Abstract 17569: T Wave Abnormality in Lead aVR and Cardiovascular Mortality - Insights Into the Forgotten Lead from NHANES-III
Background: Lead aVR is often ignored in clinical practice. We investigated whether T wave changes in aVR are predictive of cardiovascular mortality (CM) in a cross sectional US population.
Methodology: Our study population included all adults >40 years old enrolled into the NHANES III (1988 to 1994) with ECG data available. Subjects were excluded if their mortality data was missing, QRS duration>120 ms or with atrial fibrillation. All ECGs were computer analysed using the NOVACODE software and coded by the Minnesota coding. T wave was split into different amplitudes and a weighted analysis was conducted to compare the cumulative risk of CM using lowest T wave amplitude as the referent. Follow up period was 12.67 ± 4.41 years per patient. Mortality was assessed using the National Death Index. CM was defined as per ICD 10 coding (I00-99). Cox proportional hazards ratio (HR) was used to adjust for possible predictors of cardiovascular mortality.
Results: This study includes 7928 participants representative of 80274369 US adults; (45.3% male, 87.2% white) with a mean age of 59.90 ± 13.45 years. On multivariate analysis older age, male sex, hypertension, smoking, history of coronary artery disease, heart failure, stroke and diabetes were significant predictors of CM. Change in T wave amplitude was independently predictive of CM when keeping T wave amplitude < - 0.2 mv as the referent (Figure 1).
Conclusion: Changes in the T wave amplitude of the lead aVR independently predict cardiovascular mortality in a cross sectional US population. This findings merits further investigation. ECG readers need to closely analyze lead aVR.
- © 2012 by American Heart Association, Inc.