Abstract 16059: T Wave Inversion, QRS Duration and QRS/T-Angle as Electrocardiographic Predictors of the Risk for Sudden Cardiac Death
Aims: To investigate the prognostic utility of isolated T wave inversion (TWI), QRS duration and QRS/T angle on resting ECG as predictors for sudden cardiac death (SCD) and all-cause mortality.
Methods: ECG changes including, isolated TWI ≥ 0.1 mV, prolonged QRS duration from 110 to 119 ms and wide QRS/Tangle of >67° were assessed at baseline in a prospective cohort of 1,951 men aged 42-61 years.
Results: During a median follow up of 22.4 years (IQR: 18.0-24.5 years), sudden cardiac death was observed in 171 men (8.3 %). As a single ECG parameter, TWI (prevalence 2.4 %) was associated with an increased risk of SCD (hazard ratio (HR) 3.30, 95% confidence interval (CI) 1.91 to 5.71, p<0.001), after adjustment for convention risk predictors including, age alcohol consumption, smoking, history of myocardial infarction, low- and high-density lipoprotein cholesterol, systolic blood pressure, type 2 diabetes, BMI, C-reactive protein, and cardiorespiratory fitness. Similarly, prolonged QRS duration and wide QRS/T angle were significantly related to the risk of SCD, with HR 1.50 (95 % CI 1.08 to 2.19, p=0.017) for QRS duration and HR 3.03 (95 % CI 2.23 to 4.14, p<0.001) for QRS/T angle, see Table 1 . These findings, for each of the ECG parameters were consistent across relevant subgroups. TWI and QRS/T angle were independent predictors of the risk of SCD and all-cause mortality when all three ECG parameters were simultaneously entered into the multivariable models. These ECG parameters significantly improved risk prediction, integrated discrimination improvement (IDI) for TWI (0.014, p=0.036) and for QRS/T angle (0.015, p=0.002) when added to a conventional risk model as described above.
Conclusions: TWI, QRS duration and QRS/T angle are associated with risk of SCD and all cause mortality in the general population of men. Abnormal changes in TWI and QRS complex on resting ECG require consideration for referral for further diagnostic testing to reduce the risk of SCD.
- © 2013 by American Heart Association, Inc.