{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T15:47:41Z","timestamp":1790005661528,"version":"4.0.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Current methods to identify patients at higher risk for sudden cardiac death, primarily left ventricular ejection fraction \u226435%, miss \u224880% of patients who die suddenly. We tested the hypothesis that patients with elevated QRS-scores (index of myocardial scar) and wide QRS-T angles (index abnormal depolarization\u2013repolarization relationship) have high 1-year all-cause mortality and could be further risk stratified with clinical characteristics.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We screened all 12-lead ECGs over 6 months at 2 large hospital systems and analyzed clinical characteristics and 1-year mortality. Patients with ECGs obtained in hospital areas with known high mortality rates were excluded. At the first hospital, QRS-score \u22655 and QRS-T angle \u2265105\u00b0 identified 8.0% of patients and was associated with an odds ratio of 2.79 (95% confidence interval, 2.10\u20133.69) for 1-year mortality compared with patients below both ECG thresholds (13.9% versus 5.5% death rate). Left ventricular ejection fraction was &gt;35% in 82% of the former group of patients, and addition of ECG measures to left ventricular ejection fraction increased the discrimination of death risk (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001). At the second hospital, the odds ratio was 2.42 (1.95\u20133.01) for 1-year mortality (8.8% versus 3.8%). Adjustment for patient characteristics eliminated interhospital differences. Multivariable adjusted odds ratio combining data from both hospitals was 1.53 (1.28\u20131.83). Increasing heart rate and chronic renal impairment further predicted mortality.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Screening hospital ECG databases with QRS-scoring and QRS-T angle analysis identifies patients with high 1-year all-cause mortality and predominantly preserved left ventricular ejection fraction. This approach may represent a widely available method to identify patients at increased risk of death.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.113.000411","type":"journal-article","created":{"date-parts":[[2013,10,13]],"date-time":"2013-10-13T01:39:06Z","timestamp":1381628346000},"page":"1156-1162","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Screening Entire Health System ECG Databases to Identify Patients at Increased Risk of Death"],"prefix":"10.1161","volume":"6","author":[{"given":"David G.","family":"Strauss","sequence":"first","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Mewton","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard L.","family":"Verrier","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce D.","family":"Nearing","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis E.","family":"Marchlinski","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Killian","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Moxley","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larisa G.","family":"Tereshchenko","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine C.","family":"Wu","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimond","family":"Winslow","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Cox","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.","family":"Spooner","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; Drug Administration, Silver Spring, MD (D.G.S.); Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (N.M., J.M., L.G.T., K.C.W., P.M.S., J.A.C.L.); Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.L.V., B.D.N.); Division of Cardiology, Department of Medicine, Hospital of the University of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o A.C.","family":"Lima","sequence":"additional","affiliation":[{"name":"From the Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food &amp; 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