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T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial

V Floré1,2, P Claus3, M A Vos4

  • 1Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium. vincent.flore@outlook.com.

Journal of Cardiovascular Translational Research
|September 10, 2015
PubMed

Insights

T-wave alternans (TWA) and microvascular obstruction (MVO) predict recurrent cardiac events after ST-elevation myocardial infarction (STEMI). These markers, assessed months post-STEMI, are linked and indicate ongoing risk for angina or acute coronary syndrome (ACS).

Area of Science:

  • Cardiology
  • Biomedical Engineering

Background:

  • ST-elevation myocardial infarction (STEMI) survivors face significant risks of recurrent cardiac events.
  • Microvascular obstruction (MVO) and T-wave alternans (TWA) are potential indicators of adverse outcomes post-STEMI.

Purpose of the Study:

  • To investigate the relationship between T-wave alternans (TWA), infarct size, and microvascular obstruction (MVO).
  • To determine the association of these factors with recurrent cardiac morbidity after STEMI.

Main Methods:

  • 106 patients underwent TWA testing 1-12 months post-STEMI.
  • 57 patients had cardiac MRI within 2-4 days post-STEMI.
  • Follow-up averaged 3.5 years, monitoring for cardiac events.

Main Results:

  • Positive TWA and larger MVO were independently associated with recurrent angina or acute coronary syndrome (ACS).
  • MVO presence correlated with TWA and impaired left ventricular ejection fraction (LVEF).
  • Recurrent coronary ischemia was observed in 25 patients during follow-up.

Conclusions:

  • Patients post-STEMI remain at high risk for coronary ischemia symptoms.
  • MVO and TWA, assessed 1-12 months after STEMI, are interrelated and predict recurrent angina or ACS.

Keywords:
Cardiac magnetic resonance imagingMicrovascular obstructionNon-invasive risk stratificationST segment elevation myocardial infarctiont-wave alternans

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