title: T-wave amplitude variability and the risk of death in Chagas disease.
abstract: BACKGROUND
  Measurement of beat-to-beat T-wave amplitude variability (TWV) has been described as a promising new technique for the stratification of arrhythmic risk in postmyocardial infarction and dilated cardiomyopathy patients. Chagas disease (ChD) can lead to a potentially lethal cardiopathy that can present with ventricular arrhythmias, heart blocks, heart failure, and sudden death. The aim of the study was to evaluate the prognostic value of TWV in ChD patients in addition to traditional prognostic predictors.
  
  
  RESULTS
  The study enrolled 113 ambulatory ChD patients (62 men; age: 42 ± 9 years) in sinus rhythm and without other systemic diseases, evaluated by a standard clinical protocol. We computed TWV in 10-minute ECG recordings obtained in controlled resting conditions. TWV was defined as the median values among 8 consecutive 50-ms T-wave segments and dichotomized as either ≤ or > 30 μV(2). The association of TWV and death was evaluated by Cox proportional-hazards analysis, considering other established predictors. During mean follow-up time of 106 ± 28 months, 14 patients died. A value of median TWV > 30 μV(2) predicts increased risk of death in a multivariate analysis (HR = 5.76, 95% CI 1.31-25.23, P = 0.014), in addition to depressed left ventricular function, presence of nonsustained ventricular tachycardia and QRS duration >133 ms.
  
  
  CONCLUSIONS
  Repolarization variability, evaluated by TWV, is independently related to the risk of death in ChD. This noninvasive methodology could facilitate the identification of patients who may benefit from more aggressive therapeutic strategies.
authors.affiliation: Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil.
authors.forename: Antonio Luiz Pinho
authors.initials: AL
authors.lastname: Ribeiro
authors.forename: Manoel Otávio D A Costa
authors.initials: MO
authors.lastname: Rocha
authors.forename: Paolo
authors.initials: P
authors.lastname: Terranova
authors.forename: Marco
authors.initials: M
authors.lastname: Cesarano
authors.forename: Maria D O Carmo Pereira
authors.initials: MD
authors.lastname: Nunes
authors.forename: Federico
authors.initials: F
authors.lastname: Lombardi
mesh_terms: D000328:Adult; D000368:Aged; D002598:Chagas Cardiomyopathy / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography / Q000379:methods* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult