In patients with hypertrophic cardiomyopathy, T-wave alternans was closely correlated with LV dyssynchrony and inversely related to resting strain measures (P < 0.001).
Observational (n=73)
Is there an association between left ventricular deformational abnormalities measured by 2D strain imaging and T-wave alternans in patients with hypertrophic cardiomyopathy?
Myocardial dysfunction assessed by 2D strain imaging is significantly associated with T-wave alternans in HCM patients, suggesting a link between mechanical abnormalities and arrhythmia vulnerability.
p-value: p=< 0.001
ObjectiveThe aim of this study was to assess the relationship between left ventricular (LV) deformational abnormalities, measured by two-dimensional strain imaging, and T-wave alternans (TWA) in hypertrophic cardiomyopathy (HCM).BackgroundHCM is a prevalent hereditary cardiac disorder linked to arrhythmia and sudden cardiac death. Microvolt TWA involves periodic beat-to-beat variation in the amplitude or the shape of the T wave in an ECG. In HCM, TWA has been linked to increased LV mass and used previously as noninvasive prognostic tools in the evaluation and patient risk stratification.Patients and methodsThe study group consisted of 40 consecutive HCM patients. The HCM group was compared with 33 age-matched and sex-matched healthy participants. All patients and control participants underwent 12-lead ECG, conventional echocardiographic examination, two-dimensional strain imaging, treadmill exercise test, and measurement of TWA, 24-h Holter monitoring.ResultsDepending on TWA results, the patients were divided into two groups: TWA+ patients, and TWA- patients. There were no significant differences among the most conventional echocardiographic measures between TWA groups. Absolute values of esys, SRsys, SRe, and SRa were significantly smaller in HCM patients than the controls at rest and peak exercise (P < 0.001). LV dyssynchrony was evident in TWA+ patients at rest and amplified at peak stress compared with TWA- patients. TWA was closely correlated with LV dyssynchrony at rest and during exercise, and was inversely related to resting esys, SRsys, SRe, SRa, and the functional systolic and diastolic reserve as estimated by ∆ and percent of change of these variables.ConclusionThe considerable association of myocardial dysfunction with TWA+ outcome provides important new evidence on arrhythmia vulnerability in HCM.
Attia et al. (2014) conducted an observational in Hypertrophic cardiomyopathy (n=73). Hypertrophic cardiomyopathy and T-wave alternans vs. Healthy controls and TWA- patients was evaluated on Left ventricular deformational abnormalities measured by two-dimensional strain imaging and T-wave alternans (p=< 0.001). In patients with hypertrophic cardiomyopathy, T-wave alternans was closely correlated with LV dyssynchrony and inversely related to resting strain measures (P < 0.001).