1. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: epidemiology, transient risk, and intervention assessment. Ann Intern Med. 1993 Dec 15;119(12):1187-97.
2. Kuchar DL, Thorburn CW, Sammel NL. Prediction of serious arrhythmic events after myocardial infarction: signal-averaged electrocardiogram, Holter monitoring and radionuclide ventriculography. J Am Coll Cardiol. 1987 Mar;9(3):531-8.[CrossRef]
3. Rosenbaum DS, Jackson LE, Smith JM, Garan H, Ruskin JN, Cohen RJ. Electrical alternans and vulnerability to ventricular arrhythmias. N Engl J Med. 1994 Jan 27;330(4):235-41.
4. Gold MR, Bloomfield DM, Anderson KP, El- Sherif NE, Wilber DJ, Groh WJ, Estes NA 3rd, Kaufman ES, Greenberg ML, Rosenbaum DS. A comparison of T-wave alternans, signal averaged electrocardiography and programmed ventricular stimulation for arrhythmia risk stratification. J Am Coll Cardiol. 2000 Dec;36(7):2247-53.
5. Ikeda T, Sakata T, Takami M, Kondo N, Tezuka N, Nakae T, Noro M, Enjoji Y, Abe R, Sugi K, Yamaguchi T. Combined assessment of T-wave alternans and late potentials used to predict arrhythmic events after myocardial infarction. A prospective study. J Am Coll Cardiol. 2000 Mar 1;35(3):722-30.[CrossRef]
6. Ikeda T, Saito H, Tanno K, Shimizu H, Watanabe J, Ohnishi Y, Kasamaki Y, Ozawa Y. T-wave alternans as a predictor for sudden cardiac death after myocardial infarction. Am J Cardiol. 2002 Jan 1;89(1):79-82.[CrossRef]
7. Wilson LD, Rosenbaum DS. Mechanisms of arrythmogenic cardiac alternans. Europace. 2007 Nov;9 Suppl 6:vi77-82.[Web of Science]
8. Chow T, Kereiakes DJ, Bartone C, Booth T, Schloss EJ, Waller T, Chung ES, Menon S, Nallamothu BK, Chan PS. Prognostic utility of microvolt T-wave alternans in risk stratification of patients with ischemic cardiomyopathy. J Am Coll Cardiol. 2006 May 2;47(9):1820-7.[CrossRef]
9. Chow T, Kereiakes DJ, Onufer J, Woelfel A, Gursoy S, Peterson BJ, Brown ML, Pu W, Benditt DG; MASTER Trial Investigators. Does microvolt T-wave alternans testing predict ventricular tachyarrhythmias in patients with ischemic cardiomyopathy and prophylactic defibrillators? The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) trial. J Am Coll Cardiol. 2008 Nov 11;52(20):1607-15.[Web of Science]
10. Bloomfield DM, Steinman RC, Namerow PB, Parides M, Davidenko J, Kaufman ES, Shinn T, Curtis A, Fontaine J, Holmes D, Russo A, Tang C, Bigger JT Jr. Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy: a solution to the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II conundrum. Circulation. 2004 Oct 5;110(14):1885-9.
11. Gold MR, Ip JH, Costantini O, Poole JE, McNulty S, Mark DB, Lee KL, Bardy GH. Role of microvolt T-wave alternans in assessment of arrhythmia vulnerability among patients with heart failure and systolic dysfunction: primary results from the T-wave alternans sudden cardiac death in heart failure trial substudy. Circulation. 2008 Nov 11;118(20):2022-8.[Web of Science]
12. Rashba EJ, Osman AF, Macmurdy K, Kirk MM, Sarang SE, Peters RW, Shorofsky SR, Gold MR. Enhanced detection of arrhythmia vulnerability using T wave alternans, left ventricular ejection fraction, and programmed ventricular stimulation: a prospective study in subjects with chronic ischemic heart disease. J Cardiovasc Electrophysiol. 2004 Feb;15(2):170-6.[CrossRef]
13. Chan PS, Bartone C, Booth T, Kereiakes D, Chow T. Prognostic implication of redefining indeterminate microvolt T-wave alternans studies as abnormal or normal. Am Heart J. 2007 Apr;153(4):523-9.[Web of Science]
14. Ikeda T, Yoshino H, Sugi K, Tanno K, Shimizu H, Watanabe J, Kasamaki Y, Yoshida A, Kato T. Predictive value of microvolt T-wave alternans for sudden cardiac death in patients with preserved cardiac function after acute myocardial infarction: results of a collaborative cohort study. J Am Coll Cardiol. 2006 Dec 5;48(11):2268-74.[CrossRef]
15. Tapanainen JM, Still AM, Airaksinen KE, Huikuri HV. Prognostic significance of risk stratifiers of mortality, including T wave alternans, after acute myocardial infarction: results of a prospective follow-up study. J Cardiovasc Electrophysiol. 2001 Jun;12(6):645-52.[CrossRef]
16. Exner DV, Kavanagh KM, Slawnych MP, Mitchell LB, Ramadan D, Aggarwal SG, Noullett C, Van Schaik A, Mitchell RT, Shibata MA, Gulamhussein S, McMeekin J, Tymchak W, Schnell G, Gillis AM, Sheldon RS, Fick GH, Duff HJ; REFINE Investigators. Noninvasive risk assessment early after a myocardial infarction the REFINE study. J Am Coll Cardiol. 2007 Dec 11;50(24):2275-84.
