Prognostic Value of T-Wave Alternans in Patients with Congestive Heart Failure

Background: Following myocardial infarction, ventricular tachycardia and the ejection fraction are indiscriminate predictors of non-sudden (NSCD) and sudden cardiac death (SCD), which challenges the existence of distinct pathways.In contrast, left ventricular aneurysm adds risk only for sudden cardiac death but the involved mechanism is not clear, Our objective was to identify differential predictors of cardiac death, by type, in the presence of left ventricular aneurysm.Methods: We conducted an observational study of 66 patients with left ventricular aneurysm diagnosed by ventriculography between 1977 and 1985.Follow-up was concluded in January 1989.We used contractility scores for the residual myocardium and the segments adjacent to the aneurysm, the ejection fraction, and the presence of ventricular tachycardia by Holter recording.Results: At a 5.2-year median follow-up, there were 12 NSCD and 8 SCD.Patients with NSCD and those with SCD, despite a similar ejection fraction, exhibited disparate residual contractility scores (3.0 vs. 4.1, P < 0.004).A decreasing residual contractility score differentially predicted NSCD (odds ratio = 18.97,P < 0.03), while a normokinetic adjacent segment differentially predicted SCD (odds ratio = 21, P < 0.02).Ventricular tachycardia increased bifactotial model significance (P -z 0.004) for SCD only when tested concurrently with a normokinetic adjacent segment. Conclusions:The ejection fraction is of limited value for differential risk stratification because it inaccurately reflects the residual myocardial contractility.Ventricular arrhythmias are the likely mechanism for SCD when a normokinetic segment adjoins left ventricular aneurysm P91/10368 Long term job-survival after acute myocardial infsrction: What is the role of reduced left ventricular systolic function