Usefulness of Electrocardiographic Parameters for Risk Prediction in Arrhythmogenic Right Ventricular Dysplasia

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• 作者：Ardan M. Saguner ; MD^a ; Sabrina Ganahl ; MD^a ; Samuel H. Baldinger ; MD^b ; Andrea Kraus ; PhD^c ; Argelia Medeiros-Domingo ; MD ; PhD^a ; ^b ; Sebastian Nordbeck^a ; Arhan R. Saguner^a ; Andreas S. Mueller-Burri ; MD^d ; Laurent M. Haegeli ; MD^a ; Thomas Wolber ; MD^a ; ^e ; Jan Steffel ; MD^a ; Nazmi Krasniqi ; MD^a ; Etienne Delacré ; taz ; MD^b ; Thomas F. Lü ; scher ; MD^a ; ^e ; Leonhard Held ; PhD^c ; Corinna B. Brunckhorst ; MD^a ; Firat Duru ; MD^a ; ^e ; ^{firat.duru@usz.ch" class="auth_mail}
• 刊名：The American Journal of Cardiology
• 出版年：15 May 2014
• 年：2014
• 卷：113
• 期：10
• 页码：1728-1734
• 全文大小：1271 K

文摘

The value of electrocardiographic findings predicting adverse outcome in patients with arrhythmogenic right ventricular dysplasia (ARVD) is not well known. We hypothesized that ventricular depolarization and repolarization abnormalities on the 12-lead surface electrocardiogram (ECG) predict adverse outcome in patients with ARVD. ECGs of 111 patients screened for the 2010 ARVD Task Force Criteria from 3 Swiss tertiary care centers were digitized and analyzed with a digital caliper by 2 independent observers blinded to the outcome. ECGs were compared in 2 patient groups: (1) patients with major adverse cardiovascular events (MACE: a composite of cardiac death, heart transplantation, survived sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or arrhythmic syncope) and (2) all remaining patients. A total of 51 patients (46%) experienced MACE during a follow-up period with median of 4.6 years (interquartile range 1.8 to 10.0). Kaplan-Meier analysis revealed reduced times to MACE for patients with repolarization abnormalities according to Task Force Criteria (p = 0.009), a precordial QRS amplitude ratio (∑QRS mV V₁ to V₃/∑QRS mV V₁ to V₆) of ≤0.48 (p = 0.019), and QRS fragmentation (p = 0.045). In multivariable Cox regression, a precordial QRS amplitude ratio of ≤0.48 (hazard ratio [HR] 2.92, 95% confidence interval [CI] 1.39 to 6.15, p = 0.005), inferior leads T-wave inversions (HR 2.44, 95% CI 1.15 to 5.18, p = 0.020), and QRS fragmentation (HR 2.65, 95% CI 1.1 to 6.34, p = 0.029) remained as independent predictors of MACE. In conclusion, in this multicenter, observational, long-term study, electrocardiographic findings were useful for risk stratification in patients with ARVD, with repolarization criteria, inferior leads TWI, a precordial QRS amplitude ratio of ≤0.48, and QRS fragmentation constituting valuable variables to predict adverse outcome.