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Lower spatial QRS-T angle rules out sustained ventricular arrhythmias in children with hypertrophic cardiomyopathy

Published online by Cambridge University Press:  01 June 2016

Daniel Cortez ,
Nandita Sharma ,
Jean Cavanaugh ,
Froilan Tuozo ,
Gwendolyn Derk ,
Emily Lundberg ,
Keith Weiner ,
Nafiz Kiciman ,
Juan Alejos  and
Bruce Landeck
...Show all authors
Daniel Cortez*
Affiliation:
Children’s Hospital Colorado/University of Colorado, Aurora, Colorado, United States of America Department of Cardiovascular Sciences, Lund University, Lund, Sweden
Nandita Sharma
Affiliation:
Penn State Milton Hershey Medical Center, Hershey, Pennsylvania, United States of America
Jean Cavanaugh
Affiliation:
Children’s Hospital Colorado/University of Colorado, Aurora, Colorado, United States of America
Froilan Tuozo
Affiliation:
University of California at Irvine, Irvine, California, United States of America
Gwendolyn Derk
Affiliation:
University of Illinois College of Medicine, Champaign-Urbana, United States of America
Emily Lundberg
Affiliation:
University of California, Los Angeles, United States of America
Keith Weiner
Affiliation:
CHOC Children’s, Orange, California, United States of America
Nafiz Kiciman
Affiliation:
University of California at Irvine, Irvine, California, United States of America
Juan Alejos
Affiliation:
University of California, Los Angeles, United States of America
Bruce Landeck
Affiliation:
Children’s Hospital Colorado/University of Colorado, Aurora, Colorado, United States of America
Jamil Aboulhosn
Affiliation:
University of Illinois College of Medicine, Champaign-Urbana, United States of America
Shelley Miyamoto
Affiliation:
Children’s Hospital Colorado/University of Colorado, Aurora, Colorado, United States of America
Anthony C. McCanta
Affiliation:
CHOC Children’s, Orange, California, United States of America
Anjan S. Batra
Affiliation:
University of California at Irvine, Irvine, California, United States of America
*
Correspondence to: D. Cortez, MD, 13123 East 16th Avenue, Box 100, Aurora, Colorado 80045, United States of America. Tel: +303 718 6871; Fax: +720 777 7290; E-mail: Dr.danielcortez@gmail.com
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Abstract

Introduction

The spatial peaks QRS-T angle accurately distinguishes children with hypertrophic cardiomyopathy from their healthy counterparts. The spatial peaks QRS-T angle is also useful in risk stratification for ventricular arrhythmias. We hypothesised that the spatial peaks QRS-T angle would be useful for the prediction of ventricular arrhythmias in hypertrophic cardiomyopathy patients under 23 years of age.

Methods

Corrected QT interval and spatial peaks QRS-T angles were retrospectively assessed in 133 paediatric hypertrophic cardiomyopathy patients (12.4±6.6 years) with versus without ventricular arrhythmias of 30 seconds or longer. Significance, positive/negative predictive values, and odds ratios were calculated based on receiver operating characteristic curve cut-off values.

Results

In total, 10 patients with ventricular arrhythmias were identified. Although the corrected QT interval did not differentiate those with versus without ventricular arrhythmias, the spatial peaks QRS-T angle did (151.4±19.0 versus 116.8±42.6 degrees, respectively, p<0.001). At an optimal cut-off value (124.1 degrees), the positive and negative predictive values of the spatial peaks QRS-T angle were 15.4 and 100.0%, respectively, with an odds ratio of 25.9 (95% CI 1.5–452.2).

Conclusion

In children with hypertrophic cardiomyopathy, the spatial peaks QRS-T angle is associated with ventricular arrhythmia burden with high negative predictive value and odds ratio.

Keywords

Spatial QRS-T angleventricular arrhythmiaspredictionhypertrophic cardiomyopathyQTc
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 354 - 358
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Copyright
© Cambridge University Press 2016 

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