Association Between QT-Interval Components and Sudden Cardiac Death: The ARIC Study (Atherosclerosis Risk in Communities)

Wesley T. O'Neal, Matthew J. Singleton, Jason D. Roberts, Larisa G. Tereshchenko, Nona Sotoodehnia, Lin Y. Chen, Gregory M. Marcus, Elsayed Z. Soliman

    Research output: Research - peer-reviewArticle

    Abstract

    BACKGROUND: Several reports have demonstrated that prolongation of the QT interval is associated with sudden cardiac death (SCD). However, it is unknown whether any of the components within the QT interval are responsible for its association with SCD.

    METHODS AND RESULTS: We examined the association of the individual QT-interval components (R-wave onset to R-peak, R-peak to R-wave end, ST-segment, T-wave onset to T-peak, and T-peak to T-wave end) with SCD in 12 241 participants (54±5.7 years; 26% black; 55% women) from the ARIC study (Atherosclerosis Risk in Communities). The QT interval and its components were measured at baseline (1987-1989) from 12-lead ECGs. SCD cases were adjudicated by a group of physicians through December 31, 2012. During a median follow-up of 23.6 years, a total of 346 cases of SCD were identified. Although prolongation of the QT interval was associated with a 49% increased risk of SCD (hazard ratio, 1.49; 95% confidence interval, 1.01-2.18), only the T-wave onset to T-peak component (per 1-SD increase: hazard ratio, 1.19; 95% confidence interval, 1.06-1.34) was associated with SCD and not any of the other components in separate models. When all of the QT-interval components were included in the same model, T-wave onset to T-peak remained the strongest predictor of SCD (per 1-SD increase: hazard ratio, 1.21; 95% confidence interval, 1.06-1.37).

    CONCLUSIONS: The risk of SCD with the QT interval is driven by prolongation of the T-wave onset to T-peak component. This suggests that shifting the focus from the overall QT interval to its individual components will refine SCD prediction in the community.

    LanguageEnglish (US)
    JournalCirculation. Arrhythmia and electrophysiology
    Volume10
    Issue number10
    DOIs
    StatePublished - Oct 1 2017

    Fingerprint

    Sudden Cardiac Death
    Atherosclerosis
    Confidence Intervals
    Electrocardiography
    Physicians
    Lead

    Keywords

    • death, sudden, cardiac
    • follow-up studies
    • humans
    • risk

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)

    Cite this

    Association Between QT-Interval Components and Sudden Cardiac Death : The ARIC Study (Atherosclerosis Risk in Communities). / O'Neal, Wesley T.; Singleton, Matthew J.; Roberts, Jason D.; Tereshchenko, Larisa G.; Sotoodehnia, Nona; Chen, Lin Y.; Marcus, Gregory M.; Soliman, Elsayed Z.

    In: Circulation. Arrhythmia and electrophysiology, Vol. 10, No. 10, 01.10.2017.

    Research output: Research - peer-reviewArticle

    O'Neal, Wesley T. ; Singleton, Matthew J. ; Roberts, Jason D. ; Tereshchenko, Larisa G. ; Sotoodehnia, Nona ; Chen, Lin Y. ; Marcus, Gregory M. ; Soliman, Elsayed Z./ Association Between QT-Interval Components and Sudden Cardiac Death : The ARIC Study (Atherosclerosis Risk in Communities). In: Circulation. Arrhythmia and electrophysiology. 2017 ; Vol. 10, No. 10.
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    abstract = "BACKGROUND: Several reports have demonstrated that prolongation of the QT interval is associated with sudden cardiac death (SCD). However, it is unknown whether any of the components within the QT interval are responsible for its association with SCD.METHODS AND RESULTS: We examined the association of the individual QT-interval components (R-wave onset to R-peak, R-peak to R-wave end, ST-segment, T-wave onset to T-peak, and T-peak to T-wave end) with SCD in 12 241 participants (54±5.7 years; 26% black; 55% women) from the ARIC study (Atherosclerosis Risk in Communities). The QT interval and its components were measured at baseline (1987-1989) from 12-lead ECGs. SCD cases were adjudicated by a group of physicians through December 31, 2012. During a median follow-up of 23.6 years, a total of 346 cases of SCD were identified. Although prolongation of the QT interval was associated with a 49% increased risk of SCD (hazard ratio, 1.49; 95% confidence interval, 1.01-2.18), only the T-wave onset to T-peak component (per 1-SD increase: hazard ratio, 1.19; 95% confidence interval, 1.06-1.34) was associated with SCD and not any of the other components in separate models. When all of the QT-interval components were included in the same model, T-wave onset to T-peak remained the strongest predictor of SCD (per 1-SD increase: hazard ratio, 1.21; 95% confidence interval, 1.06-1.37).CONCLUSIONS: The risk of SCD with the QT interval is driven by prolongation of the T-wave onset to T-peak component. This suggests that shifting the focus from the overall QT interval to its individual components will refine SCD prediction in the community.",
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    T1 - Association Between QT-Interval Components and Sudden Cardiac Death

