Clinical Usefulness of the Combination of T-Wave Alternans and Late Potentials for Identifying High-Risk Patients With Moderately or Severely Impaired Left Ventricular Function

Naoki Kondo; Takanori Ikeda; Ayaka Kawase; Kenta Kumagai; Takao Sakata; Mitsuaki Takami; Naoki Tezuka; Takeshi Nakae; Mahito Noro; Yoshihisa Enjoji; Kaoru Sugi; Tetsu Yamaguchi

doi:10.1253/jcj.65.649

Clinical Investigation

Clinical Usefulness of the Combination of T-Wave Alternans and Late Potentials for Identifying High-Risk Patients With Moderately or Severely Impaired Left Ventricular Function

Naoki Kondo, Takanori Ikeda, Ayaka Kawase, Kenta Kumagai, Takao Sakata, Mitsuaki Takami, Naoki Tezuka, Takeshi Nakae, Mahito Noro, Yoshihisa Enjoji, Kaoru Sugi, Tetsu Yamaguchi

Author information

Naoki Kondo
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Takanori Ikeda
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Ayaka Kawase
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Kenta Kumagai
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Takao Sakata
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Mitsuaki Takami
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Naoki Tezuka
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Takeshi Nakae
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Mahito Noro
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Yoshihisa Enjoji
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Kaoru Sugi
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine
Tetsu Yamaguchi
Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine

Keywords: Left ventricular ejection fraction, QT dispersion, Signal-averaged electrocardiography, T-wave alternans, Risk stratification

JOURNAL FREE ACCESS

2001 Volume 65 Issue 7 Pages 649-653

DOI https://doi.org/10.1253/jcj.65.649

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Abstract

Ventricular tachyarrhythmia (VT) is an independent risk factor for an increased overall mortality in patients with impaired left ventricular (LV) function, but there is not an established noninvasive tool to detect such patients. The present study aimed to clarify the most useful noninvasive approach for identification of patients with moderately or severely impaired LV function complicated by VT. Sixty-seven patients in New York Heart Association (NYHA) classes I-III with an LV ejection fraction (LVEF) less than 40% and an LV end-diastolic dimension (LVDD) of at least 55 mm on echocardiography were enrolled. Impaired LV function was caused by either ischemic (n=30) or nonischemic dilated cardiomyopathy (n=37). T-wave alternans (TWA), QT dispersion (QTD), and late potentials (LP) on signal-averaged electrocardiography were sequentially determined without using antiarrhythmic drugs. VT was defined as more than 6 consecutive ventricular ectopic beats. The mean NYHA class was 1.9±0.7, mean LVEF was 31±8%, and mean LVDD was 65±10 mm. A history of VT was present in 26 of the patients (39%). Univariate and multivariate logistic analysis showed that TWA and LP were closely related to VT, whereas NYHA ≥III, LVEF <30%, LVDD ≥70 mm, and QTD ≥90 ms were not. The combination of TWA and LP had the most significant value (p=0.0004, odds ratio=8.44) by univariate analysis, and only this combination had significant value in multivariate analysis (p=0.04). Therefore, the combination of TWA and LP could be a useful index for identifying those patients with impaired LV function who are at risk for VT. (Jpn Circ J 2001; 65: 649 - 653)

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