Abstract | PURPOSE: The relatively low incidence of device-treated ventricular arrhythmias in patients with ischemic cardiomyopathy (ICM) who receive implantable cardioverter defibrillators (ICDs) for primary prevention makes improved risk stratification of ICM patients a priority. Although Cornell product (CP) ECG left ventricular hypertrophy (LVH) has been associated with increased mortality in hypertensive patients and population-based studies, whether CP LVH can improve risk stratification of high-risk ICM patients is unclear. The aim of this study is to examine if electrocardiographic LVH predicts mortality and incident ventricular arrhythmia in patients with ICM. METHODS: All-cause mortality was examined in 317 patients with ICM and a history of non-sustained ventricular tachycardia (VT) who underwent electrophysiology testing. Incident VT and ventricular fibrillation (VF) were assessed in ICD recipients (n = 186). ECG LVH was defined by CP criteria: [(R (aVL) + S (V3)) + 6 mm in women] × QRS duration >2,440 mm ms. RESULTS: During 3 years of follow-up, mortality was 20% (64 of 317) and death or incident VT or VF occurred in 35% of ICD recipients. CP LVH was associated with significantly greater 3-year mortality (28% vs 15%, p = 0.015) and 3-year mortality or incident VT/VF in ICD patients (48% vs 35%, p = 0.011). In Cox multivariate models, CP LVH was an independent predictor of mortality in all patients (hazard ratio (HR) 1.81, 95% confidence interval (CI) 1.11-2.97, p = 0.020) and of the composite endpoint of mortality or incident ventricular arrhythmia in ICD patients (HR 1.82, 95% CI 1.12-3.00, p = 0.016). CONCLUSIONS: ECG LVH using CP criteria may enhance risk stratification in high-risk patients with ICM.
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Authors | Seth R Bender, Daniel J Friedman, Steven M Markowitz, Bruce B Lerman, Peter M Okin |
Journal | Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
(J Interv Card Electrophysiol)
Vol. 34
Issue 3
Pg. 237-45
(Sep 2012)
ISSN: 1572-8595 [Electronic] Netherlands |
PMID | 22354775
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Aged
- Arrhythmias, Cardiac
(mortality, physiopathology, prevention & control)
- Cardiomyopathies
(mortality, physiopathology)
- Defibrillators, Implantable
- Electrocardiography
- Female
- Humans
- Hypertrophy, Left Ventricular
(mortality, physiopathology)
- Incidence
- Male
- Myocardial Ischemia
(mortality, physiopathology)
- Predictive Value of Tests
- Primary Prevention
- Proportional Hazards Models
- Prospective Studies
- Risk Assessment
- Risk Factors
- Tachycardia, Ventricular
(mortality, physiopathology)
- Ventricular Fibrillation
(mortality, physiopathology)
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