Beat-to-beat spatiotemporal variability in the T vector is associated with sudden cardiac death in participants without left ventricular hypertrophy: the Atherosclerosis Risk in Communities (ARIC) Study.

Pubmed ID: 25600143

Pubmed Central ID: PMC4330061

Journal: Journal of the American Heart Association

Publication Date: Jan. 19, 2015

Affiliation: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (C.A.H., L.G.T.) Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.).

MeSH Terms: Humans, Male, Female, Cohort Studies, Age Factors, Middle Aged, Risk Assessment, Sex Factors, Prospective Studies, Cause of Death, Myocardial Infarction, Linear Models, Coronary Artery Disease, Reproducibility of Results, Electrocardiography, Death, Sudden, Cardiac

Grants: HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, HHSN268201100012C, R01 HL118277, 1R01HL118277, HHSN268201100009I, HHSN268201100005G, HHSN268201100008I, HHSN268201100011I, HHSN268201100005I, HHSN268201100007I

Authors: Arking DE, Coresh J, Siscovick DS, Soliman EZ, Solomon SD, Agarwal SK, Post WS, Waks JW, Henrikson CA, Sotoodehnia N, Han L, Josephson ME, Tereshchenko LG

Cite As: Waks JW, Soliman EZ, Henrikson CA, Sotoodehnia N, Han L, Agarwal SK, Arking DE, Siscovick DS, Solomon SD, Post WS, Josephson ME, Coresh J, Tereshchenko LG. Beat-to-beat spatiotemporal variability in the T vector is associated with sudden cardiac death in participants without left ventricular hypertrophy: the Atherosclerosis Risk in Communities (ARIC) Study. J Am Heart Assoc 2015 Jan 19;4(1):e001357.

Studies:

Abstract

BACKGROUND: Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a clinical challenge. Risk stratification in the general population is needed. METHODS AND RESULTS: Beat-to-beat spatiotemporal variability in the T vector was measured as the mean angle between consecutive T-wave vectors (mean TT' angle) on standard 12-lead ECGs in 14 024 participants in the Atherosclerosis Risk in Communities (ARIC) study. Subjects with left ventricular hypertrophy, atrial arrhythmias, frequent ectopy, ventricular pacing, or QRS duration ≥120 ms were excluded. The mean spatial TT' angle was 5.21±3.55°. During a median of 14 years of follow-up, 235 SCDs occurred (1.24 per 1000 person-years). After adjustment for demographics, coronary heart disease risk factors, and known ECG markers for SCD, mean TT' angle was independently associated with SCD (hazard ratio 1.089; 95% CI 1.044 to 1.137; P<0.0001). A mean TT' angle >90th percentile (>9.57°) was associated with a 2-fold increase in the hazard for SCD (hazard ratio 2.01; 95% CI 1.28 to 3.16; P=0.002). In a subgroup of patients with T-vector amplitude ≥0.2 mV, the association with SCD was almost twice as strong (hazard ratio 3.92; 95% CI 1.91 to 8.05; P<0.0001). A significant interaction between mean TT' angle and age was found: TT' angle was associated with SCD in participants aged <55 years (hazard ratio 1.096; 95% CI 0.043 to 1.152; P<0.0001) but not in participants aged ≥55 years (P(interaction)=0.009). CONCLUSIONS: In a large, prospective, community-based cohort of left ventricular hypertrophy-free participants, increased beat-to-beat spatiotemporal variability in the T vector, as assessed by increasing TT' angle, was associated with SCD.