Scientific Publications by FDA Staff
Circ Arrhythm Electrophysiol 2013 Dec 1;6(6):1156-62
Screening Entire Health System ECG Databases to Identify Patients at Increased Risk of Death.
Strauss DG, Mewton N, Verrier RL, Nearing BD, Marchlinski FE, Killian T, Moxley J, Tereshchenko LG, Wu KC, Winslow RL, Cox C, Spooner PM, Lima JA
BACKGROUND: Current methods to identify patients at higher risk for sudden cardiac death, primarily left ventricular ejection fraction (LVEF) =35%, miss ~80% of patients who die suddenly. We tested the hypothesis that patients with elevated QRS scores (index of myocardial scar) and wide QRS-T angles (index abnormal depolarization-repolarization relationship) have high 1-year all-cause mortality and could be further risk-stratified with clinical characteristics. METHODS AND RESULTS: We screened all 12-lead ECGs (~50,000 patients) over 6 months at 2 large hospital systems and analyzed clinical characteristics and 1-year mortality. Patients with ECGs obtained in hospital areas with known high mortality rates were excluded. At one hospital, QRS score >/=5 and QRS-T angle >/=105 degrees identified 8.0% of patients and was associated with an odds ratio (OR) of 2.79 [95% confidence interval 2.10-3.69] for 1-year mortality compared to patients below both ECG thresholds (13.9% vs. 5.5% death rate). LVEF was >35% in 82% of the former group of patients and addition of ECG measures to LVEF increased the discrimination of death risk (p<0.0001). At the second hospital, the OR was 2.42 [1.95-3.01] for 1-year mortality (8.8% vs. 3.8%). Adjustment for patient characteristics eliminated inter-hospital differences. Multivariable adjusted OR combining data from both hospitals was 1.53 [1.28-1.83]. Increasing heart rate and chronic renal impairment further predicted mortality. CONCLUSIONS: Screening hospital ECG databases with QRS scoring and QRS-T angle analysis identifies patients with high 1-year all-cause mortality and predominantly preserved LVEF. This approach may represent a widely-available method to identify patients at increased risk of death.
|Category: Journal Article|
|PubMed ID: #24122522||DOI: 10.1161/CIRCEP.113.000411|
|Includes FDA Authors from Scientific Area(s): Medical Devices|
|Entry Created: 2013-10-15||Entry Last Modified: 2014-11-18|