Role of noninvasive studies in risk stratification for sudden cardiac death

Kunavarapu, Chandra; Bloomfield, Daniel M.

doi:10.1002/clc.4960270404

Cited by 7 publications

(2 citation statements)

References 41 publications

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“…Sudden cardiac death, one of the leading causes of mortality, remains a health problem of epidemic proportions. [ 13 14 ] Ventricular arrhythmias, the most important causes of sudden cardiac death, are common in hypertensive patients. The underlying mechanisms are: left ventricular hypertrophy (LVH), myocardial ischemia, and impaired left ventricular function.…”

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The relation between QT interval and T-wave variables in hypertensive patients

Mozoş

Şerban

2011

J Pharm Bioall Sci

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Background:The standard 12-lead ECG (electrocardiogram) continues to be the most frequently recorded noninvasive test in medicine. A prolonged ECG QT interval and Tpeak-Tend (Tpe) interval are predictors of ventricular arrhythmia and sudden cardiac death.Aim:The aim of this study is to analyze the relation between QT interval and T-wave variables in hypertensive patients, with and without left ventricular hypertrophy (LVH).Materials and Methods:Fifty-nine consecutive patients with grade 2 essential hypertension were included in the study. They underwent standard 12-lead ECG, and QT intervals: QTmax (the maximal duration of the QT interval in the 12 ECG leads), QTc (heart rate corrected QTmax), QTm (mean QT interval), QTII (the QT interval in lead DII), QTcII (heart rate corrected QTII), and QTd (QT dispersion); and T-wave variables: T0e (T wave duration), T0em (mean T0e), Tpe, Tpem (mean Tpem), Ta (T wave amplitude), and Tam (mean Ta) were manually assessed. LVH was diagnosed using both echocardiography and the ECG criteria.Results:QTc was prolonged in 41 patients (69%). Multiple regression analysis revealed a significant association between QT intervals and T-wave variables: QTmax and Tpe (P = 0.015), QTd and Tpe (P = 0.022) and Ta (P = 0.004), and Tpe with QTd and T0e (P < 0.05). A moderate but significant correlation was found between Tpe and QTmax, Tpe and QTII, and Ta and QTd. A prolonged QTc was more prevalent in hypertensive patients with LVH (85%), compared to hypertensive patients without LVH (50%). QTm, QTd, QTII, Tpe, Tpem were significantly elevated (P < 0.05) in patients with LVH.Conclusions:Hypertension is associated with an increased prevalence of prolonged QT intervals. QT intervals and T-wave variables are closely connected in hypertensive patients. QTm, T0em, Tpem, and Tam, do not provide significant additional information compared to QTmax, T0e, Tpe, and Ta. Left ventricular hypertrophy is associated with prolonged QT interval and Tpeak-Tend interval in hypertensive patients.

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The relation between QT interval and T-wave variables in hypertensive patients

Mozoş

Şerban

2011

J Pharm Bioall Sci

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“…6 Previous studies indicated higher risk with greater LVWT, especially with extreme hypertrophy >30 mm, but patients with mild left ventricular hypertrophy (LVH) are not event free. 7-9 Thus, morphological measures of LVH appear insufficiently characterized to effectively translate into risk stratification strategies.…”

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T-Wave Alternans and Left Ventricular Wall Thickness in Predicting Arrhythmic Risk in Patients With Hypertrophic Cardiomyopathy

Püntmann

Yap

McKenna

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp triking morphological features with increased left ventricular wall thickness (LVWT) represent the hallmark of the hypertrophic cardiomyopathy (HCM) phenotype, 1-5 yet their relationship with increased risk of ventricular tachyarrhythmias (VTAs) and sudden cardiac death (SCD) in these patients remains poorly characterized. 6 Previous studies indicated higher risk with greater LVWT, especially with extreme hypertrophy >30 mm, but patients with mild left ventricular hypertrophy (LVH) are not event free. 7-9 Thus, morphological measures of LVH appear insufficiently characterized to effectively translate into risk stratification strategies. In addition, marked heterogeneity of LVWT may play a role: recent evidence from our group indicates that in addition to the maximal LVWT, key regional LVWTs may provide complementary information of incremental value to a conventional risk stratification model. 10 Microvolt T-wave alternans (TWA) emerged as an instrumental non-invasive investigational tool in arrhythmia-prone populations. 11-15 Measuring the fluctuation in T-wave morphology on the basis of every other (alternate) heart beat is considered to represent spatial or temporal variations in ventricular repolarization, and this has been linked to both inducible and spontaneous VTAs as well as to the mechanisms leading to their initiation. Several lines of evidence support the use of TWA as a reliable predictor of VTAs and arrhythmia event-free survival in at-risk populations, including ischemic, non-ischemic dilated cardiomyopathy. 16-19 Although a few previous studies investigated the contribution of hypertrophic myocardial phenotype and regional structural variation to the genesis of arrhythmia vulnerability, 20,21 these relation- Received December 20, 2009; revised manuscript received February 18, 2010; accepted February 19, 2010; released online May 8, 2010 Time for primary review: 24 days St George's, University of London, *University College London, Heart Hospital, London, UK **The first two authors contributed equally to this work.

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Standard Screening for Cardiac Sarcoidosis

Freeman

2015

Cardiac Sarcoidosis

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Role of noninvasive studies in risk stratification for sudden cardiac death

Cited by 7 publications

References 41 publications

The relation between QT interval and T-wave variables in hypertensive patients

The relation between QT interval and T-wave variables in hypertensive patients

T-Wave Alternans and Left Ventricular Wall Thickness in Predicting Arrhythmic Risk in Patients With Hypertrophic Cardiomyopathy

Standard Screening for Cardiac Sarcoidosis

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