Tuomas V Kenttä1, Moritz F Sinner2, Bruce D Nearing2, Rebecca Freudling2, Kimmo Porthan2, Jani T Tikkanen2, Martina Müller-Nurasyid2, Katharina Schramm2, Matti Viitasalo2, Antti Jula2, Markku S Nieminen2, Annette Peters2, Veikko Salomaa2, Lasse Oikarinen2, Richard L Verrier2, Stefan Kääb2, M Juhani Junttila2, Heikki V Huikuri2. 1. From the Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland (T.V.K., J.T.T., M.J.J., H.V.H.); Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Germany (M.F.S., R.F., K.S., S.K.); German Cardiovascular Research Centre, Partner Site: Munich Heart Alliance (M.F.S., M.M.-N., A.P., S.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (B.D.N., R.L.V.); Institute of Genetic Epidemiology (R.F., M.M.-N., K.S.) and Institute of Epidemiology II (A.P.), Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg; Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Finland (K.P., M.V., A.J., M.S.N., L.O.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (J.T.T.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.). tuomas.kentta@oulu.fi. 2. From the Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland (T.V.K., J.T.T., M.J.J., H.V.H.); Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Germany (M.F.S., R.F., K.S., S.K.); German Cardiovascular Research Centre, Partner Site: Munich Heart Alliance (M.F.S., M.M.-N., A.P., S.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (B.D.N., R.L.V.); Institute of Genetic Epidemiology (R.F., M.M.-N., K.S.) and Institute of Epidemiology II (A.P.), Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg; Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Finland (K.P., M.V., A.J., M.S.N., L.O.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (J.T.T.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.).
Abstract
BACKGROUND: We developed a novel electrocardiographic marker, T-wave area dispersion (TW-Ad), which measures repolarization heterogeneity by assessing interlead T-wave areas during a single cardiac cycle and tested whether it can identify patients at risk for sudden cardiac death (SCD) in the general population. METHODS AND RESULTS: TW-Ad was measured from standard digital 12-lead ECG in 5618 adults (46% men; age, 50.9±12.5 years) participating in the Health 2000 Study-an epidemiological survey representative of the Finnish adult population. Independent replication was performed in 3831 participants of the KORA S4 Study (Cooperative Health Research in the Region of Augsburg; 49% men; age, 48.7±13.7 years; mean follow-up, 8.8±1.1 years). During follow-up (7.7±1.4 years), 72 SCDs occurred in the Health 2000 Survey. Lower TW-Ad was univariately associated with SCD (0.32±0.36 versus 0.60±0.19; P<0.001); it had an area under the receiver operating characteristic curve of 0.809. TW-Ad (≤0.46) conferred a hazard ratio of 10.8 (95% confidence interval, 6.8-17.4; P<0.001) for SCD; it remained independently predictive of SCD after multivariable adjustment for clinical risk markers (hazard ratio, 4.6; 95% confidence interval, 2.7-7.4; P<0.001). Replication analyses performed in the KORA S4 Study confirmed an increased risk for cardiac death (unadjusted hazard ratio, 5.5; 95% confidence interval, 3.2-9.5; P<0.001; multivariable adjusted hazard ratio, 1.9; 95% confidence interval, 1.1-3.5; P<0.05). CONCLUSION: Low TW-Ad, reflecting increased heterogeneity of repolarization, in standard 12-lead resting ECGs is a powerful and independent predictor of SCD in the adult general population.
BACKGROUND: We developed a novel electrocardiographic marker, T-wave area dispersion (TW-Ad), which measures repolarization heterogeneity by assessing interlead T-wave areas during a single cardiac cycle and tested whether it can identify patients at risk for sudden cardiac death (SCD) in the general population. METHODS AND RESULTS: TW-Ad was measured from standard digital 12-lead ECG in 5618 adults (46% men; age, 50.9±12.5 years) participating in the Health 2000 Study-an epidemiological survey representative of the Finnish adult population. Independent replication was performed in 3831 participants of the KORA S4 Study (Cooperative Health Research in the Region of Augsburg; 49% men; age, 48.7±13.7 years; mean follow-up, 8.8±1.1 years). During follow-up (7.7±1.4 years), 72 SCDs occurred in the Health 2000 Survey. Lower TW-Ad was univariately associated with SCD (0.32±0.36 versus 0.60±0.19; P<0.001); it had an area under the receiver operating characteristic curve of 0.809. TW-Ad (≤0.46) conferred a hazard ratio of 10.8 (95% confidence interval, 6.8-17.4; P<0.001) for SCD; it remained independently predictive of SCD after multivariable adjustment for clinical risk markers (hazard ratio, 4.6; 95% confidence interval, 2.7-7.4; P<0.001). Replication analyses performed in the KORA S4 Study confirmed an increased risk for cardiac death (unadjusted hazard ratio, 5.5; 95% confidence interval, 3.2-9.5; P<0.001; multivariable adjusted hazard ratio, 1.9; 95% confidence interval, 1.1-3.5; P<0.05). CONCLUSION: Low TW-Ad, reflecting increased heterogeneity of repolarization, in standard 12-lead resting ECGs is a powerful and independent predictor of SCD in the adult general population.
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: Julia Ramírez; Antti Kiviniemi; Stefan van Duijvenboden; Andrew Tinker; Pier D Lambiase; Juhani Junttila; Juha S Perkiömäki; Heikki V Huikuri; Michele Orini; Patricia B Munroe Journal: J Am Heart Assoc Date: 2022-08-29 Impact factor: 6.106
Authors: Heini Sánez Tähtisalo; Timo P Hiltunen; Tuomas Kenttä; Juhani Junttila; Lasse Oikarinen; Juha Virolainen; Kimmo K Kontula; Kimmo Porthan Journal: PLoS One Date: 2020-03-24 Impact factor: 3.240