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(Circulation. 2002;105:1066.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Analysis of T-Wave Morphology From the 12-Lead Electrocardiogram for Prediction of Long-Term Prognosis in Male US Veterans

Markus Zabel, MD; Marek Malik, PhD, MD; Katerina Hnatkova, PhD; Vasilios Papademetriou, MD; Andreas Pittaras, MD; Ross D. Fletcher, MD; Michael R. Franz, MD, PhD

From the Cardiology Division, Klinikum Benjamin Franklin, Free University, Berlin, Germany (M.Z.); Cardiological Sciences, St George’s Hospital Medical School, London, United Kingdom (M.M., K.H.); and the Cardiology Division, VA Medical Center and Georgetown University, Washington, DC (V.P., A.P., R.D.F., M.R.F.).

Correspondence to Michael R. Franz, MD, PhD, Division of Cardiology, VA Medical Center, 50 Irving St, NW, Washington, DC 20422. E-mail michael.franz{at}med.va.gov

Background— The aim of the present study was to assess the prognostic value of novel repolarization descriptors from the 12-lead ECG in a large cohort of US veterans.

Methods and Results— Male US veterans (n=813) with cardiovascular disease had digital 12-lead ECGs recorded at the VA Medical Center, Washington, DC, between 1984 and 1991. The patient series was retrospectively compiled in 1991; follow-up was prospectively assessed until 2000. Novel ECG variables characterizing repolarization and the T-wave loop were automatically analyzed. Of 772 patients with technically analyzable data, 252 patients (32.6%) died after a mean follow-up of 10.4±3.8 years. Direct comparison between dead and alive patients showed that the so-called T-wave residua (the absolute and relative amount of nondipolar contents within the T wave) predicted mortality (111 900±164 700 versus 85 600±144 800 between dead and alive patients, P<0.0002; and 0.43±0.62% versus 0.33±0.56%, P<0.0005 for the absolute and relative T-wave residuum, respectively). On Cox regression analysis entering age, left ventricular ejection fraction, echocardiographic left ventricular hypertrophy, and either of the T-wave residua, risk prediction was independent for the absolute (P=0.022) and for the relative (P=0.006) T-wave residuum, respectively, with age (P<0.0001), presence of left ventricular hypertrophy (P=0.002), and left ventricular ejection fraction (P=0.004) also being predictors of survival.

Conclusions— The heterogeneity of myocardial repolarization, measured by the so-called T-wave residuum in the ECG, confers long-term independent prognostic information in US veterans with cardiovascular disease.

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

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