The Association Between Characteristics Of Electrocardiogram And Prognosis Of Hypertrophic Cardiomyopathy

Objective:Hypertrophic cardiomyopathy (HCM) is the first cause of sudden cardiac death (SCD) in the young people and is also one of the main causes of heart failure. Therefore,the early diagnosis and a risk stratification of HCM has great clinical significance. At present the diagnosis of HCM relies mainly on echocardiography and magnetic resonance imaging (MRI).However, based on China’s national conditions, not every potential patient will do echocardiography or MRI, especially when he never had any symptoms. Electrocardiogram (ECG) is an economic, non-invasive way of examination and can be used for early detection of HCM. Previous studies have found that some changes of ECG in HCM may be associated with prognosis. Our study was to investigate the relationship between ECG and clinical outcomes of HCM, clarifying the significance of ECG in prognosis of HCM. Methods:From 2000 to 2012,326 unrelated HCM patients (72% male, mean age 52years) were recruited at Fuwai Hospital. We analyzed the association between characteristics of 12-lead ECG obtained at enrollment and clinical outcomes collected by follow-up in HCM patients. Results:Kaplan-Meier analysis revealed fragmented QRS (fQRS) was associated with an increased risk for all-cause mortality (p= 0.002), cardiovascular death (CVD) (p<0.001) and heart failure-related death (p=0.002). Multivariate analysis identified fQRS as an independent predictor of all-cause death (HR 2.37,95% CI 1.13-4.98, p=0.022), CVD (HR 2.86, 95% CI 1.28-6.38, p=0.01) and heart failure-related death (HR 4.15,95% CI 1.32-13.10, p=0.015). Furthermore, Kaplan-Meier analysis revealed fQRS in the lateral leads was more closely related to CVD (p= 0.034) and heart failure-related death (p= 0.0015) compared to other fQRS patients. Conclusions:fQRS is associated with all-cause mortality and CVD in patients with HCM and might serve as a marker for risk assessment in HCM patients.