T-wave and its association with myocardial fibrosis on cardiovascular magnetic resonance examination

Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc

article

Karolina M. Zareba¹  Vien T. Truong²  Wojciech Mazur²  Suzanne M. Smart¹  Xiaojuan Xia³  Jean-Philippe Couderc³  Subha V. Raman⁴ 

[1] Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center;Division of Cardiology, The Christ Hospital Health Network;Heart Research Follow-Up Program, University of Rochester Medical Center;Division of Cardiology, Indiana University School of Medicine

关键词: electrocardiography;    late gadolinium enhancement;    myocardial fibrosis;    T1 mapping;   

DOI  :  10.1111/anec.12819

来源: Wiley

【 摘 要 】

Background Risk stratification in non-ischemic myocardial disease poses a challenge. While cardiovascular magnetic resonance (CMR) is a comprehensive tool, the electrocardiogram (ECG) provides quick impactful clinical information. Studying the relationships between CMR and ECG can provide much-needed risk stratification. We evaluated the electrocardiographic signature of myocardial fibrosis defined as presence of late gadolinium enhancement (LGE) or extracellular volume fraction (ECV) ≥29%. Methods We evaluated 240 consecutive patients (51% female, 47.1 ± 16.6 years) referred for a clinical CMR who underwent 12-lead ECGs within 90 days. ECG parameters studied to determine association with myocardial fibrosis included heart rate, QRS amplitude/duration, T-wave amplitude, corrected QT and QT peak, and Tpeak-Tend. Abnormal T-wave was defined as low T-wave amplitude ≤200 µV or a negative T wave, both in leads II and V5. Results Of the 147 (61.3%) patients with myocardial fibrosis, 67 (28.2%) had ECV ≥ 29%, and 132 (54.6%) had non-ischemic LGE. An abnormal T-wave was more prevalent in patients with versus without myocardial fibrosis (66% versus 42%, p  < .001). Multivariable analysis demonstrated that abnormal T-wave (OR 1.95, 95% CI 1.09–3.49, p  = .03) was associated with myocardial fibrosis (ECV ≥ 29% or LGE) after adjustment for clinical covariates (age, gender, history of hypertension, and heart failure). Dynamic nomogram for predicting myocardial fibrosis using clinical parameters and the T-wave was developed: https://normogram.shinyapps.io/CMR_Fibrosis/ . Conclusion Low T-wave amplitude ≤ 200 µV or negative T-waves are independently associated with myocardial fibrosis. Prospective evaluation of T-wave amplitude may identify patients with a high probability of myocardial fibrosis and guide further indication for CMR.

【 授权许可】

Unknown