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Jeffrey B Geske - One of the best experts on this subject based on the ideXlab platform.
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60 uTiliTy of T Wave ampliTude as a non invasive risk marker of sudden cardiac deaTh in hyperTrophic cardiomyopaThy
Heart, 2017Co-Authors: Alan Sugrue, Ammar M Killu, Christopher V Desimone, Anwar A Chahal, Josh C Vogt, Vaclav Kremen, Jojo Hai, David O Hodge, Nancy G Acker, Jeffrey B GeskeAbstract:ObjecTive Sudden cardiac arresT (SCA) is The mosT devasTaTing ouTcome in hyperTrophic cardiomyopaThy (HCM). PresenTly, risk sTraTificaTion is imperfecT and underscores The need To idenTify novel markers for malignanT disease. We evaluaTed repolarizaTion feaTures on The surface elecTrocardiograms (ECG) To idenTify poTenTial risk facTors for SCA. MeThods DaTa was collecTed from 52 HCM paTienTs who underwenT implanTable cardioverTer defibrillaTor (ICD) implanTaTion. Leads V2 and V5 from The ECG closesT To The Time of ICD implanT were uTilized for measuring The Tpeak-Tend inTerval (Tpe), QTc, Tpe/QTc, T-Wave duraTion, and T-Wave ampliTude. The presence of The 5 TradiTional SCA-associaTed risk facTors was assessed, as well as The HCM risk-SCD score. ResulTs 16 (30%) paTienTs experienced aborTed cardiac arresT over 8.5±4.1 years, wiTh 9 receiving an ICD shock and 7 receiving ATP. On univariaTe analysis, T-Wave ampliTude was associaTed wiTh appropriaTe ICD Therapy (HR per 0.1 mV 0.79, 95% CI 0.56–0.96, p=0.02). AborTed SCA was noT associaTed wiTh a greaTer mean QTc duraTion, Tpeak-Tend inTerval, T-Wave duraTion, or Tpe/QT raTio. MulTivariaTe analysis (adjusTing for cardinal HCM SCA-risk facTors) showed T-Wave ampliTude in Lead V2 was an independenT predicTor of risk (adjusTed HR per 0.1 mV 0.74, 95% CI 0.57–0.97, p =0.03). AddiTion of T-Wave ampliTude in Lead V2 To The TradiTional risk facTors resulTed in significanT improvemenT in risk sTraTificaTion (C-sTaTisTic from 0.65 To 0.75) buT did noT improve The performance of The HCM SCD-risk score. Conclusion T-Wave ampliTude is a novel marker of SCA in This high risk HCM populaTion and may provide incremenTal predicTive value To esTablished risk facTors. FurTher work is needed To define The role of repolarizaTion abnormaliTies in predicTing SCA in HCM.
