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Prolonged T-peak to T-end Interval Predicts Implantable Cardioverter Defibrillator Therapy in Patients With Cardiac
Shohei Kataoka1, Daigo Yagishita1,2, Kyoichiro Yazaki1
1Department of Cardiology, Tokyo Women's Medical University.
Insights
The T-peak to T-end interval (Tp-e) exceeding 91 ms predicts ventricular arrhythmia events in cardiac sarcoidosis patients with defibrillators. This finding aids in risk stratification for these individuals.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Cardiac sarcoidosis (CS) poses risks for ventricular arrhythmias (VA).
- The predictive value of the T-peak to T-end interval (Tp-e) for VA in CS is not well-established.
- Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) are used in managing CS patients.
Purpose of the Study:
- To investigate the association between the Tp-e interval and VA events in CS patients with ICDs or CRT-Ds.
- To determine if Tp-e can serve as a predictor of appropriate ICD therapy in this population.
Main Methods:
- Retrospective study of 50 CS patients with ICD/CRT-D.
- Evaluation of maximum Tp-e interval from 12-lead ECG post-implantation.
- Clinical endpoint defined as appropriate ICD therapy.
- Kaplan-Meier analysis and multivariate Cox regression.
Main Results:
- A median follow-up of 85 months revealed 22 patients received appropriate ICD therapy.
- An optimal Tp-e cut-off of 91 ms predicted the clinical endpoint with 72.7% sensitivity and 87.0% specificity.
- Tp-e ≥91 ms (HR 5.10) and histological CS diagnosis (HR 3.84) were significant predictors of VA events.
Conclusions:
- A Tp-e interval of 91 ms or greater is a significant predictor of VA events in CS patients with ICD/CRT-D.
- This electrophysiological marker can aid in identifying high-risk individuals for closer monitoring and management.
- Further research may refine the role of Tp-e in predicting arrhythmias in specific cardiac conditions.
Background:
The association between the T-peak to T-end interval (Tp-e) and ventricular arrhythmia (VA) events in cardiac sarcoidosis (CS) is unknown. The purpose of this study was to investigate whether Tp-e was associated with VA events in CS patients with implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds).
Methods And Results:
We retrospectively studied 50 patients (16 men; mean [±SD] age 56.3±10.5 years) with CS and ICD/CRT-D. The maximum Tp-e in the precordial leads recorded by a 12-lead electrocardiogram after ICD/CRT-D implantation was evaluated. The clinical endpoint was defined as appropriate ICD therapy. During a median follow-up period of 85.0 months, 22 patients underwent appropriate therapy and 10 patients died. Kaplan-Meier analysis revealed that the probability of the clinical endpoint was 28.3% at 2 years and 35.3% at 4 years. The optimal cut-off value of the Tp-e for the prediction of the clinical endpoint was 91 ms, with a sensitivity of 72.7% and a specificity of 87.0% (area under the curve=0.81). Multivariate Cox regression analysis showed that Tp-e ≥91 ms (hazard ratio [HR] 5.10; 95% confidence interval [CI] 1.99-13.1; P<0.001) and a histological diagnosis of CS (HR 3.84; 95% CI 1.28-11.5; P=0.016) were significantly associated with the clinical endpoint.
Conclusions:
Tp-e ≥91 ms was a significant predictor of VA events in patients with CS and ICD/CRT-D.
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