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ECG in dilated cardiomyopathy

specific findings and long-term prognostic significance

Merlo, Marcoa; Zaffalon, Denisea; Stolfo, Davidea; Altinier, Alessandroa; Barbati, Giuliab; Zecchin, Massimoa; Bardari, Stefanoa; Sinagra, Gianfrancoa

Journal of Cardiovascular Medicine: July 2019 - Volume 20 - Issue 7 - p 450–458
doi: 10.2459/JCM.0000000000000804
Research articles: Heart failure

Objective The objective was to provide an exhaustive characterization of ECG features in a large cohort of dilated cardiomyopathies (DCMs) and then investigate their possible prognostic role in the long term.

Background ECG is an accessible, reproducible, low-cost diagnostic and prognostic tool. However, an extensive description of ECG features and their long-term prognostic role in a large cohort of DCM is lacking.

Methods All available baseline ECGs of DCM patients enrolled from 1992 to 2013 were systematically analysed. Patients underwent to a complete clinical-laboratory evaluation. The study outcome measures were death or heart transplant (D/HT) and sudden death or malignant ventricular arrhythmias (SD/MVA).

Results Four hundred and fourteen DCM patients were enrolled. During a median follow-up of 125 months, 55 and 57 patients experienced D/HT and SD/MVA, respectively. At multivariate analysis, left ventricular hypertrophy (P = 0.017), heart rate (HR, P = 0.005) and anterolateral T-wave inversion (P = 0.041) predicted D/HT. Regarding SD/MVA, S wave amplitude in V2 (P = 0.008), R wave amplitude in DIII (P = 0.007), anterolateral T-wave inversion (P = 0.017) emerged as predictors. At receiver-operating curve analyses, the addition of ECG models to the clinical-laboratory evaluation significantly increased the area under the curve both for D/HT (from 0.68 to 0.74, P = 0.042) and SD/MVA (from 0.70 to 0.77, P = 0.048).

Conclusion The exhaustive systematic evaluation of ECG has an incremental impact in the prognostication of a large cohort of DCM patients, also regarding the arrhythmic stratification.

aCardiovascular Department, ‘Ospedali Riuniti’ and University of Trieste

bBiostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy

Correspondence to Marco Merlo, Cardiovascular Department, ‘Ospedali Riuniti’ and University of Trieste, Via Valdoni 7, Trieste 34100, Italy Tel: +39 3476932365; e-mail:

Received 20 October, 2018

Revised 8 January, 2019

Accepted 16 February, 2019

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© 2019 Italian Federation of Cardiology. All rights reserved.