38 | Chapter 3 Table 2. Clinical characteristics and electrocardiographic parameters of patients without and with life-threatening arrhythmia All (n=160) No VA (n=113) VA (n=47) p-value Age, yrs 41 ± 17 38 ± 17 46 ± 14 0.002 Female, n(%) 88 (55) 69 (61) 19 (40) 0.01 Probands, n(%) 68 (43) 23 (20) 45 (96) <0.001 BSA, m2 1.9 ± 0.2 1.9 ± 0.2 2.0 ± 0.2 <0.001 Definite AC, n(%) 97 (61) 57 (50) 40 (85) <0.001 AA medication, n(%) 44 (28) 16 (14) 28 (60) <0.001 Beta blockers, n(%) 60 (38) 35 (31) 25 (53) 0.008 Mutation, n(%) 139 (87) 103 (92) 36 (77) 0.008 PKP2, n(%) 124 (78) 94 (84) 30 (64) 0.005 ICD, n(%) 20 (14) 2 (2) 18 (44) <0.001 Syncope, n(%) 40 (25) 23 (20) 17 (36) 0.04 HR, bpm 61 ± 12 63 ± 13 56 ± 10 <0.001 TWI major, n(%) 45 (28) 22 (20) 23 (49) <0.001 Epsilon wave, n(%) 13 (8) 5 (5) 8 (17) 0.008 TAD>55ms, n(%) 37 (25) 22 (21) 15 (37) 0.04 PVC>500, n(%) 43 (27) 33 (30) 10 (22) 0.32 Disease stage, n(%) • Subclinical 36 (23) 36 (32) 0 (0) <0.001 • Electrical 38 (24) 31 (27) 7 (15) 0.09 • Structural 86 (54) 46 (41) 40 (85) <0.001 Values are, n (%), mean ± standard deviation. Abbreviations: AA = anti arrhythmic, AC = arrhythmogenic cardiomyopathy, BSA = body surface area, HR = heart rate, ICD = implantable cardioverter-defibrillator, PKP2 = plakophillin-2, PVC = premature ventricular complex, TAD = terminal activation duration, TWI = T-wave inversion, VA = life-threatening ventricular arrhythmia. Patients with VA had more pronounced RV mechanical dispersion (53 ± 30 vs. 30 ± 21 ms, p <0.001). This difference was evident in both cohorts (45 ± 25 vs. 26 ± 15 ms, p <0.001 in the Oslo cohort and 63 ± 33 vs. 34 ± 25 ms, p <0.001 in the Utrecht cohort). (Figure 2, panel B) Every 10 ms increase in RV mechanical dispersion increased the odds of observing VA by 45% (OR 1.45, 95%CI (1.23 – 1.71), p <0.001). When adjusted for age, the increased odds was comparable (OR 1.41, 95%CI (1.18 – 1.69), p <0.001). The optimal cut-off for RV mechanical dispersion to detect patients with a history of VA was 24 ms (OR 1.06, 95%CI (0.96 – 1.18) per 10 ms increment <24 ms and 1.57, 95%CI (1.45 – 1.71) per 10 ms increment >24 ms). The AUC significantly decreased when dichotomizing RV mechanical dispersion, compared to using it as a continuous variable (0.71, 95%CI (0.64 – 0.77) vs. 0.78, 95%CI (0.71 – 0.86), p = 0.01). Therefore, RV mechanical dispersion was used only as a continuous variable.
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