Prognostic significance of negative T-waves and low amplitude T-waves in the general population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Holkeri ◽  
A Eranti ◽  
M.A.E Haukilahti ◽  
T Kerola ◽  
T.V Kentta ◽  
...  
Keyword(s):  
General Population ◽  
Cardiac Death ◽  
Amplitude Ratio ◽  
Prognostic Significance ◽  
Funding Source ◽  
T Wave ◽  
Kaplan Meier ◽  
General Population Cohort ◽  
Low Amplitude ◽  
T Waves

Abstract Background Negative T-waves are associated with sudden cardiac death (SCD) in the general population. Whether also low amplitude T-waves link to SCD risk in the general population is unknown. Purpose We investigated the prognostic significance of T-wave abnormalities in a general population cohort. Methods We evaluated the ECGs of 6584 Finnish general population subjects aged ≥30 years (mean age 51.2±13.9, 45.6% men) and classified them according to the T-wave morphology to 3 classes: 1) negative T-waves (negative T-wave with amplitude ≥0.1mV in ≥2 of the leads I, II, aVL, V4-V6), 2) low amplitude T-waves (negative or positive T-wave with amplitude <0.1mV and amplitude ratio of T-wave and R-wave ≤10% in ≥2 of the leads I, II, aVL, V4-V6), and 3) normal T-waves (not meeting the criteria for negative or low amplitude T-waves). Subjects were followed for 10 years for the occurrence of SCD, cardiac death, or death from any cause. Results A total of 239 subjects (3.5%) had negative T-waves, 869 (12.7%) low amplitude T-waves, and 5746 (83.8%) normal T-waves. The Table shows the baseline characteristics. Subjects with T-wave abnormalities were older and had more often cardiovascular morbidities than subjects with normal T-waves. Cardiovascular morbidities were most common in subjects with negative T-waves. After adjusting for multiple clinical factors, negative T-waves (HR 3.91; 95% CI 2.30–6.64) and low amplitude T-waves (HR 1.80; 95% CI 1.13–2.86) were associated with SCD, when compared to normal T-waves. Furthermore, both negative T-waves and low amplitude T-waves associated with cardiac death (HR 2.34; 95% CI 1.75–3.13 and HR 1.49; 95% CI 1.17–1.91, respectively) and death from any cause (HR 1.85; 95% CI 1.50–2.27 and HR 1.45; 95% CI 1.24–1.70, respectively). The Figure displays the survival plots for SCD according to T-wave group. Conclusion In addition to negative T-waves, low amplitude T-waves also associate with SCD risk in the general population. Focus should be also placed on these minor T-wave abnormalities in the future. Kaplan-Meier plot Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Finnish Medical Foundation, Aarne Koskelo Foundation

Abstract 15714: Prediction of Sudden Cardiac Death With Automated High-Throughput Analysis of T-Wave Heterogeneity in Standard 12-Lead Electrocardiogram

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tuomas Kenttä ◽  
Bruce D Nearing ◽  
Kimmo Porthan ◽  
Jani T Tikkanen ◽  
Matti Viitasalo ◽  
...  
Keyword(s):  
At Risk ◽  
Relative Risk ◽  
Sudden Cardiac Death ◽  
General Population ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Adjusted Relative Risk ◽  
T Wave ◽  
Increased Risk ◽  
Patients At Risk

Introduction: Noninvasive identification of patients at risk for sudden cardiac death (SCD) remains a major clinical challenge. Abnormal ventricular repolarization is associated with increased risk of lethal ventricular arrhythmias and SCD. Hypothesis: We investigated the hypothesis that spatial repolarization heterogeneity can identify patients at risk for SCD in general population. Methods: Spatial R-, J- and T-wave heterogeneities (RWH, JWH and TWH, respectively) were automatically analyzed with second central moment technique from standard digital 12-lead ECGs in 5618 adults (46% men; age 50.9±12.5 yrs.) who took part in Health 2000 Study, an epidemiological survey representative of the entire Finnish adult population. During average follow-up of 7.7±1.4 years, a total of 72 SCDs occurred. Thresholds of RWH, JWH and TWH were based on optimal cutoff points from ROC curves. Results: Increased RWH, JWH and TWH (Fig.1) in left precordial leads (V4-V6) were univariately associated with SCD (P<0.001, each). When adjusted with clinical risk markers (age, gender, BMI, systolic blood pressure, cholesterol, heart rate, left ventricular hypertrophy, QRS duration, arterial hypertension, diabetes, coronary heart disease and previous myocardial infarction) JWH and TWH remained as independent predictors of SCD. Increased TWH (≥102μV) was associated with a 1.9-fold adjusted relative risk (95% confidence interval [CI]: 1.2 - 3.1; P=0.011) and increased JWH (≥123μV) with a 2.0-fold adjusted relative risk for SCD (95% CI: 1.2 - 3.3; P=0.004). When both TWH and JWH were above threshold, the adjusted relative risk for SCD was 3.2-fold (95% CI: 1.7 - 6.2; P<0.001). When all heterogeneity measures (RWH, JWH and TWH) were above threshold, the risk for SCD was 3.7-fold (95% CI: 1.6 - 8.6; P=0.003). Conclusions: Automated measurement of spatial J- and T-wave heterogeneity enables analysis of high patient volumes and is able to stratify SCD risk in general population.