17. Costantini O, Hohnloser SH, Kirk MM, Lerman BB, Baker JH 2nd, Sethuraman B, Dettmer MM, Rosenbaum DS; ABCD Trial Investigators. The ABCD (Alternans Before Cardioverter Defibrillator) Trial: strategies using T-wave alternans to improve efficiency of sudden cardiac death prevention. J Am Coll Cardiol. 2009 Feb 10;53(6):471-9.
Volume 58 (2013)
Volume 57 (2012)
Volume 56 (2011)
Volume 55 (2010)
Volume 54 (2009)
Most Downloaded Articles
- Propofol vs isoflurane anesthesia-incidence of PONV in patients at maxillofacial surgery by Gecaj-Gashi, A/ Hashimi, M/ Sada, F/ Baftiu, N/ Salihu, S/ Terziqi, H and Bruqi, B
- Fetal membranes as a source of stem cells by Kmiecik, G./ Niklińska, W./ Kuć, P./ Pancewicz-Wojtkiewicz, J./ Fil, D./ Karwowska, A./ Karczewski, J. and Mackiewicz, Z.
- Magnetic nanoparticles as new diagnostic tools in medicine by Niemirowicz, K/ Markiewicz, KH/ Wilczewska, AZ and Car, H
- Optimizing biliary stent patency by coating with hydrophobin alone or hydrophobin and antibiotics or heparin: an in vitro proof of principle study by Weickert, U/ Wiesend, F/ Subkowski, T/ Eickhoff, A and Reiss, G
- Oxidative stress induced in rat liver by anticancer drugs doxorubicin, paclitaxel and docetaxel by Pieniążek, A/ Czepas, J/ Piasecka-Zelga, J/ Gwoździński, K and Koceva-Chyła, A
Microvolt T-wave alternans predicts cardiac events after acute myocardial infarction in patients treated with primary percutaneous coronary intervention
1I Department of Cardiology, Medical University of Silesia, Katowice, Poland
This content is open access.
(CC BY-NC-ND 4.0)
Citation Information: Advances in Medical Sciences. Volume 57, Issue 2, Pages 328–333, ISSN (Online) 1898-4002, ISSN (Print) 1896-1126, DOI: 10.2478/v10039-012-0033-7, January 2013
- Published Online:
Background: Current risk stratification after acute myocardial infarction (MI) depends on left ventricular ejection fraction. Microvolt T-wave alternans (MTWA) is one of promising markers to predict cardiac events in patients after acute MI treated according to current guidelines.
Methods: In this single center study, 112 consecutive patients with the first anterior ST-elevation MI undergoing PCI <12 hours from symptom onset, were enrolled prospectively. Demographics, established risk factors, myocardial contrast echocardiography (MCE) perfusion, index event data and MTWA were assessed. Composite cardiac events (CCE) defined as: death, recurrent MI, sustained ventricular tachycardia (sVT) or readmission for acute heart failure (HF) were recorded during follow-up.
Results: MTWA test was negative in 76, positive in 18 and undetermined in 7 patients. MTWA negative patients had significantly higher LVEF at 30 days. At 4 years, 26 patients experienced CCE (10 died, 2 reinfarcted and 14 HF events). In multivariate Cox proportional hazard model maximum CKMB, non-negative MTWA and reduced LVEF made the best model to predict CCE. Four year CCE free survival was 77% and was significantly lower for non-negative MTWA (94% vs 50%, p<0.003).
Conclusions: Non-negative MTWA with infarct size index and reduced LVEF could predict cardiac events in patients with anterior STEMI treated with primary PCI. MTWA non-negative patients have significantly worse outcome