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CLINICAL STUDY: ELECTROPHYSIOLOGY

Onset heart rate of microvolt-level T-wave alternans provides clinical and prognostic value in nonischemic dilated cardiomyopathy

^* Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

Manuscript received January 25, 2001; revised manuscript received September 25, 2001, accepted October 24, 2001.

^* Reprint requests and correspondence: Dr. Yoshio Ohnishi, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Kobe, 650-0017, Japan.
ohnishi{at}med.kobe-u.ac.jp

OBJECTIVES: This study was designed to determine the prognostic value of onset heart rate (OHR) in T-wave alternans (TWA) in patients with nonischemic dilated cardiomyopathy (DCM).

BACKGROUND: One of the current major issues in DCM is to prevent sudden cardiac death (SCD). However, the value of the OHR of TWA as a prognostic indicator in DCM remains to be elucidated.

METHODS: We prospectively investigated 104 patients with DCM undergoing TWA testing. The end point of this study was defined as SCD, documented sustained ventricular tachycardia/ventricular fibrillation. Relations between clinical parameters and subsequent outcome were evaluated.

RESULTS: Forty-six patients presenting with TWA were assigned to one of the following two subgroups according to OHR for TWA of 100 beats/min: group A (n = 24) with OHR 100 beats/min and group B (n = 22) with 100 < OHR 110 beats/min. T-wave alternans was negative in 37 patients (group C) and indeterminate in 21 patients. The follow-up result comprised 83 patients with determined TWA. During a follow-up duration of 21 ± 14 months, there was a total of 12 arrhythmic events, nine of which included three SCDs in group A, two in group B and one in group C. The forward stepwise multivariate Cox hazard analysis revealed that TWA with an OHR 100 beats/min and left ventricular ejection fraction were independent predictors of these arrhythmic events (p = 0.0001 and p = 0.0152, respectively).

CONCLUSIONS: The OHR of TWA is of additional prognostic value in DCM.

Abbreviations and Acronyms   DCM   nonischemic dilated cardiomyopathy   ICD   implantable cardioverter defibrillator   LVDd   left ventricular end-diastolic diameter   LVEF   left ventricular ejection fraction   NSVT   nonsustained ventricular tachycardia   OHR   onset heart rate   SAECG   signal-averaged electrocardiogram   SCD   sudden cardiac death   SVT/VF   sustained ventricular tachycardia/ventricular fibrillation   TWA   T-wave alternans

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