hypertrophy (LVH). In this study, we assessed for the first time, whether RE and its components are predictive of sudden cardiac arrest (SCA) independent of left ventricular (LV) mass. Methods: Sudden cardiac arrest (SCA) cases occurring between 2002 and 2014 in a Northwestern US metro region (catchment area approx. 1 million) were compared to geographic controls. ECGs and echocardiograms performed prior to the SCA and those of controls were acquired from the medical records and evaluated for the ECG criteria established in the RE score and for LV mass. Results: Two hundred forty-seven SCA cases (age 68.3 ± 14.6, male 64.4%) and 330 controls (age 67.4 ± 11.5, male 63.6) were included in the analysis. RE scores were greater in cases than controls (2.5 ± 2.1 vs. 1.9 ± 1.7, p < .001), and SCA cases were more likely to meet definite LVH criteria (18.6% vs. 7.9%, p < .001). In a multivariable model including echocardiographic LVH and LV function, definite LVH remained independently predictive of SCA (OR 2.04, 95% CI 1.16-3.59, p = .013). The model was replicated with the individual ECG criteria, and only SV1.2 ≥ 30 mm and delayed intrinsicoid deflection remained significant predictors of SCA. Conclusion: Left ventricular hypertrophy (LVH) as defined by the RE point score system is associated with SCA independent of echocardiographic LVH and reduced LV ejection fraction. These findings support an independent role for purely electrical LVH, in the genesis of lethal ventricular arrhythmias.

AB - Background: The Romhilt-Estes point score system (RE) is an established ECG criterion for diagnosing left ventricular hypertrophy (LVH). In this study, we assessed for the first time, whether RE and its components are predictive of sudden cardiac arrest (SCA) independent of left ventricular (LV) mass. Methods: Sudden cardiac arrest (SCA) cases occurring between 2002 and 2014 in a Northwestern US metro region (catchment area approx. 1 million) were compared to geographic controls. ECGs and echocardiograms performed prior to the SCA and those of controls were acquired from the medical records and evaluated for the ECG criteria established in the RE score and for LV mass. Results: Two hundred forty-seven SCA cases (age 68.3 ± 14.6, male 64.4%) and 330 controls (age 67.4 ± 11.5, male 63.6) were included in the analysis. RE scores were greater in cases than controls (2.5 ± 2.1 vs. 1.9 ± 1.7, p < .001), and SCA cases were more likely to meet definite LVH criteria (18.6% vs. 7.9%, p < .001). In a multivariable model including echocardiographic LVH and LV function, definite LVH remained independently predictive of SCA (OR 2.04, 95% CI 1.16-3.59, p = .013). The model was replicated with the individual ECG criteria, and only SV1.2 ≥ 30 mm and delayed intrinsicoid deflection remained significant predictors of SCA. Conclusion: Left ventricular hypertrophy (LVH) as defined by the RE point score system is associated with SCA independent of echocardiographic LVH and reduced LV ejection fraction. These findings support an independent role for purely electrical LVH, in the genesis of lethal ventricular arrhythmias.

KW - Electrocardiography

KW - Left ventricular hypertrophy

KW - Sudden cardiac arrest

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