title: Tpeak-to-Tend/QT is an independent predictor of early ventricular arrhythmias and arrhythmic death in anterior ST elevation myocardial infarction patients.
abstract: BACKGROUND
  The aim of our study was to analyse the markers of transmural dispersion of ventricular repolarization, especially Tpeak-to-Tend and Tpeak-to-Tend /QT ratio, in patients with anterior ST elevation myocardial infarction on admission and to evaluate their association with in-hospital life-threatening arrhythmias and mortality.
  
  
  RESULTS
  A total of 223 consecutive patients with anterior wall ST elevation myocardial infarction admitted to our Division of Cardiology between January 2010 and December 2012 were prospectively evaluated. A standard electrocardiogram was obtained on admission and then analysed. The primary end point was constituted by in-hospital ventricular arrhythmias and arrhythmic death. At univariate analysis heart rate (odds ratio = 1.03; 95% confidence intervals 1.006-1.05; p=0.001), maximal ST elevation (odds ratio =1.25; 95% confidence intervals 1.10-1.43; p=0.0001), QTc Bazett (odds ratio = 1.01; 95% confidence intervals 1.006-1.02; p=0.002), QT dispersion (odds ratio = 1.02; 95% confidence intervals 1.002-1.04; p=0.02) and both Tpeak-to-Tend and Tpeak-to-Tend/QT (odds ratio = 1.02; 95% confidence intervals 1.01-1.03; p<0.0001 and OR = 1.07; 95% confidence intervals 1.03-1.11; p<0.0001 respectively) were significantly associated with ventricular arrhythmias and arrhythmic mortality. Of note, Tpeak-to-Tend /QT remained a predictor of early ventricular arrhythmias and arrhythmic death (odds ratio = 1.04; 95% confidence intervals 1.003 - 1.10; p=0.03) independently from heart rate and maximal ST elevation. Receiver operating characteristic curve analysis showed that Tpeak-to-Tend /QT values <0.31 had a predictive negative value of 92% for the prediction of the composite outcome.
  
  
  CONCLUSIONS
  Tpeak-to-Tend /QT was an independent predictor of early ventricular arrhythmias and arrhythmic mortality in patients with anterior ST elevation myocardial infarction. Especially, Tpeak-to-Tend /QT <0.31 may identify a subgroup of ST elevation myocardial infarction patients with low risk of early arrhythmias and arrhythmic death.
authors.affiliation: Department of Cardiology, University Hospital of Verona, Italy mugnai.giacomo@gmail.com.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Department of Cardiology, University Hospital of Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Benfari
authors.affiliation: Department of Cardiology, University Hospital of Verona, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Fede
authors.affiliation: Department of Cardiology, University Hospital of Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Heart Rhythm Management Centre, UZ Brussel-VUB, Belgium.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
authors.affiliation: Department of Cardiology, University Hospital of Verona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vassanelli
authors.affiliation: Department of Cardiology, University Hospital of Verona, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Menegatti
authors.affiliation: Department of Cardiology, University Hospital of Verona, Italy.
authors.forename: Flavio Luciano
authors.initials: FL
authors.lastname: Ribichini
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*
keywords: ST elevation myocardial infarction; Tpeak-to-Tend; arrhythmias; dispersion of ventricular repolarization