title: Analysis of 12-lead T-wave morphology for risk stratification after myocardial infarction.
abstract: BACKGROUND
  The stratification of post-myocardial infarction (MI) patients at risk of sudden cardiac death remains important. The aim of the present study was to assess the prognostic value of novel T-wave morphology descriptors derived from resting 12-lead ECGs.
  
  
  RESULTS
  In 280 consecutive post-MI patients, a 12-lead ECG was recorded before discharge, optically scanned, and digitized. For the present study, 5 T-wave morphology descriptors were automatically calculated after singular value decomposition of the ECG signal. The total cosine R-to-T (TCRT [describes the global angle between repolarization and depolarization wavefront]) and the T-wave loop dispersion were univariately associated (P:=0.0002 and P:<0.002, respectively, U: test) with 27 prospectively defined clinical events in 261 patients (mean follow-up 32+/-10 months). Kaplan-Meier event probability curves for strata above and below the median confirmed the strong risk discrimination by TCRT and T-wave loop dispersion (P:<0.003 and P:<0.001, respectively, log-rank test). On Cox regression analysis, with the entering of age, left ventricular ejection fraction, heart rate, QRS width, reperfusion therapy, beta-adrenergic-blocker treatment, and standard deviation of R-R intervals on 24-hour Holter monitoring, TCRT (P:<0.03) yielded independent predictive value, whereas T-wave loop dispersion was of borderline independence (P:=0.064). Heart rate (P:<0.02), left ventricular ejection fraction (P:<0.02), and reperfusion therapy (P:<0.02) also remained in the final model.
  
  
  CONCLUSIONS
  Computerized T-wave morphology analysis of the 12-lead resting ECG permits independent assessment of post-MI risk and an improved risk stratification when combined with other risk markers.
authors.affiliation: Cardiology Division, Klinikum Benjamin Franklin, Free University, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Zabel
authors.forename: B
authors.initials: B
authors.lastname: Acar
authors.forename: T
authors.initials: T
authors.lastname: Klingenheben
authors.forename: M R
authors.initials: MR
authors.lastname: Franz
authors.forename: S H
authors.initials: SH
authors.lastname: Hohnloser
authors.forename: M
authors.initials: M
authors.lastname: Malik
mesh_terms: D000704:Analysis of Variance; D016757:Death, Sudden, Cardiac; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors