Document Detail


An ECG index of myocardial scar enhances prediction of defibrillator shocks: an analysis of the Sudden Cardiac Death in Heart Failure Trial.
MedLine Citation:
PMID:  20884379     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Only a minority of patients receiving implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden death receive appropriate shocks, yet almost as many are subjected to inappropriate shocks and device complications. Identifying and quantifying myocardial scar, which forms the substrate for ventricular tachyarrhythmias, may improve risk stratification.
OBJECTIVE: This study sought to determine whether the absence of myocardial scar detected by novel 12-lead electrocardiographic (ECG) Selvester QRS scoring criteria identifies patients with low risk for appropriate ICD shocks.
METHODS: We applied QRS scoring to 797 patients from the ICD arm of the Sudden Cardiac Death in Heart Failure Trial. Patients were followed up for a median of 45.5 months for ventricular tachycardia/fibrillation treated by the ICD or sudden tachyarrhythmic death (combined group referred to as VT/VF).
RESULTS: Increasing QRS score scar size predicted higher rates of VT/VF. Patients with no scar (QRS score = 0) represented a particularly low-risk cohort with 48% fewer VT/VF events than the rest of the population (absolute difference 11%; hazard ratio 0.52, 95% confidence interval 0.31 to 0.88). QRS score scar absence versus presence remained a significant prognostic factor after controlling for 10 clinically relevant variables. Combining QRS score (scar absence versus presence) with ejection fraction (≥ 25% versus < 25%) distinguished low-, middle-, and high-risk subgroups with 73% fewer VT/VF events in the low-risk versus high-risk group (absolute difference 22%; hazard ratio = 0.27, 95% confidence interval 0.12 to 0.62).
CONCLUSION: Patients with no scar by QRS scoring have significantly fewer VT/VF events. This inexpensive 12-lead ECG tool provides unique, incremental prognostic information and should be considered in risk-stratifying algorithms for selecting patients for ICDs.
Authors:
David G Strauss; Jeanne E Poole; Galen S Wagner; Ronald H Selvester; Julie M Miller; Jill Anderson; George Johnson; Steven E McNulty; Daniel B Mark; Kerry L Lee; Gust H Bardy; Katherine C Wu
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-09-25
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  8     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-27     Completed Date:  2011-05-24     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  38-45     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00000609
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MeSH Terms
Descriptor/Qualifier:
Aged
Cicatrix / pathology
Death, Sudden, Cardiac / prevention & control*
Defibrillators, Implantable* / adverse effects
Electrocardiography*
Equipment Failure Analysis
Female
Heart Conduction System / physiopathology
Heart Failure / therapy*
Humans
Male
Middle Aged
Myocardium / pathology*
Prognosis
Risk Assessment
Grant Support
ID/Acronym/Agency:
U01 HL055297-03/HL/NHLBI NIH HHS; U01 HL055297-04/HL/NHLBI NIH HHS; U01 HL055297-05/HL/NHLBI NIH HHS; U01 HL055297-06/HL/NHLBI NIH HHS; U01 HL055297-07/HL/NHLBI NIH HHS; U01 HL055496-03/HL/NHLBI NIH HHS; U01 HL055496-04/HL/NHLBI NIH HHS; U01 HL055496-05/HL/NHLBI NIH HHS; U01 HL055496-05S1/HL/NHLBI NIH HHS; U01 HL055496-06/HL/NHLBI NIH HHS; U01 HL055496-07/HL/NHLBI NIH HHS; U01 HL055766-03/HL/NHLBI NIH HHS; U01 HL055766-04/HL/NHLBI NIH HHS; U01 HL055766-05/HL/NHLBI NIH HHS; U01 HL055766-06/HL/NHLBI NIH HHS; U01 HL055766-07/HL/NHLBI NIH HHS; U01 HL55297/HL/NHLBI NIH HHS; U01 HL55496/HL/NHLBI NIH HHS; U01 HL55766/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Heart Rhythm. 2011 Jan;8(1):46-7   [PMID:  20951233 ]

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