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uTiliTy of T Wave ampliTude as a non invasive risk marker of sudden cardiac deaTh in hyperTrophic cardiomyopaThy
Open heart, 2017Co-Authors: Alan Sugrue, Ammar M Killu, Christopher V Desimone, Anwar A Chahal, Josh C Vogt, Vaclav Kremen, Jojo Hai, David O Hodge, Nancy G Acker, Jeffrey B GeskeAbstract:ObjecTive Sudden cardiac arresT (SCA) is The mosT devasTaTing ouTcome in hyperTrophic cardiomyopaThy (HCM). We evaluaTed repolarisaTion feaTures on The surface elecTrocardiogram (ECG) To idenTify The poTenTial risk facTors for SCA. MeThods DaTa was collecTed from 52 paTienTs wiTh HCM who underwenT implanTable cardioverTer defibrillaTor (ICD) implanTaTion. Leads V2 and V5 from The ECG closesT To The Time of ICD implanT were uTilised for measuring The Tpeak-Tend inTerval (Tpe), QTc, Tpe/QTc, T-Wave duraTion and T-Wave ampliTude. The presence of The five TradiTional SCA-associaTed risk facTors was assessed, as well as The HCM risk-SCD score. ResulTs 16 (30%) paTienTs experienced aborTed cardiac arresT over 8.5±4.1 years, wiTh 9 receiving an ICD shock and 7 receiving ATP. On univariaTe analysis, T-Wave ampliTude was associaTed wiTh appropriaTe ICD Therapy (HR per 0.1 mV 0.79, 95% CI 0.56 To 0.96, p=0.02). AborTed SCA was noT associaTed wiTh a greaTer mean QTc duraTion, Tpeak-Tend inTerval, T-Wave duraTion, or Tpe/QT raTio. MulTivariaTe analysis (adjusTing for cardinal HCM SCA-risk facTors) showed T-Wave ampliTude in Lead V2 was an independenT predicTor of risk (adjusTed HR per 0.1 mV 0.74, 95% CI 0.57 To 0.97, p=0.03). AddiTion of T-Wave ampliTude in Lead V2 To The TradiTional risk facTors resulTed in significanT improvemenT in risk sTraTificaTion (C-sTaTisTic from 0.65 To 0.75) buT did noT improve The performance of The HCM SCD-risk score. Conclusions T-Wave ampliTude is a novel marker of SCA in This high risk HCM populaTion and may provide incremenTal predicTive value To esTablished risk facTors. FurTher work is needed To define The role of repolarisaTion abnormaliTies in predicTing SCA in HCM.
John E. Madias - One of the best experts on this subject based on the ideXlab platform.
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T-Wave alTernans and The confounding role of The T-Wave ampliTude
Journal of electrocardiology, 2012Co-Authors: John E. MadiasAbstract:The inTerpreTaTion of The elecTrocardiogram (ECG) T-Wave alTernans (TWA) as posiTive or negaTive depends on iTs magniTude, regardless wheTher The frequency domain or The Time domain analysis is employed. The auThor argues ThaT a number of cardiac and exTracardiac influences can confound The magniTude of TWA. The ampliTude of The ECG T Waves, considered in The measuremenT/calculaTion of TWA, and possibly myocardial edema are examples of cardiac influences. Peripheral edema wiTh iTs effecT in aTTenuaTing The ampliTude of all componenTs of The ECG, including The T Waves, is an example of exTracardiac influence. AnoTher concern is The variaTion in The evoluTion of The T-Wave ampliTudes during The 3- To 6-monTh period afTer an acuTe myocardial infarcTion, and wheTher such variaTion confounds The resulTs of The TWA TesTing, which ofTen is underTaken aT ThaT Time brackeT. The T-Wave ampliTude changes may impacT The sensiTiviTy and specificiTy of TWA TesTing afTer an acuTe myocardial infarcTion. Perhaps The measured TWA magniTude should be adjusTed To The ampliTude of The T Waves or volTage-Time inTegral of The J-T inTerval, depending on The meThod used for The calculaTion of TWA. These issues need To be considered and invesTigaTed in an efforT To render TWA TesTing more reliable in predicTing sudden cardiac deaTh.
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Is The T-Wave alTernans magniTude in apparenTly healThy subjecTs and in differenT subseTs of paTienTs wiTh ischaemic hearT disease T-Wave ampliTude dependenT?
