Ratio of late to early T-wave peak amplitude in 24-h electrocardiographic recordings as indicator of symptom history in patients with long-QT syndrome types 1 and 2

Matti Viitasalo, Lasse Oikarinen, Heikki Swan, Kathryn A. Glatter, Heikki Väänänen, Heidi Fodstad, Nipavan Chiamvimonvat, Kimmo Kontula, Lauri Toivonen, Melvin M. Scheinman

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Abstract

OBJECTIVES: We tested the hypothesis that in long-QT syndrome types 1 (LQT1) and 2 (LQT2), the diurnal maximal ratio between late and early T-wave peak amplitudes correlates with a history of symptoms better than QT interval durations. BACKGROUND: Genotype and phenotype studies have delineated clinical profiles of the most prevalent LQT1 and LQT2 subtypes of inherited LQT, but prediction of arrhythmia risk remains uncertain, the baseline QTc interval being the best predictor. In experimental long-QT syndrome models, the ratio between late and early T-wave peak amplitude predicts onset of torsade de pointes. METHODS: We reviewed 24-h electrocardiographic recordings from 214 genotyped subjects - 97 with LQT1, 62 with LQT2, and 55 unaffected - to record maximal amplitude ratios between late and early T-wave peaks by use of a computer-assisted program. RESULTS: Maximal amplitude ratios between late and early T-wave peaks were higher in symptomatic than in asymptomatic patients both in LQT1 (3.2 ± 1.0 vs. 2.3 ± 0.8; p < 0.001) and LQT2 patients (2.6 ± 1.0 vs. 1.7 ± 0.5; p < 0.001). Although the QTc interval also was longer in symptomatic patients, only the maximal amplitude ratio between late and early T-wave peaks was independently associated with symptoms in both LQT1 and LQT2 patients. CONCLUSIONS: Maximal diurnal ratio between late and early T-wave peak amplitude improves noninvasive risk assessment both in LQT1 and LQT2 syndromes. We propose this new indicator in clinical evaluation of arrhythmia risk in LQT1 and LQT2.

Original languageEnglish (US)
Pages (from-to)112-120
Number of pages9
JournalJournal of the American College of Cardiology
Volume47
Issue number1
DOIs
StatePublished - Jan 3 2006

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Romano-Ward Syndrome
History
Cardiac Arrhythmias
Torsades de Pointes
Long QT Syndrome
Software
Genotype
Phenotype

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Ratio of late to early T-wave peak amplitude in 24-h electrocardiographic recordings as indicator of symptom history in patients with long-QT syndrome types 1 and 2. / Viitasalo, Matti; Oikarinen, Lasse; Swan, Heikki; Glatter, Kathryn A.; Väänänen, Heikki; Fodstad, Heidi; Chiamvimonvat, Nipavan; Kontula, Kimmo; Toivonen, Lauri; Scheinman, Melvin M.

In: Journal of the American College of Cardiology, Vol. 47, No. 1, 03.01.2006, p. 112-120.

Research output: Contribution to journalArticle

Viitasalo, Matti ; Oikarinen, Lasse ; Swan, Heikki ; Glatter, Kathryn A. ; Väänänen, Heikki ; Fodstad, Heidi ; Chiamvimonvat, Nipavan ; Kontula, Kimmo ; Toivonen, Lauri ; Scheinman, Melvin M. / Ratio of late to early T-wave peak amplitude in 24-h electrocardiographic recordings as indicator of symptom history in patients with long-QT syndrome types 1 and 2. In: Journal of the American College of Cardiology. 2006 ; Vol. 47, No. 1. pp. 112-120.
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T1 - Ratio of late to early T-wave peak amplitude in 24-h electrocardiographic recordings as indicator of symptom history in patients with long-QT syndrome types 1 and 2

AU - Viitasalo, Matti

AU - Oikarinen, Lasse

AU - Swan, Heikki

AU - Glatter, Kathryn A.

AU - Väänänen, Heikki

AU - Fodstad, Heidi

AU - Chiamvimonvat, Nipavan

AU - Kontula, Kimmo

AU - Toivonen, Lauri

AU - Scheinman, Melvin M.

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N2 - OBJECTIVES: We tested the hypothesis that in long-QT syndrome types 1 (LQT1) and 2 (LQT2), the diurnal maximal ratio between late and early T-wave peak amplitudes correlates with a history of symptoms better than QT interval durations. BACKGROUND: Genotype and phenotype studies have delineated clinical profiles of the most prevalent LQT1 and LQT2 subtypes of inherited LQT, but prediction of arrhythmia risk remains uncertain, the baseline QTc interval being the best predictor. In experimental long-QT syndrome models, the ratio between late and early T-wave peak amplitude predicts onset of torsade de pointes. METHODS: We reviewed 24-h electrocardiographic recordings from 214 genotyped subjects - 97 with LQT1, 62 with LQT2, and 55 unaffected - to record maximal amplitude ratios between late and early T-wave peaks by use of a computer-assisted program. RESULTS: Maximal amplitude ratios between late and early T-wave peaks were higher in symptomatic than in asymptomatic patients both in LQT1 (3.2 ± 1.0 vs. 2.3 ± 0.8; p < 0.001) and LQT2 patients (2.6 ± 1.0 vs. 1.7 ± 0.5; p < 0.001). Although the QTc interval also was longer in symptomatic patients, only the maximal amplitude ratio between late and early T-wave peaks was independently associated with symptoms in both LQT1 and LQT2 patients. CONCLUSIONS: Maximal diurnal ratio between late and early T-wave peak amplitude improves noninvasive risk assessment both in LQT1 and LQT2 syndromes. We propose this new indicator in clinical evaluation of arrhythmia risk in LQT1 and LQT2.

AB - OBJECTIVES: We tested the hypothesis that in long-QT syndrome types 1 (LQT1) and 2 (LQT2), the diurnal maximal ratio between late and early T-wave peak amplitudes correlates with a history of symptoms better than QT interval durations. BACKGROUND: Genotype and phenotype studies have delineated clinical profiles of the most prevalent LQT1 and LQT2 subtypes of inherited LQT, but prediction of arrhythmia risk remains uncertain, the baseline QTc interval being the best predictor. In experimental long-QT syndrome models, the ratio between late and early T-wave peak amplitude predicts onset of torsade de pointes. METHODS: We reviewed 24-h electrocardiographic recordings from 214 genotyped subjects - 97 with LQT1, 62 with LQT2, and 55 unaffected - to record maximal amplitude ratios between late and early T-wave peaks by use of a computer-assisted program. RESULTS: Maximal amplitude ratios between late and early T-wave peaks were higher in symptomatic than in asymptomatic patients both in LQT1 (3.2 ± 1.0 vs. 2.3 ± 0.8; p < 0.001) and LQT2 patients (2.6 ± 1.0 vs. 1.7 ± 0.5; p < 0.001). Although the QTc interval also was longer in symptomatic patients, only the maximal amplitude ratio between late and early T-wave peaks was independently associated with symptoms in both LQT1 and LQT2 patients. CONCLUSIONS: Maximal diurnal ratio between late and early T-wave peak amplitude improves noninvasive risk assessment both in LQT1 and LQT2 syndromes. We propose this new indicator in clinical evaluation of arrhythmia risk in LQT1 and LQT2.

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