PT - JOURNAL ARTICLE AU - Sugrue, Alan AU - Killu, Ammar M AU - DeSimone, Christopher V AU - Chahal, Anwar A AU - Vogt, Josh C AU - Kremen, Vaclav AU - Hai, JoJo AU - Hodge, David O AU - Acker, Nancy G AU - Geske, Jeffrey B AU - Ackerman, Michael J AU - Ommen, Steve R AU - Lin, Grace AU - Noseworthy, Peter A AU - Brady, Peter A TI - Utility of T-wave amplitude as a non-invasive risk marker of sudden cardiac death in hypertrophic cardiomyopathy AID - 10.1136/openhrt-2016-000561 DP - 2017 Feb 01 TA - Open Heart PG - e000561 VI - 4 IP - 1 4099 - http://openheart.bmj.com/content/4/1/e000561.short 4100 - http://openheart.bmj.com/content/4/1/e000561.full SO - Open Heart2017 Feb 01; 4 AB - 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.