T-wave heterogeneity in standard resting 12-lead ECGs is associated with 90-day cardiac mortality in women following emergency department admission: A nested case-control study.

Autor: Monteiro FR; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil., Rabelo Evangelista AB; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil., Nearing BD; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Medeiros SA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil., Tessarolo Silva F; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil., Pedreira GC; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil., Ullman E; Harvard Medical School, Boston, MA, USA.; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA., Gervino EV; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Verrier RL; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc [Ann Noninvasive Electrocardiol] 2021 May; Vol. 26 (3), pp. e12826. Date of Electronic Publication: 2021 Feb 05.
DOI: 10.1111/anec.12826
Abstrakt: Background: We investigated whether T-wave heterogeneity (TWH) can identify patients who are at risk for near-term cardiac mortality.
Methods: A nested case-control analysis was performed in the 888 patients admitted to the Emergency Department (ED) of our medical center in July through September 2018 who had ≥2 serial troponin measurement tests within 6 hr for acute coronary syndrome evaluation to rule-in or rule-out the presence of acute myocardial infarction. Patients who died from cardiac causes during 90 days after ED admission were considered cases (n = 20; 10 women) and were matched 1:4 on sex and age with patients who survived during this period (n = 80, 40 women). TWH, that is, interlead splay of T waves, was automatically assessed from precordial leads by second central moment analysis.
Results: TWH V4-6 was significantly elevated at ED admission in 12-lead resting ECGs of female patients who died of cardiac causes during the following 90 days compared to female survivors (100 ± 14.9 vs. 40 ± 3.6 µV, p < .0001). TWH V4-6 generated areas under the receiver-operating characteristic (ROC) curve (AUC) of 0.933 in women (p < .0001) and 0.573 in men (p = .4). In women, the ROC-guided 48-µV TWH V4-6 cut point for near-term cardiac mortality produced an adjusted odds ratio of 121.37 (95% CI: 2.89-6,699.84; p = .02) with 100% sensitivity and 82.5% specificity. In Kaplan-Meier survival analysis, TWH V4-6  ≥ 48 µV predicted cardiac mortality in women during 90-day follow-up with a hazard ratio of 27.84 (95% CI: 7.29-106.36, p < .0001).
Conclusion: Elevated TWH V4-6 is associated with near-term cardiac mortality among women evaluated for acute coronary syndrome.
(© 2021 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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