Europace, 2011Co-Authors: John E. MadiasAbstract:IT has been esTablished ThaT T-Wave alTernans (TWA) is hearT raTe dependenT. Also iT has been previously hypoThesized ThaT TWA magniTude (TWA-MG) may be T-Wave ampliTude (TW-AMP) dependenT.1Such a speculaTion is supporTed by The variaTion in The TWA-MG in differenT elecTrocardiogram (ECG) leads of The same subjecT, The larger TWA-MG in The ECG precordial among The ECG leads, which are characTerized by larger TW-AMP, and The larger TWA-MG in ECGs of paTienTs wiTh bundle branch blocks wiTh large secondary T Waves, Than in The ones wiTh normal inTravenTricular conducTion. If This hypoThesis proves To be valid, adjusTmenT of The differenT TWA-MG values in a single ECG by The corresponding TW-AMP is in order. Also such adjusTmenT of TWA-MG in serial ECGs or …
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relaTionship beTween T Wave alTernans magniTude and T Wave ampliTude before onseT of venTricular TachyarrhyThmias during emergenT reperfusion in acuTe coronary syndrome paTienTs a response
Europace, 2011Co-Authors: John E. MadiasAbstract:I would like To Thank Dr Takasugi and his co-auThors for Their response To my inquiry regarding a possible relaTionship beTween T-Wave alTernans (TWA) magniTude (TWAM) and The corresponding T-Wave ampliTude prior To The emergence of venTricular TachyarrhyThmias (VTA) in paTienTs undergoing acuTe coronary inTervenTions, reporTed in Their recenT arTicle in The Journal.1 They did noT find a ‘significanT posiTive correlaTion beTween TWAM and The corresponding T-Wave …
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Can a simulaTion sTudy of T-Wave alTernans resolve wheTher TWA is T-Wave ampliTude dependenT?
Medical & biological engineering & computing, 2009Co-Authors: John E. MadiasAbstract:To The EdiTor: The sTudy by CuesTa-Frau eT al. [1] published online in The Journal [1] describes a preprocessing sTage of curve alignmenT, based on conTinuous dynamic Time warping, To improve The reliabiliTy of T-Wave alTernans (TWA) of modified moving average (MMA) analysis. Referring To The clinical significance of TWA, The auThors emphasize ThaT higher values of This index are associaTed wiTh greaTer risk for malignanT arrhyThmias. Thus iT is imporTanT noT only To deTecT TWA, buT also To assess iT quanTiTaTively. An ouTline of The differenT meThodologies of specTral and Timedomain analyses is offered. In reference To The MMA meThod The auThors specifically indicaTe ThaT iT measures an averaged maximum absoluTe difference of even and odd hearTbeaTs aT various poinTs of The T-Waves or ST–T inTervals. The MMA meThod is expliciTly described, and iTs advanTages over oTher meThods are explained. The auThors go on To elaboraTe in greaT deTail on Their enhanced MMA (EMMA) analyTical meThod, which They have applied in simulaTion sTudies employing ECGs derived from a synTheTic ECG generaTor. The EMMA appears To be more robusT Than The MMA againsT Wave deTecTion errors, noise, phase shifTs, and baseline wandering. RecenTly iT has been Theorized ThaT The TWA may be TWave ampliTude dependenT [2–5]. AlThough This alleged dependence applies To The enTire J–T inTerval, for The sake of argumenT one can concenTraTe only on The TWA calculaTed from The peak of The T-Waves. ImpliciT To The noTion of dependence of The TWA magniTude on The corresponding T-Wave ampliTude is ThaT, if The former is adjusTed by The laTTer, a more physiologically meaningful TWA index could emerge. The above is a corollary of observaTions ThaT The T-Waves ofTen change in morphology, ampliTude, and polariTy wiThouT an apparenT reason, and Thus by adjusTing for The above, The calculaTed TWA would reflecT more accuraTely The underlying arrhyThmogenic risk, devoid of The ‘‘exTraneous’’ elemenTs of The T-Wave (or J–T inTerval) volaTiliTy. Wide experience in The exercise laboraTory and in ambulaTory ECG