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The T-peak-to-T-end interval: a novel ECG marker for ventricular arrhythmia and appropriate ICD therapy in patients with hypertrophic cardiomyopathy

Clinical Research in Cardiology volume 107, pages 130–137 (2018)Cite this article

Abstract

Introduction

Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of sudden cardiac death (SCD) primarily due to ventricular arrhythmia (VA). In patients (pts.) with a high risk of SCD, the implantation of an intracardiac cardioverter defibrillator (ICD) is thus indicated. Previous studies suggest that a prolonged interval between the peak and the end of the T wave, T-peak to T-end (TpTe), is associated with an elevated risk of VA and SCD in various clinical settings. The aim of our study was to evaluate the association between TpTe and VA in HCM pts. with a previously implanted ICD.

Methods

In 40 HCM pts. (51.4 ± 16.4 years; 62.5% men), TpTe was measured using the baseline digital standard resting 12-lead ECG during sinus rhythm. VA was assessed by device follow-up.

Results

Within 41.8 ± 35.1 months, 7 (17.5%) pts. had VA leading to appropriate therapy (AT), 7 pts. (17.5%) had non-sustained VA, and 26 pts. (65.0%) had no VA. The maximum TpTe was significantly prolonged in pts. with VA leading to AT compared to pts. without VA (101.3 ± 19.6 vs. 79.9 ± 15.3 ms; p = 0.004). Maximum TpTe was associated with an elevated risk of VA leading to AT (hazard ratio per 10 ms increase 1.63; 95% CI 1.04–2.54; p = 0.031) and pts. with a maximum TpTe ≤ 78 ms were without any VA leading to AT during follow-up. There was no correlation of maximum TpTe to other clinical parameters in our patient cohort.

Conclusion

A prolonged TpTe is associated with VA and AT in HCM. Our findings suggest that TpTe can possibly serve as a marker for ventricular arrhythmogenesis in pts. with HCM and assessment of TpTe might, therefore, optimize SCD risk stratification.

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Author notes

  1. Leon Dinshaw and Julia Münch equal contributions.

Affiliations

  1. Department of Cardiology-Electrophysiology, University Heart Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany

    Leon Dinshaw, Jannis Dickow, Stephan Willems & Boris A. Hoffmann

  2. Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany

    Julia Münch & Monica Patten

  3. Institute of Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Susanne Lezius

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  1. Leon Dinshaw
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  2. Julia Münch
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Correspondence to Monica Patten.

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Dinshaw, L., Münch, J., Dickow, J. et al. The T-peak-to-T-end interval: a novel ECG marker for ventricular arrhythmia and appropriate ICD therapy in patients with hypertrophic cardiomyopathy. Clin Res Cardiol 107, 130–137 (2018). https://doi.org/10.1007/s00392-017-1164-4

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  • DOI: https://doi.org/10.1007/s00392-017-1164-4

Keywords

  • Hypertrophic cardiomyopathy
  • Sudden cardiac death
  • Intracardiac cardioverter defibrillator
  • Ventricular arrhythmia