T axis as an indicator of risk of cardiac events in elderly people

Background The T axis was postulated to be a general marker of repolarisation abnormality, indicative of subclinical myocardial damage. The aim of this investigation was to assess the prognostic importance of the T axis for fatal and non-fatal cardiac events, in a prospective cohort study of men and women aged 55 years and older. Methods 2352 men and 3429 women from the population-based Rotterdam Study took part in the study. Electrocardiograms were done, and T axes were categorised as normal, borderline, or abnormal. Data were analysed with Coxʹs proportional-hazards models; adjustment for age and sex was done where appropriate. Findings During 3–6 (mean 4) years of follow-up of the 5781 participants, 165 (2·9%) fatal and 192 (3·3%) non-fatal cardiac events occurred. Participants with an abnormal T axis (n=609) had an increased risk of cardiac death (hazard ratio 3·9 [95% CI 2·8–5·6]), sudden cardiac death (4·4 [2·6–7·4]), non-fatal cardiac events (2·7 [1·9–3·9]), and combined fatal or non-fatal cardiac events (3·2 [2·5–4·1]); p<0·001 for each. Additional adjustment for established cardiovascular risk factors resulted in lower, but still significant risk for all endpoints. The risk associated with an abnormal T axis was higher than those for any other cardiovascular risk factor. Additional subgroup analyses indicated that the risk of cardiac death was not substantially modified by age, sex, or history of myocardial infarction. Interpretation The T axis is a strong and independent risk indicator of fatal and non-fatal cardiac events in the elderly.