Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Heart Rhythm. 2020 Aug;17(8):1312-1319. doi: 10.1016/j.hrthm.2020.03.030. Epub 2020 Apr 14.
Positive T wave in lead aVR (TaVR) has been associated with increased risk of adverse events in patients with various cardiovascular diseases.
The purpose of this study was to investigate the prevalence and prognostic significance of positive TaVR in patients with hypertrophic cardiomyopathy (HCM).
This study investigated 421 consecutive patients with HCM (177 women; age 51.1 ± 14.9 years). Admission electrocardiogram was examined for the presence of a positive TaVR. The primary endpoint was defined as a composite of major arrhythmic events (MAEs), which included sudden cardiac death, sustained ventricular tachycardia or fibrillation, or appropriate implantable cardioverter-defibrillator therapy. Cardiovascular mortality and all-cause death were evaluated as secondary endpoints.
During median follow-up period of 6.0 years (interquartile range 4.0-11.6 years), 53 patients (12.6%) experienced the primary endpoint. On multivariable competing analysis, after adjusting for other confounding factors, the presence of positive TaVR was found to be an independent and strong predictor of the primary composite endpoint. Time-dependent receiver operating characteristic analysis, net reclassification index, and integrated discrimination improvement showed that the addition of positive TaVR to conventional HCM risk factors improved prediction of arrhythmic events. However, in subgroup analysis, a positive TaVR lost statistical significance in patients with apical HCM but remained significant in patients with all other hypertrophy patterns.
Positive TaVR is associated with MAE in HCM patients, independent of and incremental to traditional risk factors.
在患有各种心血管疾病的患者中，aVR 导联的正向 T 波（TaVR）与不良事件风险增加相关。
本研究旨在探讨肥厚型心肌病（HCM）患者中 TaVR 阳性的患病率和预后意义。
本研究纳入了 421 例连续的 HCM 患者（女性 177 例；年龄 51.1±14.9 岁）。检查入院心电图是否存在 TaVR 阳性。主要终点定义为主要心律失常事件（MAEs）的复合终点，包括心源性猝死、持续性室性心动过速或颤动、或适当的植入式心脏复律除颤器治疗。心血管死亡率和全因死亡率被评估为次要终点。
在中位随访 6.0 年期间（四分位间距 4.0-11.6 年），53 例患者（12.6%）发生了主要终点。在多变量竞争分析中，在调整其他混杂因素后，TaVR 阳性被发现是主要复合终点的独立且强有力的预测因素。时间依赖性受试者工作特征曲线分析、净重新分类指数和综合判别改善表明，将 TaVR 阳性加入传统的 HCM 危险因素可改善心律失常事件的预测。然而，在亚组分析中，在心尖型 HCM 患者中 TaVR 阳性失去统计学意义，但在所有其他肥厚模式的患者中仍有意义。
TaVR 阳性与 HCM 患者的 MAE 相关，独立于且增加了传统的危险因素。
