Tpeak-to-Tend/QT is an independent predictor of early ventricular arrhythmias and arrhythmic death in anterior ST elevation myocardial infarction patients

Abstract

Background:

The aim of our study was to analyse the markers of transmural dispersion of ventricular repolarization, especially Tpeak-to-Tend and Tpeak-to-Tend /QT ratio, in patients with anterior ST elevation myocardial infarction on admission and to evaluate their association with in-hospital life-threatening arrhythmias and mortality.

Methods and results:

A total of 223 consecutive patients with anterior wall ST elevation myocardial infarction admitted to our Division of Cardiology between January 2010 and December 2012 were prospectively evaluated. A standard electrocardiogram was obtained on admission and then analysed. The primary end point was constituted by in-hospital ventricular arrhythmias and arrhythmic death. At univariate analysis heart rate (odds ratio = 1.03; 95% confidence intervals 1.006-1.05; p=0.001), maximal ST elevation (odds ratio =1.25; 95% confidence intervals 1.10–1.43; p=0.0001), QTc Bazett (odds ratio = 1.01; 95% confidence intervals 1.006–1.02; p=0.002), QT dispersion (odds ratio = 1.02; 95% confidence intervals 1.002–1.04; p=0.02) and both Tpeak-to-Tend and Tpeak-to-Tend/QT (odds ratio = 1.02; 95% confidence intervals 1.01–1.03; p<0.0001 and OR = 1.07; 95% confidence intervals 1.03–1.11; p<0.0001 respectively) were significantly associated with ventricular arrhythmias and arrhythmic mortality. Of note, Tpeak-to-Tend /QT remained a predictor of early ventricular arrhythmias and arrhythmic death (odds ratio = 1.04; 95% confidence intervals 1.003 – 1.10; p=0.03) independently from heart rate and maximal ST elevation. Receiver operating characteristic curve analysis showed that Tpeak-to-Tend /QT values <0.31 had a predictive negative value of 92% for the prediction of the composite outcome.

Conclusions:

Tpeak-to-Tend /QT was an independent predictor of early ventricular arrhythmias and arrhythmic mortality in patients with anterior ST elevation myocardial infarction. Especially, Tpeak-to-Tend /QT <0.31 may identify a subgroup of ST elevation myocardial infarction patients with low risk of early arrhythmias and arrhythmic death.

Keywords

Tpeak-to-Tend arrhythmias ST elevation myocardial infarction dispersion of ventricular repolarization

Get full access to this article

View all access options for this article.

References

Cannon

Greenberg

. Risk stratification and prognostic factors in the post-myocardial infarction patient. Am J Cardiol 2008; 102: 13–20.

Huikuri

Raatikainen

Moerch-Joergensen

. Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction. Eur Heart J 2009; 30: 689–698.

Kuriachan

Exner

. Role of risk stratification after myocardial infarction. Curr Treat Options Cardiovasc Med 2009; 11: 10–21.

Castro Hevia

Antzelevitch

Tornes Barzaga

. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol 2006; 47: 1828–1834.

Kanters

Haarmark

Vedel-Larsen

. Tpeak Tend interval in long QT syndrome. J Electrocardiol 2008; 41: 603–608.

Kors

Ritsema van Eck

van Herpen

. The meaning of the Tp-Te interval and its diagnostic value. J Electrocardiol 2008; 41: 575–580.

Taggart

Sutton

Opthof

. Transmural repolarisation in the left ventricle in humans during normoxia and ischaemia. Cardiovasc Res 2001; 50: 454–462.

Opthof

Coronel

Janse

. Is there a significant transmural gradient in repolarization time in the intact heart? Repolarization gradients in the intact heart. Circ Arrhythm Electrophysiol 2009; 2: 89 –96.

Antzelevitch

Sicouri

Litovsky

. Heterogeneity within the ventricular wall. Electrophysiology and pharmacology of epicardial, endocardial, and M cells. Circ Res 1991; 69: 1427–1449.

10.

Yan

Antzelevitch

. Cellular basis for the normal T wave and the electrocardiographic manifestations of the long-QT syndrome. Circulation 1998; 98: 1928–1936.

11.

Antzelevitch

Shimizu

Yan

. Cellular basis for QT dispersion. J Electrocardiol 1998; 30: 168–175.

12.

Panikkath

Reinier

Uy-Evanado

. Prolonged Tpeak-to-Tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol 2011; 4: 441–447.

13.

Haarmark

Hansen

Vedel-Larsen

. The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Electrocardiol 2009; 42: 555–560.

14.

Zhao

Xie

Chu

. Association between Tp-e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Clin Cardiol 2012; 35: 559–564.

15.

Antzelevitch

. Role of spatial dispersion of repolarization in inherited and acquired sudden cardiac death syndromes. Am J Physiol Heart Circ Physiol 2007; 293: 2024–2038.

16.

Antzelevitch

Viskin

Shimizu

. Does Tpeak-Tend provide an index of transmural dispersion of repolarization? Heart Rhythm 2007; 4: 1114–1119.

17.

Bai

. Left ventricular epicardial activation increases transmural dispersion of repolarization in healthy, long QT, and dilated cardiomyopathy dogs. Pacing Clin Electrophysiol 2005; 28: 1098–1106

18.

Xia

Liang

Kongstad

. Tpeak-Tend interval as an index of global dispersion of ventricular repolarization: evaluations using monophasic action potential mapping of the epi- and endocardium in swine. J Interv Card Electrophysiol 2005; 14: 79–87.

19.

Opthof

Janse

Coronel

. Letter by Opthof, et al. regarding article, ‘Prolonged Tpeak to tend interval on the resting electrocardiogram is associated with increased risk of sudden cardiac death’. Circ Arrhythm Electrophysiol 2011; 4: e87–88.

20.

Barbhaiya

Hanon

. Tpeak - Tend and Tpeak - Tend /QT ratio as markers of ventricular arrhythmia risk in cardiac resynchronization therapy patients. Pacing Clin Electrophysiol 2013; 36: 103–108.

21.

Gellert

Rautaharju

Snyder

. Short-term repeatability of electrocardiographic Tpeak-Tend and QT intervals. J Electrocardiol 2014; 47: 356–361.

22.

Rubart

Zipes

. Mechanisms of sudden cardiac death. J Clin Invest 2005; 115: 2305–2315.

23.

Gupta

Patel

. T_p-e/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008; 41: 567–574.

24.

Fox

Bousser

Amarenco

. Heart rate is a prognostic risk factor for myocardial infarction: a post hoc analysis in the PERFORM (Prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack) study population. Int J Cardiol 2013; 168: 3500–3505.

25.

Birnbaum

Criger

Wagner

. Prediction of the extent and severity of left ventricular dysfunction in anterior acute myocardial infarction by the admission electrocardiogram. Am Heart J 2001; 141: 915–924.

26.

Kozuch

Kralisz

Korecki

. Early and long-term prognosis of patients with coronary artery disease treated with percutaneous coronary interventions in 2005. Experience of single large-volume PCI center. Adv Med Sci 2011; 56: 222–230.