University of Oulu

Holmström L, Haukilahti A, Vähätalo J, et al. Heart 2020;106:1001–1006.

Electrocardiographic associations with myocardial fibrosis among sudden cardiac death victims

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Author: Holmström, Lauri1; Haukilahti, Anette1; Vähätalo, Juha1;
Organizations: 1Research Unit of Internal Medicine, Medical Research Center, University of Oulu and University Hospital of Oulu, Oulu, Finland
2National Institute for Health and Welfare, Department of Forensic Medicine, Oulu University Hospital, Oulu, Finland
3Cardiovascular Division, University of Miami, Miller School of Medicine, Miami, Florida, USA
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: BMJ, 2020
Publish Date: 2020-09-02


Objective: A major challenge in reducing the incidence of sudden cardiac death (SCD) is the identification of patients at risk. Myocardial fibrosis has a substantial association with SCD risk but is difficult to identify among general populations. Our aim was to find electrocardiographic (ECG) markers of myocardial fibrosis among SCD victims.

Methods: Study population was acquired from the Fingesture study, which has gathered data from 5869 consecutive autopsied SCD victims in Northern Finland between 1998 and 2017. The degree of fibrosis was determined in histological samples taken from the heart during autopsy and was categorised into four groups: (1) no fibrosis, (2) scattered mild fibrosis, (3) moderate patchy fibrosis and (4) substantial fibrosis. We were able to collect ECGs from 1100 SCD victims.

Results: The mean age of the study subjects was 66±13 years and 75% were male. QRS duration in ECG correlated with the degree of fibrosis (p<0.001, β=0.153). Prevalence of fragmented QRS complex, pathological Q waves and T wave inversions correlated with increased degree of fibrosis (p<0.001 in each). Depolarisation abnormalities were observed both in ischaemic and non-ischaemic heart disease. Repolarisation abnormalities reached statistical significance only among ischaemic SCD victims. An abnormal ECG was observed in 75.3% of the subjects in group 1, 73.7% in group 2, 88.5% in group 3 and 91.7% in group 4 patients (p<0.001).

Conclusions: Myocardial fibrosis was associated with QRS prolongation, deep Q waves, T wave inversions and QRS fragmentation. The results provide potentially useful non-invasive early recognition of patients with fibrotic cardiomyopathy and risk of SCD.

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Series: Heart
ISSN: 1355-6037
ISSN-E: 1468-201X
ISSN-L: 1355-6037
Volume: 106
Issue: 13
Pages: 1001 - 1006
DOI: 10.1136/heartjnl-2019-316105
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Copyright information: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. This is the Author's Accepted Manuscript Version of the published article. The Definitive Version of Record can be found online at: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: