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Ann Noninvasive Electrocardiol. 2013 Sep;18(5):427-35. doi: 10.1111/anec.12065. Epub 2013 Jun 9.

ECG quantification of myocardial scar and risk stratification in MADIT-II.

Author information

1
Duke University School of Medicine, Durham, NC.

Abstract

BACKGROUND:

Low left ventricular ejection fraction (LVEF) increases risk for both sudden cardiac death (SCD) and for heart failure (HF) death; however, implantable cardioverter-defibrillators (ICDs) reduce the incidence of SCD, not HF death. Distinguishing individuals at risk for HF death (non-SCD) versus SCD could improve ICD patient selection.

OBJECTIVE:

This study evaluated whether electrocardiogram (ECG) quantification of myocardial infarction (MI) could discriminate risk for SCD versus non-SCD.

METHODS:

Selvester QRS scoring was performed on 995 MADIT-II trial subjects' ECGs to quantify MI size. MIs were categorized as small (0-3 QRS points), medium (4-7) or large (≥ 8). Mortality, SCD and non-SCD rates in the conventional medical therapy (CMT) arm and mortality and ventricular tachycardia/fibrillation (VT/VF) rates in the ICD arm were analyzed by QRS score group. Both arms were analyzed to determine ICD efficacy by QRS score group.

RESULTS:

In the CMT arm, mortality, SCD and non-SCD rates were similar across QRS score groups (P = 0.73, P = 0.92, and P = 0.77). The ICD arm showed similar rates of mortality (P = 0.17) and VT/VF (P = 0.24) across QRS score groups. ICD arm mortality was lower than CMT arm mortality across QRS score groups with greatest benefit in the large scar group.

CONCLUSION:

Recently, QRS score was shown to be predictive of VT/VF in the SCD-HeFT population consisting of both ischemic and nonischemic HF and having a maximum LVEF of 35% versus 30% for MADIT-II. Our study found that QRS score did not add prognostic value in the MADIT-II population exhibiting relatively more severe cardiac dysfunction.

KEYWORDS:

electrocardiography; electrophysiology; heart failure; implantable cardioverter-defibrillator; sudden death; tachyarrhythmias

PMID:
24047486
PMCID:
PMC3779916
DOI:
10.1111/anec.12065
[Indexed for MEDLINE]
Free PMC Article

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