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Master Thesis

Valeur pronostique de l’électrocardiogramme de repos 12 dérivations chez les patients porteurs d’une cardiomyopathie hypertrophique sarcomérique

Abstract : Introduction: we aimed to determine 12-lead electrocardiogram (ECG) predictive value of major cardiovascular events in patients with sarcomeric hypertrophic cardiomyopathy (HCM) in a monocentric observational retrospective study. Material and Methods: a 12-lead resting ECG was carried out during the initial consultation and a qualitative and quantitative analysis was performed. The study endpoints were major rhythmic events, including aborted or not sudden cardiac deaths, appropriate implantable cardiac defibrillator therapies and poorly tolerated sustained ventricular tachycardia; heart failure (HF) events including deaths and hospitalizations for acute HF and heart transplantations, and first access of atrial fibrillation (AF). Results: 427 patients were included. Only 1.6% of patients had a strictly normal ECG. The most prevalent anomalies were inverted T waves (69%), pseudo-necrosis Q waves (28%), and left atrial enlargement (28%). During a median follow-up of 3.1±2.1 years, 37 patients (8.7%) presented HF events or surrogates, 14 patients (3.3%) experienced a major rhythmic event and 19.4% had a first access of AF. At univariate analysis, a statistically significant association was shown between HF events and surrogates and QRS duration ≥ 120ms (HR 3.97, 95% CI 2.04 to 7.72, p<0.001), complete left bundle branch block (LBBB) (HR 3.2, 95% CI 1.3 to 7.7, p=0.009), prolonged corrected QT interval (HR 1.02, 95% CI 1.01 to 1.02, p<0.01), lateral inverted T waves (HR 2.02, 95% CI 1.06 to 3.9, p=0.03) and anteroseptal J waves (HR 7.5, 95% CI 1.02 to 54.9, p=0.048). A statistically significant association was shown between major rhythmic events and QRS duration ≥ 120ms (HR 4.4, 95% CI 1.5 to 12.7, p=0.006), complete LBBB (HR 3.9, 95% CI 1.1 to 14.3, p=0.03), and apical inverted T waves (HR 3.3, 95% CI 1.2 to 9.6, p=0.03). Prolonged QRS (HR 1.02, 95% CI 1.004 to 1.03, p=0.006) and P waves duration (HR 1.02, 95% CI 1.001 to 1.03, p=0.03), prolonged corrected QT interval (HR 1.01, 95% CI 1.005 to 1.02, p=0.001) and first-degree atrioventricular block (HR 2.3, 95% CI 1.4 to 3.9, p=0.001) were associated with first access of AF. In multivariate analysis, none of those parameters was a predictor of de novo AF. Conclusion: a 12-lead resting electrocardiogram remains a simple, low-cost, reproducible and available exam which enables to guide HCM patient’s diagnosis and prognosis.
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Coralie Marie. Valeur pronostique de l’électrocardiogramme de repos 12 dérivations chez les patients porteurs d’une cardiomyopathie hypertrophique sarcomérique. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02438505⟩

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