Health & body · 2011
Can one ECG reading help predict risk in heart failure patients with narrow QRS complexes?
In 331 hospitalized heart failure patients with narrow QRS complexes, a flatter or positive T wave in ECG lead aVR was associated with higher mortality than a negative T wave. Mortality increased progressively as the T-wave amplitude became less negative.
Details
A prolonged QRS complex is a known prognostic marker in heart failure, but ECG markers in patients with narrow QRS complexes were less clear. The researchers evaluated whether T-wave amplitude in ECG lead aVR could provide prognostic information for these patients.
They examined 331 patients admitted to their hospital for worsening heart failure from January 2000 to October 2004. Their mean age was 68 ± 15 years (mean ± standard deviation); all had sinus rhythm and a QRS complex shorter than 120 ms. Based on peak T-wave amplitude from baseline in lead aVR, patients were grouped as negative (<−0.1 mV; 209, 63%), flat (−0.1 to 0.1 mV; 64, 19%), or positive (>0.1 mV; 58, 18%).
During a mean follow-up of 33 months, 113 patients (34%) died from any cause, the primary endpoint. After adjustment for clinical covariates, both a flat T wave (hazard ratio 1.86, 95% confidence interval 1.42–2.46) and a positive T wave (hazard ratio 6.76, 95% confidence interval 3.92–11.8) were independent predictors of mortality, compared with a negative T wave.
Mortality increased progressively as peak T-wave amplitude in lead aVR became less negative. The researchers concluded that the T wave in lead aVR provides prognostic information for risk stratification in heart failure patients with narrow QRS complexes.
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