Observational studyJournal of electrocardiology
The prognostic value of discordant T waves in lead aVR: A simple risk marker of sudden cardiac arrest in ischemic cardiomyopathy.
Observational study in Journal of electrocardiology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 12 citations in OpenAlex.
- Importance of lead aVR on predicting adverse cardiac events in patients with noncompaction cardiomyopathy.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2020Article
- T wave positivity in lead aVR is associated with mortality after transcatheter aortic valve implantation.Archives of medical sciences. Atherosclerotic diseases · 2019Article
- T wave positivity in lead aVR is associated with mortality in patients with cardiac resynchronization therapy.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2018Article
- Positive T wave in lead aVR as an independent predictor for 1-year major adverse cardiac events in patients with first anterior wall ST-segment elevation myocardial infarction.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2017Article
- Twenty-eight genetic loci associated with ST-T-wave amplitudes of the electrocardiogram.Human molecular genetics · 2016Article
- Lead aVR is a predictor for mortality in heart failure with preserved ejection fraction.Indian heart journalArticle
- Identifying the most important ECG predictors of reduced ejection fraction in patients with suspected acute coronary syndrome.Journal of electrocardiologyObservational
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundSimple and reliable ECG marker(s) for sudden cardiac arrest (SCA) could be very useful in assessing high-risk populations. Since ischemic repolarization abnormalities in the left ventricular (LV) apex are strongly correlated with discordant T waves in lead aVR, we sought to evaluate the clinical and prognostic significance of this feature in ischemic cardiomyopathy.
methodsThe PAREPET trial enrolled patients with ischemic cardiomyopathy eligible for a primary prevention implantable cardiac defibrillator (ICD). Those with persistent pacing or left bundle branch block were excluded. Amplitudes of T/aVR were automatically computed from median ECG beats at enrollment and endpoints were blindly adjudicated.
resultsThe sample was mainly composed of older men (n=138, age 65±12, 91% male, EF 29±9%). At enrollment, amplitude of T/aVR significantly correlated with EF, indexed LV end-diastolic volume, B-type natriuretic peptide (BNP), regional scar volume, and PET-quantified denervated myocardium. After a median follow up of 4.2years, there were 23 (17%) adjudicated SCA. In multivariate analysis, the presence of discordant T/aVR (>0mm, n=42, 30%) was a significant and independent predictor of SCA (hazard ratio 2.0 [95% CI 1.0-4.9]) and cardiac death (hazard ratio 1.9 [95% CI 1.0-3.7]).
conclusionsIn subjects with ischemic cardiomyopathy, discordant T waves in lead aVR are associated with high-risk clinical parameters including lower ejection fraction, greater ventricular volume, higher BNP, and more denervated myocardium. Furthermore, discordant T/aVR remained an independent predictor of SCA and cardiovascular mortality even after accounting for these prognostic factors.
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