Background
Methods
Study population
Electrocardiography and echocardiography
CMR imaging
Grouping of patients and analyses
Statistical analysis
Results
Study population and ECG
All subjects (n = 85) | SCA/VA group (n = 7) | No-SCA/VA group (n = 78) | P | |
---|---|---|---|---|
Age (years) | 54.0 (41.0–65.0) | 41.0 (33.0–49.0) | 55.0 (42.0–65.0) | 0.043 |
Male sex | 46 (54.1) | 6 (85.7) | 40 (51.3) | 0.175 |
Body mass index (kg/m2) | 22.7 (20.9–25.0) | 22.6 (22.2–28.0) | 22.7 (20.9–24.9) | 0.332 |
Diabetes mellitus | 7 (8.2) | 1 (14.3) | 6 (7.7) | 0.465 |
Hypertension | 22 (25.9) | 1 (14.3) | 21 (26.9) | 0.671 |
CAD | 4 (4.7) | 0 (0) | 4 (5.1) | > 0.999 |
Dyslipidemia | 8 (9.4) | 0 (0) | 8 (10.3) | 0.830 |
Family history of SCA | 4 (4.7) | 0 (0) | 4 (5.1) | > 0.999 |
ECG | ||||
PR interval (ms) | 164.0 (148.0–186.0) | 181.0 (166.0–198.0) | 160.0 (144.0–186.0) | 0.149 |
QRS duration (ms) | 96.0 (88.0–106.0) | 114.0 (104.0–127.0) | 96.0 (88.0–104.0) | 0.007 |
QTc (ms) | 444.0 (426.0–462.0) | 437.0 (421.5–458.5) | 444.0 (426.0–462.0) | 0.689 |
Inverted T wave in inferior leads | 11 (12.9) | 2 (28.6) | 9 (11.5) | 0.485 |
Atrial fibrillation | 25 (29.4) | 2 (28.6) | 23 (29.5) | > 0.999 |
LBBB | 1 (1.2) | 0 (0) | 1 (1.3) | > 0.999 |
RBBB | 6 (7.1) | 1 (14.3) | 5 (6.4) | 0.993 |
Imaging findings
All subjects (n = 85) | SCA/VA group (n = 7) | No-SCA/VA group (n = 78) | P | |
---|---|---|---|---|
Echocardiography | ||||
MR grade | 0.153 | |||
No | 4 (4.7) | 1 (14.3) | 3 (3.8) | |
Mild | 9 (10.6) | 2 (28.6) | 7 (9.0) | |
Moderate | 15 (17.6) | 0 (0.0) | 15 (19.2) | |
Severe | 57 (67.1) | 4 (57.1) | 53 (67.9) | |
Involved leaflet | 0.503 | |||
Anterior | 48 (56.5) | 5 (71.4) | 43 (55.1) | |
Posterior | 29 (34.1) | 1 (14.3) | 28 (35.9) | |
Both | 8 (9.4) | 1 (14.3) | 7 (9.0) | |
RVSP (mmHg) | 34.0 (28.0–47.0) | 23.0 (21.0–27.0) | 35.0 (28.0–51.0) | 0.002 |
Ruptured chordae tendinae | 26 (30.6) | 1 (14.3) | 25 (32.1) | 0.583 |
CMR | ||||
LVEF (%) | 60.0 (52.0–68.0) | 51.0 (49.0–66.5) | 60.0 (52.0–68.0) | 0.522 |
LA volume index | 56.5 (35.1–79.7) | 58.2 (40.0–80.0) | 30.0 (29.5–60.2) | 0.111 |
LVEDV index (mL/m2) | 122.3 (99.4–155.1) | 111.6 (83.1–145.3) | 122.5 (100.3–159.5) | 0.480 |
LVESV index (mL/m2) | 50.1 (32.4–72.8) | 54.9 (23.1–74.2) | 49.6 (33.3–72.7) | 0.716 |
RVEF (%) | 53.0 (43.0–60.0) | 55.0 (50.0–60.0) | 53.0 (41.0–59.0) | 0.437 |
RVEDV index (mL/m2) | 90.5 (69.3–129.0) | 96.3 (74.0–118.5) | 90.5 (69.3–128.7) | 0.936 |
RVESV index (mL/m2) | 40.5 (29.8–68.1) | 39.2 (28.2–57.8) | 41.3 (30.5–73.4) | 0.762 |
Prolapse distance (mm) | 6.6 (4.1–8.4) | 8.0 (4.8–9.7) | 6.6 (3.9–8.4) | 0.274 |
Mitral annular disjunction | 13 (15.7) | 3 (42.9) | 10 (13.2) | 0.127 |
Systolic curling motion | 9 (10.8) | 3 (42.9) | 6 (7.9) | 0.027 |
Presence of LGE | 8 (9.4) | 4 (57.1) | 4 (5.1) | < 0.001 |
LGE volume (g) | 0 (0–0) | 1.3 (0.0–15.1) | 0 (0–0) | < 0.001 |
LGE proportion (%) | 0 (0–0) | 1.2 (0.0–7.8) | 0 (0–0) | < 0.001 |
Range of age | Sex | SCA/VA type | ECG at event | LGE on CMR | LGE locations and patterns |
---|---|---|---|---|---|
SCA/VA group | |||||
30’s–40’s | Male | SCA | VF | Yes | Multifocal with patchy pattern: mesocardial at the basal to mid anteroseptal segment of LV; mesocardial to transmural at the basal to mid anterior, inferolateral, and inferior segments of LV |
