Prognostic Evaluation of Microvolt T-Wave Alternans in Hypertrophic Cardiomyopathy: 9-year Clinical Follow-up.

IF 2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Arquivos Brasileiros de Cardiologia Pub Date : 2023-09-04 eCollection Date: 2023-01-01 DOI:10.36660/abc.20220833

Murillo Oliveira Antunes, Edmundo Arteaga-Fernandez, Nelson Samesima, Horácio Gomes Pereira Filho, Afonso Yoshikiro Matsumoto, Richard L Verrier, Carlos Alberto Pastore, Charles Mady

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引用次数: 1

Abstract

Background: Sudden cardiac death (SCD) resulting from ventricular arrhythmia is the main complication of hypertrophic cardiomyopathy (HCM). Microvolt T-wave alternans (MTWA) is associated with the occurrence of ventricular arrhythmias in several heart diseases, but its role in HCM remains uncertain.

Objective: To evaluate the association of MTWA with the occurrence of SCD or potentially fatal ventricular arrhythmias in HCM patients in a long-term follow-up.

Methods: Patients diagnosed with HCM and NYHA functional class I-II were consecutively selected. At the beginning of the follow-up, the participants performed the MTWA evaluation using the modified moving average during the stress test. The results were classified as altered or normal. The composite endpoint of SCD, ventricular fibrillation, sustained ventricular tachycardia (SVT) or appropriate implantable cardiac defibrillation (ICD) therapy was assessed. The level of significance was set at 5%.

Results: A total of 132 patients (mean age of 39.5 ± 12.6 years) were recruited and followed for a mean of 9.5 years. The MTWA test was altered in 74 (56%) participants and normal in 58 (44%). Nine events (6.8%) occurred during the follow-up, with a prevalence of 1.0%/year - six SCDs, two appropriate ICD shocks and one episode of (SVT). Altered MTWA was associated with non-sustained ventricular tachycardia on Holter (p = 0.016), septal thickness ≥30 mm (p < 0.001) and inadequate blood pressure response to effort (p = 0.046). Five patients with altered MTWA (7%) and four patients with normal MTWA (7%) had the primary outcome [OR = 0.85 (95% CI: 0.21 - 3.35, p=0.83)]. Kaplan-Meir event curves showed no differences between normal and altered MTWA.

Conclusion: Altered MTWA was not associated with the occurrence of SCD or potentially fatal ventricular arrhythmias in HCM patients, and the low rate of these events during long-term follow-up suggests the good prognosis of this heart disease.

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微伏T波改变对肥厚型心肌病预后的评估：9年临床随访。

背景：室性心律失常引起的心源性猝死（SCD）是肥厚型心肌病（HCM）的主要并发症。微伏T波交替（MTWA）与几种心脏病中室性心律失常的发生有关，但其在HCM中的作用尚不确定。目的：在长期随访中，评估MTWA与HCM患者发生SCD或潜在致命性室性心律失常的关系。方法：连续选择诊断为HCM和NYHA功能I-II级的患者。在随访开始时，参与者在压力测试期间使用修正的移动平均值进行MTWA评估。结果分为改变或正常。评估SCD、心室颤动、持续性室性心动过速（SVT）或适当的植入式心脏除颤器（ICD）治疗的复合终点。结果：共招募132名患者（平均年龄39.5±12.6岁），平均随访9.5年。MTWA测试在74名（56%）参与者中改变，在58名（44%）参与者中正常。随访期间发生了9例事件（6.8%），患病率为1.0%/年——6例SCD，2例适当的ICD电击和1例（SVT）发作。MTWA改变与动态心电图上非持续性室性心动过速相关（p=0.016），间隔厚度≥30mm（p＜0.001）和血压对努力的反应不足（p＝0.046）。5名MTWA改变的患者（7%）和4名MTWA正常的患者（7%）具有主要结果[OR＝0.85（95%CI：0.21-3.35，p＝0.83）]。Kaplan-Meir事件曲线显示正常和改变的MTWA之间没有差异HCM患者的潜在致命性室性心律失常，以及长期随访中这些事件的低发生率表明这种心脏病的预后良好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Arquivos Brasileiros de Cardiologia 医学-心血管系统

CiteScore

3.70

自引率

30.80%

发文量

234

审稿时长

3-8 weeks

期刊介绍： With more than 70 years of existence, Arquivos Brasileiros de Cardiologia is the main channel for the dissemination of Brazilian scientific research on cardiovascular sciences. Published in two languages and indexed in major international databases, all scientific contributions are peer-reviewed and reviewed by editorial board members selected among the most reputable researchers in Brazil and abroad. The manuscripts are reviewed according to their relevance and originality, scientific accuracy and level of importance for the advancement of science. With an average time of nine months between the initial submission and the effective publication of the manuscripts, and less than seven months until they are published on PubMed, Arquivos Brasileiros de Cardiologia can ensure the quick inclusion of the researchers’ papers in the international literature.