T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial Infarction.
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.
Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium. vincent.flore@outlook.com.|Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. vincent.flore@outlook.com.
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Floré
Division of Imaging and Cardiovascular Dynamics, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
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Claus
Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
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Vos
Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
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Vandenberk
Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
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Van Soest
Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
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Sipido
Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Adriaenssens
Department of Imaging and Pathology, University of Leuven, Leuven, Belgium.
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Bogaert
Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Desmet
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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Willems
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D003326:Coronary Circulation; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
Cardiac magnetic resonance imaging; Microvascular obstruction; Non-invasive risk stratification; ST segment elevation myocardial infarction; t-wave alternans