Microvolt T-Wave Alternans and the Risk of Death or Sustained Ventricular Arrhythmias in Patients With Left Ventricular Dysfunction

Bloomfield, Daniel M.; Bigger, J. Thomas; Steinman, Richard C.; Namerow, Pearila Brickner; Parides, Michael K.; Curtis, Anne B.; Kaufman, Elizabeth S.; Davidenko, Jorge M.; Shinn, Timothy; Fontaine, John M.

doi:10.1016/j.jacc.2005.11.026

Cited by 241 publications

(222 citation statements)

References 36 publications

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“…However, their patients had a similar 2-year event rate to that reported in MUSTT (5), and comparable age, LVEF, incidence of QRS widening (≈30%) and 2-year event rates to those in recent TWA trials (14,21). Thus, differences in the incidence of non-sustained VT (required by Morin et al (17), unreported in prior TWA trials (14,21)), syncope (more common in the Ohio/Michigan study (14)), symptomatic heart failure and usage of angiotensin converting-enzyme or angiotensin receptor blockers are of unclear significance.…”

supporting

confidence: 64%

“…In addition, Morin et al (17) continued beta-blockers during TWA testing, that may theoretically attenuate TWA and impair its NPV (13). On the other hand, recent TWA trials reported high NPV for TWA either with (21) or without (14) continued betablockade during testing. Finally, exercise-TWA may be superior to TWA from atrial pacing (as used by Morin et al (17)), although this may influence the NPV less than other parameters (28).…”

mentioning

confidence: 99%

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Is T-wave alternans as good or better than programmed ventricular stimulation?

Narayan¹

2007

Heart Rhythm

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supporting

confidence: 64%

mentioning

confidence: 99%

Is T-wave alternans as good or better than programmed ventricular stimulation?

Narayan¹

2007

Heart Rhythm

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“…The microvolt T-wave alternans (MTWA) test is a promising noninvasive test that predicts arrhythmic risk and mortality both in patients with cardiac dysfunction and in patients with preserved LVEF (12,13). Although TWA is not traditionally considered to reflect structural heart disease, there is evidence that TWA reflects arrhythmic susceptibility related to structural nonuniformities (14).…”

Section: Introductionmentioning

confidence: 99%

No association between scar size and characteristics on T-wave alternans in post-myocardial infarction patients with relatively preserved ventricular function presented with nonsustained ventricular tachycardia

Yalın

Gölcük²,

Teker³

et al. 2014

Anadolu Kardiyol Derg

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Objective: Microvolt T-wave Alternans (TWA) is associated with abnormal repolarization and predicts arrhythmic mortality in patients with previous myocardial infarction (MI). Infarct tissue size and heterogeneity characterized by cardiac magnetic resonance (CMR) has been shown to be associated with arrhythmogenic substrates and sudden cardiac death. Although both delayed enhancement-CMR (de-CMR) and TWA are useful in risk stratification of post-MI patients with preserved left ventricular function, the relationship between scar size and TWA has not studied yet. In this study, we aimed to study the relation between TWA and scar size and characteristics assessed with CMR in post-MI patients (pts) with relatively preserved systolic function presented with nonsustained VT. Methods: This observational cross-sectional study was enrolled 36 post-MI patients with mild-systolic dysfunction and non-sustained ventricular tachycardia. Eight pts were excluded. Both TWA and contrast enhanced CMR were performed. Left ventricular ejection fraction (LVEF), dense scar, peri-infarct zone and total scar masses were assessed and these values to left ventricular (LV) mass ratios were calculated. Infarct ratios and characteristics were determined and compared among patients with negative TWA and those with positive TWA. Results: For the positive (n=12) vs. negative (n=16) TWA patients there were no significant difference between LVEF (44.9±5.4% vs. 44.0±3.2%, p=NS) and LV masses (121.89±26.56 g vs. 106.14±21.16 g, p=NS). The ratio of scar core to LV mass (3.37±0.68% vs. 3.31±1.01%, p=NS), peri-infarct zone to LV mass (23.61±7.93% vs. 21.64±9.08%, p=NS), total scar to LV mass (26.98±7.86% vs. 24.96±9.62%, p=NS) were all similar. Conclusion: There were no association between scar size and infarct heterogeneity and prevelance of TWA in post-MI patients with relatively preserved LVEF with non-sustained VT. Our data suggest that these two modalities may reflect different arrhythmogenic mechanisms in this cohort. (Anadolu Kardiyol Derg 2014; 14: 442-7)

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“…One possible explanation for MTWA performance in Grimm 21 compared to the other studies of MTWA in DCM patients might be that in Grimm beta-blockers were withheld for at least 24 hours prior to MTWA testing while 74% of patients took beta-blockers during follow-up. In contrast in ALPHA 7 , Kitamura 3 , and Bloomfield 5 were not withheld prior to MTWA testing. It is known that beta-blockers both reduce the incidence of ventricular tachyarrhythmias andparticularly in patients with non-ischemic cardiomyopathy -suppress MTWA 22,23 .…”

Section: Mtwa In Non-ischemic Dilated Cardiomyopathy Patientsmentioning

confidence: 99%

“…Many studies conducted in patients without implanted ICDs have found MTWA to be a highly accurate risk stratifier and, in particular, have found that the rate of ventricular tachyarrhythmic events (VTEs) among patients who test MTWA negative is exceedingly low [1][2][3][4][5][6][7] suggesting that ICD therapy may not benefit such patients 8 . As a result, MTWA has been proposed as a means of guiding implantable cardioverter defibrillator (ICD) therapy in patients with risk factors for SCD but without a prior history of sustained VTEs (primary prevention patients).…”

Section: Introductionmentioning

confidence: 99%