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. 2012 Sep 6:11:104.
doi: 10.1186/1475-2840-11-104.

Ambulatory ECG-based T-wave alternans and heart rate turbulence can predict cardiac mortality in patients with myocardial infarction with or without diabetes mellitus

Ren Li-na  1 , Fang Xin-hui, Ren Li-dong, Gong Jian, Wang Yong-quan, Qi Guo-xian
Affiliations

Ambulatory ECG-based T-wave alternans and heart rate turbulence can predict cardiac mortality in patients with myocardial infarction with or without diabetes mellitus

Ren Li-na et al. Cardiovasc Diabetol. .

Abstract

Background: Many patients who survive a myocardial infarction (MI) remain at risk of sudden cardiac death despite revascularization and optimal medical treatment. We used the modified moving average (MMA) method to assess the utility of T-wave alternans (TWA) and heart rate turbulence (HRT) as risk markers in MI patients with or without diabetes mellitus (DM).

Methods: We prospectively enrolled 248 consecutive patients: 96 with MI (post-MI patients); 77 MI with DM (post-MI + DM patients); 75 controls without cardiovascular disease (group control). Both TWA and HRT were measured on ambulatory electrocardiograms (AECGs). HRT was assessed by two parameters ─ turbulence onset (TO) and turbulence slope (TS). HRT was considered positive when both TO ≥0% and TS ≤2.5 ms/R-R interval were met. The endpoint was cardiac mortality.

Results: TWA values differed significantly between MI and controls. Post-MI + DM patients had higher TWA values than post-MI patients (58 ± 21 μV VS 52 ± 18 μV, P = 0.029). Impaired HRT--increased TO and decreased TS were observed in MI patients with or without DM. During follow-up of 578 ± 146 days, cardiac death occurred in ten patients and three of them suffered sudden cardiac death (SCD). Multivariate analysis determined that a HRT-positive outcome [HR (95% CI): 5.01, 1.33-18.85; P = 0.017], as well as the combination of abnormal TWA (≥47 μV) and positive HRT had significant association with the endpoint [HR (95% CI): 9.08, 2.21-37.2; P = 0.002)].

Conclusion: This study indicates that AECGs-based TWA and HRT can predict cardiac mortality in MI patients with or without DM. Combined analysis TWA and HRT may be a convenient and useful method of identifying patients at high risk for cardiovascular death.

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Figures

Figure 1
Figure 1
T-wave alternans values in the three groups: Highest in post-MI + DM patients and lowest in group control. Significant differences were observed within the groups by multiple comparisons.
Figure 2
Figure 2
Superimposed MMA waveforms for the maximum TWA in V1 (70 μV) and the associated AECGs strip for a patient. The patient suffered SCD after 12 months.
Figure 3
Figure 3
Positive Results of TWA (≥47 μV) and HRT (TO ≥0% and TS ≤2.5 ms/RRI):Post-MI with or without DM patients had a higher association of positive results for both TWA and HRT.
Figure 4
Figure 4
ROC curve for T WA magnitude and Cardiac mortality.
See this image and copyright information in PMC

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