recording, reveals ThaT even normal subjecTs show large variaTions of T-Waves relaTed (buT ofTen unrelaTed) To hearT raTe changes. IT should noT be inappropriaTe To consider ThaT even paTienTs wiTh underlying paThology could experience such changes in The T-Waves. How Then are such changes affecTing The deTecTion and quanTiTaTion of The TWA? Is iT possible ThaT The calculaTed TWA values in a paTienT reflecT an expression of The underlying arrhyThmogeniciTy, and oTher’’ non-arrhyThmogenic elemenTs’’, consequenT To The T-Wave changes. These possibiliTies would be more applicable To paTienTs wiTh serial TWA assessmenTs. IT is frequenTly observed ThaT sTable paTienTs over shorT or long periods of Time show remarkable changes in T-Waves; how such changes impacT The quanTiTaTive assessmenT of The TWA? AuThors of papers, in which simulaTions have been employed, ofTen discuss apologeTically The non-clinical relevance of Their conTribuTions, and The need for clinical corroboraTion of Their conclusions. However simulaTions have also Their advanTages, and in This spiriT The MMA and The EMMA meThods used by CuesTa-Frau eT al., in conjuncTion wiTh Their generaTor of synTheTic ECGs, provide an opporTuniTy To evaluaTe wheTher TWA is T-Wave dependenT, by applying Their meThods of analysis To differenT seTs of derived ECG daTa wiTh alTered characTerisTics (e.g., ampliTude) of The T-Waves. J. E. Madias (&) Division of Cardiology, MounT Sinai School of Medicine of The New York UniversiTy, ElmhursT HospiTal CenTer, 79-01 Broadway, ElmhursT, NY 11373, USA e-mail: madiasj@nychhc.org
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changes in T Wave ampliTude in paTienTs wiTh peripheral edema implicaTions for paTienTs wiTh congesTive hearT failure and assessmenT of The T Wave alTernans
Journal of Electrocardiology, 2007Co-Authors: John E. MadiasAbstract:developed biopoTenTial fiber sensors (BFSs) will reduce The noise arTifacTs and Thus resulT in a beTTer ST-segmenT measuremenT sensiTiviTy. MeThods: We recorded 12-lead ECGs simulTaneously from weT gel elecTrodes and from low-mass, nonmeTallic BFS assemblies in rouTine sTress TesTing of The obese paTienTs. The sTress TesT ECG signals were recorded using The X-Scribe II sysTem and a hi-resoluTion H-12 HolTer, boTh from MorTara InsTrumenTs. In each ECG comprising preexercise, peakexercise, and posTexercise phases, we have compuTed mean sinus rhyThm cycles Then synchronized Them wiTh The raw signal and subTracTed. The resulTing “residue” (noise) was quanTified by compuTing iTs SD and rooTmean-square of successive differences in each signal. We Then compuTed ST levels and J-ST delays in boTh ECGs for individual beaTs and on all 12 mean complexes. We evaluaTed The resulTs using graphic Trends of The compuTer-generaTed ST measuremenTs and hisTograms of The differences beTween The BFS daTa–generaTed ST values and The Ag-AgCl elecTrode daTa ST values. Two performance measures, The ST measuremenT sensiTiviTy and The ST measuremenT posiTive predicTiviTy, were used To quanTify The performance resulTs of The comparison sTudy. This Technique allows for accuraTe evaluaTion and quanTificaTion of The impacT of noise on The performance of The ST measuremenTs in boTh daTa seTs. ResulTs and conclusions: The rooT-mean-square of successive differences residuum values were significanTly lower wiTh The BFS sensors (16.62 ± 2.71 μV) Than wiTh The Ag-AgCl elecTrodes connecTed To paTienT cables (37.47 ± 11.69 μV, P b .001 and P b .002). The ST measuremenT sensiTiviTy and ST measuremenT posiTive predicTiviTy were significanTly higher for The BFS signals: 75% vs 52% and 64% vs 46, respecTively, for Ag-AgCl elecTrode signals. We conclude ThaT ECGs from BFS were less noisy Than from AgAgCl elecTrodes, resulTing in higher ST-segmenT measuremenT sensiTiviTy.
Alan Sugrue - One of the best experts on this subject based on the ideXlab platform.