40’s–50’s | Male | SCA | VF | Yes | Mesocardial at the basal inferoseptal segment of LV |
20’s–30’s | Male | SCA | VF | Yes | Multifocal: transmural at the basal inferior segment of LV; subendocardial at the basal anterolateral and inferolateral segments of LV |
40’s–50’s | Male | SCA | VF | Yes | Anterolateral and posteromedial papillary muscles of LV |
10’s–20’s | Male | SCA | VF | No | – |
60’s–70’s | Female | Sustained VT during treadmill test | VT | No | – |
50’s–60’s | Male | NSVT on Holter monitoring/NSVT during treadmill test | NSVT | No | – |
No-SCA/VA group | |||||
60’s–70’s | Female | – | – | Yes | Focal anterolateral papillary muscle |
50’s–60’s | Male | – | – | Yes | Basal septum of LV with linear pattern |
50’s–60’s | Male | – | – | Yes | Basal septum mid layer of LV with linear pattern |
70’s–80’s | Male | – | – | Yes | Focal distal portion of posterior papillary muscle |
Risk factors for SCA/VA
Univariable | Multivariable (Model 1) | Multivariable (Model 2) | Multivariable (Model 3) | |||||
---|---|---|---|---|---|---|---|---|
HR (95% CI) | P | HR (95% CI) | P | HR (95% CI) | P | HR (95% CI) | P | |
Male sex | 6.28 (0.75–52.28) | 0.089 | ||||||
Age (year) | 0.96 (0.91–10.00) | 0.050 | 1.07 (0.98–1.17) | 0.150 | 1.10 (0.99–1.23) | 0.076 | 1.12 (0.99–1.25) | 0.063 |
BMI (kg/m2) | 1.14 (0.98–1.33) | 0.089 | ||||||
Diabetes mellitus | 1.81 (0.22–15.1) | 0.584 | ||||||
Hypertension | 0.43 (0.05–3.54) | 0.429 | ||||||
Dyslipidemia | 0.04 (0–1453.85) | 0.550 | ||||||
ECG | ||||||||
PR interval (ms) | 1.01 (0.99–1.03) | 0.199 | ||||||
QRS duration (ms) | 1.05 (1.02–1.08) | 0.003 | 1.08 (1.01–1.14) | 0.024 | 1.06 (1.01–1.12) | 0.020 | 1.07 (1.01–1.14) | 0.023 |
QTc (ms) | 0.99 (0.97–1.02) | 0.645 | ||||||
Atrial fibrillation | 0.85 (0.16–4.38) | 0.845 | ||||||
BBB | 2.00 (0.21–19.45) | 0.550 | ||||||
Inverted T wave in inferior leads | 2.64 (0.51–13.67) | 0.248 | ||||||
Echocardiography | ||||||||
MR grade | ||||||||
Not severe | [Ref] | [Ref] | ||||||
Severe | 0.68 (0.15–3.09) | 0.618 | ||||||
Involved leaflet | ||||||||
One leaflet | [Ref] | [Ref] | ||||||
Both leaflet | 2.31 (0.27–19.89) | 0.445 | ||||||
Ruptured chordae tendinae | 0.36 (0.04–2.99) | 0.342 | ||||||
RVSP (mmHg) | 0.85 (0.74–0.97) | 0.015 | 0.89 (0.77–1.03) | 0.113 | 0.84 (0.68–1.05) | 0.123 | 0.86 (0.69–1.06) | 0.148 |
CMR | ||||||||
LVEF | 0.99 (0.94–1.05) | 0.748 | ||||||
LVEDV index | 0.99 (0.98–1.01) | 0.523 | ||||||
LVESV index | 1.00 (0.98–1.02) | 0.806 | ||||||
RVEF | 1.02 (0.96–1.08) | 0.503 | ||||||
RVEDV index | 1.00 (0.98–1.02) | 0.769 | ||||||
RVESV index | 0.99 (0.96–1.02) | 0.601 | ||||||
LA volume index | 0.97 (0.94–1.01) | 0.112 | ||||||
Prolapse distance | 1.01 (0.91–1.11) | 0.916 | ||||||
MAD* | 5.64 (1.23–25.81) | 0.026 | ||||||
Systolic curling motion* | 11.17 (2.23–55.89) | 0.003 | 13.04 (1.37–124.45) | 0.026 | 55.23 (2.18–1402.07) | 0.015 | 110.9 (2.93–4191.92) | 0.011 |
Presence of LGE† | 14.48 (3.19–65.68) | 0.001 | 19.8 (2.65–148.15) | 0.004 | – | – | – | – |
LGE volume (g)† | 1.06 (1.03–1.10) | < 0.001 | – | – | 1.08 (1.02–1.14) | 0.006 | – | – |
LGE proportion (%)† | 1.22 (1.10–1.34) | < 0.001 | – | – | – | – | 1.32 (1.08–1.60) | 0.006 |