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J Cardiovasc Transl Res. 2015 Nov;8(8):484-92. doi: 10.1007/s12265-015-9649-x. Epub 2015 Sep 8.

T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial Infarction.

Author information

1
Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium. vincent.flore@outlook.com.
2
Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. vincent.flore@outlook.com.
3
Division of Imaging and Cardiovascular Dynamics, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
4
Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
5
Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
6
Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
7
Department of Imaging and Pathology, University of Leuven, Leuven, Belgium.

Abstract

The purpose of this study is to investigate the relationship between T-wave alternans (TWA), infarct size and microvascular obstruction (MVO) and recurrent cardiac morbidity after ST elevation myocardial infarction (STEMI). One hundred six patients underwent TWA testing 1-12 months and 57 patients underwent cardiac magnetic resonance imaging (MRI) in the first 2-4 days after STEMI. During follow-up (3.5 ± 0.5 years), death (n = 2), ventricular tachycardia (n = 3), supraventricular tachycardia (n = 4), heart failure (n = 3) and recurrent coronary ischemia (n = 25) were observed. After multivariate analysis, positive TWA (HR2.59, CI1.10-6.11, p0.024) and larger MVO (HR1.08, CI1.01-1.16, p0.034) were associated with recurrent angina or ACS. Presence of MVO was correlated with TWA (Spearman rho 0.404, p0.002) and the impairment of LVEF (-0.524, p < 0.001). Patients after STEMI remain at a high risk of symptoms of coronary ischemia. The presence of MVO and TWA 1-12 months after STEMI is related to each other and to recurrent angina or ACS.

KEYWORDS:

Cardiac magnetic resonance imaging; Microvascular obstruction; Non-invasive risk stratification; ST segment elevation myocardial infarction; t-wave alternans

PMID:
26350221
DOI:
10.1007/s12265-015-9649-x
[Indexed for MEDLINE]

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