scholarly journals Do M-cells contribute significantly in T-wave morphology during normal and arrhythmogenesis conditions like short QT Syndrome?

2020 ◽  
Author(s):  
Ponnuraj Kirthi Priya ◽  
Srinivasan Jayaraman
Keyword(s):  
Cell Types ◽  
M Cells ◽  
Short Qt Syndrome ◽  
M Cell ◽  
T Wave ◽  
Wave Morphology ◽  
Qt Syndrome ◽  
Premature Beats ◽  
Low Amplitude ◽  
T Waves

AbstractAimsThis paper proposes to explain the mechanism of M-cells, particularly its role in the T-wave generation and its contribution to arrhythmogenesis in short QT syndrome 2 (SQTS2).MethodsA 2D transmural anisotropic ventricular model made up of three principal cell types were developed. Different setups in which: a) entire column of mid-myocardial (mid) cells, b) single island of cells c) two island of cells within the mid-layer d) single island of cells in endocardial (endo)-mid layer were considered as M-cells. These setups are stimulated to explain i) contribution of M-cells in T-wave morphology ii) arrhythmia generation phenomena under SQTS2 heterozygous gene mutation by creating pseudo ECGs from the tissue.ResultsFindings infer that setups with an entire layer of M-cells and a higher percentage of epicardial (epi) cells exhibit positive T-waves. Increasing the size of the island in M-cell island setups results in an increased positive T-peak. Placing the M-cell island in the bottom of the mid-layer produced low amplitude T-waves. Further, in two M-cell islands setup, a higher T-wave amplitude was observed when the islands are placed closer than far apart. Moving the M-cell island slightly into the endo layer increases the amplitude of the T-wave. Lastly, on including SQTS2 conditions and pacing with premature beats, an arrhythmia occurs only in those setups containing a layer of M-cells compared to M-cells island setup.ConclusionThese simulation findings paved the way for a better understanding of the M-cells functionality in T-wave morphology as well as promoting arrhythmogenesis under SQTS2 condition.

No impact of direct implantation of a self-expanding valve on one-year clinical outcomes. Insights from the multicenter, randomized DIRECT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Toutouzas ◽  
G Benetos ◽  
M Drakopoulou ◽  
M Karmpalioti ◽  
M Xanthopoulou ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cardiac Death ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Funding Source ◽  
Transcatheter Aortic Valve ◽  
Kaplan Meier ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

Abstract Introduction The DIRECT trial (Predilatation in Transcatheter Aortic Valve Implantation Trial) evaluated in a randomized fashion the safety and efficacy of direct (without balloon pre-dilatation) implantation of a self-expanding valve in all comers undergoing TAVI. Purpose To investigate the impact of direct implantation of a self-expanding valve on one-year clinical outcomes. Methods DIRECT trial randomized consecutive patients with severe aortic stenosis at 4 tertiary centers to undergo TAVI with the use of self-expanding prostheses with (pre-BAV) or without pre-dilatation (no-BAV). The primary endpoint was device success according to the VARC-2 criteria. Secondary endpoints included periprocedural mortality and stroke, new permanent pacemaker implantation and vascular complications. All cause death, cardiac death, stroke and heart failure hospitalizations were recorded at one year and compared between the two groups using Kaplan-Meier plots. Results In total 171 patients were randomized in 4 centers. In the intention to treat analysis 86 patients were randomized to the pre-BAV group and 85 patients to the no-BAV TAVI group. The device success according to the VARC-2 criteria was non-inferior in the no-BAV group compared to the pre-BAV group (65/85 - 76.5% for no-BAV versus 64/86 – 74.4% for pre-BAV, mean difference = 2.1%, 90% CI: −8.9 to 13). In the no-BAV group 25 (29.4%) patients underwent post balloon dilatation and in the pre-BAV group 13 patients (15.1%) (p=0.03). At one year 4 deaths were recorded in pre-BAV group (4.7%) and 3 deaths in no-BAV group (3.5%). There was no difference in Kaplan-Meier plots between the two groups in all-cause mortality (log-rank p=0.72, figure). Similarly, there was no difference in one-year incidence of stroke (1 in pre-BAV and 2 in no-BAV group, log-rank p=0.55), cardiac death (log-rank p=0.66), non-cardiac death (log-rank p=0.98) and heart failure hospitalizations (1 in pre-BAV versus 3 in no-BAV group, log-rank p=0.31). Lastly, there was no difference in the incidence of permanent pacemaker implantation between the two groups at one year (27/67 in no-BAV group versus 20/69 in pre-BAV group, log-rank p=0.24) Conclusions Direct transcatheter aortic valve implantation is non-inferior to the procedure with pre-dilatation in self-expanding valve. Despite the overall low rate of events, direct procedure has no impact on clinical outcomes at one year. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

