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


  • This work was supported by the 25th Memorial Grant from Suzuken Memorial Foundation.

  • We do not have any potential conflict of interest to disclose.

Yukio Ozaki, M.D., F.A.C.C., F.E.S.C., Department of Cardiology, Fujita Health University School of Medicine, 1–98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470–1192, Japan. Fax: +81-562-93-2315; E-mail:


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