Prolonged Tpeak-Tend interval is a risk factor for sudden cardiac death in adults with congenital heart disease

被引:11
作者
Vehmeijer, Jim T. [1 ]
Koyak, Zeliha [1 ]
Vink, A. Suzanne [1 ]
Budts, Werner [2 ,3 ]
Harris, Louise [4 ]
Silversides, Candice K. [4 ]
Oechslin, Erwin N. [4 ]
Zwinderman, Aeilko H. [5 ]
Mulder, Barbara J. M. [1 ,6 ]
de Groot, Joris R. [1 ]
机构
[1] Univ Amsterdam, Amsterdam Univ Med Ctr, Heart Ctr, Dept Clin & Expt Cardiol, Amsterdam, Netherlands
[2] Univ Ziekenhuis Leuven, Dept Cardiol, Leuven, Belgium
[3] Katholieke Univ Leuven, Dept Cardiovasc Sci, Leuven, Belgium
[4] Univ Toronto, Div Cardiol, Peter Munk Cardiac Ctr, Toronto Congenital Cardiac Ctr Adults, Toronto, ON, Canada
[5] Univ Amsterdam, Amsterdam Univ Med Ctr, Dept Clin Epidemiol & Biostat, Amsterdam, Netherlands
[6] Netherlands Heart Inst, Utrecht, Netherlands
关键词
congenital heart disease; electrocardiography; risk factor; sudden cardiac death; Tpeak-Tend; IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS; QT INTERVAL; LONG-QT; REPOLARIZATION; DISPERSION; MORTALITY; WAVE; ARRHYTHMIAS; MANAGEMENT; TETRALOGY;
D O I
10.1111/chd.12847
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective Adult congenital heart disease (ACHD) patients are at risk of sudden cardiac death (SCD). However, methods for risk stratification are not yet well-defined. The T-peak-T-end (TpTe) interval, a measure of dispersion of ventricular repolarization, is a risk factor for SCD in non-ACHD patients. We aim to evaluate whether TpTe can be used in risk stratification for SCD in ACHD patients. Design From an international multicenter cohort of 25 790 ACHD patients, we identified all SCD cases. Cases were matched to controls by age, gender, congenital defect, and (surgical) intervention. Outcome Measures TpTe was measured on a standard 12-lead ECG. The maximum TpTe of all ECG leads (TpTe-max), mean (TpTe-mean), and TpTe dispersion (maximum minus minimum) were obtained. Odds ratios (OR) for SCD cases vs controls were calculated using conditional logistic regression analysis. Results ECGs were available for 147 cases (median age at death 33.5 years (quartiles 26.2, 48.7), 66% male) and 267 controls. The mean TpTe-max was 97 +/- 24 ms in cases vs 84 +/- 17 ms in controls (P < .001); TpTe-mean was 70 +/- 16 vs 63 +/- 10 ms (P < .001); and dispersion was 51 +/- 22 ms vs 41 +/- 16 ms (P = .02), respectively. Assessing each ECG lead separately, TpTe in lead aVR predicted SCD most accurately. TpTe in lead aVR was 71 +/- 23 ms in cases vs 61 +/- 13 ms in controls (P < .001). After adjusting for impaired ventricular function, heart failure symptoms, and prolonged QRS duration, the OR of SCD of TpTe in lead aVR at an optimal cutoff of 80 ms was 5.8 (95% CI 2.7-12.4, P < .001). Conclusions The TpTe interval is associated with SCD in ACHD patients. Particularly, TpTe in lead aVR can be used as an independent risk factor for SCD in ACHD patients and may, therefore, add precision to current risk prediction models.
引用
收藏
页码:952 / 957
页数:6
相关论文
共 31 条
[21]   Accurate electrocardiographic assessment of the QT interval: Teach the tangent [J].
Postema, Pieter G. ;
De Jong, Jonas S. S. G. ;
Van der Bit, Ivo A. C. ;
Wide, Arthur A. M. .
HEART RHYTHM, 2008, 5 (07) :1015-1018
[22]   2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death [J].
