Turk Kardiyol Dern Ars. Ahead of Print: TKDA-47905 | DOI: 10.5543/tkda.2019.47905
Cardiac Mortality Predictability of T-Wave Alternans in Young ST-Elevated Myocardial Infarction Patients with Preserved Cardiac Function
Mustafa Umut Somuncu1
, Huseyin Karakurt21
Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zounguldak, Turkey2
Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
BACKGROUND Primary prevention of sudden cardiac death in ST-elevation myocardial infarction (STEMI) is a controversial issue because of the highly heterogeneous population. The effect of T-wave alternans (TWA) on cardiac mortality was examined in different populations mostly in patients with high risk of fatal arrhythmia such as patients with low left ventricular ejection fraction (LVEF). In our study, we aimed to investigate the prevalence of TWA and its relationship with cardiac mortality in a specific group such as young STEMI patients with preserved LVEF.
METHODS In this prospective study, we enrolled 108 STEMI patients under age 45 with preserved cardiac function who underwent single-vessel primary percutaneous intervention. Preserved cardiac function was accepted as LVEF≥50 which is detected by echocardiography with 24-72 hours after the procedure. TWA test was performed approximately 1 year after STEMI. TWA positivity was defined as the maximal voltage was >64 μV at heart rate,125 beats per minute as mentioned in previous studies.The patients followed up for five years and the primary outcome was defined as overall cardiac mortality.
RESULTS TWA was positive in 24 patients (22.2%). There was no difference in use of medications, traditional risk factors and LVEF according to TWA positivity. During follow-up of five years, 7 patients (6.5%) reached the endpoint. Patients with TWA positivity had 10.7 times increased odds for five-year cardiac mortality independent from other risk factors.
Conclusıons: Clinicians should consider the TWA test in young STEMI patients as TWA positivity may be associated with increased cardiac mortality in this population.
acute coronary syndrome, cardiac mortality, sudden cardiac death, fatal arrhytmhia, T-wave alternans
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Corresponding Author: Mustafa Umut Somuncu, Türkiye