The review discourages the clinical use of QT dispersion for risk stratification due to methodological limitations and lack of predictive reliability, suggesting a shift toward evaluating repolarization morphology.
Discourages QT dispersion for clinical risk stratification; leaves open whether morphology-based metrics improve prediction in future studies.
Background: Over the last few years, the concept of dispersion of repolarization, evaluated as interlead variability of QT interval duration in surface ECG, emerged as a possible tool to identify patients at high‐risk for cardiac arrhythmias. Despite substantial progress in understanding of the electrophysiological basis for dispersion of repolarization, the question remains whether interlead differences in ECG‐ recorded T‐wave duration and morphology (QT dispersion) indicate heterogeneity in ventricular recovery time and pattern. Methods and Results: Several studies investigated the prognostic significance of QT dispersion for predicting all‐cause mortality, sudden cardiac, and arrhythmic deaths. Some of those studies indicated significant and independent predictive value of QT dispersion whereas others negated such an association. Despite these controversial results, there is concern that substantial overlap in QT dispersion values between patients with and without cardiac events limits or even precludes clinical usefulness of QT dispersion for predicting future cardiac events. The methodological and conceptual limitations of QT dispersion measurements further discourage the bedside use of this noninvasive ECG parameter. Ionic channel phenomena determine the voltage and time components of the T‐wave, the T‐loop, and the QT interval duration. Since the ST‐T area is more representative of recovery times than QT interval duration, future efforts should be focused on developing and testing new automatically quantified parameters describing abnormalities of the T‐wave configuration and/or T‐loop morphology. Electrophysiologic meaning and prognostic significance of these ECG parameters remain to be studied. Conclusion: In light of conceptual and methodological limitations of QT dispersion analysis, bedside use of this method should be discouraged and the time has come to move beyond QT dispersion and focus on evaluating clinical usefulness of repolarization morphology in risk‐stratification. studies. A.N.E. 2000;5(4):373‐381
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Wojciech Zaręba (2000) studied this question.
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