Relationship between T-wave peak-end interval and corrected QT interval on electrocardiogram and risk of malignant arrhythmia in patients with hypertrophic cardiomyopathy

Yang Xiaolei; Wang Qiang; Zheng Xiaoguang; Liu Xiaotao

doi:10.3760/j.issn.1673-4777.2026.03.002

Abstract：Objective To investigate the relationship between electrocardiographic parameters T-wave peak-end interval(Tp-Te)and corrected QT interval(QTc)and the risk of malignant arrhythmia in patients with hypertrophic cardiomyopathy(HCM).Methods A total of 333 patients with HCM admitted to the 906th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from March 2020 to May 2024 were retrospectively selected.According to the results of 24 h ambulatory electrocardiography,patients with malignant arrhythmia were included in the observation group(102 cases),and those without malignant arrhythmia were included in the control group(231 cases).Clinical data and electrocardiographic parameters of the patients were collected.Multivariate regression models were used to adjust for confounding factors and analyze the independent correlations of Tp-Te and QTc with malignant arrhythmia;LOWESS smoothing curves were applied to explore their relationships with heart rate variability;stratified regression was performed to evaluate the associations in different subgroups.Results The proportion of males,age,left ventricular end-systolic diameter,left atrial volume index,left atrial diameter,and interventricular septum thickness in the observation group were all higher than those in the control group,while the left ventricular end-diastolic diameter and left ventricular ejection fraction were lower than those in the control group(all P＜0.05).The Tp-Te[(109±16)ms vs(77±15)ms]and QTc[(438±36)ms vs(412±34)ms]in the observation group were significantly higher than those in the control group,and the standard deviation of normal-to-normal R-R intervals(SDNN),standard deviation of average R-R intervals(SDANN),and root mean square of successive differences in adjacent R-R intervals(RMSSD)were lower than those in the control group(all P＜0.05).Results of independent correlation analysis showed that after adjusting for confounding factors,patients with lower levels of SDNN,SDANN,and RMSSD,as well as higher levels of Tp-Te and QTc,had a higher risk of developing malignant arrhythmia(all P＜0.05).Stratified analysis showed that Tp-Te and QTc were correlated with the risk of malignant arrhythmia in all subgroups stratified by gender,age,and cardiac structure(all P＜0.05).Threshold analysis indicated that the inflection points of Tp-Te and QTc affecting the occurrence of malignant arrhythmia were 92.66 ms and 424.66 ms,respectively.Below the thresholds,the risk decreased with the increase of these parameters,while above the thresholds,the risk increased with the elevation of these parameters.Conclusions Tp-Te and QTc are independent predictors of malignant arrhythmia in patients with HCM,with clear threshold effects.Combined with reduced heart rate variability,these parameters can provide key evidence for risk stratification and early intervention in HCM patients,optimizing clinical manage-ment strategies.