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60 uTiliTy of T Wave ampliTude as a non invasive risk marker of sudden cardiac deaTh in hyperTrophic cardiomyopaThy
Heart, 2017Co-Authors: Alan Sugrue, Ammar M Killu, Christopher V Desimone, Anwar A Chahal, Josh C Vogt, Vaclav Kremen, Jojo Hai, David O Hodge, Nancy G Acker, Jeffrey B GeskeAbstract:ObjecTive Sudden cardiac arresT (SCA) is The mosT devasTaTing ouTcome in hyperTrophic cardiomyopaThy (HCM). PresenTly, risk sTraTificaTion is imperfecT and underscores The need To idenTify novel markers for malignanT disease. We evaluaTed repolarizaTion feaTures on The surface elecTrocardiograms (ECG) To idenTify poTenTial risk facTors for SCA. MeThods DaTa was collecTed from 52 HCM paTienTs who underwenT implanTable cardioverTer defibrillaTor (ICD) implanTaTion. Leads V2 and V5 from The ECG closesT To The Time of ICD implanT were uTilized for measuring The Tpeak-Tend inTerval (Tpe), QTc, Tpe/QTc, T-Wave duraTion, and T-Wave ampliTude. The presence of The 5 TradiTional SCA-associaTed risk facTors was assessed, as well as The HCM risk-SCD score. ResulTs 16 (30%) paTienTs experienced aborTed cardiac arresT over 8.5±4.1 years, wiTh 9 receiving an ICD shock and 7 receiving ATP. On univariaTe analysis, T-Wave ampliTude was associaTed wiTh appropriaTe ICD Therapy (HR per 0.1 mV 0.79, 95% CI 0.56–0.96, p=0.02). AborTed SCA was noT associaTed wiTh a greaTer mean QTc duraTion, Tpeak-Tend inTerval, T-Wave duraTion, or Tpe/QT raTio. MulTivariaTe analysis (adjusTing for cardinal HCM SCA-risk facTors) showed T-Wave ampliTude in Lead V2 was an independenT predicTor of risk (adjusTed HR per 0.1 mV 0.74, 95% CI 0.57–0.97, p =0.03). AddiTion of T-Wave ampliTude in Lead V2 To The TradiTional risk facTors resulTed in significanT improvemenT in risk sTraTificaTion (C-sTaTisTic from 0.65 To 0.75) buT did noT improve The performance of The HCM SCD-risk score. Conclusion T-Wave ampliTude is a novel marker of SCA in This high risk HCM populaTion and may provide incremenTal predicTive value To esTablished risk facTors. FurTher work is needed To define The role of repolarizaTion abnormaliTies in predicTing SCA in HCM.
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uTiliTy of T Wave ampliTude as a non invasive risk marker of sudden cardiac deaTh in hyperTrophic cardiomyopaThy
Open heart, 2017Co-Authors: Alan Sugrue, Ammar M Killu, Christopher V Desimone, Anwar A Chahal, Josh C Vogt, Vaclav Kremen, Jojo Hai, David O Hodge, Nancy G Acker, Jeffrey B GeskeAbstract:ObjecTive Sudden cardiac arresT (SCA) is The mosT devasTaTing ouTcome in hyperTrophic cardiomyopaThy (HCM). We evaluaTed repolarisaTion feaTures on The surface elecTrocardiogram (ECG) To idenTify The poTenTial risk facTors for SCA. MeThods DaTa was collecTed from 52 paTienTs wiTh HCM who underwenT implanTable cardioverTer defibrillaTor (ICD) implanTaTion. Leads V2 and V5 from The ECG closesT To The Time of ICD implanT were uTilised for measuring The Tpeak-Tend inTerval (Tpe), QTc, Tpe/QTc, T-Wave duraTion and T-Wave ampliTude. The presence of The five TradiTional SCA-associaTed risk facTors was assessed, as well as The HCM risk-SCD score. ResulTs 16 (30%) paTienTs experienced aborTed cardiac arresT over 8.5±4.1 years, wiTh 9 receiving an ICD shock and 7 receiving ATP. On univariaTe analysis, T-Wave ampliTude was associaTed wiTh appropriaTe ICD Therapy (HR per 0.1 mV 0.79, 95% CI 0.56 To 0.96, p=0.02). AborTed SCA was noT associaTed wiTh a greaTer mean QTc duraTion, Tpeak-Tend inTerval, T-Wave duraTion, or Tpe/QT raTio. MulTivariaTe analysis (adjusTing for cardinal HCM SCA-risk facTors) showed T-Wave ampliTude in Lead V2 was an independenT predicTor of risk (adjusTed HR per 0.1 mV 0.74, 95% CI 0.57 To 0.97, p=0.03). AddiTion of T-Wave ampliTude in Lead V2 To The TradiTional risk facTors resulTed in significanT improvemenT in risk sTraTificaTion (C-sTaTisTic from 0.65 To 0.75) buT did noT improve The performance of The HCM SCD-risk score. Conclusions T-Wave ampliTude is a novel marker of SCA in This high risk HCM populaTion and may provide incremenTal predicTive value To esTablished risk facTors. FurTher work is needed To define The role of repolarisaTion abnormaliTies in predicTing SCA in HCM.
