The Prognostic Value of T Wave Amplitude in Lead aVR in Males
- 18 April 2008
- journal article
- Published by Wiley in Annals of Noninvasive Electrocardiology
- Vol. 13 (2), 113-119
- https://doi.org/10.1111/j.1542-474x.2008.00210.x
Abstract
Since there is an uncertainty regarding which of the 12 leads provides the most information, we investigated the association between repolarization phenomenon in all of the 12 leads and cardiovascular (CV) mortality. Retrospective cohort study was performed at Palo Alto Veterans Affairs Medical Center, Palo Alto, California, which included 24,270 consecutive male veterans with ECGs obtained for clinical reasons from 1987 to 2000. Analysis of computerized 12-lead resting ECGs was performed of all subjects excluding inpatients, patients with atrial fibrillation, WPW, QRS duration > 120 ms, and paced rhythms. Average follow-up was 7.5 years during which time there were 1859 CV deaths. While ST segment measurements in aVR were univariately predictive of CV death, T wave amplitude superseded them in multivariate survival analysis. In addition, T wave amplitude in aVR outperformed repolarization measurements in all other leads as well as other ECG criteria (Q waves, damage scores, LVH) for predicting CV mortality. As T wave amplitude became less negative in aVR, there was a progressive increase in relative risk (RR). When the T waves in aVR had a positive deflection (i.e., upward pointing) the RR for CV death was 5.0. T wave amplitude in lead aVR is a powerful prognostic marker for estimating risk of CV death. Upward pointing T waves (a simple visual criterion) was prevalent (7.3% of a clinical population) and was associated with an annual CV mortality of 3.4% and a risk of five times.Keywords
This publication has 22 references indexed in Scilit:
- Prognostic value of electrocardiographic criteria for left ventricular hypertrophyAmerican Heart Journal, 2005
- Predictors of Left Main or Three-Vessel Disease in Patients Who Have Acute Coronary Syndromes With Non–ST-Segment ElevationThe American Journal of Cardiology, 2005
- Electrocardiographic damage scores and cardiovascular mortalityAmerican Heart Journal, 2005
- Prognostic importance of isolated T-wave abnormalitiesThe American Journal of Cardiology, 2005
- ST elevation in lead aVR as a sign of left main disease— perpetuating an error?The American Journal of Cardiology, 2004
- Prognostic Value of Lead aVR in Patients With a First Non–ST-Segment Elevation Acute Myocardial InfarctionCirculation, 2003
- ACC/AHA 2002 guideline update for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction—summary article: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina)Journal of the American College of Cardiology, 2002
- Prediction of acute left main coronary artery obstruction by 12-lead electrocardiography: ST segment elevation in lead aVR with less ST segment elevation in lead V1Journal of the American College of Cardiology, 2001
- Value of the electrocardiogram in diagnosing the number of severely narrowed coronary arteries in rest angina pectorisThe American Journal of Cardiology, 1993
- Nonspecific electrocardiographic abnormality as a predictor of coronary heart disease: The Framingham StudyAmerican Heart Journal, 1987