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Heart failure and cardiomyopathies
Original research article
Utility of T-wave amplitude as a non-invasive risk marker of sudden cardiac death in hypertrophic cardiomyopathy
  1. Alan Sugrue1,
  2. Ammar M Killu2,
  3. Christopher V DeSimone2,
  4. Anwar A Chahal3,
  5. Josh C Vogt1,
  6. Vaclav Kremen2,4,
  7. JoJo Hai2,
  8. David O Hodge2,
  9. Nancy G Acker2,
  10. Jeffrey B Geske2,
  11. Michael J Ackerman2,5,
  12. Steve R Ommen2,
  13. Grace Lin2,
  14. Peter A Noseworthy2 and
  15. Peter A Brady2
  1. 1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
  4. 4Mayo Clinic Graduate School of Medicine, Rochester, Minnesota, USA
  5. 5Specialty Registrar, Cardiology and Internal Medicine, London Deanery, University College London Partners, UK
  6. 6Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
  7. 7Department of Pediatric Cardiology, Mayo Clinic, Rochester,  Minnesota, USA
  1. Correspondence to Dr Peter Brady Division of Cardiovascular Disease Mayo clinic Rochester 200 1st SW, Rochester, MN, 55902, USA; brady.peter{at}mayo.edu

Abstract

Objective Sudden cardiac arrest (SCA) is the most devastating outcome in hypertrophic cardiomyopathy (HCM). We evaluated repolarisation features on the surface electrocardiogram (ECG) to identify the potential risk factors for SCA.

Methods Data was collected from 52 patients with HCM who underwent implantable cardioverter defibrillator (ICD) implantation. Leads V2 and V5 from the ECG closest to the time of ICD implant were utilised for measuring the Tpeak-Tend interval (Tpe), QTc, Tpe/QTc, T-wave duration and T-wave amplitude. The presence of the five traditional SCA-associated risk factors was assessed, as well as the HCM risk-SCD score.

Results 16 (30%) patients experienced aborted cardiac arrest over 8.5±4.1 years, with 9 receiving an ICD shock and 7 receiving ATP. On univariate analysis, T-wave amplitude was associated with appropriate ICD therapy (HR per 0.1 mV 0.79, 95% CI 0.56 to 0.96, p=0.02). Aborted SCA was not associated with a greater mean QTc duration, Tpeak-Tend interval, T-wave duration, or Tpe/QT ratio. Multivariate analysis (adjusting for cardinal HCM SCA-risk factors) showed T-wave amplitude in Lead V2 was an independent predictor of risk (adjusted HR per 0.1 mV 0.74, 95% CI 0.57 to 0.97, p=0.03). Addition of T-wave amplitude in Lead V2 to the traditional risk factors resulted in significant improvement in risk stratification (C-statistic from 0.65 to 0.75) but did not improve the performance of the HCM SCD-risk score.

Conclusions T-wave amplitude is a novel marker of SCA in this high risk HCM population and may provide incremental predictive value to established risk factors. Further work is needed to define the role of repolarisation abnormalities in predicting SCA in HCM.

  • T wave

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000561

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    Footnotes

    • Funding CVD is supported by an NIH T32 training grant HL 007111. VK is supported by funding from Czech Science Foundation GACR number P103/11/P106. ACC is supported by the Translational Science Award Grant Number UL1TR000135, supporting the Mayo Clinic Center for Clinical and Translational Science (CCaTS), from the National Center for Advancing Translational Sciences (NCATS), a component of NIH and the American Heart Association (Award Number 17POST33400211).

    • Competing interests None declared.

    • Ethics approval Mayo Clinic IRB Committee.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement Any requests for data sharing should be made to the corresponding author.