T-wave Abnormalities and Cardiovascular Risk in Diabetes

T-wave abnormalities (TWA) are often found on ECG and signify abnormal ventricular repolarisation. A recent study suggests that the presence and magnitude of TWA are associated with increased risk of clinical cardiovascular events and mortality in individuals with diabetes. The study findings were published in the journal Diabetologia on January 08, 2021.

While T-wave abnormalities are associated with subclinical atherosclerosis, the relationship between TWA and hard cardiovascular endpoints is less clear and may differ in the presence of diabetes. Therefore, researchers of the Wake Forest School of Medicine, USA, conducted a study to explore these associations in participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

In the ACCORD trial, researchers included 8176 eligible participants among which 3759 had cardiovascular events, including 1430 deaths (473 of a cardiovascular aetiology), 474 heart failure events, 1452 major CHD events and 403 strokes. They determined TWA as the presence of any Minnesota Codes 5-1 through 5-4 in any lead distribution. They used multivariable Cox proportional hazards models to examine relationships between TWA and clinical cardiovascular events. They also explored the risks conferred by major vs minor TWA, differential effects of TWA by anatomic localisation (anterolateral, inferior or anterior lead distributions), and differing associations in those with or without prevalent CVD.

Key Findings of the Study

• They found that participants with TWA had increased risks of all-cause mortality (HR 1.45), cardiovascular mortality (HR 1.93), congestive heart failure (HR 2.04) and major CHD (HR 1.40), but no increased risk of stroke (HR 0.99).
• They noted that the major TWA conferred a higher risk than the minor TWA.
• When TWA was added to the UK Prospective Diabetes Study risk engine, they noted improved discrimination for incident CHD events, but only for those with prevalent CVD.
• TWA to the risk engine, they found improvements in reclassification that were of greater magnitude in those with prevalent CVD.

The authors concluded, "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."

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