T‐wave and its association with myocardial fibrosis on cardiovascular magnetic resonance examination

Abstract

Background Risk stratification in non‐ischemic myocardial disease poses a challenge. While cardiovascular magnetic resonance (CMR) is a comprehensive tool, the electrocardiogram (ECG) provides quick impactful clinical information. Studying the relationships between CMR and ECG can provide much‐needed risk stratification. We evaluated the electrocardiographic signature of myocardial fibrosis defined as presence of late gadolinium enhancement (LGE) or extracellular volume fraction (ECV) ≥29%. Methods We evaluated 240 consecutive patients (51% female, 47.1 ± 16.6 years) referred for a clinical CMR who underwent 12‐lead ECGs within 90 days. ECG parameters studied to determine association with myocardial fibrosis included heart rate, QRS amplitude/duration, T‐wave amplitude, corrected QT and QT peak, and Tpeak‐Tend. Abnormal T‐wave was defined as low T‐wave amplitude ≤200 µV or a negative T wave, both in leads II and V5. Results Of the 147 (61.3%) patients with myocardial fibrosis, 67 (28.2%) had ECV ≥ 29%, and 132 (54.6%) had non‐ischemic LGE. An abnormal T‐wave was more prevalent in patients with versus without myocardial fibrosis (66% versus 42%, p < .001). Multivariable analysis demonstrated that abnormal T‐wave (OR 1.95, 95% CI 1.09–3.49, p = .03) was associated with myocardial fibrosis (ECV ≥ 29% or LGE) after adjustment for clinical covariates (age, gender, history of hypertension, and heart failure). Dynamic nomogram for predicting myocardial fibrosis using clinical parameters and the T‐wave was developed: https://normogram.shinyapps.io/CMR_Fibrosis/. Conclusion Low T‐wave amplitude ≤ 200 µV or negative T‐waves are independently associated with myocardial fibrosis. Prospective evaluation of T‐wave amplitude may identify patients with a high probability of myocardial fibrosis and guide further indication for CMR.

Using explainable AI to investigate electrocardiogram changes during healthy aging—From expert features to raw signals

“…The amplitude of the T-wave decreases with age and shifts to the right, indicating an overall longer cardiac cycle, meaning a slower heart rate. Furthermore, the T- and P-wave intervals shorten with age; moreover, the absolute magnitude of the S-peak, Q-peak, and P-wave appears to diminish with age as well, which is in accordance with [ 36 , 37 ]. It is noteworthy that the amplitude of the R-peak shows no conclusive trend with age.…”

Dynamic prediction of malignant ventricular arrhythmias using neural networks in patients with an implantable cardioverter-defibrillator

“…Abnormalities in ventricular repolarisation, represented by the T-wave, have been associated with ventricular arrhythmic substrates such as myocardial fibrosis, and may arguably explain the relevance of these particular latent space variable for the dynamic model. 52 , 53 , 54 , 55 Related to this is the notion that there may be cardiac pathologies where beat-to-beat variations changes in the T-wave morphology are observed (e.g. due to ventricular ectopy), although it is not clear whether these variations are captured during the encoding process.…”

Digitized Electrocardiography Measurements Support the Biological Plausibility of the Pathological Significance of ST Segments in Athletes

“…For instance, low T wave amplitudes (#200 mV) or negative T waves were highly associated with myocardial fibrosis using cardiovascular magnetic resonance. 14 Moreover, it has also been suggested that intensive exercise can lead to acute myocardial damage. 26 Current guidelines suggest that ST depression $ 0.05 mV (0.5 mm) in anterior leads warrant further examination in athletes.…”

“…13 Other repolarization abnormalities, including low T wave amplitude (#200 mV) or negative T waves (leads II and V5) can indicate the development of myocardial fibrosis. 14 Surprisingly, literature searches found few assessments of ST abnormalities in athletes. The purpose of this study was to explore the association between resting ST segment deviations in athletes and ECG markers of cardiovascular health and typical response to aerobic training, such as relatively greater R and T wave amplitude.…”