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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

View larger version (42K): [in a new window]   Figure 1 A representative case of a trend graph of alternans (left side) and the T-wave spectrum (right side) during exercise testing. An alternans voltage 1.9 µV with an alternans ratio 3 is found at a 0.5-cycle/beat frequency with a heart rate (HR) of >105 beats/min. VT = ventricular tachycardia; y.o. = year old.

View larger version (14K): [in a new window]   Figure 2 The left ventricular end-diastolic diameter (LVDd) in patients with T-wave alternans (TWA) was significantly larger than that in patients without TWA (p < 0.05). No significant difference was observed in the percent fractional shortening (%FS) and QT dispersion (QTd) between the two groups.

View larger version (15K): [in a new window]   Figure 3 No significant difference was observed in the signal-averaged electrocardiogram (SAECG) between the two groups. Ventricular tachycardia (VT) was documented in an extremely high percentage of patients in the positive T-wave alternans (TWA) group. Sustained VT was documented in two patients and ventricular fibrillation in one. These three patients were TWA positive.