Abstract 16587: Tpeak-to-tend Interval Corrected for Heart Rate: A More Precise Measure of Increased Sudden Death Risk?

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Introduction: The Tpeak-to-Tend interval (Tpe) on the 12-lead electrocardiogram (ECG) predicts increased risk of sudden cardiac death (SCD). There has been some controversy on whether Tpe would be more useful if corrected for heart rate (Tpec). Hypothesis: We hypothesize that correcting the Tpe for heart rate will improve its predictive value for SCD. Methods: Cases of sudden cardiac death (SCD) (n=725; mean age 67.4 years; 95% CI 52.7 to 82.1 years; 67.7% males) from a large ongoing population based study of SCD in the Northwest US (population approx. one million) with an ECG available prior and unrelated to the SCD event were analyzed. Comparisons were made to control subjects with and without coronary artery disease (n=898; mean age 66.9 years; 95% CI 55.5 to 78.3 years; 63.7% males). The Tpe interval was corrected for heart rate using the Bazett (TpecBa) and Fridericia (TpecFd) formulae and the predictive value of Tpec for SCD was compared in logistic regression models. Results: The area-under-curve (AUC) for predicting SCD improved with both correction formulae, TpecBa at 0.628 and TpecFd at 0.606 compared to an uncorrected Tpe at 0.544 (see Figure). The optimal cut-off value for TpecBa and TpecFd was determined using the receiver-operating characteristics (ROC) curve. A TpecBa of more than 94ms and TpecFd of more than 88ms was predictive of SCD independent of age, gender, comorbidities (hypertension, diabetes mellitus, previous myocardial infarction), electrocardiographic left ventricular hypertrophy (LVH), severe left ventricular dysfunction (LVEF ≤35%), prolonged QTc (>450ms) and prolonged QRS duration (>120ms) with an odds ratio of 1.88 (95% CI, 1.36 to 2.60; p <0.0001) and 1.90 (95% CI, 1.38 to 2.62; p <0.0001) respectively. Conclusion: Correcting the Tpeak-to-Tend interval for heart rate, using either the Bazett and Fridericia formulae, improved the independent predictive value of this marker for assessment of SCD risk in the community.