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Microvolt T wave alternans in adults with congenital heart diseases characterized by right ventricle pathology or
Aleksandra Cieplucha1, Olga Trojnarska, Agnieszka Bartczak
11st Department of Cardiology, University of Medical Sciences, Poznan, Poland. ola.cieplucha@gmail.com
Insights
Microvolt T-wave alternans (MTWA) is significantly more common in adults with congenital heart disease (CHD) and is associated with ventricular arrhythmia. MTWA may aid in sudden cardiac death risk stratification for these patients.
Area of Science:
- Cardiology
- Electrophysiology
- Congenital Heart Disease Research
Background:
- Sudden cardiac death (SCD) risk assessment in adults with congenital heart disease (CHD) presents a significant clinical challenge.
- The utility of microvolt T-wave alternans (MTWA) in SCD risk stratification for adults with CHD requires further investigation.
- This study aimed to determine MTWA incidence in adults with CHD and its correlation with ventricular arrhythmia (VA) and SCD-associated clinical factors.
Purpose of the Study:
- To evaluate the incidence of microvolt T-wave alternans (MTWA) in adults with specific forms of congenital heart disease (CHD).
- To assess the association between abnormal MTWA and the occurrence of ventricular arrhythmia (VA) and other clinical parameters.
- To explore the potential role of MTWA in the risk stratification for sudden cardiac death (SCD) in this patient population.
Main Methods:
- A case-control study comparing 102 adults with CHD (right ventricle pathology or single ventricle physiology) to 45 healthy controls.
- All participants underwent spectral MTWA testing, ambulatory ECG monitoring, cardiopulmonary exercise testing, and BNP assessment.
- MTWA results were classified as positive, negative, or indeterminate, with positive and indeterminate results grouped as 'abnormal' due to similar prognostic value.
Main Results:
- Abnormal MTWA was significantly more prevalent in adults with CHD compared to controls (39.2% vs 2.3%, p < 0.00001).
- Sustained ventricular tachycardia (sVT) occurred more frequently in subjects with abnormal MTWA (19.4% vs 3.6%, p = 0.026).
- Abnormal MTWA was associated with lower blood oxygen saturation, male gender, higher NYHA class, and poorer cardiopulmonary function parameters.
Conclusions:
- Abnormal MTWA is significantly more frequent in adults with selected CHD types than in healthy individuals.
- The likelihood of abnormal MTWA increases with malignant VA, male gender, heart failure symptoms, and cyanosis.
- MTWA shows potential as a tool for risk stratification of sudden cardiac death in adult CHD patients.
Background:
Among adults with congenital heart diseases (CHD) evaluation of sudden cardiac death (SCD) risk remains a great challenge. Although microvolt T-wave alternans has been incorporated into SCD risk stratification algorithm, its role in adults with CHD still requires investigation. We sought to determine the incidence of MTWA in this specific group and its coincidence with ventricular arrhythmia (VA) and other clinical findings presumably associated with SCD.
Methods:
A case-control study was performed in which 102 patients with CHD characterized by right ventricle pathology or single ventricle physiology (TGA, UVH, Ebstein's anomaly, ccTGA, Eisenmenger syndrome, DORV, CAT, unoperated ToF) were compared to 45 age- and sex-matched controls. All subjects underwent spectral MTWA test, ambulatory ecg monitoring, cardiopulmonary test, BNP assessment. After excluding technically inadequate traces, the remaining MTWA results were classified as positive(+), negative(-) and indeterminate(ind). Due to similar prognostic significance MTWA(+) and (ind) were combined into a common group labeled 'abnormal'.
Results:
Abnormal MTWA was present more often in the study group, compared to controls (39.2% vs 2.3%, p = 0.00001). Sustained ventricular tachycardia (sVT) was observed more often among subjects with abnormal MTWA compared to MTWA(-): 19.4% vs 3.6%, p = 0.026. The patients with abnormal MTWA had a lower blood saturation (p = 0.047), more often were males (p = 0.031), had higher NYHA class (p = 0.04), worse cardiopulmonary parameters: %PeakVO2 (p = 0.034), %HRmax (p = 0.003). Factors proven to increase probability of abnormal MTWA on multivariate linear regression analysis were: sVT (OR = 20.7, p = 0.037) and male gender (OR = 15.9, p = 0.001); on univariate analysis: male gender (OR = 2.7, p = 0.021), presence of VA (OR = 2.6, p = 0.049), NYHA > I (OR = 2.06, p = 0.033), %HRmax (OR = 0.94, p = 0.005), %PeakVO2 (OR = 0.97, p = 0.042), VE/VCO2slope (OR = 1.05, p = 0.037).
Conclusions:
Abnormal MTWA occurs significantly more often in adults with the chosen forms of CHD than among healthy subjects. The probability of abnormal MTWA increases in patients with malignant VA, in males and among subjects with heart failure and cyanosis. MTWA might be of potential role in risk stratification for SCD in adults with CHD.
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