Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, Syktyvkar, Russia.
Abstract
Background: The increased Tpe/QT ratio is a novel, promising predictor of cardiac arrhythmias. However, no consensus exists regarding the Tpe/QT measurement. This study aimed to evaluate Tpe/QT variability among standard ECG leads.
Methods: Tpe/QT magnitudes were analyzed in 8 standard ECG leads (I, II, V1–V6) in 33 patients with a definite diagnosis of arrhythmogenic right ventricular cardiomyopathy. Tpe/QT values were calculated in several ways: averaging against 1 or more leads over all the patients and searching the maximum value among all measured leads in each patient (the true maximum), followed by averaging over all the patients.
Results: Maximum and minimum Tpe/QT values were distributed among all the tested ECG leads. In each lead, minimum and maximum Tpe/QT values could be observed in different patients. The dispersion of Tpe/QT magnitudes calculated in various ways reached the value of 0.055.
Conclusions: The Tpe/QT magnitude depends on the method of determining the T-wave ending and the number of ECG leads used for its calculation. To detect the increased Tpe/QT ratio, the analysis of all available ECG leads against 1 or a few leads is preferable. (Iranian Heart Journal 2024; 25(2): 75-80)
Gupta P, Patel C, Patel H, Narayanaswamy S, Malhotra B, Green JT et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 2008; 41(6):567-74. DOI:10.1016/j.jelectrocard.2008.07.016
Arteyeva NV, Azarov JE. Scenarios for Increasing, Decreasing and Stability of Tpe/QT Ratio (Simulation Study). International Journal of Biomedicine 2022; 12(4):535-538. DOI:10.21103/Article12(4)_OA2
Zhao X, Xie Z, Chu Y, Yang L, Xu W, Yang X et al. Association between Tp‐e/QT ratio and prognosis in patients undergoing primary percutaneous coronary intervention for ST‐segment elevation myocardial infarction. Clin Cardiol 2012; 35:559–564. DOI: 10.1002/clc.22022
Zumhagen S, Zeidler EM, Stallmeyer B, Ernsting M, Eckardt L, Schulze-Bahr E. Tpeak-Tend interval and Tpeak-Tend/QT ratio in patients with Brugada syndrome. Europace 2016; 18(12):1866-1872. DOI:10.1093/europace/euw033
Braschi A, Frasheri A, Lombardo RM, Abrignani MG, Presti RL, Vinci D et al. Association between Tpeak-Tend/QT and major adverse cardiovascular events in patients with Takotsubo syndrome. Acta Cardiol 2020:1-7. DOI:10.1080/00015385.2020.1776012
Sucu M, Ucaman B, Ozer O, Altas Y, Polat E. Novel Ventricular Repolarization Indices in Patients with Coronary Slow Flow. J Atr Fibrillation 2016; 9(3):1446. DOI:10.4022/jafib.1446
Tse G, Gong M, Li CKH, Leung KSK, Georgopoulos S, Bazoukis G et al. Tpeak-Tend, Tpeak-Tend/QT ratio and Tpeak-Tend dispersion for risk stratification in Brugada Syndrome: A systematic review and meta-analysis. J Arrhythm 2018; 34(6):587-597. DOI: 10.1002/joa3.12118
Bieganowska K, Sawicka-Parobczyk M, Bieganowski M, Piskorski J. Tpeak-tend interval in 12-lead electrocardiogram of healthy children and adolescents tpeak-tend interval in childhood. Ann Noninvasive Electrocardiol 2013; 18(4):344-51. DOI: 10.1111/anec.12035
Panikkath R, Reinier K, Uy-Evanado A, Teodorescu C, Hattenhauer J, Mariani R et al. Prolonged Tpeak-to-tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circ Arrhythm Electrophysiol. 2011; 4(4):441-447. DOI:10.1161/CIRCEP.110.960658
Alizade E, Yesin M, Yazicioğlu MV, Karaayvaz EB, Atici A, Arslan Ş et al. Evaluation of Tp-e Interval, Tp-e/QT Ratio, and Tp-e/QTc Ratio in Patients with Asymptomatic Arrhythmogenic Right Ventricular Cardiomyopathy. Ann Noninvasive Electrocardiol 2017; 22(1):e12362. DOI: 10.1111/anec.12362
Dural M, Mert KU, İskenderov K. Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with mitral valve stenosis before and after balloon valvuloplasty. Anatol J Cardiol 2018; 18(5):353-60. DOI: 10.14744/AnatolJCardiol.2017.7876
Cekirdekci EI, Bugan B. Can abnormal dispersion of ventricular repolarization be a predictor of mortality in arrhythmogenic right ventricular cardiomyopathy: The importance of Tp-e interval. Ann Noninvasive Electrocardiol. 2019; 24(3):e12619. DOI: 10.1111/anec.12619
Ciobanu A, Tse G, Liu T, Deaconu MV, Gheorghe GS, Ilieşiu AM et al. Electrocardiographic measures of repolarization dispersion and their relationships with echocardiographic indices of ventricular remodeling and premature ventricular beats in hypertension. J Geriatr Cardiol. 2017; 14(12):717-724. DOI: 10.11909/j.issn.1671-5411.2017.12.001.
Wu YE, Ma L, Hu ZP. Prognostic value of infarct-related-lead Tpeak-Tend/QT ratio in patients with ST-segment elevation myocardial infarction. Heart Vessels 2022; 37(4):539-548. DOI: 10.1007/s00380-021-01950-8
Panicker GK, Karnad DR, Natekar M, Kothari S, Narula D, Lokhandwala Y. Intra- and interreader variability in QT interval measurement by tangent and threshold methods in a central electrocardiogram laboratory. J Electrocardiol. 2009;42(4):348-52. DOI: 10.1016/j.jelectrocard.2009.01.003
Arteyeva, N. (2024). Tpe/QT Variability Among Standard ECG Leads: How Not to Miss the Increase in the Tpe/QT Value?. Iranian Heart Journal, 25(2), 75-80.
MLA
Natalia V Arteyeva. "Tpe/QT Variability Among Standard ECG Leads: How Not to Miss the Increase in the Tpe/QT Value?". Iranian Heart Journal, 25, 2, 2024, 75-80.
HARVARD
Arteyeva, N. (2024). 'Tpe/QT Variability Among Standard ECG Leads: How Not to Miss the Increase in the Tpe/QT Value?', Iranian Heart Journal, 25(2), pp. 75-80.
VANCOUVER
Arteyeva, N. Tpe/QT Variability Among Standard ECG Leads: How Not to Miss the Increase in the Tpe/QT Value?. Iranian Heart Journal, 2024; 25(2): 75-80.
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