Normal ranges and potential modifiers of T-wave morphology parameters among healthy individuals: A meta-analysis

T-wave morphology parameters, such as total cosine R-to-T (TCRT), T-wave loop dispersion (TWLD), T-wave morphology dispersion (TMD), and T-wave residuum (TWR), were suggested to be robust markers for adverse cardiovascular outcomes. Yet, the normal range of these parameters is unknown. This study aimed to evaluate the weighted normal values of T-wave morphology parameters of healthy individuals and study the effect of potential modifiers.

A systematic search of studies published in PubMed was conducted. Only those reporting on control groups of healthy individuals were included. Weighted means were calculated for TCRT, TWLD, TMD, and TWR. Linear regression analysis was conducted for age, percentage of males, heart rate, and QTc.

The weighted TCRT was 0.40 ± 0.05, significantly higher than the various cutoffs previously suggested to identify high risk. There was some overlap between the results of weighted normal TMD (19.42 ± 6.77°), TWLD (38.51 ± 0.31), and relative TWR (0.118 ± 0.056%) and reports on the same parameters from patients with cardiovascular disease. Women were also characterized by higher TWLD, TMD, and relative TWR. TCRT was negatively correlated with age and heart rate, and positively correlated with QTc duration, although all associations were weak (R²  < 0.9).

T-wave morphology parameters reported in the medical literature span a broad range of values in healthy individuals. Seemingly abnormal values of TWLD, TMD, and relative TWR were often reported in healthy adults. The variability between studies may stem from methodological issues. Therefore, standardizing the methodology for measuring T-wave morphology is imperative.