CLINICAL RESEARCH: VENTRICULAR TACHYCARDIA
Usefulness of microvolt T-wave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy: results from a prospective observational study
Stefan H. Hohnloser, MD, FACC*,*,
Thomas Klingenheben, MD*,
Daniel Bloomfield, MD ,
Omar Dabbous, MD, MPH and
Richard J. Cohen, MD, PhD
* J. W. Goethe University, Frankfurt, Germany
Columbia University College of Physicians and Surgeons, New York, New York, USA
University of Massachusetts Medical School, Cambridge, Massachusetts, USA
Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
Manuscript received June 5, 2002;
revised manuscript received December 4, 2002,
accepted December 12, 2002.
* Reprint requests and correspondence: Dr. Stefan H. Hohnloser, Professor of Medicine, J. W. Goethe University, Dept. of Medicine, Division of Cardiology, Theodor Stern Kai 7, 60590, Frankfurt, Germany.
hohnloser{at}em.uni-frankfurt.de
OBJECTIVES: This study was designed to evaluate the ability of microvolt-level T-wave alternans (MTWA) to identify prospectively patients with idiopathic dilated cardiomyopathy (DCM) at risk of ventricular tachyarrhythmic events and to compare its predictive accuracy with that of conventional risk stratifiers.
BACKGROUND: Patients with DCM are at increased risk of sudden death from ventricular tachyarrhythmias. At present, there are no established methods of assessing this risk.
METHODS: A total of 137 patients with DCM underwent risk stratification through assessment of MTWA, left ventricular ejection fraction, baroreflex sensitivity (BRS), heart rate variability, presence of nonsustained ventricular tachycardia (VT), signal-averaged electrocardiogram, and presence of intraventricular conduction defect. The study end point was either sudden death, resuscitated ventricular fibrillation, or documented hemodynamically unstable VT.
RESULTS: During an average follow-up of 14 ± 6 months, MTWA and BRS were significant univariate predictors of ventricular tachyarrhythmic events (p < 0.035 and p < 0.015, respectively). Multivariate Cox regression analysis revealed that only MTWA was a significant predictor.
CONCLUSIONS: Microvolt-level T-wave alternans is a powerful independent predictor of ventricular tachyarrhythmic events in patients with DCM.
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Abbreviations and Acronyms
| | BRS | = baroreflex sensitivity | | DCM | = dilated cardiomyopathy | | ECG | = electrocardiogram/electrocardiograph/ electrocardiographic | | EP | = electrophysiological | | HR | = heart rate | | ICD | = implantable cardioverter-defibrillator | | IVCD | = intraventricular conduction defect | | LVEF | = left ventricular ejection fraction | | MTWA | = microvolt-level T-wave alternans | | NSVT | = nonspecific ventricular tachycardia | | SCD | = sudden cardiac death | | VF | = ventricular fibrillation | | VT | = ventricular tachycardia |
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