Vectorcardiography Findings Are Associated with Recurrent Ventricular Arrhythmias and Mortality in Patients with Heart Failure Treated with Implantable Cardioverter-Defibrillator Device

Uzma Chaudhry, Daniel Cortez, Pyotr G. Platonov, Jonas Carlson, Rasmus Borgquist

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There is a need for refined risk stratification of sudden cardiac death and prediction of ventricular arrhythmias to correctly identify patients who are expected to benefit the most from implantable cardioverter-defibrillator (ICD) therapy. Methods: We conducted a registry-based retrospective observational study on patients with either ischemic (ICMP) or nonischemic dilated cardiomyopathy (NICMP) treated with ICD between 2002 and 2013 at a tertiary referral center. We evaluated 3 vectorcardiography (VCG) indices; spatial QRS-T angle, QRS vector magnitude (QRSvm), and T-wave vector magnitude (Twvm), and their association with all-cause mortality and ventricular arrhythmias. The VCG indices were automatically computed from resting 12-lead electrocardiograms before ICD implantation. Results: 178 patients were included in the study; 53.4% had ICMP, 79.2% were male, and mean ejection fraction was 27.4%. During the follow-up (median 89 months), 40 patients (23%) died; 31% had appropriate ICD therapy. In multivariate analysis with dichotomized variables, QRS-T angle >152° and Twvm <0.38 mV were significantly associated with increased mortality: HR 2.64 (95% CI 1.14-6.12, p = 0.02) and HR 5.30 (95% CI 2.31-12.11, p < 0.001), respectively. QRSvm <1.54 mV was borderline significant with mortality outcome (p = 0.10). The composite score of all 3 VCG indices, a score of 3, conferred an increased risk of mortality (including heart failure mortality) in multivariate analysis: HR 13.80 (95% CI 3.44-55.39, p < 0.001). Conclusion: The spatial QRS-T angle and Twvm are emerging VCG indices which are independently associated with mortality in patients with reduced left ventricular ejection fraction due to ICMP or NICMP. Using a composite score of all 3 vector indices, a maximum score was associated with poor long-term survival.

Original languageEnglish (US)
Pages (from-to)784-794
Number of pages11
JournalCardiology (Switzerland)
Volume145
Issue number12
DOIs
StatePublished - Dec 2020

Bibliographical note

Funding Information:
Governmental funding of clinical research within the Swedish National Health Service (ALF) and Region Skåne research grant covered salary costs.

Publisher Copyright:
© 2020

Keywords

  • Cardiovascular magnetic resonance
  • Heart failure
  • Implantable cardioverter-defibrillator
  • Late gadolinium enhancement
  • Left bundle branch block
  • QRS vector magnitude
  • Spatial QRS-T angle
  • T-wave vector magnitude

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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