Comparison of ECG T-wave Duration and Morphology Restitution Markers for Sudden Cardiac Death Prediction in Chronic Heart Failure

An index of T-wave morphology restitution, T M R, has previously shown to be a sudden cardiac death (SCD) predictor in a population of chronic heart failure (CHF) patients. The aim of this study is to compare the predictive value of T M R, T-wave width restitution (T W R), Tpeak-to-end (Tpe) morphology restitution (T peM R) and Tpe duration restitution (T peR) indices in the same CHF population. Holter ECG recordings from 651 CHF patients of the MUSIC study, including SCD victims and survivors, were analyzed. T M R was significantly correlated with T W R (=0.66), T peM R (=0.70) and T peR (=0.42). SCD victims showed significantly higher values of T M R, T W R and T peM R than the rest of patients, with T M R being the index most strongly associated with SCD (p=0.002, p=0.006 and p=0.011, respectively). T peR values were only borderline significantly higher in SCD victims (p=0.061). Univariate Cox analysis showed that T M R was the restitution index with the strongest predictive value (hazard ratio (HR) of 1.466, p<0.001), followed by T W R (HR of 1.295, p=0.005), T peR (HR of 1.297, p=0.004) and T peM R (HR of 1.164, p=0.020). In conclusion, considering the predictive value of the four Twave restitution indices, T M R is the preferred index for SCD risk stratification, followed by T peM R. However, the marker T W R could also be used for SCD prediction when computational efficiency is an issue.