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 Henrikson, Nona Sotoodehnia, Lichy Han, Sunil K. Agarwal, Dan E. Arking, David S. Siscovick, Scott D. Solomon, Wendy S. Post, Mark E. Josephson, Josef Coresh, Larisa Tereshchenko

    Research output: Contribution to journalArticle

    10 Citations (Scopus)

    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

    Fingerprint

    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; Sotoodehnia, Nona; Han, Lichy; Agarwal, Sunil K.; Arking, Dan E.; Siscovick, David S.; Solomon, Scott D.; Post, Wendy S.; Josephson, Mark E.; Coresh, Josef; Tereshchenko, Larisa.

    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 ; Sotoodehnia, Nona ; Han, Lichy ; Agarwal, Sunil K. ; Arking, Dan E. ; Siscovick, David S. ; Solomon, Scott D. ; Post, Wendy S. ; Josephson, Mark E. ; Coresh, Josef ; Tereshchenko, Larisa. / 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.",
    keywords = "atherosclerosis, electrocardiography, electrophysiology, epidemiology, sudden cardiac death, TT′ angle",
    author = "Waks, {Jonathan W.} and Soliman, {Elsayed Z.} and Charles Henrikson and Nona Sotoodehnia and Lichy Han and Agarwal, {Sunil K.} and Arking, {Dan E.} and Siscovick, {David S.} and Solomon, {Scott D.} and Post, {Wendy S.} and Josephson, {Mark E.} and Josef Coresh and Larisa Tereshchenko",
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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

    AU - Sotoodehnia, Nona

    AU - Han, Lichy

    AU - Agarwal, Sunil K.

    AU - Arking, Dan E.

    AU - Siscovick, David S.

    AU - Solomon, Scott D.

    AU - Post, Wendy S.

    AU - Josephson, Mark E.

    AU - Coresh, Josef

    AU - Tereshchenko, Larisa

    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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