Document Detail

Repolarization abnormality for prediction of all-cause and cardiovascular mortality in American Indians: the Strong Heart Study.
MedLine Citation:
PMID:  16174013     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Analysis of electrocardiographic (ECG) repolarization abnormality using QTc interval and principal component analysis (PCA) of the T-wave vector predict all-cause and cardiovascular (CV) mortality. Novel descriptors of T-wave morphology have been suggested as measures of repolarization heterogeneity and adverse prognosis. However, whether these T-wave descriptors provide prognostic information beyond QTc and the PCA ratio has not been examined. METHODS AND RESULTS: Predictive values of QTc, PCA, and novel ECG variables characterizing the T-wave loop were assessed in 1,729 American Indian participants in the first Strong Heart Study exam. T-loop morphology was quantified by the ratio of the second to first eigenvalues of the T-wave vector (PCA ratio), T-loop area (TLA) projected onto the dominant vector plane, T-wave morphology dispersion (TMD) and by the sum of the squares of the fourth to eighth eigenvalues, the T-wave residuum (TWR). After mean follow-up of 4.8 +/- 0.8 years, there were 183 deaths from all causes, including 51 CV deaths. In univariate Cox analyses, prolonged QTc, increased PCA ratio, TLA, TMD, and TWR were significant predictors of all-cause and CV mortality (P < 0.001). In multivariate Cox analyses adjusting for demographic and clinical risk factors for mortality, increased PCA ratio (chi-square = 7.9, P = 0.005) and TWR (chi-square = 5.3, P = 0.022) remained significant predictors of CV mortality and increased QTc (chi-square = 12.1, P < 0.001) and TWR (chi-square = 6.0, P = 0.014) of all-cause mortality. Addition of TWR to the model with clinical variables and the PCA ratio for CV mortality and to the model with clinical variables and prolonged QTc for all-cause mortality increased prognostic value of each model (increase in overall chi-square from 287.5 to 301.9 and from 221.5 to 230.3, respectively). CONCLUSION: Novel descriptors of T-wave complexity provide additional prognostic information beyond QTc and PCA ratio for prediction of all-cause and CV mortality.
Peter M Okin; Marek Malik; Katerina Hnatkova; Elisa T Lee; James M Galloway; Lyle G Best; Barbara V Howard; Richard B Devereux
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  16     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-21     Completed Date:  2005-12-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  945-51     Citation Subset:  IM    
Greenberg Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, New York, New York 10021, USA.
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MeSH Terms
Arrhythmias, Cardiac / diagnosis,  mortality
Cardiovascular Diseases / diagnosis*,  ethnology,  mortality*
Diagnosis, Computer-Assisted / methods*
Electrocardiography / methods*
Indians, North American / statistics & numerical data*
Middle Aged
Principal Component Analysis
Reproducibility of Results
Risk Assessment / methods*
Risk Factors
Sensitivity and Specificity
Survival Analysis
Survival Rate
United States / epidemiology
Grant Support
Comment In:
J Cardiovasc Electrophysiol. 2005 Sep;16(9):952-3   [PMID:  16174014 ]
Erratum In:
J Cardiovasc Electrophysiol. 2005 Sep;16(9):937

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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