Priori, Silvia G. ;
Blomstrom-Lundqvist, Carina ;
Mazzanti, Andrea ;
Blom, Nico ;
Borggrefe, Martin ;
Camm, John ;
Elliott, Perry Mark ;
Fitzsimons, Donna ;
Hatala, Robert ;
Hindricks, Gerhard ;
Kirchhof, Paulus ;
Kjeldsen, Keld ;
Kuck, Karl-Heinz ;
Hernandez-Madrid, Antonio ;
Nikolaou, Nikolaos ;
Norekval, Tone M. ;
Spaulding, Christian ;
Van Veldhuisen, Dirk J. .
EUROPACE, 2015, 17 (11) :1601-1687
[23]   Late Causes of Death After Pediatric Cardiac Surgery A 60-Year Population-Based Study [J].
Raissadati, Alireza ;
Nieminen, Heta ;
Haukka, Jari ;
Sairanen, Heikki ;
Jokinen, Eero .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2016, 68 (05) :487-498
[24]  
RCore Team, 2018, R LANG ENV STAT COMP
[25]  
Schindelin J, 2012, NAT METHODS, V9, P676, DOI [10.1038/NMETH.2019, 10.1038/nmeth.2019]
[26]   The Tpeak - Tend interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and meta-analysis [J].
Tse, Gary ;
Gong, Mengqi ;
Wong, Wing Tak ;
Georgopoulos, Stamatis ;
Letsas, Konstantinos P. ;
Vassiliou, Vassilios S. ;
Chan, Yat Sun ;
Yan, Bryan P. ;
Wong, Sunny Hei ;
Wu, William K. K. ;
Ciobanu, Ana ;
Li, Guangping ;
Shenthar, Jayaprakash ;
Saguner, Ardan M. ;
Ali-Hasan-Al-Saegh, Sadeq ;
Bhardwaj, Aishwarya ;
Sawant, Abhishek C. ;
Whittaker, Paula ;
Xia, Yunlong ;
Yan, Gan-Xin ;
Liu, Tong .
HEART RHYTHM, 2017, 14 (08) :1131-1137
[27]   Sudden cardiac death in adults with congenital heart disease: does QRS-complex fragmentation discriminate in structurally abnormal hearts? [J].
Vehmeijer, Jim T. ;
Koyak, Zeliha ;
Bokma, Jouke P. ;
Budts, Werner ;
Harris, Louise ;
Mulder, Barbara J. M. ;
de Groot, Joris R. .
EUROPACE, 2018, 20 :F122-F128
[28]   Prevention of Sudden Cardiac Death in Adults With Congenital Heart Disease Do the Guidelines Fall Short? [J].
Vehmeijer, Jim T. ;
Koyak, Zeliha ;
Budts, Werner ;
Harris, Louise ;
Silversides, Candice K. ;
Oechslin, Erwin N. ;
Bouma, Berto J. ;
Zwinderman, Aeilko H. ;
Mulder, Barbara J. M. ;
de Groot, Joris R. .
CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY, 2017, 10 (07)
[29]   Implantable cardioverter-defibrillators in adults with congenital heart disease: a systematic review and meta-analysis [J].
Vehmeijer, Jim T. ;
Brouwer, Tom F. ;
Limpens, Jacqueline ;
Knops, Reinoud E. ;
Bouma, Berto J. ;
Mulder, Barbara J. M. ;
de Groot, Joris R. .
EUROPEAN HEART JOURNAL, 2016, 37 (18) :1439-1448
[30]   Mortality in adult congenital heart disease [J].
Verheugt, Carianne L. ;
Uiterwaal, Cuno S. P. M. ;
van der Velde, Enno T. ;
Meijboom, Folkert J. ;
Pieper, Petronella G. ;
van Dijk, Arie P. J. ;
Vliegen, Hubert W. ;
Grobbee, Diederick E. ;
Mulder, Barbara J. M. .
EUROPEAN HEART JOURNAL, 2010, 31 (10) :1220-1229