Evaluation of postextrasystolic T wave alterations in identification of patients with coronary artery disease or left ventricular dysfunction

Leachman, D. Richard; Dehmer, Gregory J.; Firth, Brian G.; Markham, Roy V.; Winniford, Michael D.; Hillis, L.David

doi:10.1016/0002-8703(81)90090-9

Cited by 8 publications

(4 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, the further statistical analysis for PFD using the ROC curve and dividing the population into two groups was not significant either. These results seem to be in accordance with the findings from earlier studies, where PEST was not significant for the identification of coronary artery disease or left ventricular dysfunction [2]. According to [3], PEST appears to be a normal phenomenon present in all patients manifesting more or less equally independent of their cardiac disease.…”

Section: Discussionsupporting

confidence: 91%

“…The modified postectopic T wave returns to its original shape within one or two beats. Although PEST has been observed in the past in patients with cardiac pathologies such as coronary artery disease or left ventricular dysfunction [2], it has not been proven to be useful for the identification of those patients. However, in a previous study [3], PEST was shown to be related to postextrasystolic contractile potentiation and it was found to be more notorious in the presence of depression of myocardial contractility.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Postextrasystolic T Wave Change to Stratify Risk of Pump Failure Death in Patients with Chronic Heart Failure

Lenis

Menges

Ramírez

et al. 2016

2016 Computing in Cardiology Conference (CinC)

View full text Add to dashboard Cite

The postextrasystolic T wave change (PEST) is an electrocardiographic phenomenon in which the morphology of the normal T wave is altered for a short time after a ventricular ectopic beat (VEB). It has been observed in patients with other cardiac pathologies but it has not been proposed as a risk index for cardiac death. Since PEST seems to be potentiated in patients with depression of myocardial contractility, we hypothesize that PEST could be used to predict pump failure death (PFD) in patients with chronic heart failure (CHF). For the purpose of quantifying PEST, the parameters morphological change onset (MCO) and morphological change slope (MCS) were introduced. MCO describes an initial morphological change of the T wave after a VEB, while MCS is responsible for the description of the restitution to its original shape. 537 records from the MUSIC study were separated according to their cause of death and comparisons against the others (including survivors) were carried out. In addition, receiver operating characteristic (ROC) curves were used to determine the optimal separating thresholds for MCO and MCS that maximized the sum of sensitivity and specificity for PFD risk prediction. The results showed that no significant differences could be established and the proposed parameters do not seem to be related to any kind of cardiac death. In future, other forms of PEST quantification together with more databases can be used to definitely conclude that PEST has no predictive power.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Postextrasystolic T Wave Change to Stratify Risk of Pump Failure Death in Patients with Chronic Heart Failure

Lenis

Menges

Ramírez

et al. 2016

2016 Computing in Cardiology Conference (CinC)

View full text Add to dashboard Cite

show abstract

“…Unlike postextrasystolic augmentation of the U wave, which is linked to the arrhythmic risk in the long QT syndrome 9 and other conditions, 1 changes limited to the T wave have not been shown to be a marker of arrhythmic risk. 1,10 Their mechanism is still not fully understood. It has been suggested that when the vector of the post-VPB T wave mirrors the general direction of the ectopic QRS complex (the so-called "obedient" Twave changes), the mechanism likely represents a form of short-term cardiac memory.…”

Section: Discussionmentioning

confidence: 99%

Postextrasystolic Changes in the Complexity of the QRS Complex and T Wave

Batchvarov¹,

Camm²

2008

Noninvasive Electrocardiol

View full text Add to dashboard Cite

We tested the hypothesis that ventricular repolarization of the first sinus beat following a ventricular premature beat (VPB) can be modulated in the absence of clearly discernible T-wave changes. We applied principal component analysis (PCA) to assess QRS and T-wave complexity of sinus beats preceding and following VPBs in multiple 10-second resting 12-lead electrocardiograms of two subjects with frequent VPBs and no apparent heart disease. In both subjects, T-wave complexity of the first post-VPB beat was significantly increased compared to the beats preceding the VPB.

show abstract

“…Postextrasystolic T-wave changes, that is, changes in the T-wave amplitude, shape, or polarity of the sinus beats immediately following ventricular extrasystoles, appear neither sensitive nor specific in the identification of patients with cardiac disease and can be deemed benign (Fagin & Guidot, 1958;Leachman et al, 1981). The mechanism is unknown, but is considered to be related to cardiac memory (Batchvarov, Bajpai, & Camm, 2007) or to mechano-electrical feedback, that is, shortening of repolarization time resulting from increased ventricular filling pressure during compensatory pause (Franz, 1996).…”

Section: Pseudo-mma-twa Due To Postextrasystolic T-wave Changesmentioning

confidence: 99%

Importance of over‐reading ambulatory ECG‐based microvolt T‐wave alternans to eliminate three main sources of measurement error

Takasugi

Matsuno

Takasugi

et al. 2019

Noninvasive Electrocardiol

View full text Add to dashboard Cite

Background: Ambulatory electrocardiogram (ECG)-based microvolt T-wave alternansvalues measured by the modified moving average method (MMA-TWA) can be disrupted by T-wave changes that mimic true repolarization alternans. Methods:We investigated potential sources of measurement error by studying 19 healthy subjects (12 men; median age, 25) free of known heart disease with 36-month follow-up to establish freedom from significant arrhythmia or syncope. All participants underwent 24-hr continuous 12-lead ECG monitoring.Causes of automated MMA-TWA ≥42 µV episodes were classified based on visual inspection. Results: A total of 2,189 episodes of automated MMA-TWA episodes ≥42 µV were observed in all subjects (peak MMA-TWA: median, 94 μV; interquartile range, 81-112 μV). All episodes included one or more beats with T-wave deformation which lacked "repeating ABAB pattern" and therefore were identified as TWA measurement error. Causes of such error were categorized as: (a) artifact [72.6% (1,589/2,189), observed in 19 (100%) subjects], more frequently in limb than precordial leads; (b) T-wave changes due to changes in heart/body position [25.5% (559/2,189), observed in 14 (73.7%) subjects], frequently observed in leads V1-2; and (c) postextrasystolic T-wave changes [1.9% (41/2,189), observed in 2 (10.5%) subjects].Conclusions: Relying only on automated MMA-TWA values obtained during ambulatory ECG monitoring can lead to incorrect measurement of TWA. Our findings offer the potential to reduce false-positive TWA results and to achieve more accurate detection of true repolarization alternans. K E Y W O R D Scontinuous 12-lead electrocardiography, healthy subject, microvolt T-wave alternans, modified moving average method

show abstract

Evaluation of postextrasystolic T wave alterations in identification of patients with coronary artery disease or left ventricular dysfunction

Cited by 8 publications

References 11 publications

Postextrasystolic T Wave Change to Stratify Risk of Pump Failure Death in Patients with Chronic Heart Failure

Postextrasystolic T Wave Change to Stratify Risk of Pump Failure Death in Patients with Chronic Heart Failure

Postextrasystolic Changes in the Complexity of the QRS Complex and T Wave

Importance of over‐reading ambulatory ECG‐based microvolt T‐wave alternans to eliminate three main sources of measurement error

Contact Info

Product

Resources

About