Format

Send to

Choose Destination
J Am Heart Assoc. 2015 Jan 19;4(1):e001357. doi: 10.1161/JAHA.114.001357.

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.

Author information

1
Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.W.W., M.E.J.).
2
Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.).
3
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (C.A.H., L.G.T.).
4
University of Washington, Seattle, WA (N.S., D.S.S.).
5
Whitening School of Engineering, Johns Hopkins University, Baltimore, MD (L.H.).
6
Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A., J.C.).
7
McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.E.A.).
8
University of Washington, Seattle, WA (N.S., D.S.S.) The New York Academy of Medicine, New York, NY (D.S.S.).
9
Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.).
10
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., L.G.T.).
11
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.).

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.

KEYWORDS:

TT′ angle; atherosclerosis; electrocardiography; electrophysiology; epidemiology; sudden cardiac death

PMID:
25600143
PMCID:
PMC4330061
DOI:
10.1161/JAHA.114.001357
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center