Predictive Value of T - T Indices for Adverse Outcomes in Acquired QT Prolongation: A Meta-Analysis

Overview

Journal Front Physiol

Date 2018 Sep 21

PMID 30233403

Citations 18

Authors

Gary Tse

Mengqi Gong

Lei Meng

Cheuk W Wong

George Bazoukis

Matthew T V Chan

Martin C S Wong

Konstantinos P Letsas

Adrian Baranchuk

Gan-Xin Yan

Tong Liu

William K K Wu

Affiliations

Soon will be listed here.

Abstract

Acquired QT interval prolongation has been linked with malignant ventricular arrhythmias, such as , in turn predisposing to sudden cardiac death. Increased dispersion of repolarization has been identified as a pro-arrhythmic factor and can be observed as longer T - T interval and higher T - T/QT ratio on the electrocardiogram. However, the values of these repolarization indices for predicting adverse outcomes in this context have not been systematically evaluated. PubMed, Embase and Cochrane Library databases were searched until 14th February 2018, identifying 232 studies. Five studies on acquired QT prolongation met the inclusion criteria and 308 subjects with drug-induced LQTS patients (mean age: 66 ± 18 years old; 46% male) were included in this meta-analysis. T - T intervals were longer [mean difference [MD]: 76 ms, standard error [SE]: 26 ms, = 0.003; I = 98%] and T - T/QT ratios were higher (MD: 0.14, SE: 0.03, = 0.000; I = 29%) in patients with compared to those without these events. T - T interval and T - T/QT ratio were higher in patients with acquired QT prolongation suffering from compared to those who did not. These repolarization indices may provide additional predictive value for identifying high-risk individuals.

Citing Articles

Tpeak-Tend ECG Marker in Obesity and Cardiovascular Diseases: A Comprehensive Review.

Dykiert I, Florek K, Kraik K, Gac P, Poreba R, Poreba M Scientifica (Cairo). 2024; 2024:4904508.

PMID: 38962529 PMC: 11221957. DOI: 10.1155/2024/4904508.

The Effect of Obesity on Repolarization and Other ECG Parameters.

Dykiert I, Kraik K, Jurczenko L, Gac P, Poreba R, Poreba M J Clin Med. 2024; 13(12).

PMID: 38930116 PMC: 11205044. DOI: 10.3390/jcm13123587.

Cardiovascular waveforms - can we extract more from routine signals?.

Nandi M, Anton M, Lyle J JRSM Cardiovasc Dis. 2022; 11:20480040221121438.

PMID: 36092374 PMC: 9459482. DOI: 10.1177/20480040221121438.

Steep repolarization time gradients in pig hearts cause distinct changes in composite electrocardiographic T-wave parameters.

van der Waal J, Bear L, Meijborg V, Dubois R, Cluitmans M, Coronel R Ann Noninvasive Electrocardiol. 2022; 27(6):e12994.

PMID: 35986562 PMC: 9674780. DOI: 10.1111/anec.12994.

Electrocardiography is Useful to Predict Postoperative Ventricular Arrhythmia in Patients Undergoing Cardiac Surgery: A Retrospective Study.

Li W, Liu W, Li H Front Physiol. 2022; 13:873821.

PMID: 35586717 PMC: 9108335. DOI: 10.3389/fphys.2022.873821.

References

Pueyo E, Corrias A, Virag L, Jost N, Szel T, Varro A . A multiscale investigation of repolarization variability and its role in cardiac arrhythmogenesis. Biophys J. 2012; 101(12):2892-902. PMC: 3244062. DOI: 10.1016/j.bpj.2011.09.060. View

Tse G, Gong M, Wong W, Georgopoulos S, Letsas K, Vassiliou V . The T - T interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and meta-analysis. Heart Rhythm. 2017; 14(8):1131-1137. DOI: 10.1016/j.hrthm.2017.05.031. View

Topilski I, Rogowski O, Rosso R, Justo D, Copperman Y, Glikson M . The morphology of the QT interval predicts torsade de pointes during acquired bradyarrhythmias. J Am Coll Cardiol. 2007; 49(3):320-8. DOI: 10.1016/j.jacc.2006.08.058. View

Hinterseer M, Beckmann B, Thomsen M, Pfeufer A, Ulbrich M, Sinner M . Usefulness of short-term variability of QT intervals as a predictor for electrical remodeling and proarrhythmia in patients with nonischemic heart failure. Am J Cardiol. 2010; 106(2):216-20. DOI: 10.1016/j.amjcard.2010.02.033. View

