The T_peak − T_end interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and meta-analysis

Background The T_peak − T_end interval (the interval from the peak to the end of the T wave), an electrocardiographic marker reflecting transmural dispersion of repolarization, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death in different clinical settings. Objective This systematic review and meta-analysis evaluated the significance of the T_peak − T_end interval in predicting arrhythmic and/or mortality end points. Methods PubMed, Embase, Cochrane Library, and CINAHL Plus databases were searched through November 30, 2016. Results Of the 854 studies identified initially, 33 observational studies involving 155,856 patients were included in our meta-analysis. T_peak − T_end interval prolongation (mean cutoff value 103.3 ± 17.4 ms) was a significant predictor of the arrhythmic or mortality outcomes (odds ratio [OR] 1.14; 95% confidence interval [CI] 1.11–1.17; P <.001). When different end points were analyzed, the ORs were as follows: VT/VF, 1.10 (95% CI 1.06–1.13; P <.0001); sudden cardiac death, 1.27 (95% CI 1.17–1.39; P <.0001); cardiovascular death, 1.40 (95% CI 1.19–1.64; P <.0001); and all-cause mortality, 4.56 (95% CI 0.62–33.68; P <.0001). Subgroup analysis for each disease revealed that the risk of VT/VF or death was highest for Brugada syndrome (OR 5.68; 95% CI 1.57–20.53; P <.01), followed by hypertension (OR 1.52; 95% CI 1.26–1.85; P <.0001), heart failure (OR 1.07; 95% CI 1.04–1.11; P <.0001), and ischemic heart disease (OR 1.06; 95% CI 1.02–1.10; P = 0.001). Conclusion The T_peak − T_end interval is a useful risk stratification tool in different diseases and in the general population.