University of Oulu

Hekkanen JJ, Kenttä TV, Haukilahti MAE, Rahola JT, Holmström L, Vähätalo J, Tulppo MP, Kiviniemi AM, Pakanen L, Ukkola OH, Junttila MJ, Huikuri HV and Perkiömäki JS (2020) Increased Beat-to-Beat Variability of T-Wave Heterogeneity Measured From Standard 12-Lead Electrocardiogram Is Associated With Sudden Cardiac Death: A Case–Control Study. Front. Physiol. 11:1045. doi: 10.3389/fphys.2020.01045

Increased beat-to-beat variability of T-wave heterogeneity measured from standard 12-lead electrocardiogram Is associated with sudden cardiac death : a case–control study

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Author: Hekkanen, Jenni J.1; Kenttä, Tuomas V.1; Haukilahti, Mira Anette E.1;
Organizations: 1Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
2Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland
3Research Unit of Internal Medicine, Department of Forensic Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: Frontiers Media, 2020
Publish Date: 2020-12-01


Introduction: The prognostic significance of beat-to-beat variability of spatial heterogeneity of repolarization measured from standard 12-lead ECG is not well-understood.

Methods: We measured the short-term variability of repolarization parameters, such as T-wave heterogeneity in leads V4–V6 (TWH) and QT interval (QT), from five consecutive beats of previously recorded standard 12-lead ECG in 200 victims of unexpected sudden cardiac death (SCD) confirmed to be due to complicated atherosclerotic coronary artery disease (CAD) in medico-legal autopsy and 200 age- and sex-matched controls with angiographically confirmed CAD. The short-term variability of repolarization heterogeneity was defined as the standard deviation (SD) of the measured repolarization parameters. All ECGs were in sinus rhythm, and no premature ventricular contractions were included in the measured segment.

Results: TWH-SD and QT-SD were significantly higher in SCD victims than in subjects with CAD (6.9 ± 5.6 μV vs. 3.8 ± 2.6 μV, p = 1.8E-11; 8.3 ± 13.1 ms vs. 3.8 ± 7.1 ms, p = 0.00003, respectively). After adjusting in the multivariate clinical model with factors, such as diabetes, RR interval, and beta blocker medication, TWH-SD and QT-SD retained their significant power in discriminating between the victims of SCD and the patients with CAD (p = 0.00003, p = 0.006, respectively). TWH-SD outperformed QT-SD in identifying the SCD victims among the study subjects (area under the curve in the receiver operating characteristics curve 0.730 vs. 0.679, respectively).

Conclusion: Increased short-term variability of repolarization heterogeneity measured from standard 12-lead ECG is associated with SCD.

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Series: Frontiers in physiology
ISSN: 1664-042X
ISSN-E: 1664-042X
ISSN-L: 1664-042X
Volume: 11
Article number: 1045
DOI: 10.3389/fphys.2020.01045
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: The study was supported by a grant from the Sigrid Juselius Foundation, Helsinki, Finland; the Finnish Foundation for Cardiovascular Research, Helsinki, Finland; and the Aarne Koskelo Foundation, Helsinki, Finland.
Copyright information: © 2020 Hekkanen, Kenttä, Haukilahti, Rahola, Holmström, Vähätalo, Tulppo, Kiviniemi, Pakanen, Ukkola, Junttila, Huikuri and Perkiömäki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.