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Kentta, Tuomas V.; Sinner, Moritz F.; Nearing, Bruce D.; Freudling, Rebecca; Porthan, Kimmo; Tikkanen, Jani T.; Müller-Nurasyid, Martina; Schramm, Katharina; Viitasalo, Matti; Jula, Antti; Nieminen, Markku S.; Peters, Annette; Salomaa, Veikko; Oikarinen, Lasse; Verrier, Richard L.; Kaab, Stefan; Junttila, M. Juhani; Huikuri, Heikki V. (2018): Repolarization Heterogeneity Measured With T-Wave Area Dispersion in Standard 12-Lead ECG Predicts Sudden Cardiac Death in General Population. In: Circulation-Arrhythmia and Electrophysiology, Vol. 11, No. 2, e005762
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BACKGROUND: We developed a novel electrocardiographic marker, T-wave area dispersion (TW-Ad), which measures repolarization heterogeneity by assessing interlead T-wave areas during a single cardiac cycle and tested whether it can identify patients at risk for sudden cardiac death (SCD) in the general population. METHODS AND RESULTS: TW-Ad was measured from standard digital 12-lead ECG in 5618 adults (46% men;age, 50.9 +/- 12.5 years) participating in the Health 2000 Study-an epidemiological survey representative of the Finnish adult population. Independent replication was performed in 3831 participants of the KORA S4 Study (Cooperative Health Research in the Region of Augsburg;49% men;age, 48.7 +/- 13.7 years;mean follow-up, 8.8 +/- 1.1 years). During follow-up (7.7 +/- 1.4 years), 72 SCDs occurred in the Health 2000 Survey. Lower TW-Ad was univariately associated with SCD (0.32 +/- 0.36 versus 0.60 +/- 0.19;P<0.001);it had an area under the receiver operating characteristic curve of 0.809. TW-Ad (<= 0.46) conferred a hazard ratio of 10.8 (95% confidence interval, 6.8-17.4;P<0.001) for SCD;it remained independently predictive of SCD after multivariable adjustment for clinical risk markers (hazard ratio, 4.6;95% confidence interval, 2.7-7.4;P<0.001). Replication analyses performed in the KORA S4 Study confirmed an increased risk for cardiac death (unadjusted hazard ratio, 5.5;95% confidence interval, 3.2-9.5;P<0.001;multivariable adjusted hazard ratio, 1.9;95% confidence interval, 1.1-3.5;P<0.05). CONCLUSION: Low TW-Ad, reflecting increased heterogeneity of repolarization, in standard 12-lead resting ECGs is a powerful and independent predictor of SCD in the adult general population.