title: Prognostic significance of T-wave amplitude in lead aVR in heart failure patients with narrow QRS complexes.
abstract: BACKGROUND
  Prolonged duration of the QRS complex is a prognostic marker in patients with heart failure (HF), whereas electrocadiographic markers in HF with narrow QRS complex remain unclear. We evaluated the prognostic value of the T-wave amplitude in lead aVR in HF patients with narrow QRS complexes.
  
  
  METHODS
  We examined 331 patients who were admitted to our hospital for worsening HF (68 ± 15 years, mean ± standard deviation) from January 2000 to October 2004 who had sinus rhythm and QRS complex <120 ms. The patients were categorized into three groups according to the peak T-wave amplitude from baseline in lead aVR: negative (<-0.1 mV; n = 209, 63%), flat (-0.1-0.1 mV; n = 64, 19%), and positive (>0.1 mV; n = 58, 18%).
  
  
  RESULTS
  During a mean follow-up of 33 months, 113 (34%) patients had all-cause death, the primary end point. After adjusting for clinical covariates, flat T wave (hazard ratio [HR] 1.86, 95% confidence interval [CI] 1.42-2.46), and positive T wave (HR 6.76, 95% CI 3.92-11.8) were independent predictors of mortality, when negative T wave was considered a reference.
  
  
  CONCLUSIONS
  As the peak T-wave amplitude in lead aVR becomes less negative, there was a progressive increase in mortality. The T wave in lead aVR provides prognostic information for risk stratification in HF patients with narrow QRS complexes.
authors.affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Kentarou
authors.initials: K
authors.lastname: Okuda
authors.forename: Eiichi
authors.initials: E
authors.lastname: Watanabe
authors.forename: Kan
authors.initials: K
authors.lastname: Sano
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Arakawa
authors.forename: Mayumi
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sobue
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D015996:Survival Rate