Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims
ObjectiveA major challenge in reducing the incidence of sudden cardiac death (SCD) is the identification of patients at risk. Myocardial fibrosis has a substantial association with SCD risk but is difficult to identify among general populations. Our aim was to find electrocardiographic (ECG) markers...
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| Veröffentlicht in: | Heart (British Cardiac Society) 2020-07, Vol.106 (13), p.1001-1006 |
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| creator | Holmström, Lauri Haukilahti, Anette Vähätalo, Juha Kenttä, Tuomas Appel, Henrik Kiviniemi, Antti Pakanen, Lasse Huikuri, Heikki V Myerburg, Robert J Junttila, Juhani |
| description | ObjectiveA major challenge in reducing the incidence of sudden cardiac death (SCD) is the identification of patients at risk. Myocardial fibrosis has a substantial association with SCD risk but is difficult to identify among general populations. Our aim was to find electrocardiographic (ECG) markers of myocardial fibrosis among SCD victims.MethodsStudy population was acquired from the Fingesture study, which has gathered data from 5869 consecutive autopsied SCD victims in Northern Finland between 1998 and 2017. The degree of fibrosis was determined in histological samples taken from the heart during autopsy and was categorised into four groups: (1) no fibrosis, (2) scattered mild fibrosis, (3) moderate patchy fibrosis and (4) substantial fibrosis. We were able to collect ECGs from 1100 SCD victims.ResultsThe mean age of the study subjects was 66±13 years and 75% were male. QRS duration in ECG correlated with the degree of fibrosis (p |
| doi_str_mv | 10.1136/heartjnl-2019-316105 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2381850174</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2381850174</sourcerecordid><originalsourceid>FETCH-LOGICAL-b462t-f1728495c16b0acc5aadf5999fea9fb7184d042cc4626537c84041e22942d1453</originalsourceid><addsrcrecordid>eNqNkE1LxDAURYMoOo7-A5GCGzfVvHy0zVIGv2DAjYIbCWmaOhnaZkxaxX9vhjojuBBXCcm5l_cOQieALwBodrkwyvfLrkkJBpFSyADzHTQBlhXrp-fdeKecpxmm-QE6DGGJMWaiyPbRASWRoDlM0Mt1Y3TvnVa-su7Vq9XC6kSF4LRVvXVdSD5sv0jazxFRTVLb0rtgQ6Ja170mYagq0yXjr04qoyL-bnVv23CE9mrVBHP8fU7R08314-wunT_c3s-u5mnJMtKnNeSkYIJryEqstOZKVTUXQtRGibrMoWAVZkTrSGec5rpgmIEhRDBSAeN0is7H3pV3b4MJvWxt0KZpVGfcECShBRQcQ84ievYLXbrBd3E6SRilhEIh1oVspHRcNXhTy5W3rfKfErBc65cb_XKtX476Y-z0u3woW1NtQxvfEbgcgbJd_rcS_yS2o_4Z-QKtuqHI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2433231895</pqid></control><display><type>article</type><title>Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims</title><source>PubMed Central</source><creator>Holmström, Lauri ; Haukilahti, Anette ; Vähätalo, Juha ; Kenttä, Tuomas ; Appel, Henrik ; Kiviniemi, Antti ; Pakanen, Lasse ; Huikuri, Heikki V ; Myerburg, Robert J ; Junttila, Juhani</creator><creatorcontrib>Holmström, Lauri ; Haukilahti, Anette ; Vähätalo, Juha ; Kenttä, Tuomas ; Appel, Henrik ; Kiviniemi, Antti ; Pakanen, Lasse ; Huikuri, Heikki V ; Myerburg, Robert J ; Junttila, Juhani</creatorcontrib><description>ObjectiveA major challenge in reducing the incidence of sudden cardiac death (SCD) is the identification of patients at risk. Myocardial fibrosis has a substantial association with SCD risk but is difficult to identify among general populations. Our aim was to find electrocardiographic (ECG) markers of myocardial fibrosis among SCD victims.MethodsStudy population was acquired from the Fingesture study, which has gathered data from 5869 consecutive autopsied SCD victims in Northern Finland between 1998 and 2017. The degree of fibrosis was determined in histological samples taken from the heart during autopsy and was categorised into four groups: (1) no fibrosis, (2) scattered mild fibrosis, (3) moderate patchy fibrosis and (4) substantial fibrosis. We were able to collect ECGs from 1100 SCD victims.ResultsThe mean age of the study subjects was 66±13 years and 75% were male. QRS duration in ECG correlated with the degree of fibrosis (p<0.001, β=0.153). Prevalence of fragmented QRS complex, pathological Q waves and T wave inversions correlated with increased degree of fibrosis (p<0.001 in each). Depolarisation abnormalities were observed both in ischaemic and non-ischaemic heart disease. Repolarisation abnormalities reached statistical significance only among ischaemic SCD victims. An abnormal ECG was observed in 75.3% of the subjects in group 1, 73.7% in group 2, 88.5% in group 3 and 91.7% in group 4 patients (p<0.001).ConclusionsMyocardial fibrosis was associated with QRS prolongation, deep Q waves, T wave inversions and QRS fragmentation. The results provide potentially useful non-invasive early recognition of patients with fibrotic cardiomyopathy and risk of SCD.