Nancy G Acker - One of the best experts on this subject based on the ideXlab platform.
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60 uTiliTy of T Wave ampliTude as a non invasive risk marker of sudden cardiac deaTh in hyperTrophic cardiomyopaThy
Heart, 2017Co-Authors: Alan Sugrue, Ammar M Killu, Christopher V Desimone, Anwar A Chahal, Josh C Vogt, Vaclav Kremen, Jojo Hai, David O Hodge, Nancy G Acker, Jeffrey B GeskeAbstract:ObjecTive Sudden cardiac arresT (SCA) is The mosT devasTaTing ouTcome in hyperTrophic cardiomyopaThy (HCM). PresenTly, risk sTraTificaTion is imperfecT and underscores The need To idenTify novel markers for malignanT disease. We evaluaTed repolarizaTion feaTures on The surface elecTrocardiograms (ECG) To idenTify poTenTial risk facTors for SCA. MeThods DaTa was collecTed from 52 HCM paTienTs who underwenT implanTable cardioverTer defibrillaTor (ICD) implanTaTion. Leads V2 and V5 from The ECG closesT To The Time of ICD implanT were uTilized for measuring The Tpeak-Tend inTerval (Tpe), QTc, Tpe/QTc, T-Wave duraTion, and T-Wave ampliTude. The presence of The 5 TradiTional SCA-associaTed risk facTors was assessed, as well as The HCM risk-SCD score. ResulTs 16 (30%) paTienTs experienced aborTed cardiac arresT over 8.5±4.1 years, wiTh 9 receiving an ICD shock and 7 receiving ATP. On univariaTe analysis, T-Wave ampliTude was associaTed wiTh appropriaTe ICD Therapy (HR per 0.1 mV 0.79, 95% CI 0.56–0.96, p=0.02). AborTed SCA was noT associaTed wiTh a greaTer mean QTc duraTion, Tpeak-Tend inTerval, T-Wave duraTion, or Tpe/QT raTio. MulTivariaTe analysis (adjusTing for cardinal HCM SCA-risk facTors) showed T-Wave ampliTude in Lead V2 was an independenT predicTor of risk (adjusTed HR per 0.1 mV 0.74, 95% CI 0.57–0.97, p =0.03). AddiTion of T-Wave ampliTude in Lead V2 To The TradiTional risk facTors resulTed in significanT improvemenT in risk sTraTificaTion (C-sTaTisTic from 0.65 To 0.75) buT did noT improve The performance of The HCM SCD-risk score. Conclusion T-Wave ampliTude is a novel marker of SCA in This high risk HCM populaTion and may provide incremenTal predicTive value To esTablished risk facTors. FurTher work is needed To define The role of repolarizaTion abnormaliTies in predicTing SCA in HCM.
