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Circ Arrhythm Electrophysiol. 2019 Oct;12(10):e007549. doi: 10.1161/CIRCEP.119.007549. Epub 2019 Oct 14.

Cardiovascular Predictive Value and Genetic Basis of Ventricular Repolarization Dynamics.

Author information

1
Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry (J.R., S.v.D., A.T., M.O., P.B.M.), Queen Mary University of London, United Kingdom.
2
Institute of Cardiovascular Science, University College London, United Kingdom (J.R., S.v.D., P.D.L., M.O.).
3
Centre for Advanced Cardiovascular Imaging, William Harvey Research Institute (N.A.), Queen Mary University of London, United Kingdom.
4
Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (N.A., P.D.L.).
5
Biomedical Signal Interpretation and Computational Simulation (BSICoS) group, Aragón Institute of Engineering Research, IIS Aragón, University of Zaragoza, Spain (P.L., E.P.).
6
Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain (P.L., E.P.).
7
National Institute of Health Research Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry (A.T., P.B.M.), Queen Mary University of London, United Kingdom.

Abstract

BACKGROUND:

Early prediction of cardiovascular risk in the general population remains an important issue. The T-wave morphology restitution (TMR), an ECG marker quantifying ventricular repolarization dynamics, is strongly associated with cardiovascular mortality in patients with heart failure. Our aim was to evaluate the cardiovascular prognostic value of TMR in a UK middle-aged population and identify any genetic contribution.

METHODS:

We analyzed ECG recordings from 55 222 individuals from a UK middle-aged population undergoing an exercise stress test in UK Biobank (UKB). TMR was used to measure ventricular repolarization dynamics, exposed in this cohort by exercise (TMR during exercise, TMRex) and recovery from exercise (TMR during recovery, TMRrec). The primary end point was cardiovascular events; secondary end points were all-cause mortality, ventricular arrhythmias, and atrial fibrillation with median follow-up of 7 years. Genome-wide association studies for TMRex and TMRrec were performed, and genetic risk scores were derived and tested for association in independent samples from the full UKB cohort (N=360 631).

RESULTS:

A total of 1743 (3.2%) individuals in UKB who underwent the exercise stress test had a cardiovascular event, and TMRrec was significantly associated with cardiovascular events (hazard ratio, 1.11; P=5×10-7), independent of clinical variables and other ECG markers. TMRrec was also associated with all-cause mortality (hazard ratio, 1.10) and ventricular arrhythmias (hazard ratio, 1.16). We identified 12 genetic loci in total for TMRex and TMRrec, of which 9 are associated with another ECG marker. Individuals in the top 20% of the TMRrec genetic risk score were significantly more likely to have a cardiovascular event in the full UKB cohort (18 997, 5.3%) than individuals in the bottom 20% (hazard ratio, 1.07; P=6×10-3).

CONCLUSIONS:

TMR and TMR genetic risk scores are significantly associated with cardiovascular risk in a UK middle-aged population, supporting the hypothesis that increased spatio-temporal heterogeneity of ventricular repolarization is a substrate for cardiovascular risk and the validity of TMR as a cardiovascular risk predictor.

KEYWORDS:

T-wave morphology; exercise; genetic analyses; genetic risk score; middle aged; risk

PMID:
31607149
DOI:
10.1161/CIRCEP.119.007549

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