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Clinical significance of T wave alternans in patients with long QT syndrome
81
0 14
0 13 Decreased Lateral
Heart
Rate
Variability
and
Sudden
Death
in Amyotmphic
Sclerosis
Giorgio Marmero. Colombo’.
Paola Lanfranchi. Cinzia Misdo’.
Diisione
Bioingegneria
Fondazione
Cardiologia.
Fabrizio
‘Diisione
Clinica del LaMm
pisano’.
Neumlogir.
IFKXX.
Roberto ‘Servizio
Veruno (NO) My
Sudden death is quite common terminal event in patients (pa) sulfering from AmyMrophic Lateral Sclerosis (ALS). To evaluate a possible autonomic imbalance
in ALS. we studied 29 pts (19 M. 11 F) aged 33-74 yro (55~12).
33 age-matched
healthy
subjects
(Control).
All
pta had lower
and
and
upper
motoneumn involvement. 13 had bulbar signs. We analized Heart Rote Variability (HRV) in time domain (standard deviation of mea” R-R interval. SD, and beaMvbeat (autoregressive recognizing LFMF
mea” square difference. MSD) and in frequenq domain spectral analysis with automatic spectral decompz&tion
low frequency.
considered
LF. and high frequency
as a marker d syn~patho-vagai
component balance).
HF. their ratio W
and Contml
were evaluated at rest as well as during sympathetic and vagal enhancement by passive orthostatism (Tilt) and controlled breathing (CS) respectively. No
p
was taking any drug. Ftesults:
RR( ALS
Control
Rest
903:z
Tilt
665*88..
32511’.. . . . .
L MF 4.1f4.0
24*,()......
1W””
11.2fl2.v’
cs
799zt116”’
3ok12’^’
15f7”’
2.6f2.4”
Rest
975k122 759f103’”
5M3 36fl3”’
32zk12 18flS” 27fll”
lO.of12.0” 1.210.9”
Tilt CB 941f137 Tin&?dasvsR%& ‘~rn”~c31 ALsrs c&l/ok *mar “.@O? -kS
17f7”’
ots showed
detxassad
4tktlt” *paav “‘@&x7?
global
HRV
(lower
2.ati.2
SD1 with
impaired
vagal
control (lower MSD. higher LF/F1F during CEi,. F?s with.bulbar signs had Ilk not diirent from pt$ free from bulbar signs. One year later. 16 pts wire died: their SD had bean lower than survived pts SD. both at rest (28k12 vs 37s msec, p
died from witnessed (and 2 unwitnessed) sudden death: their previous 24 hour ambulatoryeledrocardiograrn had shown deeply depressed HRV with HF Bulbar signs did not predict
survival in this population.
Four pts
Significance of T Wave Alternans in Patients with Long QT Syndrome Wojciech Zareba, Arthur J. Moss, W. Jack Hall, Saskia le Cessie, Mark Andrew& Jennifer L. Robinson, and LQTS Study Research Group; University of Rochester Medical Center, Rochester, NY, USA Clinical
The aim of this study was to assess the clinical importance of T wave altemans (TWA) that occur in LQTS pts. Clinical variables and cardiac events (CE: syncope, cardiac arrest or cardiac death) were evaluated in 30 LQTS pts with recorded episodes of TWA, and in 50 comparison LQTS pts without documented TWA, matched for age and QTc value (every 0.025). According to the magnitude of bidirectional changes of consecutive T waves, TWA was categorized as mild (9 p’s) or advanced (21 pts). The independent risk of TWA and advanced TWA for cardiac events were evaluated in a logistic regression model, RESULTS: The clinical characteristics of TWA and non-TWA LQTS pts were similar. CE rates were 77% in TWA pts and 64% in the comparison group without TWA (ns). CE rate in patients with advanced TWA was 86% versus 66% in those without TWA (ns). However, TWA pts had significantly higher number of syncopal episodes than non-TWA pts (mean: 12 versus 3/pt; p=O.O3). Logistic regression analysis revealed that TWA or advanced TWA as single predictorsof CE had nonsignificant odds ratios = 1.79(p435)and decreased markedly 3.10(p=O.l8),respectively. These odds ratios when QTc value was added into the models, further indicating that TWA does not contribute a significant independent risk for cardiac events. CONCLUSION: LQTS patients with TWA have a high rateof cardiac events. However, the increased risk is due primarily to QTc prolongation, and TWA is not an independent risk factor to predict an occurrence of cardiac event
component virtually absent night and day. Thus. HRV seems to be depressed in ASL pts. particularly in sub@% with poor prognosis.
