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Published on: June 12, 2020
Electrocardiogram Characteristics and Outcomes in an Adult Congenital Heart Disease Population
Seyedeh Somayyeh Mousavi1, Cheryl L Raskind-Hood2, Alexandra Haffner3
1Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA.
Insights
Electrocardiogram (ECG) use in adult congenital heart disease (ACHD) can predict adverse events. Specific ECG changes like wider QRS duration and longer QTc intervals are linked to increased mortality risk in ACHD patients.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- The electrocardiogram (ECG) is a standard diagnostic tool for acquired heart conditions.
- Its utility in predicting adverse events in adult congenital heart disease (ACHD) populations remains largely unexplored.
Purpose of the Study:
- To investigate the association between resting ECG characteristics and adverse cardiac events, including mortality, in a large ACHD cohort.
- To explore whether ECG parameters and their changes over time can serve as predictors of poor outcomes in ACHD patients.
Main Methods:
- Analysis of ECGs, clinical outcomes, and vital status from 8130 adults with congenital heart disease (CHD) over a 10-year surveillance period.
- Categorization of CHD by anatomic groups (left-sided, right-sided, single-ventricle, neither) to account for hemodynamic differences.
- Evaluation of baseline ECG parameters (QRS duration, QTc interval, QRS-T angle) and changes over time (ΔQRSd, QRS-T angle deviation).
Main Results:
- Wider QRS duration, longer corrected QT (QTc), greater QRS-T angle, left bundle branch block, and rhythm changes were associated with mortality.
- Deceased patients exhibited significantly longer mean baseline QRSd and QTc compared to survivors.
- The deceased group showed a greater increase in QRSd over time (∆QRSd) than the surviving group, and this change was also more pronounced in survivors with adverse events.
Conclusions:
- ECG characteristics and their temporal changes are significantly associated with adverse cardiac events and mortality in the ACHD population.
- These findings suggest the potential for developing an ECG-based risk stratification model for identifying high-risk ACHD patients.
- Further research is warranted to refine ECG parameters for predicting outcomes in this unique patient group.
Abstract:
The electrocardiogram (ECG) is a low-cost, readily available test that may detect dysrhythmia, chamber enlargement, and ischemia in an acquired heart disease population. Use of resting ECG to predict adverse events in an adult congenital heart disease (ACHD) population is unknown. ECG characteristics, outcomes, and vital status of 8130 adults born between 1945 and 2001 with at least two available ECGs during a 10-year surveillance period (2010-2019) were evaluated at baseline and at the end of surveillance. Outcomes included cardiac hospitalizations, cardiac surgery or intervention, or death during surveillance. Broad CHD anatomic groups were analyzed as follows: "left-sided," "right-sided," "single-ventricle," and "neither" to account for differences in loading conditions. Of the cohort, 7.2% died, and 33.0% remained alive without adverse events. ECG parameters associated with mortality include wider QRS duration (QRSd), longer corrected QT (QTc), greater QRS-T angle, left bundle branch block, and rhythm change. Those who died had longer mean baseline QRSd (107.3 ms vs. 101.83 ms, p < 0.0001) and QTc (434.94 ms vs. 425.20 ms, p = 0.0004). Change in QRSd (∆QRSd) was greater in the deceased group than alive (5.18 ms vs. 2.01 ms, p < 0.0001), and in alive with an adverse event compared to those alive without an event (2.78 ms vs. 0.42 ms, p < 0.0001). Mean QRS-T angle remained concordant in those without an adverse event but deviated in the adverse event group (5.65° vs. 22.91°) (p < 0.0001). ECG characteristics and changes over time are associated with adverse cardiac events and mortality in a CHD population. Further study is needed to develop an ECG-based risk model to identify at-risk CHD patients.
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