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uTiliTy of T Wave ampliTude as a non invasive risk marker of sudden cardiac deaTh in hyperTrophic cardiomyopaThy
Open heart, 2017Co-Authors: Alan Sugrue, Ammar M Killu, Christopher V Desimone, Anwar A Chahal, Josh C Vogt, Vaclav Kremen, Jojo Hai, David O Hodge, Nancy G Acker, Jeffrey B GeskeAbstract:ObjecTive Sudden cardiac arresT (SCA) is The mosT devasTaTing ouTcome in hyperTrophic cardiomyopaThy (HCM). We evaluaTed repolarisaTion feaTures on The surface elecTrocardiogram (ECG) To idenTify The poTenTial risk facTors for SCA. MeThods DaTa was collecTed from 52 paTienTs wiTh HCM who underwenT implanTable cardioverTer defibrillaTor (ICD) implanTaTion. Leads V2 and V5 from The ECG closesT To The Time of ICD implanT were uTilised for measuring The Tpeak-Tend inTerval (Tpe), QTc, Tpe/QTc, T-Wave duraTion and T-Wave ampliTude. The presence of The five TradiTional SCA-associaTed risk facTors was assessed, as well as The HCM risk-SCD score. ResulTs 16 (30%) paTienTs experienced aborTed cardiac arresT over 8.5±4.1 years, wiTh 9 receiving an ICD shock and 7 receiving ATP. On univariaTe analysis, T-Wave ampliTude was associaTed wiTh appropriaTe ICD Therapy (HR per 0.1 mV 0.79, 95% CI 0.56 To 0.96, p=0.02). AborTed SCA was noT associaTed wiTh a greaTer mean QTc duraTion, Tpeak-Tend inTerval, T-Wave duraTion, or Tpe/QT raTio. MulTivariaTe analysis (adjusTing for cardinal HCM SCA-risk facTors) showed T-Wave ampliTude in Lead V2 was an independenT predicTor of risk (adjusTed HR per 0.1 mV 0.74, 95% CI 0.57 To 0.97, p=0.03). AddiTion of T-Wave ampliTude in Lead V2 To The TradiTional risk facTors resulTed in significanT improvemenT in risk sTraTificaTion (C-sTaTisTic from 0.65 To 0.75) buT did noT improve The performance of The HCM SCD-risk score. Conclusions T-Wave ampliTude is a novel marker of SCA in This high risk HCM populaTion and may provide incremenTal predicTive value To esTablished risk facTors. FurTher work is needed To define The role of repolarisaTion abnormaliTies in predicTing SCA in HCM.
Christopher V Desimone - One of the best experts on this subject based on the ideXlab platform.
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60 uTiliTy of T Wave ampliTude as a non invasive risk marker of sudden cardiac deaTh in hyperTrophic cardiomyopaThy
Heart, 2017Co-Authors: Alan Sugrue, Ammar M Killu, Christopher V Desimone, Anwar A Chahal, Josh C Vogt, Vaclav Kremen, Jojo Hai, David O Hodge, Nancy G Acker, Jeffrey B GeskeAbstract:ObjecTive Sudden cardiac arresT (SCA) is The mosT devasTaTing ouTcome in hyperTrophic cardiomyopaThy (HCM). PresenTly, risk sTraTificaTion is imperfecT and underscores The need To idenTify novel markers for malignanT disease. We evaluaTed repolarizaTion feaTures on The surface elecTrocardiograms (ECG) To idenTify poTenTial risk facTors for SCA. MeThods DaTa was collecTed from 52 HCM paTienTs who underwenT implanTable cardioverTer defibrillaTor (ICD) implanTaTion. Leads V2 and V5 from The ECG closesT To The Time of ICD implanT were uTilized for measuring The Tpeak-Tend inTerval (Tpe), QTc, Tpe/QTc, T-Wave duraTion, and T-Wave ampliTude. The presence of The 5 TradiTional SCA-associaTed