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Lo scopo di questo studio è di valutare il significato prognostico dell'elettrocardiogramma standard in un'ampia casistica di pazienti affetti da cardiomiopatia ipertrofica. In questo studio multicentrico sono stati considerati 841 pazienti con cardiomiopatia ipertrofica (66% uomini, età media 48±17 anni) per un follow-up di 7.1±7.1 anni, per ognuno è stato analizzato il primo elettrocardiogramma disponibile. I risultati hanno dimostrato come fattori indipendentemente correlati a morte cardiaca improvvisa la sincope inspiegata (p 0.004), il sopraslivellamento del tratto ST e/o la presenza di onde T positive giganti (p 0.048), la durata del QRS >= 120 ms (p 0.017). Sono stati costruiti due modelli per predire il rischio di morte improvvisa: il primo basato sui fattori di rischio universalmente riconosciuti (spessore parietale >= 30 mm, tachicardie ventricolari non sostenute all'ECG Holter 24 ore, sincope e storia familiare di morte improvvisa) e il secondo con l'aggiunta delle variabili sopraslivellamento del tratto ST/onde T positive giganti e durata del QRS >= 120 ms. Entrambi i modelli stratificano i pazienti in base al numero dei fattori di rischio, ma il secondo modello risulta avere un valore predittivo maggiore (chi-square da 12 a 22, p 0.002). In conclusione nella cardiomiopatia ipertrofica l'elettrocardiogramma standard risulta avere un valore prognostico e migliora l'attuale modello di stratificazione per il rischio di morte improvvisa., The purpose of this study was to investigate the prognostic significance of standard electrocardiogram (ECG) in a large cohort of patients with hypertrophic cardiomyopathy (HCM). In this multicenter study 841 HCM patients (66% men, mean age 48±17 yrs) were followed for 7.1±7.1 years and the first collected ECG was considered for the analysis. The results showed that independent predictors of sudden cardiac death were unexplained syncope (p 0.004), ST segment elevation and/or giant positive T waves (p 0.048), QRS duration >= 120 ms (p 0.017). Two models has been contructed to predict the risk of sudden death: the first based on the already well known established risk factors (wall thickness >= 30 mm, non-sustained ventricular tachycardia on ECG Holter monitoring, syncope and family history of sudden death) and the second with the addition of ST segment elevation/giant positive T waves and QRS duration >= 120 ms. Whereas both models stratified patients according to the number of risk factors, the second model showed a higher predictive power (chi-square from 12 to 22, p 0.002). In conclusion in HCM standard ECG has a prognostic value and improves the current risk stratification model.

Lo scopo di questo studio è di valutare il significato prognostico dell'elettrocardiogramma standard in un'ampia casistica di pazienti affetti da cardiomiopatia ipertrofica. In questo studio multicentrico sono stati considerati 841 pazienti con cardiomiopatia ipertrofica (66% uomini, età media 48±17 anni) per un follow-up di 7.1±7.1 anni, per ognuno è stato analizzato il primo elettrocardiogramma disponibile. I risultati hanno dimostrato come fattori indipendentemente correlati a morte cardiaca improvvisa la sincope inspiegata (p 0.004), il sopraslivellamento del tratto ST e/o la presenza di onde T positive giganti (p 0.048), la durata del QRS >= 120 ms (p 0.017). Sono stati costruiti due modelli per predire il rischio di morte improvvisa: il primo basato sui fattori di rischio universalmente riconosciuti (spessore parietale >= 30 mm, tachicardie ventricolari non sostenute all'ECG Holter 24 ore, sincope e storia familiare di morte improvvisa) e il secondo con l'aggiunta delle variabili sopraslivellamento del tratto ST/onde T positive giganti e durata del QRS >= 120 ms. Entrambi i modelli stratificano i pazienti in base al numero dei fattori di rischio, ma il secondo modello risulta avere un valore predittivo maggiore (chi-square da 12 a 22, p 0.002). In conclusione nella cardiomiopatia ipertrofica l'elettrocardiogramma standard risulta avere un valore prognostico e migliora l'attuale modello di stratificazione per il rischio di morte improvvisa., The purpose of this study was to investigate the prognostic significance of standard electrocardiogram (ECG) in a large cohort of patients with hypertrophic cardiomyopathy (HCM). In this multicenter study 841 HCM patients (66% men, mean age 48±17 yrs) were followed for 7.1±7.1 years and the first collected ECG was considered for the analysis. The results showed that independent predictors of sudden cardiac death were unexplained syncope (p 0.004), ST segment elevation and/or giant positive T waves (p 0.048), QRS duration >= 120 ms (p 0.017). Two models has been contructed to predict the risk of sudden death: the first based on the already well known established risk factors (wall thickness >= 30 mm, non-sustained ventricular tachycardia on ECG Holter monitoring, syncope and family history of sudden death) and the second with the addition of ST segment elevation/giant positive T waves and QRS duration >= 120 ms. Whereas both models stratified patients according to the number of risk factors, the second model showed a higher predictive power (chi-square from 12 to 22, p 0.002). In conclusion in HCM standard ECG has a prognostic value and improves the current risk stratification model.

