Clinical Significance of T-Wave Alternans in Hypertrophic Cardiomyopathy.

Kuroda, Nobutoshi; Ohnishi, Yozo; Yoshida, Akihiro; Kimura, Akinori; Yokoyama, Mitsuhiro

doi:10.1253/circj.66.457

Cited by 28 publications

(21 citation statements)

References 33 publications

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“…6,7 Relevant to the patients with hypertrophic cardiomyopathy, the TWA is thought to reflect the unique myofibrillar arrangement and/or myocardial fibrosis as the surrogate for electrical instability of the myocardium, rather than reflecting the size of the LV wall thickness (LVWT). 8, 9 In line with this our findings bear significance as to the regional predilection and not the absolute magnitude of the LVH in itself (LV mass or maximal LVWT) that carries the predictive link of ventricular arrhythmic events and also TWA outcome. 1,10 Given that TWA is caused by the underlying regional inhomogeneities of ventricular repolarization, it is conceivable that it is the regional distribution of increased LVWT that may have a more relevant role in susceptibility to ventricular tachyarrhythmia over theprominent hypertrophic phenotype.…”

supporting

confidence: 79%

An Interplay Between Left Ventricular Wall Thickness and T-Wave Alternans in Patients With Hypertrophic Cardiomyopathy in Predicting Ventricular Tachyarrythmic Events:

Püntmann

2010

Circ J

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supporting

confidence: 79%

An Interplay Between Left Ventricular Wall Thickness and T-Wave Alternans in Patients With Hypertrophic Cardiomyopathy in Predicting Ventricular Tachyarrythmic Events:

Püntmann

2010

Circ J

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“…21, 22 In the present study we investigated the relationship between echocardiographic morphological distribution of LVH in HCM patients and TWA, a surrogate risk marker of VTAs and explored the congruence with our previous findings. 10 …”

mentioning

confidence: 66%

T-Wave Alternans and Left Ventricular Wall Thickness in Predicting Arrhythmic Risk in Patients With Hypertrophic Cardiomyopathy

Püntmann

Yap

McKenna

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp triking morphological features with increased left ventricular wall thickness (LVWT) represent the hallmark of the hypertrophic cardiomyopathy (HCM) phenotype, 1-5 yet their relationship with increased risk of ventricular tachyarrhythmias (VTAs) and sudden cardiac death (SCD) in these patients remains poorly characterized. 6 Previous studies indicated higher risk with greater LVWT, especially with extreme hypertrophy >30 mm, but patients with mild left ventricular hypertrophy (LVH) are not event free. 7-9 Thus, morphological measures of LVH appear insufficiently characterized to effectively translate into risk stratification strategies. In addition, marked heterogeneity of LVWT may play a role: recent evidence from our group indicates that in addition to the maximal LVWT, key regional LVWTs may provide complementary information of incremental value to a conventional risk stratification model. 10 Microvolt T-wave alternans (TWA) emerged as an instrumental non-invasive investigational tool in arrhythmia-prone populations. 11-15 Measuring the fluctuation in T-wave morphology on the basis of every other (alternate) heart beat is considered to represent spatial or temporal variations in ventricular repolarization, and this has been linked to both inducible and spontaneous VTAs as well as to the mechanisms leading to their initiation. Several lines of evidence support the use of TWA as a reliable predictor of VTAs and arrhythmia event-free survival in at-risk populations, including ischemic, non-ischemic dilated cardiomyopathy. 16-19 Although a few previous studies investigated the contribution of hypertrophic myocardial phenotype and regional structural variation to the genesis of arrhythmia vulnerability, 20,21 these relation- Received December 20, 2009; revised manuscript received February 18, 2010; accepted February 19, 2010; released online May 8, 2010 Time for primary review: 24 days St George's, University of London, *University College London, Heart Hospital, London, UK **The first two authors contributed equally to this work.

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“…Prolonged QT dispersion and positive T wave alternans have been reported in HCM cases 17,19 . Thus, a repolarization disturbance is also a potential mechanism of VAs in HCM.…”

Section: Repolarization Abnormalities and Ventricular Arrhythmiasmentioning

confidence: 97%

“…In HCM cases, the detection ratio of late potentials on the signal averaged electrocardiogram has been reported to be not significantly high 17 . A 13 previous report demonstrated that induction of ventricular arrhythmias in EPS is not necessarily effective for a risk stratification of sudden death in HCM patients suggesting that the mechanism of VAs is not solely attributed to one mechanism in HCM 18 .…”

Section: Repolarization Abnormalities and Ventricular Arrhythmiasmentioning

confidence: 99%

Late gadolinium enhancement on cardiac magnetic resonance represents the depolarizing and repolarizing electrically damaged foci causing malignant ventricular arrhythmia in hypertrophic cardiomyopathy

et al. 2015

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Clinical Significance of T-Wave Alternans in Hypertrophic Cardiomyopathy.

Cited by 28 publications

References 33 publications

An Interplay Between Left Ventricular Wall Thickness and T-Wave Alternans in Patients With Hypertrophic Cardiomyopathy in Predicting Ventricular Tachyarrythmic Events:

An Interplay Between Left Ventricular Wall Thickness and T-Wave Alternans in Patients With Hypertrophic Cardiomyopathy in Predicting Ventricular Tachyarrythmic Events:

T-Wave Alternans and Left Ventricular Wall Thickness in Predicting Arrhythmic Risk in Patients With Hypertrophic Cardiomyopathy

Late gadolinium enhancement on cardiac magnetic resonance represents the depolarizing and repolarizing electrically damaged foci causing malignant ventricular arrhythmia in hypertrophic cardiomyopathy

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