title: T-peak to T-end interval for prediction of ventricular tachyarrhythmia and mortality in a primary prevention population with systolic cardiomyopathy.
abstract: BACKGROUND
  The electrocardiographic T-wave peak to T-wave end interval (Tpe) correlates with dispersion of ventricular repolarization (DVR). Increased DVR increases propensity toward electrical reentry that can cause ventricular tachyarrhythmia. The baseline rate-corrected Tpe (Tpec) has been shown to predict ventricular tachyarrhythmia and death in multiple patient populations but not among cardiomyopathic patients undergoing insertion of an implantable cardioverter-defibrillator (ICD) for primary prevention.
  
  
  OBJECTIVE
  The purpose of this study was to assess the risk stratification ability of the Tpec in patients with systolic cardiomyopathy without prior ventricular tachyarrhythmia (ie, the primary prevention population).
  
  
  METHODS
  We performed prospective follow-up of 305 patients (73% men; left ventricular ejection fraction [LVEF] 23 ± 7%) with LVEF ≤35% and an ICD implanted for primary prevention. Baseline ECGs were analyzed with automated algorithms. Endpoints were ventricular tachycardia (VT)/ventricular fibrillation (VF), death, and a combined endpoint of VT/VF or death, assessed by device follow-up and Social Security Death Index query.
  
  
  RESULTS
  The average Tpec was 107 ± 22 ms. During device clinic follow-up of 31 ± 23 months, 82 patients (27%) had appropriate ICD therapy for VT/VF, and during mortality follow-up of 49 ± 21 months, 91 patients (30%) died. On univariable analysis, Tpec predicted VT/VF, death, and the combined endpoint of VT/VF or death (P < .05 for each endpoint). Multivariable analysis included univariable predictors among demographics, clinical data, laboratory data, medications used, and electrocardiography parameters. After correction, Tpec remained predictive of VT/VF (hazard ratio [HR] per 10-ms increase 1.16, P = .009), all-cause mortality (HR per 10 ms 1.13, P = .05), and the combined endpoint (HR per 10 ms 1.17, P = .001).
  
  
  CONCLUSIONS
  Tpec independently predicts both VT/VF and overall mortality in patients with systolic dysfunction and ICDs implanted for primary prevention.
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Rosenthal
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Stahls
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Freddy M
authors.initials: FM
authors.lastname: Abi Samra
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Bernard
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Sammy
authors.initials: S
authors.lastname: Khatib
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Polin
authors.affiliation: GE Healthcare, Wauwatosa, Wisconsin.
authors.forename: Joel Q
authors.initials: JQ
authors.lastname: Xue
authors.affiliation: Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana. Electronic address: dmorin@ochsner.org.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Morin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D014693:Ventricular Fibrillation / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy
keywords: Death; Electrocardiography; T-peak to T-end; Ventricular tachyarrhythmia