</description><identifier>ISSN: 1355-6037</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heartjnl-2019-316105</identifier><identifier>PMID: 32201371</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Arrhythmias and sudden death ; cardiac arrhythmias and resuscitation science ; Cardiomyopathy ; Cardiovascular disease ; Coronary vessels ; ECG/electrocardiogram ; Electrocardiography ; Forensic pathology ; Heart ; Medical records ; Questionnaires ; Studies ; Variables</subject><ispartof>Heart (British Cardiac Society), 2020-07, Vol.106 (13), p.1001-1006</ispartof><rights>Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2020 Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b462t-f1728495c16b0acc5aadf5999fea9fb7184d042cc4626537c84041e22942d1453</citedby><cites>FETCH-LOGICAL-b462t-f1728495c16b0acc5aadf5999fea9fb7184d042cc4626537c84041e22942d1453</cites><orcidid>0000-0002-6166-5589</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32201371$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Holmström, Lauri</creatorcontrib><creatorcontrib>Haukilahti, Anette</creatorcontrib><creatorcontrib>Vähätalo, Juha</creatorcontrib><creatorcontrib>Kenttä, Tuomas</creatorcontrib><creatorcontrib>Appel, Henrik</creatorcontrib><creatorcontrib>Kiviniemi, Antti</creatorcontrib><creatorcontrib>Pakanen, Lasse</creatorcontrib><creatorcontrib>Huikuri, Heikki V</creatorcontrib><creatorcontrib>Myerburg, Robert J</creatorcontrib><creatorcontrib>Junttila, Juhani</creatorcontrib><title>Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims</title><title>Heart (British Cardiac Society)</title><addtitle>Heart</addtitle><addtitle>Heart</addtitle><description>ObjectiveA major challenge in reducing the incidence of sudden cardiac death (SCD) is the identification of patients at risk. Myocardial fibrosis has a substantial association with SCD risk but is difficult to identify among general populations. Our aim was to find electrocardiographic (ECG) markers of myocardial fibrosis among SCD victims.MethodsStudy population was acquired from the Fingesture study, which has gathered data from 5869 consecutive autopsied SCD victims in Northern Finland between 1998 and 2017. The degree of fibrosis was determined in histological samples taken from the heart during autopsy and was categorised into four groups: (1) no fibrosis, (2) scattered mild fibrosis, (3) moderate patchy fibrosis and (4) substantial fibrosis. We were able to collect ECGs from 1100 SCD victims.ResultsThe mean age of the study subjects was 66±13 years and 75% were male. QRS duration in ECG correlated with the degree of fibrosis (p<0.001, β=0.153). Prevalence of fragmented QRS complex, pathological Q waves and T wave inversions correlated with increased degree of fibrosis (p<0.001 in each). Depolarisation abnormalities were observed both in ischaemic and non-ischaemic heart disease. Repolarisation abnormalities reached statistical significance only among ischaemic SCD victims. An abnormal ECG was observed in 75.3% of the subjects in group 1, 73.7% in group 2, 88.5% in group 3 and 91.7% in group 4 patients (p<0.001).ConclusionsMyocardial fibrosis was associated with QRS prolongation, deep Q waves, T wave inversions and QRS fragmentation. The results provide potentially useful non-invasive early recognition of patients with fibrotic cardiomyopathy and risk of SCD.</description><subject>Arrhythmias and sudden death</subject><subject>cardiac arrhythmias and resuscitation science</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular disease</subject><subject>Coronary vessels</subject><subject>ECG/electrocardiogram</subject><subject>Electrocardiography</subject><subject>Forensic pathology</subject><subject>Heart</subject><subject>Medical records</subject><subject>Questionnaires</subject><subject>Studies</subject><subject>Variables</subject><issn>1355-6037</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNqNkE1LxDAURYMoOo7-A5GCGzfVvHy0zVIGv2DAjYIbCWmaOhnaZkxaxX9vhjojuBBXCcm5l_cOQieALwBodrkwyvfLrkkJBpFSyADzHTQBlhXrp-fdeKecpxmm-QE6DGGJMWaiyPbRASWRoDlM0Mt1Y3TvnVa-su7Vq9XC6kSF4LRVvXVdSD5sv0jazxFRTVLb0rtgQ6Ja170mYagq0yXjr04qoyL-bnVv23CE9mrVBHP8fU7R08314-wunT_c3s-u5mnJMtKnNeSkYIJryEqstOZKVTUXQtRGibrMoWAVZkTrSGec5rpgmIEhRDBSAeN0is7H3pV3b4MJvWxt0KZpVGfcECShBRQcQ84ievYLXbrBd3E6SRilhEIh1oVspHRcNXhTy5W3rfKfErBc65cb_XKtX476Y-z0u3woW1NtQxvfEbgcgbJd_rcS_yS2o_4Z-QKtuqHI</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Holmström, Lauri</creator><creator>Haukilahti, Anette</creator><creator>Vähätalo, Juha</creator><creator>Kenttä, Tuomas</creator><creator>Appel, Henrik</creator><creator>Kiviniemi, Antti</creator><creator>Pakanen, Lasse</creator><creator>Huikuri, Heikki