Europace Advance Access originally published online on January 22, 2009
Europace 2009 11(5):643-649; doi:10.1093/europace/eun393
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Non-invasive Electrophysiology and Risk Stratification
ST-segment depression as a risk factor in hypertrophic cardiomyopathy
Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Mellat Park, Vali-e-Asr Avenue, PO Box 15745-1341, Tehran 1996911151, Iran
Aims: From the spectrum of electrocardiogram (ECG) changes that may occur in hypertrophic cardiomyopathy (HCM), there is no criterion reported to be useful for risk stratification. We sought to determine whether there was a relationship between the resting ECG findings and prognosis in patients with HCM.
Methods and results: We retrospectively analysed data on 173 consecutive patients admitted to our centre with a diagnosis of HCM. The 12-lead ECGs were assessed for underlying rhythm, PR interval, QRS voltages, QRS width, corrected QT interval, ST-segment deviation, T-wave inversion, and left atrial enlargement (LAE). During a mean follow-up of 50 months, 6.4% of patients had a combined endpoint [sudden death or appropriate implantable cardioverter-defibrillator (ICD) therapy]. The frequency of the combined endpoint was greater in patients with syncope, non-sustained ventricular tachycardia, maximal left ventricular (LV) wall thickness 
30 mm, and ST-segment depression in the high lateral leads (all P < 0.05). Other ECG findings (LV hypertrophy, LAE, abnormal Q wave, abnormal ST-T changes, and underlying rhythm), family history of sudden death, and LV outflow obstruction were not related to the combined endpoint. The results of our multivariate analysis demonstrated that ST-segment depression in the high lateral leads (OR: 20.0, 95% CI: 12.7–27.5; P = 0.0001) and syncope (OR: 19.0, 95% CI: 11.7–26.9; P = 0.0001) were the predictors of sudden death or appropriate ICD therapy in patients with HCM.
Conclusion: The results of this study indicated that, in addition to generally accepted risk factors, ST-segment depression in the high lateral leads could be of prognostic significance in HCM patients.
Key Words: Risk stratification, Hypertrophic cardiomyopathy, Electrocardiography, Prognosis
* Corresponding author. Tel: +98 21 2392 2163, Fax: +98 21 2204 8174, Email: majid.haghjoo{at}gmail.com
Manuscript submitted 16 September 2008. Accepted after revision 30 December 2008.
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- The quest for perfection: the contribution of the electrocardiogram to the prevention of sudden death in hypertrophic cardiomyopathy
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Europace 2009 11: 548-549.[Full Text]
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  C. O'Mahony and P. Elliott The quest for perfection: the contribution of the electrocardiogram to the prevention of sudden death in hypertrophic cardiomyopathy Europace, May 1, 2009; 11(5): 548 - 549. [Full Text] [PDF]
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