The Prognostic Value of T Wave Amplitude in Lead aVR in Males
Open accessAbstract
Background: 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. Methods: 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. Results: While ST segment measurements in aVR were univariately predictive of CV death, T wave amplitude superseded them in multivariate survival analysis.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. Conclusions: 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.
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The simple visual criterion of an upward pointing T wave in aVR in males is associated with an annual cardiovascular mortality of 3.4% and a five times risk.
“The simple visual criterion of an upward pointing T wave in aVR in males was associated with an annual cardiovascular mortality of 3.4% and the risk of five times.49”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [49]
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The Year of 2008 in Electrocardiology
Stern, S. (2010) · Annals of Noninvasive Electrocardiology · doi:10.1111/j.1542-474x.2009.00347.x · Cited by 1 · see citing works
- Authors
- Tan, S. Y., Engel, G., Myers, J., Sandri, M., & Froelicher, V. F.
- Affiliations
- National Heart Centre Singapore (SG)
- VA Palo Alto Health Care System (US)
- Venue
- Annals of Noninvasive Electrocardiology
- Publisher
- Wiley
- Published
- 2008-04
- Volume
- 13
- Issue
- 2
- Pages
- 113-119
- ISSN
- 1082-720X (ISSN-L)
- 1542-474X
- PMC
- PMC6932252
- OpenAlex
- W2156862993
- Cited by
- 49
- References
- 23
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 2 · 2021: 4 · 2020: 3 · 2019: 4 · 2018: 6 · 2017: 3 · 2016: 2 · 2015: 6 · 2014: 6 · 2013: 2 · 2012: 1
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annals of Noninvasive Electrocardiology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK6 RX002477)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- T-wave amplitude, lead aVR, cardiovascular mortality, prognostic factors, repolarization abnormalities, ST segment, 12-lead ECG, veterans, male patients
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Cardiovascular Diseases, Cause of Death, Electrocardiography, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Retrospective Studies, Sensitivity and Specificity, Signal Processing, Computer-Assisted, Cohort Studies, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Odds Ratio, Survival Analysis, Risk Assessment
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