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Saito K, Kondo Y, Takahashi M, Kitahara H, Nakayama T, Fujimoto Y, Kobayashi Y. Factors that predict ventricular arrhythmias in the late phase after acute myocardial infarction. ESC Heart Fail 2021; 8:4152-4160. [PMID: 34173350 PMCID: PMC8497219 DOI: 10.1002/ehf2.13499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/25/2021] [Accepted: 06/16/2021] [Indexed: 11/07/2022] Open
Abstract
Aims Little is known regarding factors that predict the occurrence of lethal ventricular arrhythmias (VAs) occurring after acute myocardial infarction (AMI). This observational cohort study aimed to identify factors that predicted lethal VAs during the late phase after AMI in patients with reduced left ventricular ejection fraction (LVEF). Methods and results Data were collected from our AMI database regarding consecutive patients with an LVEF of ≤40% after AMI (January 2012 to July 2018). The ‘late phase’ was defined as ≥7 days after AMI onset, and the primary endpoint was defined as lethal VAs in the late phase. The study included 136 patients (82% men; mean age: 66 ± 13 years). The average LVEF at admission was 32.7 ± 8.2%. During a mean follow‐up period of 20.7 months, 14 patients (10%) experienced lethal VAs, including ventricular fibrillation (n = 8) and sustained ventricular tachycardia (n = 10). Univariate analyses revealed that lethal VAs were predicted by age and LVEF at admission. Receiver operating characteristic curve analysis indicated that the optimal cut‐off value was 23% for using the LVEF at admission to predict the primary endpoint (area under the curve: 0.77, P < 0.0001). Multivariable analysis also demonstrated that LVEF at admission was an independent predictor of the primary endpoint (risk ratio = 7.12, P = 0.001). Conclusions Lethal VAs in the late phase are common in patients with AMI, and reduced LVEF and cardiac function at admission play a significant role in the risk stratification for future lethal VAs in this population.
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Affiliation(s)
- Kan Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, Chuo-ku, 260-8677, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, Chuo-ku, 260-8677, Japan
| | | | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, Chuo-ku, 260-8677, Japan
| | - Takashi Nakayama
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, Chuo-ku, 260-8677, Japan
| | - Yoshihide Fujimoto
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, Chuo-ku, 260-8677, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, Chuo-ku, 260-8677, Japan
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Voglimacci-Stephanopoli Q, Rollin A, Mondoly P, Monteil B, Mandel F, Galinier M, Carrié D, Maury P. Correlations between arrhythmogenic substrate and noninvasive risk stratification in ischemic heart disease patients modifications by radiofrequency ablation. J Cardiovasc Electrophysiol 2019; 30:2344-2352. [PMID: 31433084 DOI: 10.1111/jce.14136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Several noninvasive risk factors for ventricular arrhythmias have been described in postmyocardial infarction (MI) patients, whose relationships with scar characteristics and modifications by ablation are unknown. METHODS Twenty-two patients with previous MI referred for ventricular tachycardia ablation were prospectively included. ECG, heart rate variability (HRV), signal-averaged ECG (SA-ECG), and T wave alternans (TWA) were performed before and after radiofrequency ablation. Scar areas were correlated to preablation parameters. Pre and postablation parameters were furthermore compared. RESULTS Left ventricular ejection fraction and some spectral and time-domain HRV parameters were significantly correlated to the scar areas. QRS duration was larger after vs before ablation (120 ± 29 vs 105 ± 22 msec, P = .01). No significant modification in time or spectral domain of HRV was observed. There was no significant change in TWA and SA-ECG before and after ablation. Borderline decreases in quantitative TWA parameters were noted in patients with positive TWA and successful ablation procedure. CONCLUSION Some noninvasive risk factors were linked to the scar areas, but few were significantly modified after ablation. Larger populations are needed to demonstrate significant differences or correlations.
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Affiliation(s)
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Benjamin Monteil
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Franck Mandel
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France.,INSERM Unity U 1048, Toulouse, France
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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 5 years in patients with hypertrophic cardiomyopathy. Anatol J Cardiol 2018; 20:165-173. [PMID: 30152798 PMCID: PMC6237941 DOI: 10.14744/anatoljcardiol.2018.15945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
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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Floré V, Claus P, Vos MA, Vandenberk B, Van Soest S, Sipido KR, Adriaenssens T, Bogaert J, Desmet W, Willems R. T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial Infarction. J Cardiovasc Transl Res 2015; 8:484-92. [PMID: 26350221 DOI: 10.1007/s12265-015-9649-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/21/2015] [Indexed: 12/01/2022]
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.
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Affiliation(s)
- V Floré
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium. .,Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - P Claus
- Division of Imaging and Cardiovascular Dynamics, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - M A Vos
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - B Vandenberk
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - S Van Soest
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - K R Sipido
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - T Adriaenssens
- Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - J Bogaert
- Department of Imaging and Pathology, University of Leuven, Leuven, Belgium
| | - W Desmet
- Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - R Willems
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.,Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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