AIMS: Total cosine R-to-T (TCRT) measured from the standard 12-lead electrocardiogram (ECG) reflects the spatial relationship between depolarization and repolarization wavefronts and a low TCRT value is a marker of poor prognosis. We tested the hypothesis that measurement of TCRT or QRS/T angle from exercise ECG would provide even more powerful prognostic information. METHODS AND RESULTS: The prognostic significances of TCRT and QRS/T angle were assessed from exercise ECG recordings in 1297 patients [age 56 ± 13 years (mean ± SD), 67% males] undergoing a clinically indicated bicycle stress-test and the subsequent follow-up. During an average follow-up of 45 ± 12 months, 74 patients died (5.7%); 34 (2.6%) were cardiac deaths, and 24 (1.9%) were sudden cardiac deaths. Total cosine R-to-T and QRS/T angle exhibited a correlation with the RR intervals in the total cohort, but the individual responses were variable, e.g. median correlation of TCRT-RR was 0.89 with an inter-quartile range from 0.55 to 0.98. A reduced correlation of TCRT-RR during the recovery phase of exercise ECG predicted cardiac death [adjusted heart rate (HR) 3.5, 95% confidence interval (CI): 1.8-6.8, P= 0.001] similarly as the baseline TCRT measured from ECG at rest (adjusted HR 3.4, 95% CI: 1.4-8.1, P= 0.01). The poor correlation between the TCRT-RR both during the exercise and recovery was specifically related to a risk of sudden cardiac death (adjusted HR 6.2, 95% CI: 2.1-17.8, P< 0.001). CONCLUSIONS: Loss of rate-adaptation of the spatial relationship between depolarization and repolarization wavefronts is a strong predictor of cardiac death, especially of sudden cardiac death.
AIMS: Total cosine R-to-T (TCRT) measured from the standard 12-lead electrocardiogram (ECG) reflects the spatial relationship between depolarization and repolarization wavefronts and a low TCRT value is a marker of poor prognosis. We tested the hypothesis that measurement of TCRT or QRS/T angle from exercise ECG would provide even more powerful prognostic information. METHODS AND RESULTS: The prognostic significances of TCRT and QRS/T angle were assessed from exercise ECG recordings in 1297 patients [age 56 ± 13 years (mean ± SD), 67% males] undergoing a clinically indicated bicycle stress-test and the subsequent follow-up. During an average follow-up of 45 ± 12 months, 74 patients died (5.7%); 34 (2.6%) were cardiac deaths, and 24 (1.9%) were sudden cardiac deaths. Total cosine R-to-T and QRS/T angle exhibited a correlation with the RR intervals in the total cohort, but the individual responses were variable, e.g. median correlation of TCRT-RR was 0.89 with an inter-quartile range from 0.55 to 0.98. A reduced correlation of TCRT-RR during the recovery phase of exercise ECG predicted cardiac death [adjusted heart rate (HR) 3.5, 95% confidence interval (CI): 1.8-6.8, P= 0.001] similarly as the baseline TCRT measured from ECG at rest (adjusted HR 3.4, 95% CI: 1.4-8.1, P= 0.01). The poor correlation between the TCRT-RR both during the exercise and recovery was specifically related to a risk of sudden cardiac death (adjusted HR 6.2, 95% CI: 2.1-17.8, P< 0.001). CONCLUSIONS: Loss of rate-adaptation of the spatial relationship between depolarization and repolarization wavefronts is a strong predictor of cardiac death, especially of sudden cardiac death.
Authors: Gary Tse; Mengqi Gong; Cheuk Wai Wong; Cynthia Chan; Stamatis Georgopoulos; Yat Sun Chan; Bryan P Yan; Guangping Li; Paula Whittaker; Ana Ciobanu; Sadeq Ali-Hasan-Al-Saegh; Sunny H Wong; William K K Wu; George Bazoukis; Konstantinos Lampropoulos; Wing Tak Wong; Lap Ah Tse; Adrian M Baranchuk; Konstantinos P Letsas; Tong Liu Journal: Ann Noninvasive Electrocardiol Date: 2017-09-12 Impact factor: 1.468
Authors: Andrew Oehler; Trevor Feldman; Charles A Henrikson; Larisa G Tereshchenko Journal: Ann Noninvasive Electrocardiol Date: 2014-09-09 Impact factor: 1.468
Authors: Janne T Rahola; Antti M Kiviniemi; Olavi H Ukkola; Mikko P Tulppo; M Juhani Junttila; Heikki V Huikuri; Tuomas V Kenttä; Juha S Perkiömäki Journal: Ann Noninvasive Electrocardiol Date: 2021-01-23 Impact factor: 1.468
Authors: Irena Andršová; Katerina Hnatkova; Martina Šišáková; Ondřej Toman; Peter Smetana; Katharina M Huster; Petra Barthel; Tomáš Novotný; Georg Schmidt; Marek Malik Journal: Front Physiol Date: 2022-02-07 Impact factor: 4.566