Beat-to-beat spatiotemporal variability in the T vector is associated with sudden cardiac death in participants without left ventricular hypertrophy

the Atherosclerosis Risk in Communities (ARIC) Study

Jonathan W. Waks, Elsayed Z. Soliman, Charles A. Henrikson, Nona Sotoodehnia, Lichy Han, Sunil K. Agarwal, Dan Arking, David S. Siscovick, Scott D. Solomon, Wendy S Post, Mark E. Josephson, Josef Coresh, Larisa G. Tereshchenko

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a clinical challenge. Risk stratification in the general population is needed.

METHODS AND RESULTS: Beat-to-beat spatiotemporal variability in the T vector was measured as the mean angle between consecutive T-wave vectors (mean TT' angle) on standard 12-lead ECGs in 14 024 participants in the Atherosclerosis Risk in Communities (ARIC) study. Subjects with left ventricular hypertrophy, atrial arrhythmias, frequent ectopy, ventricular pacing, or QRS duration ≥120 ms were excluded. The mean spatial TT' angle was 5.21±3.55°. During a median of 14 years of follow-up, 235 SCDs occurred (1.24 per 1000 person-years). After adjustment for demographics, coronary heart disease risk factors, and known ECG markers for SCD, mean TT' angle was independently associated with SCD (hazard ratio 1.089; 95% CI 1.044 to 1.137; P<0.0001). A mean TT' angle >90th percentile (>9.57°) was associated with a 2-fold increase in the hazard for SCD (hazard ratio 2.01; 95% CI 1.28 to 3.16; P=0.002). In a subgroup of patients with T-vector amplitude ≥0.2 mV, the association with SCD was almost twice as strong (hazard ratio 3.92; 95% CI 1.91 to 8.05; P<0.0001). A significant interaction between mean TT' angle and age was found: TT' angle was associated with SCD in participants aged <55 years (hazard ratio 1.096; 95% CI 0.043 to 1.152; P<0.0001) but not in participants aged ≥55 years (P(interaction)=0.009).

CONCLUSIONS: In a large, prospective, community-based cohort of left ventricular hypertrophy-free participants, increased beat-to-beat spatiotemporal variability in the T vector, as assessed by increasing TT' angle, was associated with SCD.

Original languageEnglish (US)
Pages (from-to)e001357
JournalJournal of the American Heart Association
Volume4
Issue number1
DOIs
StatePublished - Jan 19 2015

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Sudden Cardiac Death
Left Ventricular Hypertrophy
Atherosclerosis
Electrocardiography
Coronary Disease
Cardiac Arrhythmias
Cardiovascular Diseases
Demography
Population

Keywords

  • atherosclerosis
  • electrocardiography
  • electrophysiology
  • epidemiology
  • sudden cardiac death
  • TT′ angle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Beat-to-beat spatiotemporal variability in the T vector is associated with sudden cardiac death in participants without left ventricular hypertrophy : the Atherosclerosis Risk in Communities (ARIC) Study. / Waks, Jonathan W.; Soliman, Elsayed Z.; Henrikson, Charles A.; Sotoodehnia, Nona; Han, Lichy; Agarwal, Sunil K.; Arking, Dan; Siscovick, David S.; Solomon, Scott D.; Post, Wendy S; Josephson, Mark E.; Coresh, Josef; Tereshchenko, Larisa G.

In: Journal of the American Heart Association, Vol. 4, No. 1, 19.01.2015, p. e001357.

Research output: Contribution to journalArticle

Waks, Jonathan W. ; Soliman, Elsayed Z. ; Henrikson, Charles A. ; Sotoodehnia, Nona ; Han, Lichy ; Agarwal, Sunil K. ; Arking, Dan ; Siscovick, David S. ; Solomon, Scott D. ; Post, Wendy S ; Josephson, Mark E. ; Coresh, Josef ; Tereshchenko, Larisa G. / Beat-to-beat spatiotemporal variability in the T vector is associated with sudden cardiac death in participants without left ventricular hypertrophy : the Atherosclerosis Risk in Communities (ARIC) Study. In: Journal of the American Heart Association. 2015 ; Vol. 4, No. 1. pp. e001357.
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abstract = "BACKGROUND: Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a clinical challenge. Risk stratification in the general population is needed.METHODS AND RESULTS: Beat-to-beat spatiotemporal variability in the T vector was measured as the mean angle between consecutive T-wave vectors (mean TT' angle) on standard 12-lead ECGs in 14 024 participants in the Atherosclerosis Risk in Communities (ARIC) study. Subjects with left ventricular hypertrophy, atrial arrhythmias, frequent ectopy, ventricular pacing, or QRS duration ≥120 ms were excluded. The mean spatial TT' angle was 5.21±3.55°. During a median of 14 years of follow-up, 235 SCDs occurred (1.24 per 1000 person-years). After adjustment for demographics, coronary heart disease risk factors, and known ECG markers for SCD, mean TT' angle was independently associated with SCD (hazard ratio 1.089; 95{\%} CI 1.044 to 1.137; P<0.0001). A mean TT' angle >90th percentile (>9.57°) was associated with a 2-fold increase in the hazard for SCD (hazard ratio 2.01; 95{\%} CI 1.28 to 3.16; P=0.002). In a subgroup of patients with T-vector amplitude ≥0.2 mV, the association with SCD was almost twice as strong (hazard ratio 3.92; 95{\%} CI 1.91 to 8.05; P<0.0001). A significant interaction between mean TT' angle and age was found: TT' angle was associated with SCD in participants aged <55 years (hazard ratio 1.096; 95{\%} CI 0.043 to 1.152; P<0.0001) but not in participants aged ≥55 years (P(interaction)=0.009).CONCLUSIONS: In a large, prospective, community-based cohort of left ventricular hypertrophy-free participants, increased beat-to-beat spatiotemporal variability in the T vector, as assessed by increasing TT' angle, was associated with SCD.",
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T1 - Beat-to-beat spatiotemporal variability in the T vector is associated with sudden cardiac death in participants without left ventricular hypertrophy