V</creator><creator>Myerburg, Robert J</creator><creator>Junttila, Juhani</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ Publishing Group LTD</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6166-5589</orcidid></search><sort><creationdate>20200701</creationdate><title>Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims</title><author>Holmström, Lauri ; Haukilahti, Anette ; Vähätalo, Juha ; Kenttä, Tuomas ; Appel, Henrik ; Kiviniemi, Antti ; Pakanen, Lasse ; Huikuri, Heikki V ; Myerburg, Robert J ; Junttila, Juhani</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b462t-f1728495c16b0acc5aadf5999fea9fb7184d042cc4626537c84041e22942d1453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Arrhythmias and sudden death</topic><topic>cardiac arrhythmias and resuscitation science</topic><topic>Cardiomyopathy</topic><topic>Cardiovascular disease</topic><topic>Coronary vessels</topic><topic>ECG/electrocardiogram</topic><topic>Electrocardiography</topic><topic>Forensic pathology</topic><topic>Heart</topic><topic>Medical records</topic><topic>Questionnaires</topic><topic>Studies</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Holmström, Lauri</creatorcontrib><creatorcontrib>Haukilahti, Anette</creatorcontrib><creatorcontrib>Vähätalo, Juha</creatorcontrib><creatorcontrib>Kenttä, Tuomas</creatorcontrib><creatorcontrib>Appel, Henrik</creatorcontrib><creatorcontrib>Kiviniemi, Antti</creatorcontrib><creatorcontrib>Pakanen, Lasse</creatorcontrib><creatorcontrib>Huikuri, Heikki V</creatorcontrib><creatorcontrib>Myerburg, Robert J</creatorcontrib><creatorcontrib>Junttila, Juhani</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Heart (British Cardiac Society)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Holmström, Lauri</au><au>Haukilahti, Anette</au><au>Vähätalo, Juha</au><au>Kenttä, Tuomas</au><au>Appel, Henrik</au><au>Kiviniemi, Antti</au><au>Pakanen, Lasse</au><au>Huikuri, Heikki V</au><au>Myerburg, Robert J</au><au>Junttila, Juhani</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims</atitle><jtitle>Heart (British Cardiac Society)</jtitle><stitle>Heart</stitle><addtitle>Heart</addtitle><date>2020-07-01</date><risdate>2020</risdate><volume>106</volume><issue>13</issue><spage>1001</spage><epage>1006</epage><pages>1001-1006</pages><issn>1355-6037</issn><eissn>1468-201X</eissn><abstract>ObjectiveA major challenge in reducing the incidence of sudden cardiac death (SCD) is the identification of patients at risk. Myocardial fibrosis has a substantial association with SCD risk but is difficult to identify among general populations. Our aim was to find electrocardiographic (ECG) markers of myocardial fibrosis among SCD victims.MethodsStudy population was acquired from the Fingesture study, which has gathered data from 5869 consecutive autopsied SCD victims in Northern Finland between 1998 and 2017. The degree of fibrosis was determined in histological samples taken from the heart during autopsy and was categorised into four groups: (1) no fibrosis, (2) scattered mild fibrosis, (3) moderate patchy fibrosis and (4) substantial fibrosis. We were able to collect ECGs from 1100 SCD victims.ResultsThe mean age of the study subjects was 66±13 years and 75% were male. QRS duration in ECG correlated with the degree of fibrosis (p<0.001, β=0.153). Prevalence of fragmented QRS complex, pathological Q waves and T wave inversions correlated with increased degree of fibrosis (p<0.001 in each). Depolarisation abnormalities were observed both in ischaemic and non-ischaemic heart disease. Repolarisation abnormalities reached statistical significance only among ischaemic SCD victims. An abnormal ECG was observed in 75.3% of the subjects in group 1, 73.7% in group 2, 88.5% in group 3 and 91.7% in group 4 patients (p<0.001).ConclusionsMyocardial fibrosis was associated with QRS prolongation, deep Q waves, T wave inversions and QRS fragmentation. The results provide potentially useful non-invasive early recognition of patients with fibrotic cardiomyopathy and risk of SCD.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>32201371</pmid><doi>10.1136/heartjnl-2019-316105</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-6166-5589</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Arrhythmias and sudden death cardiac arrhythmias and resuscitation science Cardiomyopathy Cardiovascular disease Coronary vessels ECG/electrocardiogram Electrocardiography Forensic pathology Heart Medical records Questionnaires Studies Variables |
| title | Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims |
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