University of Oulu

Holkeri, A., Eranti, A., Haukilahti, M. A. E., Kerola, T., Kenttä, T. V., Noponen, K., Seppänen, T., Rissanen, H., Heliövaara, M., Knekt, P., Junttila, M. J., Huikuri, H. V., & Aro, A. L. (2021). Prognostic significance of flat T-waves in the lateral leads in general population. Journal of Electrocardiology, 69, 105–110.

Prognostic significance of flat T-waves in the lateral leads in general population

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Author: Holkeri, Arttu1; Eranti, Antti2; Haukilahti, M. Anette E.3;
Organizations: 1Department of Internal Medicine, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland
2Heart Center, Central Hospital of North Karelia, Tikkamäentie 16, 80210 Joensuu, Finland
3Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Faculty of Medicine, PO Box 5000, FI-90014 Oulu, Finland
4Center for Machine Vision and Signal Analysis, University of Oulu, PO Box 4500, Oulu FI-90014, Finland
5Finnish Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland
6Division of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Meilahti Tower Hospital, PL 340, 00029 HUS Helsinki, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
Persistent link:
Language: English
Published: Elsevier, 2021
Publish Date: 2022-10-11


Background: Negative T-waves are associated with sudden cardiac death (SCD) risk in the general population. Whether flat T-waves also predict SCD is not known. The aim of the study was to examine the clinical characteristics and risk of SCD in general population subjects with flat T-waves.

Methods: We examined the electrocardiograms of 6750 Finnish general population adults aged ≥30 years and classified the subjects into 3 groups: 1) negative T-waves with an amplitude ≥0.1 mV in ≥2 of the leads I, II, aVL, V4–V6, 2) negative or positive low amplitude T-waves with an amplitude <0.1 mV and the ratio of T-wave and R-wave <10% in ≥2 of the leads I, II, aVL, V4–V6, and 3) normal positive T-waves (not meeting the aforesaid criteria). The association between T-wave classification and SCD was assessed during a 10-year follow-up.

Results: A total of 215 (3.2%) subjects had negative T-waves, 856 (12.7%) flat T-waves, and 5679 (84.1%) normal T-waves. Flat T-wave subjects were older and had more often cardiovascular morbidities compared to normal T-wave subjects, while negative T-wave subjects were the oldest and had most often cardiovascular morbidities. After adjusting for multiple factors, both flat T-waves (hazard ratio [HR] 1.81; 95% confidence interval [CI] 1.13–2.91) and negative T-waves (HR 3.27; 95% CI 1.85–5.78) associated with SCD.

Conclusions: Cardiovascular risk factors and disease are common among subjects with flat T-waves, but these minor T-wave abnormalities are also independently associated with increased SCD risk.

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Series: Journal of electrocardiology
ISSN: 0022-0736
ISSN-E: 1532-8430
ISSN-L: 0022-0736
Volume: 69
Pages: 105 - 110
DOI: 10.1016/j.jelectrocard.2021.10.001
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by the Aarne Koskelo Foundation to A.H.; the Paavo Ilmari Ahvenainen Foundation to A.H.; and Sigrid Juselius Foundation to A.A and A.H.
Copyright information: © 2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http:/