T2 - the Atherosclerosis Risk in Communities (ARIC) Study

AU - Waks, Jonathan W.

AU - Soliman, Elsayed Z.

AU - Henrikson, Charles A.

AU - Sotoodehnia, Nona

AU - Han, Lichy

AU - Agarwal, Sunil K.

AU - Arking, Dan

AU - Siscovick, David S.

AU - Solomon, Scott D.

AU - Post, Wendy S

AU - Josephson, Mark E.

AU - Coresh, Josef

AU - Tereshchenko, Larisa G.

PY - 2015/1/19

Y1 - 2015/1/19

N2 - BACKGROUND: Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a clinical challenge. Risk stratification in the general population is needed.METHODS AND RESULTS: Beat-to-beat spatiotemporal variability in the T vector was measured as the mean angle between consecutive T-wave vectors (mean TT' angle) on standard 12-lead ECGs in 14 024 participants in the Atherosclerosis Risk in Communities (ARIC) study. Subjects with left ventricular hypertrophy, atrial arrhythmias, frequent ectopy, ventricular pacing, or QRS duration ≥120 ms were excluded. The mean spatial TT' angle was 5.21±3.55°. During a median of 14 years of follow-up, 235 SCDs occurred (1.24 per 1000 person-years). After adjustment for demographics, coronary heart disease risk factors, and known ECG markers for SCD, mean TT' angle was independently associated with SCD (hazard ratio 1.089; 95% CI 1.044 to 1.137; P<0.0001). A mean TT' angle >90th percentile (>9.57°) was associated with a 2-fold increase in the hazard for SCD (hazard ratio 2.01; 95% CI 1.28 to 3.16; P=0.002). In a subgroup of patients with T-vector amplitude ≥0.2 mV, the association with SCD was almost twice as strong (hazard ratio 3.92; 95% CI 1.91 to 8.05; P<0.0001). A significant interaction between mean TT' angle and age was found: TT' angle was associated with SCD in participants aged <55 years (hazard ratio 1.096; 95% CI 0.043 to 1.152; P<0.0001) but not in participants aged ≥55 years (P(interaction)=0.009).CONCLUSIONS: In a large, prospective, community-based cohort of left ventricular hypertrophy-free participants, increased beat-to-beat spatiotemporal variability in the T vector, as assessed by increasing TT' angle, was associated with SCD.

AB - BACKGROUND: Despite advances in prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) remains a clinical challenge. Risk stratification in the general population is needed.METHODS AND RESULTS: Beat-to-beat spatiotemporal variability in the T vector was measured as the mean angle between consecutive T-wave vectors (mean TT' angle) on standard 12-lead ECGs in 14 024 participants in the Atherosclerosis Risk in Communities (ARIC) study. Subjects with left ventricular hypertrophy, atrial arrhythmias, frequent ectopy, ventricular pacing, or QRS duration ≥120 ms were excluded. The mean spatial TT' angle was 5.21±3.55°. During a median of 14 years of follow-up, 235 SCDs occurred (1.24 per 1000 person-years). After adjustment for demographics, coronary heart disease risk factors, and known ECG markers for SCD, mean TT' angle was independently associated with SCD (hazard ratio 1.089; 95% CI 1.044 to 1.137; P<0.0001). A mean TT' angle >90th percentile (>9.57°) was associated with a 2-fold increase in the hazard for SCD (hazard ratio 2.01; 95% CI 1.28 to 3.16; P=0.002). In a subgroup of patients with T-vector amplitude ≥0.2 mV, the association with SCD was almost twice as strong (hazard ratio 3.92; 95% CI 1.91 to 8.05; P<0.0001). A significant interaction between mean TT' angle and age was found: TT' angle was associated with SCD in participants aged <55 years (hazard ratio 1.096; 95% CI 0.043 to 1.152; P<0.0001) but not in participants aged ≥55 years (P(interaction)=0.009).CONCLUSIONS: In a large, prospective, community-based cohort of left ventricular hypertrophy-free participants, increased beat-to-beat spatiotemporal variability in the T vector, as assessed by increasing TT' angle, was associated with SCD.

KW - atherosclerosis

KW - electrocardiography

KW - electrophysiology

KW - epidemiology

KW - sudden cardiac death

KW - TT′ angle

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