Total cosine R-to-T (TCRT) derived from resting 12-lead ECGs yielded independent predictive value for clinical events in post-myocardial infarction patients (P<0.03).
Cohort (n=280)
Does computerized T-wave morphology analysis of the 12-lead resting ECG improve risk stratification for clinical events in post-MI patients?
Computerized T-wave morphology analysis from a standard resting 12-lead ECG provides independent prognostic value for risk stratification in post-MI patients.
p-value: p=<0.03
BACKGROUND: The stratification of post-myocardial infarction (MI) patients at risk of sudden cardiac death remains important. The aim of the present study was to assess the prognostic value of novel T-wave morphology descriptors derived from resting 12-lead ECGs. METHODS AND RESULTS: In 280 consecutive post-MI patients, a 12-lead ECG was recorded before discharge, optically scanned, and digitized. For the present study, 5 T-wave morphology descriptors were automatically calculated after singular value decomposition of the ECG signal. The total cosine R-to-T (TCRT describes the global angle between repolarization and depolarization wavefront) and the T-wave loop dispersion were univariately associated (P:=0.0002 and P:<0.002, respectively, U: test) with 27 prospectively defined clinical events in 261 patients (mean follow-up 32+/-10 months). Kaplan-Meier event probability curves for strata above and below the median confirmed the strong risk discrimination by TCRT and T-wave loop dispersion (P:<0.003 and P:<0.001, respectively, log-rank test). On Cox regression analysis, with the entering of age, left ventricular ejection fraction, heart rate, QRS width, reperfusion therapy, beta-adrenergic-blocker treatment, and standard deviation of R-R intervals on 24-hour Holter monitoring, TCRT (P:<0.03) yielded independent predictive value, whereas T-wave loop dispersion was of borderline independence (P:=0.064). Heart rate (P:<0.02), left ventricular ejection fraction (P:<0.02), and reperfusion therapy (P:<0.02) also remained in the final model. CONCLUSIONS: Computerized T-wave morphology analysis of the 12-lead resting ECG permits independent assessment of post-MI risk and an improved risk stratification when combined with other risk markers.
Zabel et al. (Tue,) conducted a cohort in Post-myocardial infarction (n=280). T-wave morphology descriptors (TCRT and T-wave loop dispersion) vs. Strata above and below the median was evaluated on Prospectively defined clinical events (p=<0.03). Total cosine R-to-T (TCRT) derived from resting 12-lead ECGs yielded independent predictive value for clinical events in post-myocardial infarction patients (P<0.03).