TWARMI pilot trial: The value and optimal criteria of microvolt T‐wave alternans in the diagnosis of reversible myocardial ischemia in patients without structural cardiac disease

Puljević, Mislav; Daniłowicz‐Szymanowicz, Ludmiła; Molon, Giulio; Puljević, Davor; Raczak, Grzegorz; Canali, G; Velagić, Vedran; Pezo-Nikolić, Borka; Miličić, Davor

doi:10.1111/anec.12610

Cited by 4 publications

(6 citation statements)

References 23 publications

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“…The number of subjects with multi-VD in the abnormal TWA value group was higher than the number in the other group, 44 subjects vs 35 subjects respectively. Eventhough it was not statistically significant, the result is similar with the study that mentioned there will be higher TWA value if there is more vessels with significant stenosis (Puljevic et al, 2019).…”

Section: Resultssupporting

confidence: 85%

“…Myocardial ischemia and infarction cause slowed repolarization and manifest as changes of the ST-segment and T-wave in the electrocardiogram (ECG) (Li et al, 2021). One of the most potential ECG parameter is the TWA, which detects beat to beat morphological and amplitude changes of the T wave (Janusek et al, 2015;Puljevic et al, 2019;Verrier & Nieminen, 2010). TWA has a one-year negative predictive value (near 95%) for ventricular arrhythmia (Narayan, 2006).…”

Section: Introductionmentioning

confidence: 99%

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Abnormal T-Wave Alternans In Coronary Artery Disease Left Ventricle Ejection Fraction >40% With Myocardial Infarction

Pramadi Rahman,

Maharani,

Andi Arso

2023

AJHS

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Coronary artery disease (CAD) may present with or without myocardial infarction, with the left ventricle ejection fraction (LVEF) <40% or >40%. Myocardial infarction with LVEF <40% has been reported to cause abnormal T-wave alternans (TWA) value. The data about abnormal TWA value in myocardial infarction with LVEF >40% is still limited. A case-control analytic study was held at Dr. Sardjito general hospital Since March 2021 until April 2022 on adult CAD subjects with LVEF >40%. The TWA value was obtained from treadmill test which was then divided into the case group if the TWA value was abnormal and into the control group if the TWA value was normal. The data about myocardial infarction was retrospectively evaluated afterwards. Hypothesis testing was performed by Chi-Square test. Multivariate analysis using logistic regression test was conducted to determine the effect of confounding variables on TWA value. A total of 124 subjects were included in this study (62 subjects in the case group with abnormal TWA value, and 62 subjects in the control group with normal TWA value) with the mean age of 55,48 ± 8,6 years old and 83,8% were male subjects The proportion of subjects with abnormal TWA value with myocardial infarction and without myocardial infarction were 74,6% and 16,7% respectively. The Chi-Square test showed an association between PAH and abnormal TWA with OR 14,395 (CI 95%: 5,88-35,21; p<0,001). After multivariate analysis, myocardial infarction was the only remaining variable independently associated with abnormal TWA values. Abnormal TWA value occurred more frequently in subjects with myocardial infarction compared to subjects without myocardial infarction, in population of CAD LVEF >40%, with the possibility of 14,395 times more frequent

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Section: Resultssupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Abnormal T-Wave Alternans In Coronary Artery Disease Left Ventricle Ejection Fraction >40% With Myocardial Infarction

Pramadi Rahman,

Maharani,

Andi Arso

2023

AJHS

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“…Regarding ECG repolarization, instability markers measuring microvolt T wave alternans have been shown to take higher values in CAD patients than in healthy subjects and also in CAD patients with significant stenosis than in patients with no major stenosis [29,30]. These results were confirmed in subsequent studies, which additionally revealed greater accuracy of T wave alternans when compared with conventional ST segment analysis for CAD detection [31]. Other repolarization markers, like the QT interval, HR-corrected QT interval (QTc) and spatial QT dispersion have been explored prior to, during and after stress testing in a large cohort of patients undergoing coronary angiography [32].…”

Section: Discussionmentioning

confidence: 63%

QT variability unrelated to RR variability during stress testing for identification of coronary artery disease

Castillo

Hernando

Orini

et al. 2021

Phil. Trans. R. Soc. A.