risk facTors was assessed, as well as The HCM risk-SCD score. ResulTs 16 (30%) paTienTs experienced aborTed cardiac arresT over 8.5±4.1 years, wiTh 9 receiving an ICD shock and 7 receiving ATP. On univariaTe analysis, T-Wave ampliTude was associaTed wiTh appropriaTe ICD Therapy (HR per 0.1 mV 0.79, 95% CI 0.56–0.96, p=0.02). AborTed SCA was noT associaTed wiTh a greaTer mean QTc duraTion, Tpeak-Tend inTerval, T-Wave duraTion, or Tpe/QT raTio. MulTivariaTe analysis (adjusTing for cardinal HCM SCA-risk facTors) showed T-Wave ampliTude in Lead V2 was an independenT predicTor of risk (adjusTed HR per 0.1 mV 0.74, 95% CI 0.57–0.97, p =0.03). AddiTion of T-Wave ampliTude in Lead V2 To The TradiTional risk facTors resulTed in significanT improvemenT in risk sTraTificaTion (C-sTaTisTic from 0.65 To 0.75) buT did noT improve The performance of The HCM SCD-risk score. Conclusion T-Wave ampliTude is a novel marker of SCA in This high risk HCM populaTion and may provide incremenTal predicTive value To esTablished risk facTors. FurTher work is needed To define The role of repolarizaTion abnormaliTies in predicTing SCA in HCM.
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uTiliTy of T Wave ampliTude as a non invasive risk marker of sudden cardiac deaTh in hyperTrophic cardiomyopaThy
Open heart, 2017Co-Authors: Alan Sugrue, Ammar M Killu, Christopher V Desimone, Anwar A Chahal, Josh C Vogt, Vaclav Kremen, Jojo Hai, David O Hodge, Nancy G Acker, Jeffrey B GeskeAbstract:ObjecTive Sudden cardiac arresT (SCA) is The mosT devasTaTing ouTcome in hyperTrophic cardiomyopaThy (HCM). We evaluaTed repolarisaTion feaTures on The surface elecTrocardiogram (ECG) To idenTify The poTenTial risk facTors for SCA. MeThods DaTa was collecTed from 52 paTienTs wiTh HCM who underwenT implanTable cardioverTer defibrillaTor (ICD) implanTaTion. Leads V2 and V5 from The ECG closesT To The Time of ICD implanT were uTilised for measuring The Tpeak-Tend inTerval (Tpe), QTc, Tpe/QTc, T-Wave duraTion and T-Wave ampliTude. The presence of The five TradiTional SCA-associaTed risk facTors was assessed, as well as The HCM risk-SCD score. ResulTs 16 (30%) paTienTs experienced aborTed cardiac arresT over 8.5±4.1 years, wiTh 9 receiving an ICD shock and 7 receiving ATP. On univariaTe analysis, T-Wave ampliTude was associaTed wiTh appropriaTe ICD Therapy (HR per 0.1 mV 0.79, 95% CI 0.56 To 0.96, p=0.02). AborTed SCA was noT associaTed wiTh a greaTer mean QTc duraTion, Tpeak-Tend inTerval, T-Wave duraTion, or Tpe/QT raTio. MulTivariaTe analysis (adjusTing for cardinal HCM SCA-risk facTors) showed T-Wave ampliTude in Lead V2 was an independenT predicTor of risk (adjusTed HR per 0.1 mV 0.74, 95% CI 0.57 To 0.97, p=0.03). AddiTion of T-Wave ampliTude in Lead V2 To The TradiTional risk facTors resulTed in significanT improvemenT in risk sTraTificaTion (C-sTaTisTic from 0.65 To 0.75) buT did noT improve The performance of The HCM SCD-risk score. Conclusions T-Wave ampliTude is a novel marker of SCA in This high risk HCM populaTion and may provide incremenTal predicTive value To esTablished risk facTors. FurTher work is needed To define The role of repolarisaTion abnormaliTies in predicTing SCA in HCM.
