From the Department of Medicine, Division of Cardiology, J.W. Goethe
University, Frankfurt, Germany, and the Division of Cardiology, VA Medical
Center and Georgetown University, Washington, DC (M.R.F.).
Correspondence to Stefan H. Hohnloser, MD, FACC, FESC, J.W. Goethe University, Department of Medicine, Division of Cardiology, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Background—Risk stratification by
means of analysis of QT dispersion (QTD) in the 12-lead surface
ECG is under intense investigation in various patient populations. The
aim of the present prospective study was to evaluate the prognostic
value of QTD and other ECG variables reflecting dispersion of
ventricular repolarization in comparison with established
risk stratifiers during long-term follow-up in a large cohort of
post–myocardial infarction patients treated according to contemporary
therapeutic guidelines.
Methods and Results—In 280 consecutive infarct survivors, the
12-lead ECG was optically scanned and digitized for analysis of
QTD (QTmax-QTmin) and 25 other repolarization
variables, including recently developed and validated
parameters such as the T peak–to–T end interval and the
area under the T wave. In addition, a variety of established risk
stratifiers were assessed. After a mean follow-up period of 32±10
months, 30 patients reached one of the prospectively defined study end
points (death, ventricular tachycardia, or
resuscitated ventricular fibrillation). Comparisons between
event and nonevent patients by means of Kaplan-Meier event probability
analyses revealed that none of the ECG dispersion variables
were of discriminative value. In contrast, variables such as left
ventricular ejection fraction (P=0.007),
mean 24-hour heart rate (P=0.022), or heart rate
variability (P=0.007) proved to be potentially useful
risk stratifiers in this patient population. On
multivariate analysis, only LVEF, heart rate
variability, and a history of thrombolysis were
independent predictors of outcome.
Conclusions—Determination of QTD from the surface ECG even when
performed with the best available methodology failed to predict
subsequent risk in this large series of infarct survivors.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Assessment of QT Dispersion for Prediction of Mortality or Arrhythmic Events After Myocardial Infarction
Results of a Prospective, Long-term Follow-up Study
Key Words: infarction • death, sudden • risk factors • electrophysiology
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