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Myocardial Infarction in Neonatal Mice, A Model of Cardiac Regeneration
Published on: May 24, 2016
Cardiac mortality predictability of T-wave alternans in young ST-elevated myocardial infarction patients with
Mustafa Umut Somuncu1, Huseyin Karakurt2
1Department of Cardiology, Bülent Ecevit University Faculty of Medicine, Zounguldak, Turkey.
Insights
T-wave alternans (TWA) positivity significantly increases 5-year cardiac mortality risk by 10.7 times in young ST-elevation myocardial infarction (STEMI) survivors with preserved ejection fraction. This suggests TWA testing may aid risk stratification in this population.
Area of Science:
- Cardiology
- Electrophysiology
- Preventive Medicine
Background:
- Primary prevention of sudden cardiac death (SCD) in ST-elevation myocardial infarction (STEMI) is challenging due to population heterogeneity.
- T-wave alternans (TWA) is a marker of arrhythmia risk, often studied in patients with low ejection fraction.
- The prognostic value of TWA in young STEMI patients with preserved ejection fraction remains less understood.
Purpose of the Study:
- To determine the prevalence of T-wave alternans (TWA) in young ST-elevation myocardial infarction (STEMI) patients with preserved left ventricular ejection fraction (LVEF).
- To evaluate the association between TWA positivity and 5-year cardiac mortality in this specific patient cohort.
Main Methods:
- Prospective study of 108 STEMI patients (<45 years) with LVEF ≥50% post-percutaneous coronary intervention.
- TWA testing performed ~1 year post-STEMI; positivity defined as >64 μV at 125 bpm.
- 5-year follow-up for cardiac mortality.
Main Results:
- TWA positivity was found in 22.2% of patients.
- No significant differences in medications, risk factors, or LVEF between TWA-positive and negative groups.
- Patients with TWA positivity had a 10.7-fold increased odds of 5-year cardiac mortality, independent of other factors.
Conclusions:
- T-wave alternans (TWA) is a significant independent predictor of cardiac mortality in young STEMI survivors with preserved LVEF.
- TWA testing may be a valuable tool for risk stratification in this population.
- Clinicians should consider TWA assessment for primary prevention of SCD in these patients.
Objective:
Primary prevention of sudden cardiac death in ST-elevation myocardial infarction (STEMI) is a complicated issue due to the highly heterogeneous population. The effect of T-wave alternans (TWA) on cardiac mortality has been examined in various populations, most often in patients with a high risk of fatal arrhythmia, such as patients with a low left ventricular ejection fraction (LVEF). The aim of the present study was to investigate the prevalence of TWA and its relationship to cardiac mortality in young STEMI patients with preserved LVEF.
Methods:
A total of 108 STEMI patients with preserved cardiac function who were under the age of 45 and underwent single-vessel primary percutaneous coronary intervention were enrolled in this prospective study. Preserved cardiac function was defined as an LVEF of ≥50% as detected with echocardiography 24 to 72 hours after the procedure. The TWA test was performed approximately 1 year after the STEMI occurrence. TWA positivity was defined with a maximal voltage of >64 μV and a heart rate of 125 beats per minute, as in previous studies. The patients were followed up for 5 years and overall cardiac mortality was measured.
Results:
There was a positive TWA finding in 24 patients (22.2%). There was no significant difference in the use of medications, traditional risk factors, or LVEF in those with TWA positivity. During a follow-up period of 5 years, 7 patients (6.5%) reached the endpoint. Patients with TWA positivity had 10.7 times greater odds for 5-year cardiac mortality, independent of other risk factors.
Conclusion:
Clinicians should consider using the TWA test in young STEMI patients, as TWA positivity may be associated with increased cardiac mortality in this population.
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