Exercise-induced quantitative microvolt T-wave alternans in hypertrophic cardiomyopathy

Antunes, Murillo de Oliveira; Samesima, Nelson; Filho, Horácio Gomes Pereira; Matsumoto, Afonso Yoshikiro; Verrier, Richard L.; Pastore, Carlos Alberto; Arteaga-Fernández, E; Mady, Charles

doi:10.1016/j.jelectrocard.2016.10.010

Cited by 16 publications

(23 citation statements)

References 24 publications

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“…A positive MTWA test is associated with a poor arrhythmic prognosis in various cardiac disorders and has emerged as an important tool for stratifying the risk of potentially lethal VA ( 5 ). The TWA has been approved by the Food and Drug Administration as a noninvasive method to evaluate the need for ICD implantation in post-myocardial infarction and LV dysfunction of ischemic or non-ischemic etiology ( 6 , 7 ). However, only a few studies have analyzed the TWA in HCM ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…The TWA has been approved by the Food and Drug Administration as a noninvasive method to evaluate the need for ICD implantation in post-myocardial infarction and LV dysfunction of ischemic or non-ischemic etiology ( 6 , 7 ). However, only a few studies have analyzed the TWA in HCM ( 6 ). There are no studies investigating TWA in HCM by the Modified Moving Average (MMA) method on ambulatory electrocardiography.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the relationship between the ambulatory electrocardiography-based micro T wave alternans and the predicted risk score of sudden cardiac death at five years in patients with hypertrophic cardiomyopathy

Özyılmaz¹

2018

Anatol J Cardiol

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Objective:Micro T-wave alternans (MTWA) has been associated with poor arrhythmic prognosis in various cardiac disorders. The aim of this study was to assess the relationship between the presence of MTWA and the predicted 5-year risk of sudden cardiac death (HCM Risk-SCD) among patients with hypertrophic cardiomyopathy (HCM).Methods:A total of 117 consecutive HCM patients were included in this prospective observational study. Patients were divided into two groups, according to the presence [MTWA (+) group (n=44)] or absence [MTWA (−) group (n=73)] of MTWA on ambulatory (Holter) electrocardiography.Results:The risk of HCM Risk-SCD (%), the rate of high-risk patients (HCM Risk-ECG >6%), the requirement for cardiopulmonary resuscitation, and implanted cardioverter defibrillator therapy, the percentage of some clinical, echocardiographic, and Holter findings were all statistically higher in the MTWA (+) group than in the MTWA (−) group (all p<0.05). Both in the univariate and multivariate analyses, T-wave alternans (+) and the New York Heart Association’s functional classification assigned that the HCM Risk-SCD is an independent predictor of high risk. In the receiver operating characteristic curve analysis, the HCM Risk-SCD >4.9% was identified as an effective cutoff point in the MTWA (+) for HCM. The HCM Risk-SCD value of more than 4.9 yielded a sensitivity of 93.2% and a specificity of 84.5%.Conclusion:The presence of the MTWA on ambulatory electrocardiogram seems to be significantly associated with increasing percentages of the predicted HCM Risk-SCD score in patients with HCM. The MTWA was determined as an independent high-risk indicator for HCM Risk-SCD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of the relationship between the ambulatory electrocardiography-based micro T wave alternans and the predicted risk score of sudden cardiac death at five years in patients with hypertrophic cardiomyopathy

Özyılmaz¹

2018

Anatol J Cardiol

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“…These Figure 2: Boxplot comparing (A) the magnitude of AP amplitude alternans (mV) in Control and HCM populations at 250, 300 and 350ms pacing length, (B) the magnitude of AP duration alternans (ms) in Control and HCM populations at 250, 300, 350, 400 and 450ms pacing length results therefore do not strongly suggest that HCM cardiomyocytes are more prone to alternans in action potential biomarkers compared to Controls. This may suggest that TWA on the ECG, observed in HCM and proposed as potential tool for risk stratification [3], may be due to other dynamics than single cell abnormalities. Alteration of the tissue structure leading to heterogeneities and conduction delays may rather be the cause of TWA.…”

Section: Discussionmentioning

confidence: 98%

“…However, most patients remain asymptomatic, and identifying the patients at risk is therefore critical to provide them with appropriate treatment. Several studies [1] [2] [3] have suggested T wave alternans (TWA) as a potential tool to identify these high risk patients, but the mechanisms behind TWA are still unclear [4] [5]. HCM hearts suffer from electrophysiological abnormalities affecting the repolarisation phase.…”

Section: Introductionmentioning

confidence: 99%

Investigation of the Presence and Mechanisms of Action Potential Alternans in Hypertrophic Cardiomyopathy

Lyon

Mincholé

Passini

et al. 2017

Computing in Cardiology Conference (CinC)

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Hypertrophic cardiomyopathy (HCM) is a common cardiac genetic disorder. It is a leading cause of sudden cardiac death in young adults, yet most patients remain asymptomatic. T wave alternans (TWA) have been proposed as a potential tool for HCM risk stratification [1] [2] [3] but the mechanisms at stake remain unclear [4] [5]. HCM has been associated with a dysregulation of Ca 2+ cycling and an elevation in intracellular calcium concentration [6] that may affect the cardiac action potential (AP). Our goal is to investigate whether these electrophysiological abnormalities may be a mechanism responsible for the presence of TWA in HCM. We use a population of 9,118 control and HCM models defined in [7] and measure alternans in AP and Ca 2+ transient biomarkers for pacing cycle lengths from 250ms to 700ms. HCM cardiomyocytes show a distinct AP phenotype with longer AP and Ca 2+ duration (486±84ms vs 286±52ms, 691±82ms vs 522±65ms p<0.001). However, there is no significant difference in alternans propensity in HCM compared to controls, except for AP amplitude at low pacing lengths (300ms: 13.4% HCM models, 2.6% control models, p<0.001). HCM amplitude and duration alternans also presented larger magnitude than Controls. These findings suggest that TWA in HCM may be related to whole-organ tissue heterogeneities rather than an alteration of the cellular substrate.

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“…We can affirm that, despite continuous advances in knowledge, 10 , 15 the assessment of SD risk in HCM is limited to a small number of patients (5%) and is still a great challenge. The guidelines have so far included increasing number of risk factors 15 with low predictive value, and validated for a frequent, but still underdiagnosed disease, characterized by patients with a normal life cycle and free from SD.…”

mentioning

confidence: 83%

Prevention of Sudden Death in Hypertrophic Cardiomyopathy

Arteaga-Fernández

Antunes

2018

Arquivos Brasileiros De Cardiologia

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Exercise-induced quantitative microvolt T-wave alternans in hypertrophic cardiomyopathy

Cited by 16 publications

References 24 publications

Assessment of the relationship between the ambulatory electrocardiography-based micro T wave alternans and the predicted risk score of sudden cardiac death at five years in patients with hypertrophic cardiomyopathy

Assessment of the relationship between the ambulatory electrocardiography-based micro T wave alternans and the predicted risk score of sudden cardiac death at five years in patients with hypertrophic cardiomyopathy

Investigation of the Presence and Mechanisms of Action Potential Alternans in Hypertrophic Cardiomyopathy

Prevention of Sudden Death in Hypertrophic Cardiomyopathy

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