Quantitative T-wave morphology assessment from surface ECG is linked with cardiac events risk in genotype-positive KCNH2 mutation carriers with normal QTc values
(2019) In Journal of Cardiovascular Electrophysiology 30(12). p.2907-2913- Abstract
Introduction: Long QT syndrome (LQTS) mutation carriers have elevated the risk of cardiac events even in the absence of QTc prolongation; however, mutation penetrance in patients with normal QTc may be reflected in abnormal T-wave shape, particularly in KCNH2 mutation carriers. We aimed to assess whether the magnitude of a three-dimensional T-wave vector (TwVM) will identify KCNH2-mutation carriers with normal QTc at risk for cardiac events. Methods: Adult LQT2 patients with QTc < 460 ms in men and <470 ms in women (n = 113, age 42 ± 16 years, 43% male) were compared with genotype-negative family members (n = 1007). The TwVM was calculated using T-wave amplitudes in leads V6, II, and V2 as the square root of (TV62 +... (More)
Introduction: Long QT syndrome (LQTS) mutation carriers have elevated the risk of cardiac events even in the absence of QTc prolongation; however, mutation penetrance in patients with normal QTc may be reflected in abnormal T-wave shape, particularly in KCNH2 mutation carriers. We aimed to assess whether the magnitude of a three-dimensional T-wave vector (TwVM) will identify KCNH2-mutation carriers with normal QTc at risk for cardiac events. Methods: Adult LQT2 patients with QTc < 460 ms in men and <470 ms in women (n = 113, age 42 ± 16 years, 43% male) were compared with genotype-negative family members (n = 1007). The TwVM was calculated using T-wave amplitudes in leads V6, II, and V2 as the square root of (TV62 + TII2 + (0.5*TV2)2). Cox regression analysis adjusted for gender and time-dependent beta-blocker use was performed to assess cardiac event (CE) risk, defined as syncope, aborted cardiac arrest, implantable cardioverter-defibrillator therapy, or sudden death. Results: Dichotomized by median of 0.30 mV, lower TwVM was associated with elevated CE risk compared to those with high TwVM (HR = 2.95, 95% CI, 1.25-6.98, P =.014) and also remained significant after including sex and time-dependent beta-blocker usage in the Cox regression analysis (HR = 2.64, 95% CI, 1.64-4.24, P <.001). However, these associations were found only in women but not in men who had low event rates. Conclusion: T-wave morphology quantified as repolarization vector magnitude using T-wave amplitudes retrieved from standard 12-lead electrocardiogram predicts cardiac events risk in LQT2 women and appears useful for risk stratification of KCNH2-mutation carriers without QTc prolongation.
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- author
- Cortez, Daniel LU ; Zareba, Wojciech ; McNitt, Scott ; Polonsky, Bronislava ; Rosero, Spencer Z. and Platonov, Pyotr G. LU
- organization
- publishing date
- 2019-10-03
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- cardiac events, long QT syndrome, T-wave vector magnitude
- in
- Journal of Cardiovascular Electrophysiology
- volume
- 30
- issue
- 12
- pages
- 2907 - 2913
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:31579959
- scopus:85074089075
- ISSN
- 1045-3873
- DOI
- 10.1111/jce.14210
- language
- English
- LU publication?
- yes
- id
- 8b7d4ce0-a4bc-443b-a22f-fa3ef7dd86ee
- date added to LUP
- 2019-11-07 12:33:19
- date last changed
- 2024-08-21 10:47:10
@article{8b7d4ce0-a4bc-443b-a22f-fa3ef7dd86ee, abstract = {{<p>Introduction: Long QT syndrome (LQTS) mutation carriers have elevated the risk of cardiac events even in the absence of QTc prolongation; however, mutation penetrance in patients with normal QTc may be reflected in abnormal T-wave shape, particularly in KCNH2 mutation carriers. We aimed to assess whether the magnitude of a three-dimensional T-wave vector (TwVM) will identify KCNH2-mutation carriers with normal QTc at risk for cardiac events. Methods: Adult LQT2 patients with QTc < 460 ms in men and <470 ms in women (n = 113, age 42 ± 16 years, 43% male) were compared with genotype-negative family members (n = 1007). The TwVM was calculated using T-wave amplitudes in leads V6, II, and V2 as the square root of (TV6<sup>2</sup> + TII<sup>2</sup> + (0.5*TV2)<sup>2</sup>). Cox regression analysis adjusted for gender and time-dependent beta-blocker use was performed to assess cardiac event (CE) risk, defined as syncope, aborted cardiac arrest, implantable cardioverter-defibrillator therapy, or sudden death. Results: Dichotomized by median of 0.30 mV, lower TwVM was associated with elevated CE risk compared to those with high TwVM (HR = 2.95, 95% CI, 1.25-6.98, P =.014) and also remained significant after including sex and time-dependent beta-blocker usage in the Cox regression analysis (HR = 2.64, 95% CI, 1.64-4.24, P <.001). However, these associations were found only in women but not in men who had low event rates. Conclusion: T-wave morphology quantified as repolarization vector magnitude using T-wave amplitudes retrieved from standard 12-lead electrocardiogram predicts cardiac events risk in LQT2 women and appears useful for risk stratification of KCNH2-mutation carriers without QTc prolongation.</p>}}, author = {{Cortez, Daniel and Zareba, Wojciech and McNitt, Scott and Polonsky, Bronislava and Rosero, Spencer Z. and Platonov, Pyotr G.}}, issn = {{1045-3873}}, keywords = {{cardiac events; long QT syndrome; T-wave vector magnitude}}, language = {{eng}}, month = {{10}}, number = {{12}}, pages = {{2907--2913}}, publisher = {{Wiley-Blackwell}}, series = {{Journal of Cardiovascular Electrophysiology}}, title = {{Quantitative T-wave morphology assessment from surface ECG is linked with cardiac events risk in genotype-positive KCNH2 mutation carriers with normal QTc values}}, url = {{http://dx.doi.org/10.1111/jce.14210}}, doi = {{10.1111/jce.14210}}, volume = {{30}}, year = {{2019}}, }