QRS-T morphology measured from exercise electrocardiogram as a predictor of cardiac mortality

Total cosine R-to-T (TCRT) measured from the standard 12-lead electrocardiogram (ECG) reflects the spatial relationship between depolarization and repolarization wavefronts and a low TCRT value is a marker of poor prognosis. We tested the hypothesis that measurement of TCRT or QRS/T angle from exerc...

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Veröffentlicht in:Europace (London, England) Jg. 13; H. 5; S. 701 - 707
Hauptverfasser: Kentta, T., Karsikas, M., Junttila, M. J., Perkiomaki, J. S., Seppanen, T., Kiviniemi, A., Nieminen, T., Lehtimaki, T., Nikus, K., Lehtinen, R., Viik, J., Kahonen, M., Huikuri, H. V.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England 01.05.2011
Schlagworte:
Adult
Aged
Death, Sudden, Cardiac - epidemiology
Electrocardiography - methods
Exercise Test - methods
Female
Follow-Up Studies
Heart Diseases - diagnosis
Heart Diseases - mortality
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Risk Factors
Stroke Volume
ISSN:1099-5129, 1532-2092, 1532-2092
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Zusammenfassung:Total cosine R-to-T (TCRT) measured from the standard 12-lead electrocardiogram (ECG) reflects the spatial relationship between depolarization and repolarization wavefronts and a low TCRT value is a marker of poor prognosis. We tested the hypothesis that measurement of TCRT or QRS/T angle from exercise ECG would provide even more powerful prognostic information. The prognostic significances of TCRT and QRS/T angle were assessed from exercise ECG recordings in 1297 patients [age 56 ± 13 years (mean ± SD), 67% males] undergoing a clinically indicated bicycle stress-test and the subsequent follow-up. During an average follow-up of 45 ± 12 months, 74 patients died (5.7%); 34 (2.6%) were cardiac deaths, and 24 (1.9%) were sudden cardiac deaths. Total cosine R-to-T and QRS/T angle exhibited a correlation with the RR intervals in the total cohort, but the individual responses were variable, e.g. median correlation of TCRT-RR was 0.89 with an inter-quartile range from 0.55 to 0.98. A reduced correlation of TCRT-RR during the recovery phase of exercise ECG predicted cardiac death [adjusted heart rate (HR) 3.5, 95% confidence interval (CI): 1.8-6.8, P= 0.001] similarly as the baseline TCRT measured from ECG at rest (adjusted HR 3.4, 95% CI: 1.4-8.1, P= 0.01). The poor correlation between the TCRT-RR both during the exercise and recovery was specifically related to a risk of sudden cardiac death (adjusted HR 6.2, 95% CI: 2.1-17.8, P< 0.001). Loss of rate-adaptation of the spatial relationship between depolarization and repolarization wavefronts is a strong predictor of cardiac death, especially of sudden cardiac death.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:1099-5129
1532-2092
1532-2092
DOI:10.1093/europace/euq461