Association of T-Wave Abnormalities With Major Cardiovascula
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T-wave abnormalities (TWA) are often found on ECG and signify abnormal ventricular repolarization. While TWA have been shown to be associated with subclinical atherosclerosis, the relationship between TWA and hard cardiovascular endpoints is less clear and may differ in the presence of diabetes, so we sought to explore these associations in participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

TWA were operationally defined as the presence of any Minnesota Codes 5-1 through 5-4 in any lead distribution. Multivariable Cox proportional hazards models were constructed to examine relationships between TWA and clinical cardiovascular events. Secondary analyses explored the risks conferred by major vs minor TWA, differential effects of TWA by anatomic localization (anterolateral, inferior or anterior lead distributions), and differing associations in those with or without prevalent CVD.

-- Among 8176 eligible participants (mean 62.1 years, 61.4% male), there were 3759 cardiovascular events, including 1430 deaths (473 of a cardiovascular etiology), 474 heart failure events, 1452 major CHD events and 403 strokes.

-- Participants with TWA had increased risks of all-cause mortality, cardiovascular mortality, congestive heart failure and major CHD, but no increased risk of stroke.

-- Major TWA conferred a higher risk than minor TWA.

-- When TWA were added to the UK Prospective Diabetes Study risk engine, there was improved discrimination for incident CHD events, but only for those with prevalent CVD.

-- Adding TWA to the risk engine yielded improvements in reclassification that were of greater magnitude in those with prevalent CVD.

Conclusively, the presence and magnitude of TWA are associated with increased risk of clinical cardiovascular events and mortality in individuals with diabetes and may have value in refining risk, particularly in those with prevalent CVD.