Non-invasive risk stratification for sudden cardiac death by heart rate turbulence and microvolt T-wave alternans in patients after myocardial infarction

Background: Decades of research now link TWA with inducible and spontaneous clinical ventricular arrhythmias. This bench-to-bedside foundation makes TWA, NT-ProBNP a very plausible index of susceptibility to ventricular arrythmia, and motivates the need to define optimal combination of TWA and NT-ProBNP in predicting ventricular arrythmia in myocardial infarction patients. We research this study with 2 targets: 1. To evaluate the role of TWA in predicting sudden cardiac death in myocardial infarction patients. 2. To evaluate the role of NT-ProBNP in predicting sudden cardiac death in myocardial infarction patients 3. Evaluate the role of the combined NT-ProBNP and TWA in predicting sudden cardiac death in myocardial infarction patients. Methods: Prospective study with follow up the mortality in 2 years: 71 chronic myocardial infarction patients admitted to hospital from 5/2009 to 5/20011 and 50 healthy person was done treadmill test to caculate TWA; ECG, echocardiography, NT-ProBNP. Results: Cut-off point of NT-ProBNP in predicting sudden cardiac death is 3168 pg/ml; AUC = 0,86 (95% CI: 0,72 - 0,91); Cut-off point of TWA in predicting sudden cardiac death is 107 µV; AUC = 0,81 (95% CI: 0,69 - 0,87); NT-ProBNP can predict sudden cardiac death with OR= 7,26 (p<0,01); TWA can predict sudden cardiac death with OR= 8,45 (p<0,01). The combined NT-ProBNP and TWA in predicting ventricular arrythmia in heart failure patients: OR= 17,91 (p<0,001). Conclusions: The combined NT-ProBNP and TWA have the best predict value of sudden cardiac death in myocardial infarction patients, compare to NT-ProBNP or TWA alone

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Ambulatory ECG-Based T-Wave Alternans and Heart Rate Turbulence Predict High Risk of Arrhythmic Events in Patients With Old Myocardial Infarction

Circulation Journal ◽

10.1253/circj.cj-09-0420 ◽

2009 ◽

Vol 73 (12) ◽

pp. 2223-2228 ◽

Cited By ~ 36

Author(s):

Shingo Maeda ◽

Mitsuhiro Nishizaki ◽

Noriyoshi Yamawake ◽

Takashi Ashikaga ◽

Hiroshi Shimada ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Rate ◽

High Risk ◽

Heart Rate Turbulence ◽

T Wave ◽

Ambulatory Ecg ◽

Old Myocardial Infarction ◽

T Wave Alternans

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Utility of heart rate turbulence and T‐wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.13639 ◽

2018 ◽

Vol 29 (9) ◽

pp. 1257-1264 ◽

Cited By ~ 9

Author(s):

Shinya Yamada ◽

Akiomi Yoshihisa ◽

Yu Sato ◽

Takamasa Sato ◽

Masashi Kamioka ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Cardiac Death ◽

Heart Rate Turbulence ◽

Heart Failure Patients ◽

T Wave ◽

T Wave Alternans

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Abstract 2148: Abnormal T Wave Alternans Could Provide Additional Risk Stratification in Patients with Prolonged QRS Duration

Circulation ◽

10.1161/circ.118.suppl_18.s_675-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Takanao Mine ◽

Tetsuzou Kanemori ◽

Hiroaki Nakamura ◽

Tohru Masuyama ◽

Mitsumasa Ohyanagi

Keyword(s):

Heart Rate ◽

Risk Stratification ◽

Cardiac Death ◽

Heart Diseases ◽

Qt Dispersion ◽

Additional Risk ◽

T Wave ◽

Life Threatening ◽

Qrs Duration ◽

T Wave Alternans

QT dispersion, signal averaged electrocardiogram (SAECG) and T wave alternans (TWA) have been found to be increased susceptibility to life-threatening arrhythmias or cardiac death (LTA/CD). Patients with heart diseases often present prolonged QRS duration (p-QRSd), however the risk stratification in patients with p-QRSd still remains. We investigated whether QT dispersion, SAECG and TWA would provide additional risk stratification in patients with p-QRSd. We studied 52 patients (47 males, mean age 66±9 yrs) with QRS duration ≥ 120ms (34 RBBB type and 18 LBBB type) who had heart diseases (45 coronary artery disease and 7 dilated cardiomyopaty). QT dispersion was measured from standard 12-lead ECG. The filtered QRS duration (f-QRS) and root mean square voltage of the terminal 40ms of the QRS complex (RMS40) were obtained by SAECG. TWA was measured with the CH 2000. TWA was considered positive when the alternans with alternans voltage ≥ 1.9μV and alternance ratio ≥ 3 was sustained ≥ 1 minute in vector magnitude, X, Y, Z, V4 or two precordal leads at heart rate ≤ 110bpm. TWA was classified negative when the alternans wasn’t presented at heart rate ≤ 110bpm and considered indeterminate if the record didn’t meet either positively or negatively. Abnormal TWA was defined as positive or indeterminate. An abnormal TWA test was present in 56% (23 patients had negative TWA, 11 had indeterminate and 18 had positive). During the follow-up periods (69±41 months), 15 patients had life-threatening arrhythmias (n=12) and/or cardiac death (n=7). Univariate analysis revealed left ventricular ejection fraction (LVEF), RMS40 and abnormal TWA (n=29) as significant variables, however there was no significant difference in LTA/CD rate between BBB types, and no associations between QT dispersion and LTA/CD. On logistic regression analysis, only LVEF (p=0.02) and abnormal TWA (p=0.02, odds ratio 9.803 [95%CI 1.430 to 67.207]) were independently associated with LTA/CD. Abnormal T wave alternans could provide additional risk stratification in patients with prolonged QRS duration.

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