Prognostic significance of flat T-waves in the lateral leads in general population

2021 ◽  
Vol 69 ◽  
pp. 105-110
Author(s):  
Arttu Holkeri ◽  
Antti Eranti ◽  
M. Anette E. Haukilahti ◽  
Tuomas Kerola ◽  
Tuomas V. Kenttä ◽  
...  
Keyword(s):  
General Population ◽  
Prognostic Significance ◽  
T Waves

Association of isolated T inversion and sudden cardiac death – etiology and gender differences

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A.E Haukilahti ◽  
L Holmstrom ◽  
J Vahatalo ◽  
T.V Kentta ◽  
L Pakanen ◽  
...  
Keyword(s):  
Gender Differences ◽  
Sudden Cardiac Death ◽  
General Population ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Common Finding ◽  
Control Group ◽  
Funding Source ◽  
Increased Risk ◽  
Significant Difference

Abstract Background Inferolateral T wave inversion has been associated with increased risk of mortality and sudden cardiac death (SCD) in general population. However, the association between isolated T inversion and SCD is still unclear. Purpose The purpose of this study was to examine whether isolated T inversion associates with SCD, and find out possible gender differences. Methods FinGesture Study has systematically collected clinical data and medico-legal autopsy data from 5,869 consecutive SCD victims (mean age 64.9±12.4 yrs.) in Northern of Finland between years 1998 and 2017. Previously recorded electrocardiograms (ECG) were available and analyzed in 1,101 subjects. The control group consisted of 7,217 subjects representative of Finnish general population (mean age 51.5±12.4 yrs.). T inversion was interpreted isolated if there was at least two T inversions ≥−0.1 mV in at least two contiguous leads, and there were no ECG signs of left ventricular hypertrophy (LVH) defined by Sokolow-Lyon criteria or bunchle brand block (BBB) attached to it. Results In a current study, isolated T inversion was more common finding among SCD victims compared to general population: isolated T inversion in any leads 10.9% vs. 0.9% (SCD vs. general population, p&lt;0.001), laterally 7.7% vs. 0.1% (p&lt;0.001), inferiorly 3.2% vs. 0.5% (p&lt;0.001) and anteriorly 2.9% vs. 0.4% (p&lt;0.001). Particularly, isolated T inversion seemed to assoaciate with ischemic SCD taking into account that 61.5% of the total isolated T inversions were seen in ischemic SCD victims (p=0.018). In addition, 62.1% of the inferior isolated T inversions (p=0.023) and 61.7% of the lateral isolated T inversions (p=0.031) were in ischemic SCD victims versus 37.9% and 38.3% in non-ischemic SCD victims, respectively. The prevalence of isolated T inversion in any lead was also higher among male SCD victims compared to female victims (12.8% vs. 8.2%, p&lt;0.001, respectively). There was no statistically significant difference in the prevalence of LVH and strain changes between the populations. Among bundle branch blocks left BBB was predictably more typical in SCD victims (5.8% vs. 0.5%, p&lt;0.001). Conclusion We noticed an association between isolated T inversion and SCD. The association was most prominent in males and in those with ischemic etiology of SCD. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Finnish Medical Foundation, Finnish Foundation for Cardiovascular Research

scholarly journals Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension

2021 ◽  
Vol 10 (10) ◽  
pp. 2147
Author(s):  
Marcin Waligóra ◽  
Matylda Gliniak ◽  
Jan Bylica ◽  
Paweł Pasieka ◽  
Patrycja Łączak ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Predictive Value ◽  
Prognostic Significance ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Response To Treatment ◽  
T Wave ◽  
Kaplan Meier ◽  
Surface Ecg ◽  
Lv Volume ◽  
Ventricle Volume

