Microvolt QRS Alternans in Hypertrophic Cardiomyopathy: A Novel Risk Marker of Late Ventricular Arrhythmias
| العنوان: | Microvolt QRS Alternans in Hypertrophic Cardiomyopathy: A Novel Risk Marker of Late Ventricular Arrhythmias |
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| المؤلفون: | Kimia Sheikholeslami, Arnon Adler, Karthik Viswanathan, Adrian Suszko, Danna A. Spears, Harry Rakowski, Anna Woo, Praloy Chakraborty, Vijay S. Chauhan |
| المصدر: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 23 (2021) |
| بيانات النشر: | Wiley, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, Precordial examination, QRS complex, Risk Factors, Internal medicine, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, In patient, ventricular arrhythmia, End point, alternans, business.industry, Proportional hazards model, ECG, Hazard ratio, Hypertrophic cardiomyopathy, risk assessment, Arrhythmias, Cardiac, Ventricular pacing, Cardiomyopathy, Hypertrophic, medicine.disease, hypertrophic cardiomyopathy, RC666-701, Cardiology, Cardiology and Cardiovascular Medicine, business |
| الوصف: | Background Unlike T‐wave alternans (TWA), the relation between QRS alternans (QRSA) and ventricular arrhythmia (VA) risk has not been evaluated in hypertrophic cardiomyopathy (HCM). We assessed microvolt QRSA/TWA in relation to HCM risk factors and late VA outcomes in HCM. Methods and Results Prospectively enrolled patients with HCM (n=130) with prophylactic implantable cardioverter‐defibrillators underwent digital 12‐lead ECG recordings during ventricular pacing (100–120 beats/min). QRSA/TWA was quantified using the spectral method. Patients were categorized as QRSA+ and/or TWA+ if sustained alternans was present in ≥2 precordial leads. The VA end point was appropriate implantable cardioverter‐defibrillator therapy over 5 years of follow‐up. QRSA+ and TWA+ occurred together in 28% of patients and alone in 7% and 7% of patients, respectively. QRSA magnitude increased with pacing rate (1.9±0.6 versus 6.2±2.0 µV; P =0.006). Left ventricular thickness was greater in QRSA+ than in QRSA− patients (22±7 versus 20±6 mm; P =0.035). Over 5 years follow‐up, 17% of patients had VA. The annual VA rate was greater in QRSA+ versus QRSA− patients (5.8% versus 2.0%; P =0.006), with the QRSA+/TWA− subgroup having the greatest rate (13.3% versus 2.6%; P P =0.001). Separate Cox models revealed QRSA+ (hazard ratio [HR], 2.9 [95% CI, 1.2–7.0]; P =0.019) and QRSA+/TWA− (HR, 7.9 [95% CI, 2.9–21.7]; P Conclusions In HCM, microvolt QRSA is a novel, rate‐dependent phenomenon that can exist without TWA and is associated with greater left ventricular thickness. QRSA increases VA risk 3‐fold in all patients, whereas the absence of QRSA confers low VA risk in patients with Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02560844. |
| اللغة: | English |
| تدمد: | 2047-9980 0256-0844 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::92e714319c9015ee9c87b4aadf72c994 https://www.ahajournals.org/doi/10.1161/JAHA.121.022036 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....92e714319c9015ee9c87b4aadf72c994 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20479980 02560844 |
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