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ECG Score of Ostman-Smith et al for Predicting Risk of Sudden Death in a Patient with Hypertrophic Cardiomyopathy

Purpose: To evaluate a patient with hypertrophic cardiomyopathy for the risk of a life-threatening arrhythmia using the ECG score of Ostman-Smith et al.

Description

Ostman-Smith et al developed a score for identifying a patient with hypertrophic cardiomyopathy who is at increased risk for sudden death. The authors are from Gothenburg University, Sunderby Hospital, Linkoping University and Lund University in Sweden and Oxford University in England.


Parameters:

(1) deviation in the QRS axis

(2) pathologic T wave inversion

(3) ST-segment depression

(4) dominant S wave in V4

(5) sum of QRS amplitudes in limb leads: sum of R+S waves (or Q if deeper than S) in all 6 limb leads

(6) 12-lead amplitude-duration product

(7) QTc in milliseconds from Bazee's formula

 

Parameter

Finding

Points

any deviation in QRS axis

absent

0

 

present

1

pathologic T wave inversion

none

0

 

limb leads only

1

 

precordial leads with or without change in limb leads

2

ST segment depression

none or < 2 mm

0

 

>= 2 mm

2

dominant S wave in V4

absent

0

 

present

2

limb lead QRS amplitude sum

< 7.7 mV

0

 

7.7 to 9.9 mV

1

 

10 to 11.9 mV

2

 

>= 12 mV

3

12 lead amplitude duration product

< 2.2 mV•s

0

 

2.2 to 2.49 mV•s

1

 

2.5 to 2.99 mV•s

2

 

>= 3.0 mV•s

3

QTc

< 440 ms

0

 

>= 440 ms

1

 

total score =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 14

• A score >= 6 was associated with a high risk for a potentially life-threatening cardiac arrhythmia.


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Specialty

Objective

ICD-10