T wave positivity in lead aVR is associated with mortality in patients with cardiac resynchronization therapy
- 15 Downloads
Positive T wave polarity in lead aVR (TPaVR) is associated with a poor prognostic indicator in patients with heart failure reduce ejection fraction (HFrEF). Our aim was to investigate the relationship between positive TPaVR and mortality in patients with cardiac resynchronization therapy defibrillator (CRT-D).
We included retrospectively 224 HFrEF patients with CRT-D in sinus rhythm. Laboratory, electrocardiographic (ECG), and echocardiographic data were recorded. T wave polarity was measured in lead DI, DII, and aVR from surface ECG.
The patients were divided as living and deceased. They followed for 2.5 ± 0.9 years. Thirty-three patients (14.7%) died. Six patients (18.2%) were TPaVR positive before CRT-D and this number increased to 22 (66.6%) after CRT-D in the deceased group. Pulse (p = 0.049), hyperlipidemia (p = 0.022), and NT-proBNP levels were higher in the deceased group (p = 0.001). TPaVR before CRT-D (p < 0.001) and TPaVR after CRT-D (p < 0.001) were significantly positive in the deceased group. Positive TPaVR after CRT-D was the only independent predictor for mortality in binominal logistic regression analysis (OR 1.211, 95% CI 1.105–1.328, p < 0.001).
In CRT-D patients, a positive TPaVR in surface ECG may be a strong mortality indicator.
KeywordsCardiac resynchronization Mortality ECG Lead aVR
Compliance with ethical standards
The Local Ethics Committee of Cukurova University Medical Faculty approved our retrospective study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Bleumink GS, Knetsch AM, Sturkenboom MCJM, Straus SMJM, Hofman A, Deckers JW, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure. The Rotterdam Study. Eur Heart J. 2004;25(18):1614–9. https://doi.org/10.1016/j.ehj.2004.06.038.CrossRefPubMedGoogle Scholar
- 4.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975. https://doi.org/10.1002/ejhf.592. CrossRefPubMedGoogle Scholar
- 5.Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace. 2013;15(8):1070–118. https://doi.org/10.1093/europace/eut206.CrossRefPubMedGoogle Scholar
- 6.Boriani G, Kranig W, Donal E, Calo L, Casella M, Delarche N, et al. A randomized double-blind comparison of biventricular versus left ventricular stimulation for cardiac resynchronization therapy: the Biventricular versus Left Univentricular Pacing with ICD Back-up in Heart Failure Patients (B-LEFT HF) trial. Am Heart J. 2010;159(6):1052–1058.e1. https://doi.org/10.1016/j.ahj.2010.03.008.CrossRefPubMedGoogle Scholar
- 7.Bogale N, Witte K, Priori S, Cleland J, Auricchio A, Gadler F, et al. The European Cardiac Resynchronization Therapy Survey: comparison of outcomes between de novo cardiac resynchronization therapy implantations and upgrades. Eur J Heart Fail. 2011;13(9):974–83. https://doi.org/10.1093/eurjhf/hfr085.CrossRefPubMedGoogle Scholar
- 10.Ducas R, Ariyarajah V, Philipp R, Ducas J, Elliott J, Jassal D, et al. The presence of ST-elevation in lead aVR predicts significant left main coronary artery stenosis in cardiogenic shock resulting from myocardial infarction: the Manitoba cardiogenic shock registry. Int J Cardiol. 2013;166(2):465–8. https://doi.org/10.1016/j.ijcard.2011.11.003.CrossRefPubMedGoogle Scholar
- 11.Kobayashi A, Misumida N, Aoi S, Kanei Y. Positive T wave in lead aVR as an independent predictor for 1-year major adverse cardiac events in patients with first anterior wall ST-segment elevation myocardial infarction. Ann Noninvasive Electrocardiol. 2017;22(6) https://doi.org/10.1111/anec.12442.
- 12.Misumida N, Kobayashi A, Fox JT, Hanon S, Schweitzer P, Kanei Y. Predictive value of ST-segment elevation in lead aVR for left main and/or three-vessel disease in non-ST-segment elevation myocardial infarction. Ann Noninvasive Electrocardiol. 2016;21(1):91–7. https://doi.org/10.1111/anec.12272.CrossRefPubMedGoogle Scholar
- 13.Tanaka Y, Konno T, Tamura Y, Tsuda T, Furusho H, Takamura M, et al. Impact of T wave amplitude in lead aVR on predicting cardiac events in ischemic and nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator. Ann Noninvasive Electrocardiol. 2017;22(6) https://doi.org/10.1111/anec.12452.
- 17.Buxton AE, Lee KL, Hafley GE, Pires LA, Fisher JD, Gold MR, et al. Limitations of ejection fraction for prediction of sudden death risk in patients with coronary artery disease: lessons from the MUSTT study. J Am Coll Cardiol. 2007;50(12):1150–7. https://doi.org/10.1016/j.jacc.2007.04.095.CrossRefPubMedGoogle Scholar
- 18.Al-Zaiti SS, Fallavollita JA, Canty JM, Carey MG. The prognostic value of discordant T waves in lead aVR: a simple risk marker of sudden cardiac arrest in ischemic cardiomyopathy. J Electrocardiol. 2015;48(5):887–92. https://doi.org/10.1016/j.jelectrocard.2015.06.013.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Phan D, Narayanan K, Uy-Evanado A, Teodorescu C, Reinier K, Chugh H, et al. T-wave reversal in the augmented unipolar right arm electrocardiographic lead is associated with increased risk of sudden death. J Interv Card Electrophysiol. 2016;45(2):141–7. https://doi.org/10.1007/s10840-015-0078-1.CrossRefPubMedGoogle Scholar
- 21.Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. N Engl J Med. 2005;352(15):1539–49. https://doi.org/10.1056/NEJMoa050496.CrossRefPubMedGoogle Scholar