title: T-wave inversion, QRS duration, and QRS/T angle as electrocardiographic predictors of the risk for sudden cardiac death.
abstract: The aim of this study was to investigate the prognostic utility of isolated T-wave inversion (TWI), QRS duration, and QRS/T angle on electrocardiogram at rest as predictors for sudden cardiac death (SCD) and death from all causes. The assessment of electrocardiographic findings was based on a population-based cohort of 1,951 men (age 42 to 61 years) with a follow-up period of 20 years. Isolated TWI in the absence of ST depression, bundle branch block or major arrhythmias, prolonged QRS duration from 110 to 119 ms, and a wide QRS/T angle of >67° were identified from the 12-lead electrocardiograms. SCD was observed in 171 men (8.3%) during the follow-up. As a single electrocardiographic parameter, TWI (prevalence 2.4%) was associated with an increased risk of SCD (hazard ratio [HR] 3.30, 95% confidence interval [CI] 1.91 to 5.71, p<0.001) after adjustment for age and clinical factors. Similarly, prolonged QRS duration and wide QRS/T angle were significantly related to the risk of SCD, with HR 1.50 (95% CI 1.08 to 2.19, p=0.017) for QRS duration and HR 3.03 (95% CI 2.23 to 4.14, p<0.001) for QRS/T angle. The integrated discrimination improvement was significant when TWI (0.014, p=0.036) or QRS/T angle (0.015, p=0.002) was added to the model with age and clinical factors. In conclusion, TWI, QRS duration, and QRS/T angle are significantly associated with the risk of SCD and death from all causes beyond conventional cardiovascular risk predictors in the general population.
authors: Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Internal Medicine, Lapland Central Hospital, Rovaniemi, Finland. Electronic address: jariantero.laukkanen@uef.fi.
authors: Jari Antero
authors: JA
authors: Laukkanen
authors: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors: Emanuele
authors: E
authors: Di Angelantonio
authors: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors: Hassan
authors: H
authors: Khan
authors: Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Internal Medicine, Lapland Central Hospital, Rovaniemi, Finland.
authors: Sudhir
authors: S
authors: Kurl
authors: Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
authors: Kimmo
authors: K
authors: Ronkainen
authors: Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
authors: Pentti
authors: P
authors: Rautaharju
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D004562:Electrocardiography; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors