TY - JOUR
T1 - Global Electric Heterogeneity Risk Score for Prediction of Sudden Cardiac Death in the General Population
T2 - The Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health (CHS) Studies
AU - Waks, Jonathan W.
AU - Sitlani, Colleen M.
AU - Soliman, Elsayed Z.
AU - Kabir, Muammar
AU - Ghafoori, Elyar
AU - Biggs, Mary L.
AU - Henrikson, Charles A.
AU - Sotoodehnia, Nona
AU - Biering-Sørensen, Tor
AU - Agarwal, Sunil K.
AU - Siscovick, David S.
AU - Post, Wendy S.
AU - Solomon, Scott D.
AU - Buxton, Alfred E.
AU - Josephson, Mark E.
AU - Tereshchenko, Larisa G.
N1 - Funding Information:
The ARIC Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, HHSN268201100012C). CHS is supported by National Heart, Lung, and Blood Institute contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086 and grant U01HL080295, with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by R01AG023629 from the National Institute on Aging. A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. This work was supported by 1R01HL118277 (Dr Tereshchenko), R01HL116747 (Dr Sotoodehnia), and R01HL111089 (Dr Sotoodehnia).
Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/6/7
Y1 - 2016/6/7
N2 - Background - Asymptomatic individuals account for the majority of sudden cardiac deaths (SCDs). Development of effective, low-cost, and noninvasive SCD risk stratification tools is necessary. Methods and Results - Participants from the Atherosclerosis Risk in Communities study and Cardiovascular Health Study (n=20 177; age, 59.3±10.1 years; age range, 44-100 years; 56% female; 77% white) were followed up for 14.0 years (median). Five ECG markers of global electric heterogeneity (GEH; sum absolute QRST integral, spatial QRST angle, spatial ventricular gradient [SVG] magnitude, SVG elevation, and SVG azimuth) were measured on standard 12-lead ECGs. Cox proportional hazards and competing risks models evaluated associations between GEH electrocardiographic parameters and SCD. An SCD competing risks score was derived from demographics, comorbidities, and GEH parameters. SCD incidence was 1.86 per 1000 person-years. After multivariable adjustment, baseline GEH parameters and large increases in GEH parameters over time were independently associated with SCD. Final SCD risk scores included age, sex, race, diabetes mellitus, hypertension, coronary heart disease, stroke, and GEH parameters as continuous variables. When GEH parameters were added to clinical/demographic factors, the C statistic increased from 0.777 to 0.790 (P=0.008), the risk score classified 10-year SCD risk as high (>5%) in 7.2% of participants, 10% of SCD victims were appropriately reclassified into a high-risk category, and only 1.4% of SCD victims were inappropriately reclassified from high to intermediate risk. The net reclassification index was 18.3%. Conclusions - Abnormal electrophysiological substrate quantified by GEH parameters is independently associated with SCD in the general population. The addition of GEH parameters to clinical characteristics improves SCD risk prediction.
AB - Background - Asymptomatic individuals account for the majority of sudden cardiac deaths (SCDs). Development of effective, low-cost, and noninvasive SCD risk stratification tools is necessary. Methods and Results - Participants from the Atherosclerosis Risk in Communities study and Cardiovascular Health Study (n=20 177; age, 59.3±10.1 years; age range, 44-100 years; 56% female; 77% white) were followed up for 14.0 years (median). Five ECG markers of global electric heterogeneity (GEH; sum absolute QRST integral, spatial QRST angle, spatial ventricular gradient [SVG] magnitude, SVG elevation, and SVG azimuth) were measured on standard 12-lead ECGs. Cox proportional hazards and competing risks models evaluated associations between GEH electrocardiographic parameters and SCD. An SCD competing risks score was derived from demographics, comorbidities, and GEH parameters. SCD incidence was 1.86 per 1000 person-years. After multivariable adjustment, baseline GEH parameters and large increases in GEH parameters over time were independently associated with SCD. Final SCD risk scores included age, sex, race, diabetes mellitus, hypertension, coronary heart disease, stroke, and GEH parameters as continuous variables. When GEH parameters were added to clinical/demographic factors, the C statistic increased from 0.777 to 0.790 (P=0.008), the risk score classified 10-year SCD risk as high (>5%) in 7.2% of participants, 10% of SCD victims were appropriately reclassified into a high-risk category, and only 1.4% of SCD victims were inappropriately reclassified from high to intermediate risk. The net reclassification index was 18.3%. Conclusions - Abnormal electrophysiological substrate quantified by GEH parameters is independently associated with SCD in the general population. The addition of GEH parameters to clinical characteristics improves SCD risk prediction.
KW - death, sudden, cardiac
KW - electrocardiography
KW - electrophysiology
KW - risk assessment
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UR - http://www.scopus.com/inward/citedby.url?scp=84963971777&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.116.021306
DO - 10.1161/CIRCULATIONAHA.116.021306
M3 - Article
C2 - 27081116
AN - SCOPUS:84963971777
SN - 0009-7322
VL - 133
SP - 2222
EP - 2234
JO - Circulation
JF - Circulation
IS - 23
ER -