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Multicenter Study
. 2017 Oct;10(10):e005485.
doi: 10.1161/CIRCEP.117.005485.

Association Between QT-Interval Components and Sudden Cardiac Death: The ARIC Study (Atherosclerosis Risk in Communities)

Wesley T O'Neal  1 , Matthew J Singleton  2 , Jason D Roberts  2 , Larisa G Tereshchenko  2 , Nona Sotoodehnia  2 , Lin Y Chen  2 , Gregory M Marcus  2 , Elsayed Z Soliman  2
Affiliations
Multicenter Study

Association Between QT-Interval Components and Sudden Cardiac Death: The ARIC Study (Atherosclerosis Risk in Communities)

Wesley T O'Neal et al. Circ Arrhythm Electrophysiol. 2017 Oct.

Abstract

Background: Several reports have demonstrated that prolongation of the QT interval is associated with sudden cardiac death (SCD). However, it is unknown whether any of the components within the QT interval are responsible for its association with SCD.

Methods and results: We examined the association of the individual QT-interval components (R-wave onset to R-peak, R-peak to R-wave end, ST-segment, T-wave onset to T-peak, and T-peak to T-wave end) with SCD in 12 241 participants (54±5.7 years; 26% black; 55% women) from the ARIC study (Atherosclerosis Risk in Communities). The QT interval and its components were measured at baseline (1987-1989) from 12-lead ECGs. SCD cases were adjudicated by a group of physicians through December 31, 2012. During a median follow-up of 23.6 years, a total of 346 cases of SCD were identified. Although prolongation of the QT interval was associated with a 49% increased risk of SCD (hazard ratio, 1.49; 95% confidence interval, 1.01-2.18), only the T-wave onset to T-peak component (per 1-SD increase: hazard ratio, 1.19; 95% confidence interval, 1.06-1.34) was associated with SCD and not any of the other components in separate models. When all of the QT-interval components were included in the same model, T-wave onset to T-peak remained the strongest predictor of SCD (per 1-SD increase: hazard ratio, 1.21; 95% confidence interval, 1.06-1.37).

Conclusions: The risk of SCD with the QT interval is driven by prolongation of the T-wave onset to T-peak component. This suggests that shifting the focus from the overall QT interval to its individual components will refine SCD prediction in the community.

Keywords: death, sudden, cardiac; follow-up studies; humans; risk.

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Figures

Figure 1
Figure 1. Distribution of QT interval
Figure 2
Figure 2. Risk of Sudden Cardiac Death across QRS duration*
*Each hazard ratio was computed using a restricted cubic spline model with the median R-wave Onset to R-peak (A) value of 24 ms as the reference, and for R-peak to R-wave End (B), a median value of 18 ms was used as the reference. Models included the following; age, sex, race, heart rate, smoking, systolic blood pressure, diabetes, body mass index, low-density lipoprotein cholesterol, antihypertensive medication use, and left ventricular hypertrophy. Dotted-lines represent the 95% confidence interval.
Figure 3
Figure 3. Risk of Sudden Cardiac Death across ST-segment*
*Each hazard ratio was computed using a restricted cubic spline model with the median ST-segment value of 114 ms as the reference, and was adjusted for age, sex, race, heart rate, smoking, systolic blood pressure, diabetes, body mass index, low-density lipoprotein cholesterol, antihypertensive medication use, and left ventricular hypertrophy. Dotted-lines represent the 95% confidence interval.
Figure 4
Figure 4. Risk of Sudden Cardiac Death across T-wave*
*Each hazard ratio was computed using a restricted cubic spline model with the median T-wave Onset to T-peak Duration (A) value of 100 ms as the reference, and for T-peak to T-wave End (B), a median value of 96 ms was used as the reference. Models included the following; age, sex, race, heart rate, smoking, systolic blood pressure, diabetes, body mass index, low-density lipoprotein cholesterol, antihypertensive medication use, and left ventricular hypertrophy. Dotted-lines represent the 95% confidence interval.
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