Abstract 15967: Electrical Surrogates for Severely Reduced Left Ventricular Ejection Fraction

Introduction: Severely depressed LV systolic function is currently the most common clinical criterion for identifying patients that may benefit from the primary prevention ICD. We have previously demonstrated that the vast majority of those who may benefit from primary prevention do not undergo screening with an echocardiogram. Hypothesis: The collective presence of specific abnormal 12-lead ECG markers correlates with severely reduced LV ejection fraction (LVEF). Methods: A pooled analysis of prospectively identified sudden cardiac arrest (SCA) cases and geographical controls (69% with coronary disease) was performed from an ongoing community-based study in the US Northwest (catchment population approx. 1 million). Subjects were required to have archived 12-lead ECG and echocardiography data available. LVEF was determined from echocardiography reports, and archived ECGs were evaluated for elevated resting heart rate >75bpm, left ventricular hypertrophy, delayed QRS transition zone, QRS-T angle >90°, prolonged QTc (>450ms in men; >460 in women), and prolonged T-peak to T-end >89ms. Results: 561 patients were included in the analysis (mean age 66.5±12.8, 65% male). 53% of the subjects with EF >35% (n=476) had 0-1 ECG abnormalities, compared to 18% in the group with low EF ≤35% (n=85). Conversely, 34% of subjects with low EF had ≥4 ECG abnormalities, compared to 9% among subjects with EF >35% (p 35% corresponding to the number of ECG abnormalities is presented in the Figure. Conclusions: The presence of specific ECG abnormalities was collectively associated with identification of severely reduced LV systolic function among patients with a high coronary disease burden. These findings may improve the effectiveness of screening for deployment of SCA primary prevention in the community.