Vectorcardiography Findings Are Associated with Recurrent Ventricular Arrhythmias and Mortality in Patients with Heart Failure Treated with Implantable Cardioverter-Defibrillator Device

Abstract

<b><i>Background:</i></b> There is a need for refined risk stratification of sudden cardiac death and prediction of ventricular arrhythmias to correctly identify patients who are expected to benefit the most from implantable cardioverter-defibrillator (ICD) therapy. <b><i>Methods:</i></b> We conducted a registry-based retrospective observational study on patients with either ischemic (ICMP) or nonischemic dilated cardiomyopathy (NICMP) treated with ICD between 2002 and 2013 at a tertiary referral center. We evaluated 3 vectorcardiography (VCG) indices; spatial QRS-T angle, QRS vector magnitude (QRSvm), and T-wave vector magnitude (Twvm), and their association with all-cause mortality and ventricular arrhythmias. The VCG indices were automatically computed from resting 12-lead electrocardiograms before ICD implantation. <b><i>Results:</i></b> 178 patients were included in the study; 53.4% had ICMP, 79.2% were male, and mean ejection fraction was 27.4%. During the follow-up (median 89 months), 40 patients (23%) died; 31% had appropriate ICD therapy. In multivariate analysis with dichotomized variables, QRS-T angle &#x3e;152° and Twvm &#x3c;0.38 mV were significantly associated with increased mortality: HR 2.64 (95% CI 1.14–6.12, <i>p</i> = 0.02) and HR 5.30 (95% CI 2.31–12.11, <i>p</i> &#x3c; 0.001), respectively. QRSvm &#x3c;1.54 mV was borderline significant with mortality outcome (<i>p</i> = 0.10). The composite score of all 3 VCG indices, a score of 3, conferred an increased risk of mortality (including heart failure mortality) in multivariate analysis: HR 13.80 (95% CI 3.44–55.39, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> The spatial QRS-T angle and Twvm are emerging VCG indices which are independently associated with mortality in patients with reduced left ventricular ejection fraction due to ICMP or NICMP. Using a composite score of all 3 vector indices, a maximum score was associated with poor long-term survival.