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. 2009 Oct;14(4):355-9.
doi: 10.1111/j.1542-474X.2009.00325.x.

Influence of diabetes and/or myocardial infarction on prevalence of abnormal T-wave alternans

David T Martin  1 , Azadeh Shoraki, Richard W Nesto, Martin K Rutter
Affiliations

Influence of diabetes and/or myocardial infarction on prevalence of abnormal T-wave alternans

David T Martin et al. Ann Noninvasive Electrocardiol. 2009 Oct.

Abstract

Background: Subjects with microvolt-level T-wave alternans (TWA) in association with structural heart disease have an increased risk for sudden cardiac death. The presence of diabetes (DM) is associated with an increased risk of sudden death but there is limited data on the impact of DM and previous myocardial infarction (MI) on TWA prevalence.

Methods: We performed a case-control cross-sectional study in 140 patients referred for routine exercise testing within a large multispecialty clinic. All patients with a history of DM and MI status within the past year were eligible: group 1 (no DM or MI), group 2 (DM only), group 3 (MI only), group 4 (DM and MI). Patients performed a symptom-limited Bruce protocol exercise test with assessment of TWA by the spectral method using commercially available equipment. We used published criteria for the blinded interpretation of TWA; all tests not unequivocally negative were considered abnormal.

Results: Age and gender were similar in all groups. The prevalence of abnormal TWA in groups 1-4 was 24%, 20%, 48%, and 62%, respectively (between group P = 0.002). Logistic regression analysis in all patients showed that abnormal TWA was related to prior MI [OR (95% CI): 4.0 (1.8-8.9), P < 0.001] but not to prevalent DM [0.9 (0.4-1.8), P = 0.72]. In patients with DM, the prevalence of abnormal TWA was related to reduced ejection fraction (P = 0.034) but not to BMI, DM duration, glycemic control, insulin use, or the presence of microvascular complications.

Conclusion: The presence of DM alone does not increase risk of abnormal TWA. Prospective studies are required to establish the prognostic value of TWA in patients with DM.

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Figures

Figure 1
Figure 1
Distribution of abnormal T‐wave alternans in the four study groups.
Figure 2
Figure 2
Box plot showing distribution of left ventricular ejection fraction in the four study groups.
One way RM ANOVA on ranks: P < 0.001. Pairwise comparisons: P < 0.05 for group 1 versus 3, 1 versus 4, and 2 versus 4.
See this image and copyright information in PMC

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