Electrocardiographic T-wave morphology and risk of mortality. (1st April 2021)

• Record Type: Journal Article
• Authors: Isaksen, Jonas L.; Ghouse, Jonas; Graff, Claus; Olesen, Morten S.; Holst, Anders G.; Pietersen, Adrian; Nielsen, Jonas B.; Skov, Morten W.; Kanters, Jørgen K.
• Is Part Of: International journal of cardiology. Volume 328(2021)
• Page Start: 199
• Page End: 205
• Publication Date: 2021-04-01
• Subjects: Electrocardiography -- Electrocardiogram -- T-wave morphology -- QT interval -- Cardiovascular death -- All-cause mortality; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.12.016
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Electrocardiographic T-wave morphology is used in drug safety studies as an adjunct to the QTc interval, but few measurements of T-wave morphology can be interpreted in clinical practice. Morphology combination score (MCS) is a combination of T-wave flatness/peakedness, asymmetry, and notching, enabling easy visual assessment of T-wave morphology. We aimed to test the association between T-wave morphology, quantified by MCS, and mortality. Methods: We included electrocardiograms recorded in 2001–2011 from 342, 294 primary care patients. Using Cox regression, we evaluated the association between MCS, cardiovascular death, and all-cause mortality, adjusting for heart rate, QTc, QT-prolonging drugs, diabetes, ischemic heart disease, hypertension, and congestive heart failure. Results: 270, 039 individuals (44% men, median age 55 [inter-quartile range: 42–67 years]) were included and followed for a median of 9.3 years, during which time 13, 489 (5.0%) died from cardiovascular causes and 50, 481 (18.7%) from any cause. High values of MCS (i.e. asymmetric, flattened, and/or notched T waves) were associated with an adjusted mortality Hazard Ratio of 1.75 (95% CI 1.62–1.89) and 1.61 (1.43–1.92) for women and men, respectively. Low values of MCS (i.e. peaked and symmetric T waves) were associated with a Hazard Ratio of 1.18 (1.08–1.28) and 1.71 (1.48–1.98) for women and men, respectively. Conclusions: In a large primary care population, we found that T-wave asymmetry, flatness, and notching provided prognostic information on mortality independent of heart rate, QTc, and baseline comorbidities. Highlights: ECG T-wave morphology was linked to mortality in 270, 039 primary care patients. Increased risk found for asymmetric, notched, flattened, and overly peaked T waves. The association was independent of QT interval, heart rate, and comorbidities.