University of Oulu

Ramírez, J., Kiviniemi, A., Van Duijvenboden, S., Tinker, A., Lambiase, P. D., Junttila, J., Perkiömäki, J. S., Huikuri, H. V., Orini, M., & Munroe, P. B. (2022). Ecg t‐wave morphologic variations predict ventricular arrhythmic risk in low‐ and moderate‐risk populations. Journal of the American Heart Association, 11(17), e025897.

ECG T‐wave morphologic variations predict ventricular arrhythmic risk in low‐ and moderate‐risk populations

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Author: Ramírez, Julia1,2,3; Kiviniemi, Antti4; van Duijvenboden, Stefan1,5;
Organizations: 1Clinical Pharmacology and Precision Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
2Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
3Centro de Investigación Biomédica en Red ‐ Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain
4Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
5Institute of Cardiovascular Science, University College London, London, United Kingdom
6National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
7Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2.2 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2023-02-15


Background: Early identification of individuals at risk of sudden cardiac death (SCD) remains a major challenge. The ECG is a simple, common test, with potential for large‐scale application. We developed and tested the predictive value of a novel index quantifying T‐wave morphologic variations with respect to a normal reference (TMV), which only requires one beat and a single‐lead ECG.

Methods and results: We obtained reference T‐wave morphologies from 23 962 participants in the UK Biobank study. With Cox models, we determined the association between TMV and life‐threatening ventricular arrhythmia in an independent data set from UK Biobank study without a history of cardiovascular events (N=51 794; median follow‐up of 122 months) and SCD in patients with coronary artery disease from ARTEMIS (N=1872; median follow‐up of 60 months). In UK Biobank study, 220 (0.4%) individuals developed life‐threatening ventricular arrhythmias. TMV was significantly associated with life‐threatening ventricular arrhythmias (hazard ratio [HR] of 1.13 per SD increase [95% CI, 1.03–1.24]; P=0.009). In ARTEMIS, 34 (1.8%) individuals reached the primary end point. Patients with TMV ≥5 had an HR for SCD of 2.86 (95% CI, 1.40–5.84; P=0.004) with respect to those with TMV <5, independently from QRS duration, corrected QT interval, and left ventricular ejection fraction. TMV was not significantly associated with death from a cause other than SCD.

Conclusions: TMV identifies individuals at life‐threatening ventricular arrhythmia and SCD risk using a single‐beat single‐lead ECG, enabling inexpensive, quick, and safe risk assessment in large populations.

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Series: Journal of the American Heart Association
ISSN: 2047-9980
ISSN-E: 2047-9980
ISSN-L: 2047-9980
Volume: 11
Issue: 17
Article number: e025897
DOI: 10.1161/JAHA.121.025897
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Dr Ramírez acknowledges the “María Zambrano” fellowship support from the European Union–NextGenerationEU and the support from the Marie Sklodowska‐Curie grant 786833. We also wish to acknowledge support by the Medical Research Council grant MR/N025083/1. Dr Lambiase is supported by University College London/University College London Hospital Biomedicine National Institute of Health Research (NIHR). Drs Tinker and Munroe acknowledge the NIHR Cardiovascular Biomedical Research Centre at Barts and Queen Mary University of London, UK. Dr Junttila acknowledges funding from Academy of Finland, Sigrid Juselius Foundation, and Finnish Foundation for Cardiovascular Research.
Copyright information: © 2022 The Authors. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.