@Article{chd.12847,
AUTHOR = {Jim T. Vehmeijer, Zeliha Koyak, A. Suzanne Vink, Werner Budts, Louise Harris, Candice K. Silversides, Erwin N. Oechslin, Aeilko H. Zwinderman, Barbara J.M. Mulder, Joris R. de Groot},
TITLE = {Prolonged T<sub>peak</sub>‐T<sub>end</sub> interval is a risk factor for sudden cardiac death in adults with congenital heart disease},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {6},
PAGES = {952--957},
URL = {http://www.techscience.com/schd/v14n6/38915},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Adult congenital heart disease (ACHD) patients are at risk of sudden
cardiac death (SCD). However, methods for risk stratification are not yet well‐
defined. The T<sub>peak</sub>‐T<sub>end</sub> (TpTe) interval, a measure of dispersion of ventricular repolari‐
zation, is a risk factor for SCD in non‐ACHD patients. We aim to evaluate whether 
TpTe can be used in risk stratification for SCD in ACHD patients.<br/>
<b>Design:</b> From an international multicenter cohort of 25 790 ACHD patients, we iden‐
tified all SCD cases. Cases were matched to controls by age, gender, congenital de‐
fect, and (surgical) intervention.<br/>
<b>Outcome Measures:</b> TpTe was measured on a standard 12‐lead ECG. The maximum 
TpTe of all ECG leads (TpTe‐max), mean (TpTe‐mean), and TpTe dispersion (maximum 
minus minimum) were obtained. Odds ratios (OR) for SCD cases vs controls were 
calculated using conditional logistic regression analysis.<br/>
<b>Results:</b> ECGs were available for 147 cases (median age at death 33.5 years (quartiles 
26.2, 48.7), 66% male) and 267 controls. The mean TpTe‐max was 97 ± 24 ms in cases 
vs 84 ± 17 ms in controls (P < .001); TpTe‐mean was 70 ± 16 vs 63 ± 10 ms (P < .001); 
and dispersion was 51 ± 22 ms vs 41 ± 16 ms (P = .02), respectively. Assessing each 
ECG lead separately, TpTe in lead aVR predicted SCD most accurately. TpTe in lead 
aVR was 71 ± 23 ms in cases vs 61 ± 13 ms in controls (P < .001). After adjusting for 
impaired ventricular function, heart failure symptoms, and prolonged QRS duration, 
the OR of SCD of TpTe in lead aVR at an optimal cutoff of 80 ms was 5.8 (95% CI 
2.7‐12.4, P < .001).<br/>
<b>Conclusions:</b> The TpTe interval is associated with SCD in ACHD patients. Particularly, 
TpTe in lead aVR can be used as an independent risk factor for SCD in ACHD patients 
and may, therefore, add precision to current risk prediction models.},
DOI = {10.1111/chd.12847}
}