BACKGROUND: Prolongation of initial ventricular depolarization on the 12-lead electrocardiogram (ECG), or delayed intrinsicoid deflection (DID), can indicate left ventricular hypertrophy (LVH). The possibility that this marker could convey distinct risk of sudden cardiac arrest (SCA) has not been evaluated. OBJECTIVE: To evaluate the association of DID and SCA in the community. METHODS: In the ongoing prospective, population-based Oregon Sudden Unexpected Death Study (Oregon SUDS; catchment area approximately 1 million), SCA cases were compared to geographic controls with no SCA. Archived ECGs (closest and unrelated to SCA event for cases) were evaluated for the presence of DID, defined as ≥0.05 second in leads V5 or V6. Left ventricular (LV) mass and function were evaluated from archived echocardiograms. RESULTS: SCA cases (n = 272, 68.7 ± 14.6 years, 63.6% male) as compared to controls (n = 351, 67.6 ± 11.4 years, 63.3% male) were more likely to have DID on ECG (28.3% vs. 17.1%, P = .001). DID was associated with increased SCA odds (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.31-2.81; P = .001), but showed poor correlation with LV mass and echocardiographic LVH (kappa 0.13). In multivariate analysis adjusted for clinical and ECG markers, reduced LV ejection fraction, and echocardiographic LVH, DID remained an independent predictor of SCA (OR 1.82; 95% CI 1.12-2.97; P = .016). Additionally, in a sensitivity analysis restricted to narrow QRS, DID and ECG LVH by voltage were each independently associated with SCA risk. CONCLUSION: DID was associated with increased SCA risk independent of echocardiographic LVH, ECG LVH, and reduced LV ejection fraction, potentially reflecting unique electrical remodeling that warrants further investigation.
BACKGROUND: Prolongation of initial ventricular depolarization on the 12-lead electrocardiogram (ECG), or delayed intrinsicoid deflection (DID), can indicate left ventricular hypertrophy (LVH). The possibility that this marker could convey distinct risk of sudden cardiac arrest (SCA) has not been evaluated. OBJECTIVE: To evaluate the association of DID and SCA in the community. METHODS: In the ongoing prospective, population-based Oregon Sudden Unexpected Death Study (Oregon SUDS; catchment area approximately 1 million), SCA cases were compared to geographic controls with no SCA. Archived ECGs (closest and unrelated to SCA event for cases) were evaluated for the presence of DID, defined as ≥0.05 second in leads V5 or V6. Left ventricular (LV) mass and function were evaluated from archived echocardiograms. RESULTS: SCA cases (n = 272, 68.7 ± 14.6 years, 63.6% male) as compared to controls (n = 351, 67.6 ± 11.4 years, 63.3% male) were more likely to have DID on ECG (28.3% vs. 17.1%, P = .001). DID was associated with increased SCA odds (odds ratio [OR] 1.92; 95% confidence interval [CI] 1.31-2.81; P = .001), but showed poor correlation with LV mass and echocardiographic LVH (kappa 0.13). In multivariate analysis adjusted for clinical and ECG markers, reduced LV ejection fraction, and echocardiographic LVH, DID remained an independent predictor of SCA (OR 1.82; 95% CI 1.12-2.97; P = .016). Additionally, in a sensitivity analysis restricted to narrow QRS, DID and ECG LVH by voltage were each independently associated with SCA risk. CONCLUSION:DID was associated with increased SCA risk independent of echocardiographic LVH, ECG LVH, and reduced LV ejection fraction, potentially reflecting unique electrical remodeling that warrants further investigation.
Authors: Sabine M J M Straus; Jan A Kors; Marie L De Bruin; Cornelis S van der Hooft; Albert Hofman; Jan Heeringa; Jaap W Deckers; J Herre Kingma; Miriam C J M Sturkenboom; Bruno H Ch Stricker; Jacqueline C M Witteman Journal: J Am Coll Cardiol Date: 2006-01-17 Impact factor: 24.094
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Authors: Sumeet S Chugh; Kyndaron Reinier; Audrey Uy-Evanado; Harpriya S Chugh; David Elashoff; Christopher Young; Angelo Salvucci; Jonathan Jui Journal: JACC Clin Electrophysiol Date: 2022-03-30
Authors: Kristjan Norland; Gardar Sveinbjornsson; Rosa B Thorolfsdottir; Olafur B Davidsson; Vinicius Tragante; Sridharan Rajamani; Anna Helgadottir; Solveig Gretarsdottir; Jessica van Setten; Folkert W Asselbergs; Jon Th Sverrisson; Sigurdur S Stephensen; Gylfi Oskarsson; Emil L Sigurdsson; Karl Andersen; Ragnar Danielsen; Gudmundur Thorgeirsson; Unnur Thorsteinsdottir; David O Arnar; Patrick Sulem; Hilma Holm; Daniel F Gudbjartsson; Kari Stefansson Journal: Nat Commun Date: 2019-10-22 Impact factor: 14.919