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<p>The prognostic significance of flat T-wave findings remains unclear. This study investigated the association between flat T-wave patterns and cardiovascular events. We analyzed data from 4508 patients with cardiovascular risk who were enrolled in the multicenter, prospective Coupling Study, with available electrocardiographic (ECG) records and follow-up outcomes (mean age 69 years; 51% male). Flat T waves were defined as T waves with an amplitude &lt;0.1 mV and a T wave-to-R wave ratio of &lt;10% in ≥2 of leads I, II, aVL, and V4–V6. Negative ST-T findings were defined as the area below the baseline in the ST-T segment. The primary endpoint was cardiovascular events, including stroke, myocardial infarction, hospitalization for heart failure, and aortic dissection. Over a median 5.0-year follow-up, 210 cardiovascular events occurred. Compared to the control group (<i>N</i> = 3426), both the flat T-wave (<i>N</i> = 539) and negative ST-T (<i>N</i> = 541) groups exhibited significantly greater risk of cardiovascular events after adjustment for age, gender, smoking, comorbidities, medications, office systolic blood pressure, N-terminal pro-B-type natriuretic peptide, and troponin T (flat T: hazard ratio [HR] 1.52, 95% confidence interval [CI], 1.01–2.29; <i>p</i> = 0.044; negative ST-T: HR 2.23, 95% CI, 1.58–3.15; <i>p</i> &lt; 0.001). Findings in patients with hypertension (<i>N</i> = 4135) were consistent with those in the overall cohort: the flat T group had an HR of 1.54 (95% CI, 1.03–2.33; <i>p</i> = 0.037), and the negative ST-T group had an HR of 2.24 (95% CI, 1.57–3.18; <i>p</i> &lt; 0.001) for incidence of cardiovascular events. In conclusion, flat T-wave findings on ECG were independently associated with cardiovascular events among patients with cardiovascular risk, including those with hypertension.</p><p></p>

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Digital ECG detection of flat T waves predicts cardiovascular events in high-risk patients: the Coupling Study

  • 期刊论文

  • 发表日期：

    2025年11月21日

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  • Tomoyuki Kabutoya,
  • Satoshi Hoshide,
  • Kazuomi Kario

摘要

The prognostic significance of flat T-wave findings remains unclear. This study investigated the association between flat T-wave patterns and cardiovascular events. We analyzed data from 4508 patients with cardiovascular risk who were enrolled in the multicenter, prospective Coupling Study, with available electrocardiographic (ECG) records and follow-up outcomes (mean age 69 years; 51% male). Flat T waves were defined as T waves with an amplitude <0.1 mV and a T wave-to-R wave ratio of <10% in ≥2 of leads I, II, aVL, and V4–V6. Negative ST-T findings were defined as the area below the baseline in the ST-T segment. The primary endpoint was cardiovascular events, including stroke, myocardial infarction, hospitalization for heart failure, and aortic dissection. Over a median 5.0-year follow-up, 210 cardiovascular events occurred. Compared to the control group (N = 3426), both the flat T-wave (N = 539) and negative ST-T (N = 541) groups exhibited significantly greater risk of cardiovascular events after adjustment for age, gender, smoking, comorbidities, medications, office systolic blood pressure, N-terminal pro-B-type natriuretic peptide, and troponin T (flat T: hazard ratio [HR] 1.52, 95% confidence interval [CI], 1.01–2.29; p = 0.044; negative ST-T: HR 2.23, 95% CI, 1.58–3.15; p < 0.001). Findings in patients with hypertension (N = 4135) were consistent with those in the overall cohort: the flat T group had an HR of 1.54 (95% CI, 1.03–2.33; p = 0.037), and the negative ST-T group had an HR of 2.24 (95% CI, 1.57–3.18; p < 0.001) for incidence of cardiovascular events. In conclusion, flat T-wave findings on ECG were independently associated with cardiovascular events among patients with cardiovascular risk, including those with hypertension.