The objective of this study was to investigate the prognostic significance of 12-lead electrocardiogram (ECG) patterns in a large multicenter cohort of patients with hypertrophic cardiomyopathy; 1,004 consecutive patients with hypertrophic cardiomyopathy and a recorded standard ECG (64% men, mean age 50 +/- 16 years) were evaluated at 4 Italian centers. The study end points were sudden cardiac death (SCD) or surrogates, including appropriate implanted cardiac defibrillator discharge and resuscitated cardiac arrest and major cardiovascular events (including. SCD or surrogates and death due to heart failure, cardioembolic stroke, or heart transplantation). Prevalence of baseline electrocardiographic characteristics was: normal ECG 4%, ST-segment depression 56%, pseudonecrosis waves 33%, "pseudo ST-segment elevation myocardial infarction (STEMI)" pattern 17%, QRS duration >= 120 ms 17%, giant inverted T waves 6%, and low QRS voltages 3%. During a mean follow-up of 7.4 +/- 6.8 years, 77 patients experienced SCD or surrogates and 154 patients experienced major cardiovascular events. Independent predictors of SCD or surrogates were unexplained syncope (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.4 to 4.5, p = 0.003), left ventricular ejection fraction = 120 ms (HR 1.69, 95% CI 1.16 to 2.47, p = 0.007), and prolonged QTc interval (HR 1.68, 95% CI 1.21 to 2.34, p = 0.002). In conclusion, a detailed qualitative and quantitative electrocardiographic analyses provide independent predictors of prognosis that could be integrated with the available score systems to improve the power of the current model. (C) 2016 Elsevier Inc. All rights reserved.

To assess the effect of computer-aided detection (CAD) as a second reader on the sensitivity and specificity of computed tomographic (CT) colonography in detecting 6-9-mm colorectal cancer (CRC) lesions.Individuals with clinical indications for colonoscopy--either for symptoms or as part of participating in a surveillance program or CRC screening--were prospectively enrolled at one of 10 academic centers between July 2007 and May 2009. Institutional review board approval was obtained at each clinical site, and all participants provided written informed consent. All participants underwent CT colonography and colonoscopy on the same day. Experienced readers interpreted the CT colonography images unassisted and then reviewed all colorectal lesion-like structures pinpointed by the CAD algorithm. Segmental unblinding of CT colonoscopy findings at colonoscopy was utilized. The sensitivity and specificity of unassisted and CAD-assisted reading in identifying individuals with 6-9-mm lesions were calculated and compared by means of pairwise analysis.A total of 618 participants (mean age, 57.9 years; 54.5% male) were included in the final analysis. Of these participants, 464 (75.1%) had no lesions 6 mm or larger, and 52 (8.4%) had 6-9-mm lesions. The sensitivity of CT colonography with unassisted reading and that with CAD-assisted reading in identifying individuals with 6-9-mm lesions was 65.4% (95% confidence interval [CI]: 50.9%, 78.0%) and 76.9% (95% CI: 63.2%, 87.5%; P = .016), respectively. No significant change in specificity was observed: The specificity of CT colonography with unassisted and that with CAD-assisted reading was 91.8% (95% CI: 88.9%, 94.1%) and 90.9% (95% CI: 88.0%, 93.4%; P = .063), respectively. Evaluation of CAD candidates required an additional 1.6 minutes (25th-75th percentile: 1.0 minute to 3.4 minutes).The addition of CAD to reading performed by experienced readers resulted in a significant benefit in the detection of 6-9-mm polyps at CT colonography in this cohort.http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120376/-/DC1.