Ambulatory ECG-based T-wave alternans and heart rate turbulence can predict cardiac mortality in patients with myocardial infarction with or without diabetes mellitus

Cardiovascular Diabetology

Original Investigation

Ren Li-dong¹  Ren Li-na²  Qi Guo-xian²  Wang Yong-quan²  Fang Xin-hui²  Gong Jian³ 

[1] Department of Anesthesiology, Central Hospital of Dalian, No. 826 Southwest Road, Shahekou District, 116033, Dalian, China;Department of Cardiology, The First Affiliated Hospital of China Medical University, 110001, Shenyang, China;Department of Clinical Pharmacy, School of Life Science and Biopharmaceutics, Shenyang Pharmaceutical University, 103 Wenhua Road, 110016, Shenyang, China;

关键词: Ambulatory electrocardiograms;    Heart rate turbulence;    Myocardial infarction;    T-wave alternans;    Diabetes mellitus;   

DOI  :  10.1186/1475-2840-11-104

 received in 2012-08-26, accepted in 2012-08-28,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundMany patients who survive a myocardial infarction (MI) remain at risk of sudden cardiac death despite revascularization and optimal medical treatment. We used the modified moving average (MMA) method to assess the utility of T-wave alternans (TWA) and heart rate turbulence (HRT) as risk markers in MI patients with or without diabetes mellitus (DM).MethodsWe prospectively enrolled 248 consecutive patients: 96 with MI (post-MI patients); 77 MI with DM (post-MI + DM patients); 75 controls without cardiovascular disease (group control). Both TWA and HRT were measured on ambulatory electrocardiograms (AECGs). HRT was assessed by two parameters ─ turbulence onset (TO) and turbulence slope (TS). HRT was considered positive when both TO ≥0% and TS ≤2.5 ms/R-R interval were met. The endpoint was cardiac mortality.ResultsTWA values differed significantly between MI and controls. Post-MI + DM patients had higher TWA values than post-MI patients (58 ± 21 μV VS 52 ± 18 μV, P = 0.029). Impaired HRT--increased TO and decreased TS were observed in MI patients with or without DM. During follow-up of 578 ± 146 days, cardiac death occurred in ten patients and three of them suffered sudden cardiac death (SCD). Multivariate analysis determined that a HRT-positive outcome [HR (95% CI): 5.01, 1.33–18.85; P = 0.017], as well as the combination of abnormal TWA (≥47 μV) and positive HRT had significant association with the endpoint [HR (95% CI): 9.08, 2.21–37.2; P = 0.002)].ConclusionThis study indicates that AECGs-based TWA and HRT can predict cardiac mortality in MI patients with or without DM. Combined analysis TWA and HRT may be a convenient and useful method of identifying patients at high risk for cardiovascular death.

【 授权许可】

Unknown   
© Li-na et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.