    T2 - Circulation: Arrhythmia and Electrophysiology

    AU - O'Neal,Wesley T.

    AU - Singleton,Matthew J.

    AU - Roberts,Jason D.

    AU - Tereshchenko,Larisa G.

    AU - Sotoodehnia,Nona

    AU - Chen,Lin Y.

    AU - Marcus,Gregory M.

    AU - Soliman,Elsayed Z.

    PY - 2017/10/1

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    N2 - BACKGROUND: Several reports have demonstrated that prolongation of the QT interval is associated with sudden cardiac death (SCD). However, it is unknown whether any of the components within the QT interval are responsible for its association with SCD.METHODS AND RESULTS: We examined the association of the individual QT-interval components (R-wave onset to R-peak, R-peak to R-wave end, ST-segment, T-wave onset to T-peak, and T-peak to T-wave end) with SCD in 12 241 participants (54±5.7 years; 26% black; 55% women) from the ARIC study (Atherosclerosis Risk in Communities). The QT interval and its components were measured at baseline (1987-1989) from 12-lead ECGs. SCD cases were adjudicated by a group of physicians through December 31, 2012. During a median follow-up of 23.6 years, a total of 346 cases of SCD were identified. Although prolongation of the QT interval was associated with a 49% increased risk of SCD (hazard ratio, 1.49; 95% confidence interval, 1.01-2.18), only the T-wave onset to T-peak component (per 1-SD increase: hazard ratio, 1.19; 95% confidence interval, 1.06-1.34) was associated with SCD and not any of the other components in separate models. When all of the QT-interval components were included in the same model, T-wave onset to T-peak remained the strongest predictor of SCD (per 1-SD increase: hazard ratio, 1.21; 95% confidence interval, 1.06-1.37).CONCLUSIONS: The risk of SCD with the QT interval is driven by prolongation of the T-wave onset to T-peak component. This suggests that shifting the focus from the overall QT interval to its individual components will refine SCD prediction in the community.

    AB - BACKGROUND: Several reports have demonstrated that prolongation of the QT interval is associated with sudden cardiac death (SCD). However, it is unknown whether any of the components within the QT interval are responsible for its association with SCD.METHODS AND RESULTS: We examined the association of the individual QT-interval components (R-wave onset to R-peak, R-peak to R-wave end, ST-segment, T-wave onset to T-peak, and T-peak to T-wave end) with SCD in 12 241 participants (54±5.7 years; 26% black; 55% women) from the ARIC study (Atherosclerosis Risk in Communities). The QT interval and its components were measured at baseline (1987-1989) from 12-lead ECGs. SCD cases were adjudicated by a group of physicians through December 31, 2012. During a median follow-up of 23.6 years, a total of 346 cases of SCD were identified. Although prolongation of the QT interval was associated with a 49% increased risk of SCD (hazard ratio, 1.49; 95% confidence interval, 1.01-2.18), only the T-wave onset to T-peak component (per 1-SD increase: hazard ratio, 1.19; 95% confidence interval, 1.06-1.34) was associated with SCD and not any of the other components in separate models. When all of the QT-interval components were included in the same model, T-wave onset to T-peak remained the strongest predictor of SCD (per 1-SD increase: hazard ratio, 1.21; 95% confidence interval, 1.06-1.37).CONCLUSIONS: The risk of SCD with the QT interval is driven by prolongation of the T-wave onset to T-peak component. This suggests that shifting the focus from the overall QT interval to its individual components will refine SCD prediction in the community.

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    KW - follow-up studies

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    KW - risk

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