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Prognostic value of the 12-lead surface electrocardiogram in sarcomeric hypertrophic cardiomyopathy: data from the

Nicolas Ledieu1, Louis Larnier2, Vincent Auffret1,3

  • 1Département de Cardiologie et Maladies Vasculaires, Service de Cardiologie et maladies vasculaires, CHU Rennes, Rennes, France.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|October 12, 2019
PubMed

Insights

The electrocardiogram (ECG) has limited value in predicting long-term outcomes for hypertrophic cardiomyopathy (HCM) patients. While some ECG abnormalities predict specific events like death or heart failure hospitalization, they are not independent predictors of overall clinical outcomes.

Area of Science:

  • Cardiology
  • Genetics
  • Internal Medicine

Background:

  • Sarcomeric hypertrophic cardiomyopathy (HCM) is a genetic heart disease characterized by left ventricular hypertrophy.
  • The 12-lead surface electrocardiogram (ECG) is a common screening tool, but its prognostic value in HCM is not well-established.
  • Identifying reliable predictors of long-term clinical outcomes is crucial for managing HCM patients.

Purpose of the Study:

  • To determine if baseline surface electrocardiogram (ECG) findings can independently predict long-term clinical outcomes in a large cohort of patients with sarcomeric hypertrophic cardiomyopathy (HCM).
  • To investigate the association between specific ECG abnormalities and major adverse cardiovascular events in HCM.
  • To assess the prognostic utility of the standard 12-lead ECG in this patient population.

Main Methods:

  • Retrospective observational study involving 994 patients with sarcomeric HCM from the REMY French HCM clinical research observatory.
  • Primary endpoint: composite of all-cause mortality, major non-fatal arrhythmic events, heart failure (HF) hospitalization, and stroke.
  • Uni- and multivariable Cox regression analyses were used to identify independent predictors of clinical outcomes.

Main Results:

  • Only 1.8% of patients had a normal baseline ECG; common abnormalities included inverted T waves (63.7%) and P-wave abnormalities (30.4%).
  • During a mean follow-up of 4.0 years, 21.8% of patients experienced major cardiovascular events.
  • While prolonged QTc interval, low QRS voltage, and PVCs predicted worse outcomes in univariable analysis, none were independent predictors of the primary composite endpoint after adjusting for clinical variables. Abnormal Q waves predicted all-cause death, and prolonged QTc predicted HF hospitalization.

Conclusions:

  • The standard 12-lead surface ECG does not have independent prognostic value for the primary composite outcome in patients with sarcomeric HCM.
  • Specific ECG findings like abnormal Q waves and prolonged QTc may predict secondary endpoints (all-cause death and HF hospitalization, respectively).
  • The surface ECG's role in predicting long-term outcomes in HCM is limited, despite its use in screening.
Abstract

Keywords:
12-lead electrocardiogramHypertrophic cardiomyopathyPrognosisRegistryRisk predictors

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