Comparison of ECG T-wave Duration and morphology restitution markers for sudden cardiac death prediction in chronic heart Failure

Abstract

An index ofT-wave morphology restitution, TMR, has previously shown to be a sudden cardiac death (SCD) predictor in a population of chronic heart failure (CHF) patients. The aim of this study is to compare the predictive value of TMR, T-wave width restitution (TWR), T-peak-to-end (Tpe) morphology restitution (TpeMR) and Tpe duration restitution (TpeR) indices in the same CHF population. Holter ECG recordings from 651 CHF patients of the MUSIC study, including SCD victims and survivors, were analyzed. TMR was significantly correlated with TWR (ρ=0.66), TpeMR (ρ=0.70) and TpeR (ρ=0.42). SCD victims showed significantly higher values of TMR, TWR and TpeMR than the rest of patients, with TMR being the index most strongly associated with SCD (p=0.002, p=0.006 and p=0.011, respectively). TpeR values were only borderline significantly higher in SCD victims (p=0.061). Univariate Cox analysis showed that TMR was the restitution index with the strongest predictive value (hazard ratio (HR) of 1.466, p<0.001), followed by TWR (HR of 1.295, p=0.005), TpeR (HR of 1.297, p=0.004) and TpeMR (HR of 1.164, p=0.020). In conclusion, considering the predictive value of the four T-wave restitution indices, TMR is the preferred index for SCD risk stratification, followed by TpeMR. However, the marker TWR could also be used for SCD prediction when computational efficiency is an issue.