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Total cosine R-to-T for predicting ventricular arrhythmic and mortality outcomes: A systematic review and meta-analysis.

Total cosine R-to-T for predicting ventricular arrhythmic and mortality outcomes: A systematic review and meta-analysis.
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Tse G, Gong M, Wong CW, Chan C, Georgopoulos S, Chan YS, Yan BP, Li G, Whittaker P, Ciobanu A, Ali-Hasan-Al-Saegh S, Wong SH, Wu WKK, Bazoukis G, Lampropoulos K, Wong WT, Tse LA, Baranchuk AM, Letsas KP, Liu T, ,


Tse G, Gong M, Wong CW, Chan C, Georgopoulos S, Chan YS, Yan BP, Li G, Whittaker P, Ciobanu A, Ali-Hasan-Al-Saegh S, Wong SH, Wu WKK, Bazoukis G, Lampropoulos K, Wong WT, Tse LA, Baranchuk AM, Letsas KP, Liu T, , (click to view)

Tse G, Gong M, Wong CW, Chan C, Georgopoulos S, Chan YS, Yan BP, Li G, Whittaker P, Ciobanu A, Ali-Hasan-Al-Saegh S, Wong SH, Wu WKK, Bazoukis G, Lampropoulos K, Wong WT, Tse LA, Baranchuk AM, Letsas KP, Liu T, ,

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Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2017 09 12() doi 10.1111/anec.12495
Abstract
BACKGROUND
The total cosine R-to-T (TCRT), a vectorcardiographic marker reflecting the spatial difference between the depolarization and repolarization wavefronts, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death (SCD) in different clinical settings. However, its prognostic value has been controversial.

OBJECTIVE
This systematic review and meta-analysis evaluated the significance of TRCT in predicting arrhythmic and/or mortality endpoints.

METHODS
PubMed and Embase databases were searched through December 31, 2016.

RESULTS
Of the 890 studies identified initially, 13 observational studies were included in our meta-analysis. A total of 11,528 patients, mean age 47 years old, 72% male, were followed for 43 ± 6 months. Data from five studies demonstrated lower TCRT values in myocardial infarction patients with adverse events (syncope, ventricular arrhythmias, or sudden cardiac death) compared to those without these events (mean difference = -0.36 ± 0.05, p < .001; I(2)  = 48%). By contrast, only two studies analyzed outcomes in heart failure, and pooled meta-analysis did not demonstrate significant difference in TCRT between event-positive and event-negative patients (mean difference = -0.01 ± 0.10, p > .05; I(2)  = 80%).

CONCLUSION
TCRT is lower in MI patients at high risk of adverse events when compared to those free from such events. It can provide additional risk stratification beyond the use of clinical parameters and traditional electrocardiogram markers. Its value in other diseases such as heart failure requires further studies.

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