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(Circulation. 2001;103:3075.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Dispersion of Ventricular Depolarization-Repolarization
A Noninvasive Marker for Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy
From the Departments of Pathology (P.T., C.B., G.T.) and Cardiology (D.C., A.N., B.B.), University of Padua Medical School, Padua, Italy.
Correspondence to Gaetano Thiene, MD, FESC, Istituto di Anatomia Patologica, Via A. Gabelli, 61, 35121 Padua, Italy. E-mail cardpath{at}unipd.it
Background—We retrospectively investigated the value of clinical and ECG findings as well as QT-QRS dispersion in predicting the risk of sudden death in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).
Methods and
Results—Duration and interlead variability of
the QT interval and QRS complex were measured manually from standard
ECGs in 20 sudden death victims with ARVC diagnosed at autopsy (group
I), in 20 living ARVC patients with sustained ventricular
tachycardia (group II), in 20 living ARVC patients with 
3
consecutive premature ventricular beats (group III), and in
20 control subjects (group IV). QT and QRS dispersions were greater in
group I (77.5±10.6 ms for QT and 45.7±8.1 ms for QRS) compared with
group II (64.5±13.9 ms for QT
[P=0.001] and 33.5±8.7 ms
for QRS [P=0.0004]) and in
group II compared with group III (48±8.9 ms for QT
[P<0.0001] and 28±5.2 ms
for QRS [P<0.0001]) and
group IV (33.5±4.8 ms for QT
[P<0.0001] and 18.5±3.6 ms
for QRS [P<0.0001]).
Negative T wave beyond V1 and syncope were
statistically more frequent in group I
(P=0.02 and
P=0.007, respectively). On
multivariate analysis, QRS dispersion remained
an independent predictor of sudden death
(P<0.0001), followed by
syncope (P=0.09). In assessing
risk of sudden death, QRS dispersion 
40 ms had a sensitivity and
specificity of 90% and 77%, respectively; QT dispersion >65 ms, 85%
and 75%, respectively; negative T wave beyond
V1, 85% and 42%, respectively; and syncope,
40% and 90%, respectively.
Conclusions—QRS
dispersion (40 ms) was the strongest independent predictor of sudden
death in ARVC. Syncope, QT dispersion >65 ms, and negative T wave
beyond V1 refined arrhythmic risk stratification
in these patients.
Key Words: cardiomyopathy • death, sudden • electrocardiography
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