Arrhythmias and Conduction Disturbances
T-Wave Inversion, QRS Duration, and QRS/T Angle as Electrocardiographic Predictors of the Risk for Sudden Cardiac Death

https://doi.org/10.1016/j.amjcard.2013.12.026Get rights and content

The aim of this study was to investigate the prognostic utility of isolated T-wave inversion (TWI), QRS duration, and QRS/T angle on electrocardiogram at rest as predictors for sudden cardiac death (SCD) and death from all causes. The assessment of electrocardiographic findings was based on a population-based cohort of 1,951 men (age 42 to 61 years) with a follow-up period of 20 years. Isolated TWI in the absence of ST depression, bundle branch block or major arrhythmias, prolonged QRS duration from 110 to 119 ms, and a wide QRS/T angle of >67° were identified from the 12-lead electrocardiograms. SCD was observed in 171 men (8.3%) during the follow-up. As a single electrocardiographic parameter, TWI (prevalence 2.4%) was associated with an increased risk of SCD (hazard ratio [HR] 3.30, 95% confidence interval [CI] 1.91 to 5.71, p <0.001) after adjustment for age and clinical factors. Similarly, prolonged QRS duration and wide QRS/T angle were significantly related to the risk of SCD, with HR 1.50 (95% CI 1.08 to 2.19, p = 0.017) for QRS duration and HR 3.03 (95% CI 2.23 to 4.14, p <0.001) for QRS/T angle. The integrated discrimination improvement was significant when TWI (0.014, p = 0.036) or QRS/T angle (0.015, p = 0.002) was added to the model with age and clinical factors. In conclusion, TWI, QRS duration, and QRS/T angle are significantly associated with the risk of SCD and death from all causes beyond conventional cardiovascular risk predictors in the general population.

Section snippets

Methods

The study population is a representative sample of men living in the city of Kuopio and its surrounding rural communities in Eastern Finland, the participants in a longitudinal population-based study designed to investigate risk factors for cardiovascular outcomes. The men were aged 42 to 61 years at baseline examinations performed from March 1984 to December 1989. Of 3,235 potentially eligible men, 2,682 (83%) volunteered to participate in this study, whereas 186 did not respond to the

Results

The mean age of the subjects was 53 years (range 42 to 61). Characteristics of the study population are listed in Table 1. There were 46 men (2.4%) with isolated TWI on the ECG at rest. Common electrocardiographic findings according to the presence of TWI are presented in Table 2. Men with TWI had a greater prevalence of Q waves (8%), first- or second-degree atrioventricular conduction delays (12%), and ectopic ventricular and supraventricular complexes (17%). There were no subjects with

Discussion

Our study provides evidence that isolated TWI, prolonged QRS duration, and wide QRS/T angle are associated with an increased risk of SCD in the general male population beyond conventional cardiovascular risk predictors. In this study, we excluded all subjects with ST-segment depression, bundle branch block, or supraventricular arrhythmias to clarify the impact of TWI as an isolated risk marker for SCD.

When TWI, widened QRS/T angle, and QRS duration were entered simultaneously into the

Acknowledgment

The authors thank the staff of the Kuopio Research Institute of Exercise Medicine and the Research Institute of Public Health, University of Eastern Finland, Kuopio, Finland for data collection in the study.

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    This study was supported by the Academy of Finland, Helsinki, Finland; City of Kuopio, Kuopio, Finland; Finnish Medical Foundation, Helsinki, Finland; Finnish Cultural Foundation, Helsinki, Finland; and Jane and Aatos Erkko Foundation, Helsinki, Finland.

    See page 1182 for disclosure information.

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