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CLINICAL STUDIES

Determinant of microvolt-level T-wave alternans in patients with dilated cardiomyopathy

^a First Department of Internal Medicine, Kobe University School of Medicine, Kobe, Japan

Manuscript received August 6, 1998; revised manuscript received March 6, 1999, accepted April 14, 1999.

Reprint requests and correspondence: Dr. Yoshio Ohnishi, The First Department of Internal Medicine, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
ohnishi{at}med.kobe-u.ac.jp

OBJECTIVES

The aim of this study was to clarify the clinical significance and the determinant of microvolt-level T-wave alternans (TWA) in patients with dilated cardiomyopathy (DCM).

BACKGROUND

The prevention of sudden death in patients with DCM remains the therapeutic target. T-wave alternans has been proposed as a powerful tool for identification of patients at high risk for ventricular arrhythmias and sudden death in coronary artery disease.

METHODS

In 58 DCM patients, TWA was measured during bicycle exercise testing using a CH 2000 system (Cambridge Heart, Bedford, Massachusetts). The New York Heart Association class, signal-averaged electrocardiogram, QT dispersion, left ventricular end-diastolic diameter (LVDd) and percent fractional shortening detected by echocardiogram and the grade of the ventricular arrhythmia were obtained in all patients.

RESULTS

T-wave alternans was positive in 23 patients (TWA+ group), negative in 25 (TWA– group) and indeterminate in 10. Univariate analysis showed that the percentage of patients with ventricular tachycardia (VT) and the LVDd in the TWA+ group was significantly higher than those in the TWA– group (61% vs. 8%, p < 0.001 and 65 ± 11 mm vs. 58 ± 8 mm, p < 0.05, respectively). The sensitivity, specificity and predictive accuracy of TWA for VT were 88%, 72% and 77%, respectively. Multivariate analysis showed that the presence of VT was a major independent determinant of TWA in patients with DCM (p = 0.003).

CONCLUSIONS

T-wave alternans was closely related to VT in patients with DCM. T-wave alternans is a useful noninvasive test for identifying high risk patients with DCM who have VT.

Abbreviations and Acronyms   DCM = dilated cardiomyopathy   %FS = percent fractional shortening   HCM = hypertrophic cardiomyopathy   LAS 40 = duration of the low amplitude (<40 Hz) signals of the terminal filtered QRS complex   LVDd = left ventricular end-diastolic diameter   NYHA = New York Heart Association   QTd = QT dispersion   RMS 40 = root mean square voltage of the terminal 40 ms of the filtered QRS complex   SAECG = signal-averaged electrocardiogram   TWA = T-wave alternans   VF = ventricular fibrillation   VT = ventricular tachycardia

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