QRS-T morphology measured from exercise electrocardiogram as a predictor of cardiac mortality

• Published in: Europace (London, England) England), 2011-05, Vol.13 (5), p.701-707
• Main Authors: Kenttä, Tuomas, Karsikas, Mari, Junttila, M Juhani, Perkiömäki, Juha S, Seppänen, Tapio, Kiviniemi, Antti, Nieminen, Tuomo, Lehtimäki, Terho, Nikus, Kjell, Lehtinen, Rami, Viik, Jari, Kähönen, Mika, Huikuri, Heikki V
• Format: Article
• Language: English
• Subjects: Adult; Aged; Death, Sudden, Cardiac - epidemiology; Electrocardiography - methods; Exercise Test - methods; Female; Follow-Up Studies; Heart Diseases - diagnosis; Heart Diseases - mortality; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Risk Factors; Stroke Volume
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euq461

Total cosine R-to-T (TCRT) measured from the standard 12-lead electrocardiogram (ECG) reflects the spatial relationship between depolarization and repolarization wavefronts and a low TCRT value is a marker of poor prognosis. We tested the hypothesis that measurement of TCRT or QRS/T angle from exercise ECG would provide even more powerful prognostic information. The prognostic significances of TCRT and QRS/T angle were assessed from exercise ECG recordings in 1297 patients [age 56 ± 13 years (mean ± SD), 67% males] undergoing a clinically indicated bicycle stress-test and the subsequent follow-up. During an average follow-up of 45 ± 12 months, 74 patients died (5.7%); 34 (2.6%) were cardiac deaths, and 24 (1.9%) were sudden cardiac deaths. Total cosine R-to-T and QRS/T angle exhibited a correlation with the RR intervals in the total cohort, but the individual responses were variable, e.g. median correlation of TCRT-RR was 0.89 with an inter-quartile range from 0.55 to 0.98. A reduced correlation of TCRT-RR during the recovery phase of exercise ECG predicted cardiac death [adjusted heart rate (HR) 3.5, 95% confidence interval (CI): 1.8-6.8, P= 0.001] similarly as the baseline TCRT measured from ECG at rest (adjusted HR 3.4, 95% CI: 1.4-8.1, P= 0.01). The poor correlation between the TCRT-RR both during the exercise and recovery was specifically related to a risk of sudden cardiac death (adjusted HR 6.2, 95% CI: 2.1-17.8, P< 0.001). Loss of rate-adaptation of the spatial relationship between depolarization and repolarization wavefronts is a strong predictor of cardiac death, especially of sudden cardiac death.