Frontal plane T-wave axis orientation predicts coronary events: Findings from the Moli-sani study

Licia Iacoviello, Marialaura Bonaccio, Augusto Di Castelnuovo, Simona Costanzo, Amalia De Curtis, Mariarosaria Persichillo, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello, Livia Rago, Deodato Assanelli, Fabio Badilini, Martino Vaglio, Peter W. Macfarlane, on behalf of the, Moli-sani study Investigators

Research output: Contribution to journalArticlepeer-review


Background and aims The orientation of the frontal plane T-wave axis (T axis) is a reliable measure of ventricular repolarisation. We investigated the association between T-axis and the risk of coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), stroke and cardiovascular (CVD) mortality. Methods A sample of 21,287 Moli-sani participants randomly recruited from the general adult (≥35 y) Italian population, free of CVD disease, were followed for a median of 4.4 years. T-axis was measured from a standard 12-lead resting ECG. Results After adjusting for CVD risk factors, subjects with abnormal T-axis showed an increase in the risk of both CHD (Hazard Ratio (HR) = 2.65; 95% CI = 1.67–4.21), HF (HR = 2.56; 1.80–3.63), AF (HR = 2.48; 1.56–3.94) and CVD mortality (HR = 2.83; 1.50–5.32). The association with CHD and HF, but not with AF or CVD death, remained significant after further adjustment for ECG abnormalities. Subjects with abnormal T-axis showed higher levels of subclinical inflammation, hs-troponin I and hs-NT-proBNP (p < 0.001 for all). However, further adjustment for troponin I and/or NT-proBNP determined a reduction of HRs ranging from 12.1 to 24.0% for CHD, while additional adjustment for inflammation markers did not change any association. Conclusions An abnormal T-axis orientation is associated with an increased risk of both CHD and HF, independently of common CVD risk factors and other ECG abnormalities. This association was partially explained by increased hs-troponin I and hs-NT-proBNP levels.

Original languageEnglish
Pages (from-to)51-57
Number of pages7
Publication statusPublished - Sep 1 2017


  • Cardiovascular disease
  • ECG
  • Heart failure
  • Population study
  • T-wave axis
  • Ventricular repolarisation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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