TY - JOUR
T1 - T-wave reversal in the augmented unipolar right arm electrocardiographic lead is associated with increased risk of sudden death
AU - Phan, Derek
AU - Narayanan, Kumar
AU - Uy-Evanado, Audrey
AU - Teodorescu, Carmen
AU - Reinier, Kyndaron
AU - Chugh, Harpriya
AU - Gunson, Karen
AU - Jui, Jonathan
AU - Chugh, Sumeet S.
N1 - Publisher Copyright:
© 2015, Springer Science+Business Media New York.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Background: Repolarization abnormalities are associated with ventricular arrhythmias, and published studies report that a reversal of T wave polarity (positive or flat T wave) in lead aVR may be linked to increased cardiovascular mortality. We evaluated whether a positive or flat T wave in aVR is a risk marker for sudden cardiac death (SCD). Methods: SCD cases from the Oregon Sudden Unexpected Death Study (catchment population ~1 million) were compared to geographic controls with coronary artery disease and no history of SCD. Archived electrocardiograms performed prior and unrelated to the SCD event were evaluated. Results: SCD cases (n = 691, 67.6 ± 14.9 years, 69 % male) were more likely than controls (n = 663, 66.2 ± 11.6 years, 67 % male) to have diabetes (40 vs 32 %; p < 0.01), left ventricular ejection fraction (LVEF) ≤35 % (27 vs 11 %; p < 0.01), prolonged QTc (≥450 ms; 54 vs 28 %; p < 0.01) and positive (19 vs 13 %; p < 0.01) or flat T wave (14 vs 7 %; p < 0.01) in aVR. On multivariable analysis, a positive/flat T wave in aVR was independently associated with SCD (OR 1.9, 95 % CI 1.3–2.8, p < 0.01). However, a positive T wave alone lost statistical significance in patients with LVEF ≤ 35 % and QTc ≥ 450 ms. In a subgroup analysis among patients with normal LVEF, QTc, and no diabetes, a positive T wave in aVR (but not a flat T wave) remained associated with SCD (OR 2.8, 95 % CI 1.2–6.1, p < 0.01). Conclusions: A positive or flat T wave in lead aVR was associated with SCD in subsets of patients. This simple ECG marker in this often-ignored lead may contribute to enhancement of SCD risk stratification, and warrants further evaluation.
AB - Background: Repolarization abnormalities are associated with ventricular arrhythmias, and published studies report that a reversal of T wave polarity (positive or flat T wave) in lead aVR may be linked to increased cardiovascular mortality. We evaluated whether a positive or flat T wave in aVR is a risk marker for sudden cardiac death (SCD). Methods: SCD cases from the Oregon Sudden Unexpected Death Study (catchment population ~1 million) were compared to geographic controls with coronary artery disease and no history of SCD. Archived electrocardiograms performed prior and unrelated to the SCD event were evaluated. Results: SCD cases (n = 691, 67.6 ± 14.9 years, 69 % male) were more likely than controls (n = 663, 66.2 ± 11.6 years, 67 % male) to have diabetes (40 vs 32 %; p < 0.01), left ventricular ejection fraction (LVEF) ≤35 % (27 vs 11 %; p < 0.01), prolonged QTc (≥450 ms; 54 vs 28 %; p < 0.01) and positive (19 vs 13 %; p < 0.01) or flat T wave (14 vs 7 %; p < 0.01) in aVR. On multivariable analysis, a positive/flat T wave in aVR was independently associated with SCD (OR 1.9, 95 % CI 1.3–2.8, p < 0.01). However, a positive T wave alone lost statistical significance in patients with LVEF ≤ 35 % and QTc ≥ 450 ms. In a subgroup analysis among patients with normal LVEF, QTc, and no diabetes, a positive T wave in aVR (but not a flat T wave) remained associated with SCD (OR 2.8, 95 % CI 1.2–6.1, p < 0.01). Conclusions: A positive or flat T wave in lead aVR was associated with SCD in subsets of patients. This simple ECG marker in this often-ignored lead may contribute to enhancement of SCD risk stratification, and warrants further evaluation.
KW - Electrocardiography
KW - Lead aVR
KW - Risk stratification
KW - Sudden cardiac death
UR - http://www.scopus.com/inward/record.url?scp=84958886265&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84958886265&partnerID=8YFLogxK
U2 - 10.1007/s10840-015-0078-1
DO - 10.1007/s10840-015-0078-1
M3 - Article
C2 - 26628059
AN - SCOPUS:84958886265
SN - 1383-875X
VL - 45
SP - 141
EP - 147
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 2
ER -