Diastolic electromechanical coupling: Association of the ecg t-peak to t-end interval with echocardiographic markers of diastolic dysfunction

Andrew Sauer, Jane E. Wilcox, Adin Cristian Andrei, Rod Passman, Jeffrey J. Goldberger, Sanjiv J. Shah

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Background-Electromechanical coupling, a well-described phenomenon in systolic dysfunction, has not been well studied in diastole. We hypothesized that the ECG T-peak to T-end (TpTe) interval, representing transmural dispersion of repolarization, is associated with echocardiographic markers of diastolic dysfunction (DD). Methods and Results-We performed a prospective, cross-sectional study of the association between TpTe and markers of DD in 84 consecutive, unselected patients referred for exercise echocardiography. We systematically measured TpTe on the resting ECG, and we performed comprehensive assessment of DD at rest and at peak stress. ECGs and echocardiograms were analyzed independently, blinded to each other and to all clinical data. By univariable analysis, increased TpTe was associated with older age, increased E/e' ratio, and DD (P<0.05 for all associations after correcting for multiple comparisons). Increased TpTe was inversely associated with reduced tissue Doppler e' velocity, a marker of DD (R=.0.66, P<0.0001). This association persisted after adjusting for age, QTc, exercise-induced wall motion abnormalities, and left ventricular mass index (β=.0.41 [95% confidence interval, .0.70 to .0.12] cm/s per 10-ms increase in TpTe; P=0.006). Baseline TpTe was also independently associated with resting DD (adjusted odds ratio, 3.9 [95% confidence interval, 1.4-10.7]; P=0.009) and peak exercise E/e' ratio (P<0.0001). Conclusions-Increased TpTe is associated with both resting and exercise-induced DD. Electromechanical coupling may represent a pathophysiologic link between electrical transmural dispersion of repolarization and abnormal myocardial relaxation, and may be a novel therapeutic target.

Original languageEnglish (US)
Pages (from-to)537-543
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Issue number3
StatePublished - Jun 2012
Externally publishedYes


  • Diastole
  • ECG
  • Echocardiography
  • Repolarization
  • Tissue doppler imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


Dive into the research topics of 'Diastolic electromechanical coupling: Association of the ecg t-peak to t-end interval with echocardiographic markers of diastolic dysfunction'. Together they form a unique fingerprint.

Cite this