Prognostic Significance of T‐Wave Amplitude in Lead aVR in Heart Failure Patients with Narrow QRS Complexes

Background: Prolonged duration of the QRS complex is a prognostic marker in patients with heart failure (HF), whereas electrocadiographic markers in HF with narrow QRS complex remain unclear. We evaluated the prognostic value of the T‐wave amplitude in lead aVR in HF patients with narrow QRS complexes. Methods: We examined 331 patients who were admitted to our hospital for worsening HF (68 ± 15 years, mean ± standard deviation) from January 2000 to October 2004 who had sinus rhythm and QRS complex <120 ms. The patients were categorized into three groups according to the peak T‐wave amplitude from baseline in lead aVR: negative (<–0.1 mV; n = 209, 63%), flat (–0.1–0.1 mV; n = 64, 19%), and positive (>0.1 mV; n = 58, 18%). Results: During a mean follow‐up of 33 months, 113 (34%) patients had all‐cause death, the primary end point. After adjusting for clinical covariates, flat T wave (hazard ratio HR] 1.86, 95% confidence interval CI] 1.42–2.46), and positive T wave (HR 6.76, 95% CI 3.92–11.8) were independent predictors of mortality, when negative T wave was considered a reference. Conclusions: As the peak T‐wave amplitude in lead aVR becomes less negative, there was a progressive increase in mortality. The T wave in lead aVR provides prognostic information for risk stratification in HF patients with narrow QRS complexes. Ann Noninvasive Electrocardiol 2011;16(3):250–257