Porthan Kimmo, Viitasalo Matti, Jula Antti, Reunanen Antti, Rapola Janne, Väänänen Heikki, Nieminen Markku S, Toivonen Lauri, Salomaa Veikko, Oikarinen Lasse
Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland.
Heart Rhythm. 2009 Aug;6(8):1202-8, 1208.e1. doi: 10.1016/j.hrthm.2009.05.006. Epub 2009 May 8.
The predictive value of ECG QT interval for mortality in the general population has been weak. Only a few population studies on the predictive value of ECG T-wave morphology parameters for mortality have been reported.
The purpose of this study was to examine the predictive value of ECG QT interval and T-wave morphology parameters for all-cause and cardiovascular mortality in the general population.
The prognostic values of ECG QT interval and four T-wave morphology parameters (principal component analysis ratio, T-wave morphology dispersion, total cosine R-to-T, T-wave residuum) were assessed in 5,917 adults (45% men; age 52 +/- 14 years) participating in the Finnish population-based Health 2000 Study.
After a mean follow-up of 5.9 +/- 0.8 years, 335 deaths had occurred, including 131 cardiovascular deaths. QT interval and, with a few exceptions, all T-wave morphology parameters were significant univariate mortality predictors. In men, in Cox multivariate analyses, principal component analysis ratio and T-wave morphology dispersion remained as independent predictors of all-cause and cardiovascular mortality, with the above-median T-wave morphology dispersion group showing the highest risk of cardiovascular death (hazard ratio [HR] 4.4, 95% confidence interval [CI] 2.1-9.4). In women, independent mortality predictors were total cosine R-to-T (cardiovascular mortality) and T-wave residuum (all-cause and cardiovascular mortality), with the above-median T-wave residuum group showing the highest risk of cardiovascular death (HR 2.2, 95% CI 1.1-4.2).
In the general population, T-wave morphology parameters, but not heart rate-corrected QT interval, provide independent prognostic information on mortality. The prognostic value of T-wave morphology parameters is specifically related to cardiovascular mortality and seems to be gender specific.
心电图QT间期对普通人群死亡率的预测价值一直较弱。仅有少数关于心电图T波形态参数对死亡率预测价值的人群研究报道。
本研究旨在探讨心电图QT间期及T波形态参数对普通人群全因死亡率和心血管死亡率的预测价值。
在参与基于芬兰人群的健康2000研究的5917名成年人（45%为男性；年龄52±14岁）中，评估心电图QT间期和四个T波形态参数（主成分分析比值、T波形态离散度、总余弦R到T、T波残差）的预后价值。
平均随访5.9±0.8年后，发生了335例死亡，其中包括131例心血管死亡。QT间期以及除少数例外的所有T波形态参数均为显著的单因素死亡率预测指标。在男性中，在Cox多变量分析中，主成分分析比值和T波形态离散度仍然是全因死亡率和心血管死亡率的独立预测指标，T波形态离散度高于中位数的组显示心血管死亡风险最高（风险比[HR]4.4，95%置信区间[CI]2.1 - 9.4）。在女性中，独立的死亡率预测指标是总余弦R到T（心血管死亡率）和T波残差（全因和心血管死亡率），T波残差高于中位数的组显示心血管死亡风险最高（HR 2.2，95%CI 1.1 - 4.2）。
在普通人群中，T波形态参数而非心率校正后的QT间期可提供关于死亡率的独立预后信息。T波形态参数的预后价值与心血管死亡率特别相关，且似乎具有性别特异性
