Pirkola Joni M, Konttinen Maija, Kenttä Tuomas V, Holmström Lauri T A, Junttila M Juhani, Ukkola Olavi H, Huikuri Heikki V, Perkiömäki Juha S
Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Ann Noninvasive Electrocardiol. 2018 Jul;23(4):e12539. doi: 10.1111/anec.12539. Epub 2018 Feb 27.
The prognostic value of T-wave morphology parameters in coronary artery disease in the current treatment era is not well established.
The Innovation to reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study included 1,946 patients with angiographically verified coronary artery disease (CAD). The study patients underwent thorough examinations including 12-lead digital electrocardiogram (ECG) at baseline.
During a follow-up period of 73 ± 22 months, a total of 201 (10.3%) patients died. Of the study patients, 95 (4.9%) experienced cardiac death (CD) consisting of 44 (2.3%) sudden cardiac deaths (SCD) and 51 (2.6%) nonsudden cardiac deaths (NSCD), and 106 (5.4%) patients experienced noncardiac death (NCD). T-wave morphology dispersion (TMD), T-wave area dispersion (TWAD), and total cosine R-to-T (TCRT) had a significant association with CD even after adjustment with relevant clinical risk markers in the Cox regression analysis (multivariate HRs: 1.015, 95% CI 1.007-1.023, p = .0003; 0.474, 95% CI 0.305-0.737, p = .0009; 0.598, 95% CI 0.412-0.866, p = .006, respectively). When including these parameters to the clinical risk model for CD, the C-index increased from 0.810 to 0.823 improving the discrimination significantly (integrated discrimination index [IDI] = 0.0118, 95% CI 0.0028-0.0208, p = .01). These parameters were more closely associated with NSCD (multivariate p-values from .016 to .001) than with SCD (univariate/multivariate p-values for TMD .015/.197 and for TCRT .012/.43).
T-wave morphology parameters describing repolarization heterogeneity improve the predictive power of the clinical risk model for CD in patients with CAD in the current treatment era.
在当前治疗时代，T波形态参数在冠状动脉疾病中的预后价值尚未明确。
“糖尿病交叉点减少心血管并发症创新研究”（ARTEMIS）纳入了1946例经血管造影证实患有冠状动脉疾病（CAD）的患者。研究患者在基线时接受了包括12导联数字心电图（ECG）在内的全面检查。
在73±22个月的随访期内，共有201例（10.3%）患者死亡。在研究患者中，95例（4.9%）发生心源性死亡（CD），其中包括44例（2.3%）心源性猝死（SCD）和51例（2.6%）非心源性猝死（NSCD），106例（5.4%）患者发生非心源性死亡（NCD）。在Cox回归分析中，即使在调整了相关临床风险标志物后，T波形态离散度（TMD）、T波面积离散度（TWAD）和总余弦R到T（TCRT）与CD仍有显著关联（多变量风险比：1.015，95%置信区间1.007 - 1.023，p = 0.0003；0.474，95%置信区间0.30五 - 0.737，p = 0.0009；0.598，95%置信区间0.412 - 0.866，p = 0.006）。当将这些参数纳入CD的临床风险模型时，C指数从0.810提高到0.823，显著改善了辨别能力（综合辨别指数[IDI] = 0.0118，95%置信区间0.0028 - 0.0208，p = 0.01）。这些参数与NSCD的关联（多变量p值从0.016到0.001）比与SCD的关联更密切（TMD的单变量/多变量p值为0.015/0.197，TCRT的单变量/多变量p值为0.012/0.43）。
描述复极异质性的T波形态参数提高了当前治疗时代CAD患者CD临床风险模型的预测能力。
