title: Early repolarization and positive T-wave alternans as risk markers for life-threatening arrhythmias in patients with vasospastic angina.
abstract: BACKGROUND
  Several arrhythmogenic markers have been suggested as predictors for risk of life-threatening arrhythmias during symptom-free periods in vasospastic angina (VSA), but no definite conclusion has been drawn.
  
  
  OBJECTIVE
  To investigate prevalence of fatal ventricular tachyarrhythmia in VSA and its relation to appearance of early repolarization (ER) and positive T wave alternans (p-TWA) in patients with VSA during symptom-free periods.
  
  
  METHODS
  We studied 116 consecutive patients with chest pain who underwent an acetylcholine provocation test for VSA diagnosis. Patients were divided into two groups with positive (VSA group; 66 cases) and negative (control group; 50 cases) provocation test results. The presence of ER on electrocardiogram and the modified moving average analysis of TWA during symptom-free periods were explored.
  
  
  RESULTS
  The incidences of ER and p-TWA were higher in the VSA than in the control group (P=0.001 and P=0.006, respectively). Multivariate analysis revealed that ER and p-TWA were independent predictors of VSA (odds ratio, 5.65 and 4.94; 95% confidence interval: 1.11-28.9 and 1.22-19.9, respectively). The incidence of coexisting baseline ER and p-TWA was significantly higher in VSA patients with life-threatening arrhythmic events (3/3 vs. 6/38; P<0.001) than in those without.
  
  
  CONCLUSIONS
  VSA patients with arrhythmic events showed a high incidence of ER and p-TWA during symptom-free periods. Therefore, baseline ER and p-TWA may help to identify VSA patients at high risk for life-threatening arrhythmias.
authors.affiliation: Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan; Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: janes.ina929@gmail.com.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Inamura
authors.affiliation: Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nishizaki
authors.affiliation: Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
authors.forename: Noriyosi
authors.initials: N
authors.lastname: Yamawake
authors.affiliation: Department of Cardiology, Kameda Medical Center, Chiba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Division of Cardiology, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan.
authors.forename: Harumizu
authors.initials: H
authors.lastname: Sakurada
authors.affiliation: Department of Health Examination, Toride Kitasoma Medical Center Hospital, Ibaraki, Japan; Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Hiraoka
authors.affiliation: Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000109:Acetylcholine / Q000378:metabolism; D000368:Aged; D000788:Angina Pectoris, Variant / Q000150:complications*; D017023:Coronary Angiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000503:physiopathology
chemical_list: D000109:Acetylcholine
keywords: J wave; Multivessel vasospasm; T wave alternans; Vasospastic angina; Ventricular fibrillation