Dynamic ECG Changes Are a Novel Risk Marker for Sudden Cardiac Death

Eur Heart J. 2023 Nov 13:ehad770. doi: 10.1093/eurheartj/ehad770. Online ahead of print.


Background and aims: ECG abnormalities have been evaluated as static risk markers for sudden cardiac death (SCD) but the potential importance of dynamic ECG remodeling has not been investigated. In this study, the nature and prevalence of dynamic ECG remodeling were studied among individuals who eventually suffered SCD.

Methods: The study population was drawn from two prospective community-based SCD studies in Oregon, USA (2002-, discovery cohort) and California, USA (2015-, validation cohort). For this present sub-study, 231 discovery cases (2015-2017) and 203 validation cases (2015-2021) with ≥2 archived pre-SCD ECGs were ascertained, and were matched to 234 discovery and 203 validation controls based on age, sex, and duration between the ECGs. Dynamic ECG remodeling was measured as progression of a previously validated cumulative 6-variable ECG electrical risk score (ERS).

Results: Oregon SCD cases displayed greater ERS increase over time vs. controls [+1.06 (95% CI +0.89 to +1.24) vs. -0.05 (-0.21 to +0.11); p < 0.001]. These findings were successfully replicated in California [+0.87 (+0.7 to +1.04) vs. -0.11 (-0.27 to 0.05); p < 0.001]. In multivariable models, abnormal dynamic ECG remodeling improved SCD prediction over baseline ECG, demographics, and clinical SCD risk factors in both Oregon [AUC 0.770 (95% CI 0.727-0.812) increased to AUC 0.869 (95% CI 0.837-0.902)] and California cohorts.

Conclusions: Dynamic ECG remodeling improved SCD risk prediction beyond clinical factors combined with the static ECG, with successful validation in a geographically distinct population. These findings introduce a novel concept of SCD dynamic risk and warrant further detailed investigation.

Keywords: ECG; dynamic; general population; risk prediction; sudden cardiac death.