Principal Component Analysis of the T Wave in Patients with Chest Pain and Conduction Disturbances

There is a need for markers reflecting the increased risk in patients with conduction disturbances. Conduction disturbances presumably cause inhomogeneous repolarization that may create an arrhythmogenic substrate. In patients with normal conduction, parameters derived from principal components analysis (PCA) of the T wave contain prognostic information. The nondipolar PCA components are assumed to reflect repolarization inhomogeneity. This study examined the PCA parameters in relation to conduction disturbances. PCA was performed on continuously recorded 12‐lead ECGs in 800 patients with chest pain and nondiagnostic ECG on admission. The patients with conduction disturbance on admission were classified into separate groups and related to comparison groups without conduction disturbance recruited from the same series. For each patient, the dipolar and nondipolar components were quantified by medians of the ratio of the two largest eigenvalues (S2/S1 Median), the residue that summarizes the eigenvalues S4–S8 (TWRabsMedian) and the ratio of this residue to the total power of the T wave (TWRrelMedian). The parameters were assessed with respect to common clinical and ECG parameters, discharge diagnosis, and total mortality during a 35‐month follow‐up. TWRabsMedian increased with increasing conduction disturbance. In 135 patients with conduction disturbances, ROC curves for TWRabsMedian as indicator of mortality exhibited areas under a curve of 0.66, 0.65, and 0.56 at 6‐month, 24‐month, and 35‐month follow‐up. Conduction disturbances were associated with increased nondipolar PCA component and, thus, with increased repolarization inhomogeneity. The nondipolar PCA component contained a moderate amount of prognostic information not present in a simple ECG diagnosis of a conduction disturbance.