Predictive Value of Electrocardiographic T-Wave Morphology Parameters and T-Wave Peak to T-Wave End Interval for Sudden Cardiac Death in the General Population

Abstract

Ventricular repolarization abnormalities increase the risk of ventricular arrhythmias, and prolongation and shortening of the electrocardiographic QT interval increase the risk of SCD. 4,5 However, the association between QT duration and SCD in the general population has been relatively weak. Recently, an association between prolongation of the T-wave peak to T-wave end interval (TPE) and SCD was found in a general population sample.6 Furthermore, computerized measures of the 3-dimensional T-wave loop, the T-wave morphology parameters, have contained prognostic value for cardiovascular morbidity and mortality in several population studies, 7−12 but their relation specifically to SCD is less clear. The aim of the present study was to test the hypothesis that TPE and T-wave morphology parameters predict SCD in the general population.© 2013 American Heart Association, Inc. Original ArticleBackground-Previous population studies have found an association between electrocardiographic T-wave morphology parameters and cardiovascular mortality, but their relationship to sudden cardiac death (SCD) is not clear. To our knowledge, there are no follow-up studies assessing the association between electrocardiographic T-wave peak to T-wave end interval (TPE) and SCD. We assessed the predictive value of electrocardiographic T-wave morphology parameters and TPE for SCD in an adult general population sample. Methods and Results-A total of 4 T-wave morphology parameters (principal component analysis ratio, T-wave morphology dispersion, total cosine R-to-T, T-wave residuum) as well as TPE were measured from digital standard 12-lead ECGs in 5618 adults (46% men; mean age 50.9±12.5 years) participating in the Finnish population-based Health 2000 Study. After a mean follow-up time of 7.7±1.4 years, 72 SCDs had occurred. In univariable analyses, all T-wave morphology parameters were associated with an increased SCD risk. In multivariable Cox models, T-wave morphology dispersion and total cosine R-to-T remained as predictors of SCD, with T-wave morphology dispersion showing the highest SCD risk (hazard ratio of 1.4 [95% confidence interval 1.1−1.7, P=0.001] per 1 SD increase in the log e T-wave morphology dispersion). In contrast, TPE was not associated with SCD in univariable or multivariable analyses. Conclusions-Electrocardiographic T-wave morphology parameters describing the 3-dimensional shape of the T-wave stratify SCD risk in the general population, but we did not find an association between TPE and SCD.

T-peak to T-end interval for prediction of ventricular tachyarrhythmia and mortality in a primary prevention population with systolic cardiomyopathy

“…Prospective studies included patients with coronary artery disease, (15) those with Brugada syndrome, (16,17) ST-elevation myocardial infarction, (18,19) and a general population sample. (20) Retrospective investigations included patients with out-of-hospital cardiac arrest, (21) acquired long QT syndrome, (22) and a group with systolic cardiomyopathy undergoing biventricular ICD implantation. (23) The normal range of Tpe has been defined in a large population of women without cardiovascular disease (n=36,299).…”

“…Subsequently, studies have been carried out in various patient populations to assess the ability of Tpe c to predict ventricular tachyarrhythmia and/or death. (14)(15)(16)(17)(18)(19)(20)(21)(22)(23) However, data are lacking regarding the ability of Tpe c to predict outcomes in the population with systolic cardiomyopathy without any history of ventricular tachyarrhythmia (i.e., the primary prevention population).…”

Electrocardiographic T Wave Abnormalities and the Risk of Sudden Cardiac Death: The Finnish Perspective

“…12 In this sample of >5600 individuals with nearly 8 years of follow-up, maximum TPE interval had hazard ratios <1 before and after adjustments. Given these results, the significance of TPE interval in SCD prediction is questionable.…”

Ventricular Repolarization Intervals in Children Previously Treated with Anthracyclines

“…We concentrated specifically on Bazett corrected QT interval (QTc), QT dispersion (QTd), T-wave peak to end (TPE) interval, its maximum, its dispersion, TPE/QT, and TPE/JT. These intervals are markers of ventricular repolarization heterogeneity and useful in assessing the potential risk for ventricular arrhythmias [8].…”