Markus Lingman1, Marianne Hartford2, Thomas Karlsson3, Johan Herlitz4, Aigars Rubulis2, Kenneth Caidahl5, Lennart Bergfeldt2. 1. Institute of Medicine, Dept of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Dept of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Dept of Medicine, Halland Hospital, Sweden. Electronic address: markus.lingman@regionhalland.se. 2. Institute of Medicine, Dept of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Dept of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 3. Health Metrics, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4. Institute of Medicine, Dept of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Dept of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Center of Pre-hospital Research in Western Sweden, University of Borås, Borås, Sweden. 5. Dept of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: Prediction of sudden cardiac death (SCD) after acute coronary syndromes (ACS) remains a challenge. Although electrophysiology measures obtained by 3-D vectorcardiography (VCG) shortly after ACS may be useful predictors of SCD, they have not been adopted into clinical practice. The main objective of our study was to assess whether the VCG-derived QRS-T area angle (between area vectors) and the QRS-T angle (between maximum vectors) have additional value beyond standard risk factors in predicting SCD after ACS. METHODS AND RESULTS: We studied 643 consecutive ACS patients for whom data on VCG and echocardiography during the index hospitalization were available. Seventy-seven patients (12%) died, 37 (6%) from SCD and 21 (3%) from other cardiac causes during the 30-month follow-up. After adjusting for 9 standard risk factors (age, sex, diabetes, previous stroke, left ventricular ejection fraction; and estimated glomerular filtration rate, heart rate, systolic blood pressure<100mmHg, and Killip class>1 on admission), QRS-T area angle and QRS-T angle were shown to have independent predictive value for both SCD and all cardiac deaths. Reclassification analysis showed that both measures had additional predictive value beyond the 9 standard risk factors. For SCD, net reclassification improvements for QRS-T area angle and QRS-T angle were 46% and 45% and relative integrated discriminative improvements were 16% and 13% (vs the average~11% of the 9 standard risk factors). CONCLUSIONS: The VCG-derived QRS-T area angle and QRS-T angle improved prediction of SCD after ACS beyond standard risk factors. Further evaluation of their clinical utility and cost-effectiveness is therefore warranted.
BACKGROUND: Prediction of sudden cardiac death (SCD) after acute coronary syndromes (ACS) remains a challenge. Although electrophysiology measures obtained by 3-D vectorcardiography (VCG) shortly after ACS may be useful predictors of SCD, they have not been adopted into clinical practice. The main objective of our study was to assess whether the VCG-derived QRS-T area angle (between area vectors) and the QRS-T angle (between maximum vectors) have additional value beyond standard risk factors in predicting SCD after ACS. METHODS AND RESULTS: We studied 643 consecutive ACS patients for whom data on VCG and echocardiography during the index hospitalization were available. Seventy-seven patients (12%) died, 37 (6%) from SCD and 21 (3%) from other cardiac causes during the 30-month follow-up. After adjusting for 9 standard risk factors (age, sex, diabetes, previous stroke, left ventricular ejection fraction; and estimated glomerular filtration rate, heart rate, systolic blood pressure<100mmHg, and Killip class>1 on admission), QRS-T area angle and QRS-T angle were shown to have independent predictive value for both SCD and all cardiac deaths. Reclassification analysis showed that both measures had additional predictive value beyond the 9 standard risk factors. For SCD, net reclassification improvements for QRS-T area angle and QRS-T angle were 46% and 45% and relative integrated discriminative improvements were 16% and 13% (vs the average~11% of the 9 standard risk factors). CONCLUSIONS: The VCG-derived QRS-T area angle and QRS-T angle improved prediction of SCD after ACS beyond standard risk factors. Further evaluation of their clinical utility and cost-effectiveness is therefore warranted.
Authors: Sarah Gleeson; Yi-Wen Liao; Clementina Dugo; Andrew Cave; Lifeng Zhou; Zina Ayar; Jonathan Christiansen; Tony Scott; Liane Dawson; Andrew Gavin; Todd T Schlegel; Patrick Gladding Journal: PLoS One Date: 2017-03-30 Impact factor: 3.240
Authors: Gunilla Lundahl; Lennart Gransberg; Gabriel Bergqvist; Göran Bergström; Lennart Bergfeldt Journal: PLoS One Date: 2020-09-17 Impact factor: 3.240
Authors: Andrzej Jaroszyński; Jacek Furmaga; Tomasz Zapolski; Tomasz Zaborowski; Sławomir Rudzki; Wojciech Dąbrowski Journal: BMC Nephrol Date: 2019-12-02 Impact factor: 2.388