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Stress test electrocardiogram (ECG) analysis is widely used for coronary artery disease (CAD) diagnosis despite its limited accuracy. Alterations in autonomic modulation of cardiac electrical activity have been reported in CAD patients during acute ischemia. We hypothesized that those alterations could be reflected in changes in ventricular repolarization dynamics during stress testing that could be measured through QT interval variability (QTV). However, QTV is largely dependent on RR interval variability (RRV), which might hinder intrinsic ventricular repolarization dynamics. In this study, we investigated whether different markers accounting for low-frequency (LF) oscillations of QTV unrelated to RRV during stress testing could be used to separate patients with and without CAD. Power spectral density of QTV unrelated to RRV was obtained based on time-frequency coherence estimation. Instantaneous LF power of QTV and QTV unrelated to RRV were obtained. LF power of QTV unrelated to RRV normalized by LF power of QTV was also studied. Stress test ECG of 100 patients were analysed. Patients referred to coronary angiography were classified into non-CAD or CAD group. LF oscillations in QTV did not show significant differences between CAD and non-CAD groups. However, LF oscillations in QTV unrelated to RRV were significantly higher in the CAD group as compared with the non-CAD group when measured during the first phases of exercise and last phases of recovery. ROC analysis of these indices revealed area under the curve values ranging from 61 to 73%. Binomial logistic regression analysis revealed LF power of QTV unrelated to RRV, both during the first phase of exercise and last phase of recovery, as independent predictors of CAD. In conclusion, this study highlights the importance of removing the influence of RRV when measuring QTV during stress testing for CAD identification and supports the added value of LF oscillations of QTV unrelated to RRV to diagnose CAD from the first minutes of exercise. This article is part of the theme issue ‘Advanced computation in cardiovascular physiology: new challenges and opportunities’.

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“…Prolonged radiation exposure leads to capillary network and myocardium damage, eventually contributing to the development of myocardial, heart valve, and cusp fibrosis ( 12 ). Given that lung cancer has been known to have a higher risk of cardiovascular events, potential biomarkers to indicate susceptibility to heart ischemia need to be identified ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Serum Concentration of Adrenomedullin and Myocardial Ischemic T Wave Changes in Patients With Lung Cancer

Lin

Jiang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPatients with lung cancer are at increased risk for the development of cardiovascular diseases. Molecular markers for early diagnosis of cardiac ischemia are of great significance for the early prevention of cardiovascular events in patients with lung cancer. By evaluating the relationship between adrenomedullin (ADM) and myocardial ischemic T wave changes, the clinical value of circulating ADM as a predictor of myocardial ischemia in patients with lung cancer is confirmed.MethodsWe enrolled patients with lung cancer and healthy people from 2019 to 2021 and extracted a detailed ECG parameter. After adjustment for potential confounders, logistic regression was used to assess the association of clinical data. We performed analyses on differences in T wave between patients with lung cancer and healthy people, and the relationship between T wave and ADM among patients with lung cancer. Receiver operator characteristic (ROC) curves were drawn to confirm the diagnostic value of biomarkers.ResultsAfter adjusting for potential confounders, the incidence of T wave inversion or flattening in patients with lung cancer was higher than in healthy people (OR: 3.3228, P = 0.02). Also, further analysis of the data of lung cancer patients revealed that the ADM in lung cancer patients with T wave inversion or flat was higher than those with normal T wave (189.8 ± 51.9 vs. 131.9 ± 38.4, p < 0.001). The area under the ROC curve was 0.8137.ConclusionAmong the patients with lung cancer, serum ADM concentration is associated with the incidence of the abnormal T wave. ADM might be a potentially valuable predictor for heart ischemia in patients with lung cancer.

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TWARMI pilot trial: The value and optimal criteria of microvolt T‐wave alternans in the diagnosis of reversible myocardial ischemia in patients without structural cardiac disease

Abstract: Part of article was presented on Dubrovnik ESC highlights 2015 as a poster presentation and won the first price.

Cited by 4 publications

References 23 publications

Abnormal T-Wave Alternans In Coronary Artery Disease Left Ventricle Ejection Fraction >40% With Myocardial Infarction

Abnormal T-Wave Alternans In Coronary Artery Disease Left Ventricle Ejection Fraction >40% With Myocardial Infarction

QT variability unrelated to RR variability during stress testing for identification of coronary artery disease

Relationship Between Serum Concentration of Adrenomedullin and Myocardial Ischemic T Wave Changes in Patients With Lung Cancer

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