Key result
Abnormal T- and P-wave morphology links to LV fibrosis in sudden cardiac death victims.
Why the study?
The relationship between electrocardiographic spatial heterogeneity of repolarization and atrial depolarization with arrhythmic substrate represented by left ventricular fibrosis was unknown.
Are abnormal T- and P-wave morphology parameters on standard 12-lead ECG associated with left ventricular fibrosis in victims of sudden cardiac death?
Observational (n=378)
Are abnormal T- and P-wave morphology parameters on standard 12-lead ECG associated with left ventricular fibrosis in victims of sudden cardiac death?
Abnormal spatial heterogeneity in T- and P-wave morphology on standard 12-lead ECG is independently associated with the severity of left ventricular fibrosis in victims of sudden cardiac death, providing a mechanistic basis for their prognostic value.
ECG abnormalities may signal LV fibrosis substrate in SCD; hypothesis-generating for prospective validation before clinical use.
AIMS: To evaluate the relationship between spatial heterogeneity of electrocardiographic repolarization and spatial heterogeneity of atrial depolarization with arrhythmic substrate represented by left ventricular fibrosis. METHODS AND RESULTS: We assessed the associations of T- and P-wave morphology parameters analysed from the standard 12-lead electrocardiograms with left ventricular fibrosis in 378 victims of unexpected sudden cardiac death (SCD) who underwent medico-legal autopsy. Based on autopsy findings, the SCD victims were categorized into four different groups according to different stages of severity of left ventricular fibrosis (substantial fibrosis, moderate patchy fibrosis, scattered mild fibrosis, no fibrosis). T-wave and P-wave area dispersion (TWAd: 0.0841 ± 0.496, 0.170 ± 0.492, 0.302 ± 404, 0.296 ± 0.476, P = 0.008; PWAd: 0.574 ± 0.384, 0.561 ± 0.367, 0.654 ± 0.281, 0.717 ± 0.257, P = 0.011, respectively; low values abnormal), non-dipolar components of T-wave and P-wave morphology (T_NonDipolarABS: 0.0496 ± 0.0377, 0.0571 ± 0.0487, 0.0432 ± 0.0476, 0.0380 ± 0.0377, P = 0.027; P_NonDipolarABS: 0.0132 ± 0.0164, 0.0130 ± 0.0135, 0.0092 ± 0.0117, 0.0069 ± 0.00472, P = 0.005, respectively, high values abnormal), T-wave morphology dispersion (TMD: 45.9 ± 28.3, 40.5 ± 25.8, 35.5 ± 24.9, 33.0 ± 24.6, P = 0.030, respectively, high values abnormal), and P-wave heterogeneity (PWH: 20.0 ± 9.44, 19.7 ± 8.87, 17.9 ± 9.78, 15.4 ± 4.60, P = 0.019, respectively, high values abnormal) differed significantly between the groups with different stages of left ventricular fibrosis. After adjustment with heart weight, T_NonDipolarABS [standardized β (sβ) = 0.131, P = 0.014], PWAd (sβ = -0.161, P = 0.003), P_NonDipolarABS (sβ = 0.174, P = 0.001), and PWH (sβ = 0.128, P = 0.015) retained independent association, and TWAd (sβ = -0.091, P = 0.074) and TMD (sβ = 0.097, P = 0.063) tended to retain their association with the degree of myocardial fibrosis. CONCLUSION: Our findings suggest that abnormal values of T- and P-wave morphology are associated with arrhythmic substrate represented by ventricular fibrosis partly explaining the mechanism behind their prognostic significance.
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Hekkanen et al. (2023) conducted an observational in unexpected sudden cardiac death (SCD) (n=378). T- and P-wave morphology parameters was evaluated on Association of T- and P-wave morphology parameters with left ventricular fibrosis. Abnormal T- and P-wave morphology parameters, including P-wave area dispersion (sβ=-0.161, P=0.003), were independently associated with left ventricular fibrosis in sudden cardiac death victims.
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