How do prolonged Tpe interval, T peak amplitude and QRS durations among individuals with coronary heart disease (CHD) in Atlanta associate with future non-fatal HF and fatal CVD outcomes? Open Access

Bamgboje, Abayomi (Summer 2024)

Permanent URL: https://etd.library.emory.edu/concern/etds/jw827c946?locale=f
Published

Abstract

Background:

Ventricular depolarization and repolarization markers, such as T peak amplitude, Tpe interval, and QRS duration, have been recognized as significant predictors of prognosis in both heart failure patients and apparently healthy individuals. However, contemporary studies examining their prognostic significance in stable coronary heart disease, a common cause of mortality, are limited.

Method:

Data were sourced from the Mental Stress Ischemia Prognosis Study (MIPS) and Myocardial Infarction and Mental Stress Study 2 (MIMS2) conducted between June 2011 and March 2016.

Participants were categorized into tall or short resting T-Peak amplitude measured with an electrocardiogram in limb lead 1. Baseline characteristics, including age, Body mass Index, QRS duration, Tpe interval, Systolic/diastolic blood pressure (SBP/DBP), heart rate, creatinine, potassium, hemoglobin, gender, and race, were analyzed using Cox Proportional Hazard regression models to assess associations with mortality and HF outcomes.

Result:

We analyzed baseline characteristics of 446 stable CHD patients based on their T-peak amplitude. The lower mean T-peak amplitude group (n=226) compared with the higher mean T-peak amplitude group (n=220) had a lower mean EF (66% vs. 73%), a higher percentage of Black participants, and more baseline HF cases, while other characteristics such as age, BMI, QRS duration, blood pressure, heart rate, creatinine, potassium, and hemoglobin levels showed

 

no significant differences. Of the 446 stable patients, 45 experienced incident non-fatal HF, and 23 experienced cardiovascular mortality during a median follow-up period of 1836 and 1862 days, respectively. T-Peak amplitude in limb lead 1 (<6mm vs. ≥6mm) emerged as a significant predictor of heart failure (HR 2.96, 95% CI: 1.64, 5.33) and cardiovascular mortality (HR 2.48, 95% CI: 1.08, 5.66). T-Peak to end in lead V2 and QRS duration did not predict incident heart failure or cardiovascular mortality.

 Conclusion:

We found that T-Peak amplitude in limb lead 1 was a robust predictor of adverse CVD outcomes in CHD patients independent of sociodemographic and other CVD factors.

Table of Contents

Table of Contents

Chapter 1. INTRODUCTION pg. 1

Chapter 2. LITERATURE REVIEW pg. 8-16

Chapter 3. METHODS pg. 17-20

Study objectives pg. 17

Study selection pg. 18

Data Sources pg. 19

Collecting summarizing and reporting results pg. 20

Chapter 4. RESULTS pg. 21

Baseline Characteristics of Participants pg.21-22

Prognostic Indicators for Non-fatal Heart Failure pg.22-23

Prognostic Indicators for Cardiovascular Mortality pg. 23

Survival Analysis Data pg.24

Chapter 5. DISCUSSION and LIMITATIONS pg. 25-27

Limitations pg. 27

Appendix 1 pg. 28-32

References pg.32-40

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