Darbar D, Kimbrough J, Jawaid A, McCray R, Ritchie M, Roden D . Persistent atrial fibrillation is associated with reduced risk of torsades de pointes in patients with drug-induced long QT syndrome. J Am Coll Cardiol. 2008; 51(8):836-42. PMC: 2271078. DOI: 10.1016/j.jacc.2007.09.066. View

Tse G, Gong M, Meng L, Wong C, Georgopoulos S, Bazoukis G . Meta-analysis of T-T and T-T/QT ratio for risk stratification in congenital long QT syndrome. J Electrocardiol. 2018; 51(3):396-401. DOI: 10.1016/j.jelectrocard.2018.03.001. View

DESSERTENNE F . [Ventricular tachycardia with 2 variable opposing foci]. Arch Mal Coeur Vaiss. 1966; 59(2):263-72. View

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4:1. PMC: 4320440. DOI: 10.1186/2046-4053-4-1. View

Coronel R, Wilms-Schopman F, Opthof T, Janse M . Dispersion of repolarization and arrhythmogenesis. Heart Rhythm. 2009; 6(4):537-43. DOI: 10.1016/j.hrthm.2009.01.013. View

10.

Choy L, Yeo J, Tse V, Chan S, Tse G . Cardiac disease and arrhythmogenesis: Mechanistic insights from mouse models. Int J Cardiol Heart Vasc. 2016; 12:1-10. PMC: 5064289. DOI: 10.1016/j.ijcha.2016.05.005. View

11.

Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green J . T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008; 41(6):567-74. DOI: 10.1016/j.jelectrocard.2008.07.016. View

12.

Hinterseer M, Thomsen M, Beckmann B, Pfeufer A, Schimpf R, Wichmann H . Beat-to-beat variability of QT intervals is increased in patients with drug-induced long-QT syndrome: a case control pilot study. Eur Heart J. 2007; 29(2):185-90. DOI: 10.1093/eurheartj/ehm586. View

13.

Xia Y, Liang Y, Kongstad O, Holm M, Olsson B, Yuan S . Tpeak-Tend interval as an index of global dispersion of ventricular repolarization: evaluations using monophasic action potential mapping of the epi- and endocardium in swine. J Interv Card Electrophysiol. 2005; 14(2):79-87. DOI: 10.1007/s10840-005-4592-4. View

14.

Lee S, Harris N, Robinson R, Yeoh L, MacDonald I, Heller S . Effects of adrenaline and potassium on QTc interval and QT dispersion in man. Eur J Clin Invest. 2003; 33(2):93-8. DOI: 10.1046/j.1365-2362.2003.01123.x. View

15.

Takasugi N, Goto H, Takasugi M, Verrier R, Kuwahara T, Kubota T . Prevalence of Microvolt T-Wave Alternans in Patients With Long QT Syndrome and Its Association With Torsade de Pointes. Circ Arrhythm Electrophysiol. 2016; 9(2):e003206. DOI: 10.1161/CIRCEP.115.003206. View

16.

Couderc J, Xia J, Xu X, Kaab S, Hinteeser M, Zareba W . Static and Dynamic Electrocardiographic Patterns Preceding Torsades de Pointes in the Acquired and Congenital Long QT Syndrome. Comput Cardiol (2010). 2011; 37:357-360. PMC: 3124352. View

17.

Nicolson W, McCann G, Smith M, Sandilands A, Stafford P, Schlindwein F . Prospective evaluation of two novel ECG-based restitution biomarkers for prediction of sudden cardiac death risk in ischaemic cardiomyopathy. Heart. 2014; 100(23):1878-85. DOI: 10.1136/heartjnl-2014-305672. View

18.

Zareba W, MOSS A, le Cessie S, Hall W . T wave alternans in idiopathic long QT syndrome. J Am Coll Cardiol. 1994; 23(7):1541-6. DOI: 10.1016/0735-1097(94)90653-x. View

19.

Couderc J, Kaab S, Hinterseer M, McNitt S, Xia X, Fossa A . Baseline values and sotalol-induced changes of ventricular repolarization duration, heterogeneity, and instability in patients with a history of drug-induced torsades de pointes. J Clin Pharmacol. 2008; 49(1):6-16. DOI: 10.1177/0091270008325927. View

20.

Tse G . Both transmural dispersion of repolarization and of refractoriness are poor predictors of arrhythmogenicity: a role for iCEB (QT/QRS)?. J Geriatr Cardiol. 2016; 13(9):813-814. PMC: 5122509. DOI: 10.11909/j.issn.1671-5411.2016.09.007. View