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Delayed QRS transition in the precordial leads of an electrocardiogram as a predictor of sudden cardiac death in the general population.
- Source :
-
Heart rhythm [Heart Rhythm] 2014 Dec; Vol. 11 (12), pp. 2254-60. Date of Electronic Publication: 2014 Aug 13. - Publication Year :
- 2014
-
Abstract
- Background: QRS transition zone is related to the electrical axis of the heart in the horizontal plane and is easily determined from the precordial leads of a standard 12-lead ECG. However, whether delayed QRS transition, or clockwise rotation of the heart, carries prognostic implications and predicts sudden cardiac death (SCD) is unclear.<br />Objective: The purpose of this study was to study whether delayed transition is associated with mortality and SCD.<br />Methods: We evaluated 12-lead ECGs of 10,815 Finnish middle-aged subjects from the general population (52% men, mean age 44 ± 8.5 years) and followed them for 30 ± 11 years. Main end-points were mortality and SCD.<br />Results: Delayed QRS transition at lead V4 or later occurred in 1770 subjects (16.4%) and markedly delayed transition at lead V5 or later in 146 subjects (1.3%). Delayed transition zone was associated with older age, male gender, higher body mass index, hypertension, baseline cardiovascular disease, leftward shift of the frontal QRS axis, wider QRS-T angle, and ECG left ventricular hypertrophy. After adjusting for several clinical and ECG variables, delayed transition was associated with overall mortality (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.07-1.22, P < .001) and SCD (HR 1.23, 95% CI 1.03-1.47, P = .029). Markedly delayed transition at V5 or later predicted significantly SCD (HR 1.89, 95% CI 1.18-3.03, P = .008) and all-cause mortality (HR 1.30, 95% CI 1.07-1.58, P = .01). However, further adjustments for repolarization abnormalities attenuated this effect.<br />Conclusion: Delayed QRS transition in the precordial leads of an ECG seems to be a novel ECG risk marker for SCD. In particular, markedly delayed transition was associated with significantly increased risk of SCD, independent of confounding factors.<br /> (Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Age Distribution
Female
Finland epidemiology
Humans
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Population Surveillance
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Sex Distribution
Time Factors
Arrhythmias, Cardiac diagnosis
Arrhythmias, Cardiac mortality
Cause of Death
Death, Sudden, Cardiac epidemiology
Electrocardiography methods
Subjects
Details
- Language :
- English
- ISSN :
- 1556-3871
- Volume :
- 11
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Heart rhythm
- Publication Type :
- Academic Journal
- Accession number :
- 25131180
- Full Text :
- https://doi.org/10.1016/j.hrthm.2014.08.014