Clinical Pharmacology and Precision Medicine William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London London United Kingdom.
Aragon Institute of Engineering Research University of Zaragoza Zaragoza Spain.
J Am Heart Assoc. 2022 Sep 6;11(17):e025897. doi: 10.1161/JAHA.121.025897. Epub 2022 Aug 29.
Background Early identification of individuals at risk of sudden cardiac death (SCD) remains a major challenge. The ECG is a simple, common test, with potential for large-scale application. We developed and tested the predictive value of a novel index quantifying T-wave morphologic variations with respect to a normal reference (TMV), which only requires one beat and a single-lead ECG. Methods and Results We obtained reference T-wave morphologies from 23 962 participants in the UK Biobank study. With Cox models, we determined the association between TMV and life-threatening ventricular arrhythmia in an independent data set from UK Biobank study without a history of cardiovascular events (N=51 794; median follow-up of 122 months) and SCD in patients with coronary artery disease from ARTEMIS (N=1872; median follow-up of 60 months). In UK Biobank study, 220 (0.4%) individuals developed life-threatening ventricular arrhythmias. TMV was significantly associated with life-threatening ventricular arrhythmias (hazard ratio [HR] of 1.13 per SD increase [95% CI, 1.03-1.24]; =0.009). In ARTEMIS, 34 (1.8%) individuals reached the primary end point. Patients with TMV ≥5 had an HR for SCD of 2.86 (95% CI, 1.40-5.84; =0.004) with respect to those with TMV <5, independently from QRS duration, corrected QT interval, and left ventricular ejection fraction. TMV was not significantly associated with death from a cause other than SCD. Conclusions TMV identifies individuals at life-threatening ventricular arrhythmia and SCD risk using a single-beat single-lead ECG, enabling inexpensive, quick, and safe risk assessment in large populations.
早期识别发生心源性猝死（SCD）风险的个体仍然是一个主要挑战。心电图是一种简单、常见的检测手段，具有广泛应用的潜力。我们开发并测试了一种新的指数，该指数通过量化 T 波形态相对于正常参考的变化（TMV）来预测风险，仅需一个心动周期和一个导联心电图即可完成。
我们从英国生物库研究中的 23962 名参与者中获得了参考 T 波形态。使用 Cox 模型，我们在没有心血管事件史的英国生物库研究的独立数据集中（N=51794；中位随访 122 个月）以及 ARTEMIS 中冠心病患者的 SCD 中（N=1872；中位随访 60 个月）确定了 TMV 与危及生命的室性心律失常之间的关联。在英国生物库研究中，有 220 名（0.4%）个体发生危及生命的室性心律失常。TMV 与危及生命的室性心律失常显著相关（每增加一个标准差的 HR 为 1.13[95%CI，1.03-1.24]；=0.009）。在 ARTEMIS 中，有 34 名（1.8%）患者达到了主要终点。TMV≥5 的患者发生 SCD 的 HR 为 2.86（95%CI，1.40-5.84；=0.004），而 TMV<5 的患者的 HR 为 1.40-5.84，与 QRS 持续时间、校正 QT 间期和左心室射血分数独立相关。TMV 与非 SCD 原因导致的死亡无显著相关性。
TMV 使用单个心动周期单个导联心电图识别发生危及生命的室性心律失常和 SCD 风险的个体，能够在大人群中进行廉价、快速和安全的风险评估。
