Gary Tse1, Mengqi Gong2, Wing Tak Wong3, Stamatis Georgopoulos4, Konstantinos P Letsas4, Vassilios S Vassiliou5, Yat Sun Chan6, Bryan P Yan6, Sunny Hei Wong7, William K K Wu8, Ana Ciobanu9, Guangping Li2, Jayaprakash Shenthar10, Ardan M Saguner11, Sadeq Ali-Hasan-Al-Saegh12, Aishwarya Bhardwaj13, Abhishek C Sawant13, Paula Whittaker14, Yunlong Xia15, Gan-Xin Yan16, Tong Liu17. 1. Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China; School of Health Sciences, University of Manchester, Manchester, United Kingdom. Electronic address: tseg@cuhk.edu.hk. 2. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China. 3. School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China. 4. Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece. 5. Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Royal Brompton Hospital and Imperial College London, London, United Kingdom. 6. Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China. 7. Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China. 8. Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China; Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China. 9. Department of Cardiology, Theodor Burghele Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 10. Electrophysiology Unit, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India. 11. Department of Cardiology, University Heart Center, Zurich, Switzerland. 12. Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 13. Division of Cardiology, Department of Internal Medicine, State University of New York at Buffalo, Buffalo, New York. 14. School of Health Sciences, University of Manchester, Manchester, United Kingdom. 15. Department of Cardiovascular Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China. 16. Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania; Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China. 17. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China. Electronic address: liutongdoc@126.com.
Abstract
BACKGROUND: The Tpeak - Tend interval (the interval from the peak to the end of the T wave), an electrocardiographic marker reflecting transmural dispersion of repolarization, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death in different clinical settings. OBJECTIVE: This systematic review and meta-analysis evaluated the significance of the Tpeak - Tend interval in predicting arrhythmic and/or mortality end points. METHODS: PubMed, Embase, Cochrane Library, and CINAHL Plus databases were searched through November 30, 2016. RESULTS: Of the 854 studies identified initially, 33 observational studies involving 155,856 patients were included in our meta-analysis. Tpeak - Tend interval prolongation (mean cutoff value 103.3 ± 17.4 ms) was a significant predictor of the arrhythmic or mortality outcomes (odds ratio [OR] 1.14; 95% confidence interval [CI] 1.11-1.17; P < .001). When different end points were analyzed, the ORs were as follows: VT/VF, 1.10 (95% CI 1.06-1.13; P < .0001); sudden cardiac death, 1.27 (95% CI 1.17-1.39; P < .0001); cardiovascular death, 1.40 (95% CI 1.19-1.64; P < .0001); and all-cause mortality, 4.56 (95% CI 0.62-33.68; P < .0001). Subgroup analysis for each disease revealed that the risk of VT/VF or death was highest for Brugada syndrome (OR 5.68; 95% CI 1.57-20.53; P < .01), followed by hypertension (OR 1.52; 95% CI 1.26-1.85; P < .0001), heart failure (OR 1.07; 95% CI 1.04-1.11; P < .0001), and ischemic heart disease (OR 1.06; 95% CI 1.02-1.10; P = 0.001). CONCLUSION: The Tpeak - Tend interval is a useful risk stratification tool in different diseases and in the general population.
BACKGROUND: The Tpeak - Tend interval (the interval from the peak to the end of the T wave), an electrocardiographic marker reflecting transmural dispersion of repolarization, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death in different clinical settings. OBJECTIVE: This systematic review and meta-analysis evaluated the significance of the Tpeak - Tend interval in predicting arrhythmic and/or mortality end points. METHODS: PubMed, Embase, Cochrane Library, and CINAHL Plus databases were searched through November 30, 2016. RESULTS: Of the 854 studies identified initially, 33 observational studies involving 155,856 patients were included in our meta-analysis. Tpeak - Tend interval prolongation (mean cutoff value 103.3 ± 17.4 ms) was a significant predictor of the arrhythmic or mortality outcomes (odds ratio [OR] 1.14; 95% confidence interval [CI] 1.11-1.17; P < .001). When different end points were analyzed, the ORs were as follows: VT/VF, 1.10 (95% CI 1.06-1.13; P < .0001); sudden cardiac death, 1.27 (95% CI 1.17-1.39; P < .0001); cardiovascular death, 1.40 (95% CI 1.19-1.64; P < .0001); and all-cause mortality, 4.56 (95% CI 0.62-33.68; P < .0001). Subgroup analysis for each disease revealed that the risk of VT/VF or death was highest for Brugada syndrome (OR 5.68; 95% CI 1.57-20.53; P < .01), followed by hypertension (OR 1.52; 95% CI 1.26-1.85; P < .0001), heart failure (OR 1.07; 95% CI 1.04-1.11; P < .0001), and ischemic heart disease (OR 1.06; 95% CI 1.02-1.10; P = 0.001). CONCLUSION: The Tpeak - Tend interval is a useful risk stratification tool in different diseases and in the general population.
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