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(Circulation. 2000;102:1252.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Analysis of 12-Lead T-Wave Morphology for Risk Stratification After Myocardial Infarction

Markus Zabel, MD; Burak Acar, PhD; Thomas Klingenheben, MD; Michael R. Franz, MD, PhD; Stefan H. Hohnloser, MD; Marek Malik, PhD, MD

From the Cardiology Division (M.Z.), Klinikum Benjamin Franklin, Free University, Berlin, Germany; Cardiological Sciences (B.A., M.M.), St George’s Hospital Medical School, London, England; Cardiology Division (T.K., S.H.H.), J.W. Goethe University, Frankfurt, Germany; and Cardiology Division (M.R.F.), VA Medical Center and Georgetown University, Washington, DC.

Correspondence to Marek Malik, PhD, MD, Cardiological Sciences, St George’s Hospital Medical School, London SW17 0RE, UK. E-mail m.malik{at}sghms.ac.uk

Background—The stratification of post–myocardial infarction (MI) patients at risk of sudden cardiac death remains important. The aim of the present study was to assess the prognostic value of novel T-wave morphology descriptors derived from resting 12-lead ECGs.

Methods and Results—In 280 consecutive post-MI patients, a 12-lead ECG was recorded before discharge, optically scanned, and digitized. For the present study, 5 T-wave morphology descriptors were automatically calculated after singular value decomposition of the ECG signal. The total cosine R-to-T (TCRT [describes the global angle between repolarization and depolarization wavefront]) and the T-wave loop dispersion were univariately associated (P=0.0002 and P<0.002, respectively, U test) with 27 prospectively defined clinical events in 261 patients (mean follow-up 32±10 months). Kaplan-Meier event probability curves for strata above and below the median confirmed the strong risk discrimination by TCRT and T-wave loop dispersion (P<0.003 and P<0.001, respectively, log-rank test). On Cox regression analysis, with the entering of age, left ventricular ejection fraction, heart rate, QRS width, reperfusion therapy, ß-adrenergic–blocker treatment, and standard deviation of R-R intervals on 24-hour Holter monitoring, TCRT (P<0.03) yielded independent predictive value, whereas T-wave loop dispersion was of borderline independence (P=0.064). Heart rate (P<0.02), left ventricular ejection fraction (P<0.02), and reperfusion therapy (P<0.02) also remained in the final model.

Conclusions—Computerized T-wave morphology analysis of the 12-lead resting ECG permits independent assessment of post-MI risk and an improved risk stratification when combined with other risk markers.

Key Words: myocardial infarction • death, sudden • risk factors • waves • electrocardiography

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