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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
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Prognostic value of T-wave morphology parameters in coronary artery disease in current treatment era

Joni M Pirkola1, Maija Konttinen1, Tuomas V Kenttä1

  • 1Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|February 28, 2018
PubMed

Insights

T-wave morphology parameters significantly improve cardiac death prediction in coronary artery disease (CAD) patients. These ECG markers enhance existing risk models, offering better prognostic insights in the current treatment era.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Electrocardiography

Background:

  • Prognostic value of T-wave morphology in coronary artery disease (CAD) is not well-established in the current treatment era.
  • The Innovation to reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study investigated this in 1,946 CAD patients.

Purpose of the Study:

  • To evaluate the prognostic value of T-wave morphology parameters in predicting cardiac death (CD) in patients with CAD.
  • To determine if these parameters improve the predictive power of existing clinical risk models.

Main Methods:

  • Analysis of 12-lead digital electrocardiograms (ECGs) from 1,946 CAD patients in the ARTEMIS study.
  • Assessment of T-wave morphology parameters including T-wave morphology dispersion (TMD), T-wave area dispersion (TWAD), and total cosine R-to-T (TCRT).
  • Cox regression analysis and risk model discrimination assessment (C-index, integrated discrimination index) over a 73-month follow-up.

Main Results:

  • TMD, TWAD, and TCRT were significantly associated with cardiac death (CD) after adjusting for clinical risk markers.
  • Inclusion of these parameters increased the C-index of the clinical risk model for CD from 0.810 to 0.823 (p=0.01).
  • Parameters showed stronger association with nonsudden cardiac death (NSCD) than sudden cardiac death (SCD).

Conclusions:

  • T-wave morphology parameters describing repolarization heterogeneity enhance the predictive capability of clinical risk models for cardiac death in CAD patients.
  • These ECG-derived metrics offer improved prognostic value in the current therapeutic landscape for CAD.
Abstract

Keywords:
T-wave morphologyelectrocardiogramrepolarization

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