Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
Exploring the association of electrocardiographic markers and arrhythmic risk in hypertrophic cardiomyopathy: A systematic review and meta-analysis.
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Chiotis Sotirios, Giannopoulos Georgios, Zgouridou Aikaterini, Konstantinidou Sonia-Evdokia, Peletidi Aliki, Economou Fotios, Paraschou Vasileios, Chaitidis Nikolaos, Boulmpou Aristi, Doundoulakis Ioannis, Vassilikos Vassileios P
Аннотация
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a primary genetic myocardial disorder associated with sudden cardiac death (SCD) due to ventricular arrhythmias, however risk stratification remains challenging. Electrocardiographic (ECG) markers may offer non-invasive tools for improved risk assessment, but their prognostic value remains unclear. The purpose of this study is to systematically evaluate the association between ECG markers and the risk of major arrhythmic events (MAEs) in HCM patients.
METHODS: We conducted a systematic search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Clinical Trials from inception to December 2024, including studies providing data on ECG variables and MAEs in patients with HCM. Pooled effect estimates were calculated using Der Simonian-Laird random-effects model.
RESULTS: 12 studies with 3,419 HCM patients were included. Pooled results demonstrated that the presence of fragmented QRS (fQRS) was significantly associated with MAEs (OR: 7.03, 95% CI: 3.19; 15.48) with moderate diagnostic performance [AUC = 0.76, sensitivity 59% (95% CI: 37%; 78%), specificity 80% (95% CI: 64%; 90%)]. Prolonged QTc interval (MD: 10.57 ms, 95% CI: 1-20.15), T-wave peak-to-end (Tp-e) interval (MD: 15.35 ms, 95% CI: 9.45; 21.26) and QT dispersion (QTd) (SMD: 0.48; 95% CI: 0.19; 0.77) were also associated with MAEs. In contrast, PR interval, P-wave, QRS duration and the presence of right bundle branch block (RBBB) demonstrated no significant associations.
CONCLUSION: This meta-analysis highlights the potential prognostic utility of specific ECG markers, particularly fQRS and repolarization abnormalities in stratifying arrhythmic risk in HCM.
PROSPERO REGISTRATION NUMBER: CRD42025635276.
METHODS: We conducted a systematic search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Clinical Trials from inception to December 2024, including studies providing data on ECG variables and MAEs in patients with HCM. Pooled effect estimates were calculated using Der Simonian-Laird random-effects model.
RESULTS: 12 studies with 3,419 HCM patients were included. Pooled results demonstrated that the presence of fragmented QRS (fQRS) was significantly associated with MAEs (OR: 7.03, 95% CI: 3.19; 15.48) with moderate diagnostic performance [AUC = 0.76, sensitivity 59% (95% CI: 37%; 78%), specificity 80% (95% CI: 64%; 90%)]. Prolonged QTc interval (MD: 10.57 ms, 95% CI: 1-20.15), T-wave peak-to-end (Tp-e) interval (MD: 15.35 ms, 95% CI: 9.45; 21.26) and QT dispersion (QTd) (SMD: 0.48; 95% CI: 0.19; 0.77) were also associated with MAEs. In contrast, PR interval, P-wave, QRS duration and the presence of right bundle branch block (RBBB) demonstrated no significant associations.
CONCLUSION: This meta-analysis highlights the potential prognostic utility of specific ECG markers, particularly fQRS and repolarization abnormalities in stratifying arrhythmic risk in HCM.
PROSPERO REGISTRATION NUMBER: CRD42025635276.