Dataset Information

Association Between QT-Interval Components and Sudden Cardiac Death: The ARIC Study (Atherosclerosis Risk in Communities).

ABSTRACT: BACKGROUND:Several reports have demonstrated that prolongation of the QT interval is associated with sudden cardiac death (SCD). However, it is unknown whether any of the components within the QT interval are responsible for its association with SCD. METHODS AND RESULTS:We examined the association of the individual QT-interval components (R-wave onset to R-peak, R-peak to R-wave end, ST-segment, T-wave onset to T-peak, and T-peak to T-wave end) with SCD in 12?241 participants (54±5.7 years; 26% black; 55% women) from the ARIC study (Atherosclerosis Risk in Communities). The QT interval and its components were measured at baseline (1987-1989) from 12-lead ECGs. SCD cases were adjudicated by a group of physicians through December 31, 2012. During a median follow-up of 23.6 years, a total of 346 cases of SCD were identified. Although prolongation of the QT interval was associated with a 49% increased risk of SCD (hazard ratio, 1.49; 95% confidence interval, 1.01-2.18), only the T-wave onset to T-peak component (per 1-SD increase: hazard ratio, 1.19; 95% confidence interval, 1.06-1.34) was associated with SCD and not any of the other components in separate models. When all of the QT-interval components were included in the same model, T-wave onset to T-peak remained the strongest predictor of SCD (per 1-SD increase: hazard ratio, 1.21; 95% confidence interval, 1.06-1.37). CONCLUSIONS:The risk of SCD with the QT interval is driven by prolongation of the T-wave onset to T-peak component. This suggests that shifting the focus from the overall QT interval to its individual components will refine SCD prediction in the community.

SUBMITTER: O'Neal WT

PROVIDER: S-EPMC5659833 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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Association Between QT-Interval Components and Sudden Cardiac Death: The ARIC Study (Atherosclerosis Risk in Communities).

O'Neal Wesley T WT Singleton Matthew J MJ Roberts Jason D JD Tereshchenko Larisa G LG Sotoodehnia Nona N Chen Lin Y LY Marcus Gregory M GM Soliman Elsayed Z EZ

Circulation. Arrhythmia and electrophysiology 20171001 10

<h4>Background</h4>Several reports have demonstrated that prolongation of the QT interval is associated with sudden cardiac death (SCD). However, it is unknown whether any of the components within the QT interval are responsible for its association with SCD.<h4>Methods and results</h4>We examined the association of the individual QT-interval components (R-wave onset to R-peak, R-peak to R-wave end, ST-segment, T-wave onset to T-peak, and T-peak to T-wave end) with SCD in 12 241 participants (54± ...[more]

PMID: 29030380

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Project description:BACKGROUND:The risk of sudden cardiac death (SCD) is known to be dynamic. However, the accuracy of a dynamic SCD prediction is unknown. We aimed to measure the dynamic predictive accuracy of ECG biomarkers of SCD and competing non-sudden cardiac death (non-SCD). METHODS:Atherosclerosis Risk In Community study participants with analyzable ECGs in sinus rhythm were included (n?=?15,716; 55% female, 73% white, age 54.2?±?5.8 y). ECGs of 5 follow-up visits were analyzed. Global electrical heterogeneity and traditional ECG metrics (heart rate, QRS, QTc) were measured. Adjudicated SCD was the primary outcome; non-SCD was the competing outcome. Time-dependent area under the receiver operating characteristic curve (ROC(t) AUC) analysis was performed to assess the prediction accuracy of a continuous biomarker in a period of 3,6,9?months, and 1,2,3,5,10, and 15?years using a survival analysis framework. Reclassification improvement as compared to clinical risk factors (age, sex, race, diabetes, hypertension, coronary heart disease, stroke) was measured. RESULTS:Over a median 24.4 y follow-up, there were 577 SCDs (incidence 1.76 (95%CI 1.63-1.91)/1000 person-years), and 829 non-SCDs [2.55 (95%CI 2.37-2.71)]. No ECG biomarkers predicted SCD within 3?months after ECG recording. Within 6?months, spatial ventricular gradient (SVG) elevation predicted SCD (AUC 0.706; 95%CI 0.526-0.886), but not a non-SCD (AUC 0.527; 95%CI 0.303-0.75). SVG elevation more accurately predicted SCD if the ECG was recorded 6?months before SCD (AUC 0.706; 95%CI 0.526-0.886) than 2?years before SCD (AUC 0.608; 95%CI 0.515-0.701). Within the first 3?months after ECG recording, only SVG azimuth improved reclassification of the risk beyond clinical risk factors: 18% of SCD events were reclassified from low or intermediate risk to a high-risk category. QRS-T angle was the strongest long-term predictor of SCD (AUC 0.710; 95%CI 0.668-0.753 for ECG recorded within 10?years before SCD). CONCLUSION:Short-term and long-term predictive accuracy of ECG biomarkers of SCD differed, reflecting differences in transient vs. persistent SCD substrates. The dynamic predictive accuracy of ECG biomarkers should be considered for competing SCD risk scores. The distinction between markers predicting short-term and long-term events may represent the difference between markers heralding SCD (triggers or transient substrates) versus markers identifying persistent substrate.

Dataset Information

Association Between QT-Interval Components and Sudden Cardiac Death: The ARIC Study (Atherosclerosis Risk in Communities).

Publications

Association Between QT-Interval Components and Sudden Cardiac Death: The ARIC Study (Atherosclerosis Risk in Communities).

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