Abstract 18449: T-peak to T-end Interval: A Novel ECG Predictor of Sudden Death in the General Population
Introduction: The interval between the peak and end of the T wave (T peak to T end, TpTe) measures transmural dispersion of ventricular repolarization, and early studies indicate its potential as a predictor of arrhythmogenesis. However, community-based evaluations have not been conducted.
Hypothesis: Prolonged TpTe interval and TpTe/QT ratio are predictors of sudden cardiac death (SCD) in the general population.
Methods: We evaluated TpTe as well as other ECG predictors in an ongoing community-based study of one million residents in a northwestern US metro area using a case-control design. Cases had SCD; 95% also had documented or probable coronary artery disease (CAD); controls were from the same region with documented CAD. Analysis was limited to subjects with available 12 lead ECGs in sinus rhythm, for cases prior to and unrelated to SCD (179 cases and 184 controls). TpTe, QT, and JT durations were measured in lead V5. Bivariate comparisons were made using independent-samples ttests; multiple logistic regression was used to model the association between measured variables and SCD.
Results: The mean age was similar in cases (66yrs; 63% male) and controls (66yrs; 64% male). The mean TpTe in cases (92+/−19ms) was significantly longer when compared to the controls (77.1+/−14ms), p<0.01. The TpTe/QT ratio was significantly higher in cases (0.23+/−0.04) than in controls (0.20+/−0.14), p=0.006. The mean QRS duration was 99+/−22ms in cases and 97+/−18ms in controls, p=0.28. The mean QTc and JTc intervals were significantly longer among cases than controls (449+/−37ms and 420+/−45ms; p<0.01 and 333+/−36 and 313+/−41 ms, p<0.01 respectively). TpTe remained a significant predictor for SCA after adjusting for age, gender, QTc and QRS duration in logistic regression. A one-standard deviation increase in TpTe (18 ms) resulted in a 3-fold increased odds of SCD (OR 3.3, 95% CI 2.4 − 4.5), while a one-standard deviation increase in QTc (44 ms) resulted in a doubling of odds (OR 2.2, 95% CI 1.7 − 2.9).
Conclusion: The TpTe interval and the TpTe/QT ratio in lead V5 on the resting ECG are significant predictors of SCD in patients with coronary artery disease. These findings have implications for SCD risk stratification in coronary artery disease.
- © 2010 by American Heart Association, Inc.