Using QRS loop descriptors to characterize the risk of sudden cardiac death in patients with structurally normal hearts.

Cheng‐I Wu ,I-Hsin Lee,Wan-Hsin Hsieh,Shih‐Lin Chang ,Ta‐Chuan Tuan ,Fa Po Chung ,Ting‐Yung Chang ,Li‐Wei Lo ,Yu‐Cheng Hsieh ,Yenn‐Jiang Lin ,An‐Ning Feng ,Men-Tzung Lo ,Tze‐Fan Chao ,Amelia Yun-Yu Chen ,Chin‐Yu Lin ,Weikai Wang ,Jo‐Nan Liao ,Yu‐Feng Hu ,Chorng–Kuang How ,Shih‐Ann Chen

doi:10.1371/journal.pone.0263894

Abstract

The predictive value of non-invasive electrocardiographic examination findings for the risk of sudden cardiac death (SCD) in populations with structurally normal hearts remains unclear. This study aimed to investigate the characteristics of the QRS vectorcardiography of surface electrocardiography in patients with structurally normal hearts who experienced SCD. We consecutively enrolled patients who underwent vectorcardiography between March 2017 and December 2018 in a tertiary referral medical center. These patients didn't have structural heart diseases, histories of congestive heart failure, or reduced ejection fraction, and they were classified into SCD (with aborted SCD history and cerebral performance category score of 1) and control groups (with an intervention for atrioventricular node reentrant tachycardia and without SCD history). A total of 162 patients (mean age, 54.3±18.1 years; men, 75.9%), including 59 in the SCD group and 103 in the control group, underwent propensity analysis. The baseline demographic variables, underlying diseases, QRS loop descriptors (the percentage of the loop area, loop dispersion, and inter-lead QRS dispersion), and other electrocardiographic parameters were compared between the two groups. In the univariate and multivariate analyses, a smaller percentage of the loop area (odds ratio, 0.0003; 95% confidence interval, 0.00-0.02; p<0.001), more significant V4-5 dispersion (odds ratio, 1.04; 95% confidence interval, 1.02-1.07; p = 0.002), and longer QRS duration (odds ratio, 1.05; 95% confidence interval, 1.00-1.10; p = 0.04) were associated with SCD. In conclusion, the QRS loop descriptors of surface electrocardiography could be used as non-invasive markers to identify patients experiencing aborted SCD from a healthy population. A decreased percentage of loop area and elevated V4-5 QRS dispersion values assessed using vectorcardiography were associated with an increased risk of SCD in patients with structurally normal hearts.

Highlights

Sudden cardiac death (SCD) is a significant public health problem worldwide, accounting for approximately 12–20% of all deaths annually [1,2,3]
The QRS loop descriptors and vectorcardiographic parameters derived from surface ECG could be used as non-invasive markers to identify patients at a high risk for sudden cardiac death (SCD)
Low PL and high V4-5 QRS dispersion values are associated with patients who had structurally normal hearts and experienced aborted SCD

Summary

Introduction

Sudden cardiac death (SCD) is a significant public health problem worldwide, accounting for approximately 12–20% of all deaths annually [1,2,3]. To avoid such tragedy, it is important to identify high-risk patients vulnerable to cardiac arrest. Developing a good tool is exceptionally challenging because detailed information on these patients is usually limited [4]. Echocardiography and electrocardiography (ECG) have been widely validated as classifiers for certain populations to detect low ejection fraction and structural abnormalities in high-risk patients. Identifying the abnormal substrates of the ventricle to define high-risk groups has become an important issue because these subtle discontinuities may induce VA leading to SCD [6]

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