In pulmonary hypertension (PH), T wave inversions (TWI) are typically observed in precordial leads V1–V3 but can also extend further to the left-sided leads. To date, the cause and prognostic significance of this extension have not yet been assessed. Therefore, we aimed to assess the relationship between heart morphology and precordial TWI range, and the role of TWI in monitoring treatment efficacy and predicting survival. We retrospectively analyzed patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) treated in a reference pulmonary hypertension center. Patients were enrolled if they had a cardiac magnetic resonance (cMR) and 12-lead surface ECG performed at the time of assessment. They were followed from October 2008 until March 2021. We enrolled 77 patients with PAH and 56 patients with inoperable CTEPH. They were followed for a mean of 51 ± 33.5 months, and during this time 47 patients died (35.3%). Precordial TWI in V1–V6 were present in 42 (31.6%) patients, while no precordial TWI were observed only in 9 (6.8%) patients. The precordial TWI range correlated with markers of PH severity, including right ventricle to left ventricle volume RVEDVLVEDV (R = 0.76, p < 0.0001). The presence of TWI in consecutive leads from V1 to at least V5 predicted severe RV dilatation (RVEDVLVEDV ≥ 2.3) with a sensitivity of 88.9% and specificity of 84.1% (AUC of 0.90, 95% CI = 0.83–0.94, p < 0.0001). Presence of TWI from V1 to at least V5 was also a predictor of mortality in Kaplan–Meier estimation (p = 0.02). Presence of TWI from V1 to at least V5 had a specificity of 64.3%, sensitivity of 58.1%, negative predictive value of 75%, and positive predictive value of 45.5% as a mortality predictor. In patients showing a reduction in TWI range of at least one lead after treatment compared with patients without this reduction, we observed a significant improvement in RV-EDV and RV−EDVLV−EDV. We concluded that the extension of TWI to left-sided precordial leads reflects significant pathological alterations in heart geometry represented by an increase in RV/LV volume and predicts poor survival in patients with PAH and CTEPH. Additionally, we found that analysis of precordial TWI range can be used to monitor the effectiveness of hemodynamic response to treatment of pulmonary hypertension.

scholarly journals Predicting sudden cardiac death in a general population using an electrocardiographic risk score

Heart ◽  
2019 ◽  
Vol 106 (6) ◽  
pp. 427-433 ◽  
Author(s):  
Arttu Holkeri ◽  
Antti Eranti ◽  
M Anette E Haukilahti ◽  
Tuomas Kerola ◽  
Tuomas V Kenttä ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
General Population ◽  
Risk Score ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Wave Inversion ◽  
Population Cohort ◽  
General Population Cohort ◽  
Qrs Duration ◽  
Ecg Abnormalities

ObjectiveWe investigated whether combining several ECG abnormalities would identify general population subjects with a high sudden cardiac death (SCD) risk.MethodsIn a sample of 6830 participants (mean age 51.2±13.9 years; 45.5% male) in the Mini-Finland Health Survey, a general population cohort representative of the Finnish adults aged ≥30 years conducted in 1978–1980, we examined their ECGs, following subjects for 24.3±10.4 years. We analysed the association between individual ECG abnormalities and 10-year SCD risk and developed a risk score using five ECG abnormalities independently associated with SCD risk: heart rate >80 beats per minute, PR duration >220 ms, QRS duration >110 ms, left ventricular hypertrophy and T-wave inversion. We validated the score using an external general population cohort of 10 617 subjects (mean age 44.0±8.5 years; 52.7% male).ResultsNo ECG abnormalities were present in 4563 subjects (66.8%), while 96 subjects (1.4%) had ≥3 ECG abnormalities. After adjusting for clinical factors, the SCD risk increased progressively with each additional ECG abnormality. Subjects with ≥3 ECG abnormalities had an HR of 10.23 (95% CI 5.29 to 19.80) for SCD compared with those without abnormalities. The risk score similarly predicted SCD risk in the validation cohort, in which subjects with ≥3 ECG abnormalities had HR 10.82 (95% CI 3.23 to 36.25) for SCD compared with those without abnormalities.ConclusionThe ECG risk score successfully identified general population subjects with a high SCD risk. Combining ECG risk markers may improve the risk stratification for SCD.

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