0 15
0 16
Persistent Myocsrdial lschemia as Risk Factor of Sudden Cardiac Death Dalia Pangonyt6, Juozas Bluzhas, Elena StalioraitytB. Institute of Cardiology, Kaunas, Lithuania
Marker of Dispersion as a Interval QT Acute during vulnerability Electrical Ischemia Myocardial A.van de Loo,W.Arendts,H.Just,S.H.Hohn~oaer Medzinische Klinik III.universit;itsklinik Freiburg
To determine the morphological basis of risk indicators of sudden ischemic death, major coronary arteries (CA) and myocardium from 100 males (47.8k.E yrs) who died suddenly (within 6 h) due to “pure” ischemic heart disease, signs of i.e., without clinical pathological and accompanied by cardiovascular or other diseases compensatory hypertrophy of the heart, as well as old and definite recent myocardial infarction, were investigated. morphometric Serial macroscopic, histological and techniques, automatic image analysis (Quantimet 520) of myocardial collagen network inclusive, were used. Severe atherosclerotic narrowing (75% and more) at least of one CA, most commonly of the proximal segments, and symmetric cardiac hypertrophy with mass increment of 28 percent on average were found in 78.3 percent cases. A 3.2 -fold increase in the percentage volume of myocardial fibrillar collagen network, when compared with controls, was revealed, as evidenced by reactive interstitial fibrosis with interstitial space remodelling and not numerous foci of reparative fibrosis. Direct relation between summary maximal CA stenotic lesions and interstitial myocardial fibrosis was also found. Conclusion: the symmetric hypertrophy of the heart, remodelling of the fibrillar collagen matrix and fibrosis are the morphological evidence of persistent ischemia, causing diastolic, and later, systolic dysfunction of left ventricle one of the main risk factor of the sudden cardiac death.
Dispersion(D) of the QT-interval was determined hospitaltime of in standard 12-lead ECG at admission of 33 patients presenting with acute were myocardial infarction (MI) . ECG-intervals a PC-based digitizing measured by means of a utilizing a determined was tablet.QT-D specifically designed software and was defined as QTmax minus Ql'min. Adjusted QT-D (defined as QT_D divided by the square-root of the number of leads evaluated) was also calculated. developing ventricular ECGs of 11 Patients fibrillation(VF) during the course of the first 24 hours were compared to 22 recordings of patients without VF.
~
QT-D as measured from the surface Conclusion: inhomogeneity of indicate ECG appears to during myocardial ventrcular repolarisation ischemia.Computerized determination of QT-D may risk for information useful provide MI ealy stratifikation of patients with acute during the course of hospital stay.
0 14
0 13 Decreased Lateral
Heart
Rate
Variability
and
Sudden
Death
in Amyotmphic
Sclerosis
Giorgio Marmero. Colombo’.
Paola Lanfranchi. Cinzia Misdo’.
Diisione
Bioingegneria
Fondazione
Cardiologia.
Fabrizio
‘Diisione
Clinica del LaMm
pisano’.
Neumlogir.
IFKXX.
Roberto ‘Servizio
Veruno (NO) My
Sudden death is quite common terminal event in patients (pa) sulfering from AmyMrophic Lateral Sclerosis (ALS). To evaluate a possible autonomic imbalance
in ALS. we studied 29 pts (19 M. 11 F) aged 33-74 yro (55~12).
33 age-matched
healthy
subjects
(Control).
All
pta had lower
and
and
upper
motoneumn involvement. 13 had bulbar signs. We analized Heart Rote Variability (HRV) in time domain (standard deviation of mea” R-R interval. SD, and beaMvbeat (autoregressive recognizing LFMF
mea” square difference. MSD) and in frequenq domain spectral analysis with automatic spectral decompz&tion
low frequency.
considered
LF. and high frequency
as a marker d syn~patho-vagai
component balance).
HF. their ratio W
and Contml
were evaluated at rest as well as during sympathetic and vagal enhancement by passive orthostatism (Tilt) and controlled breathing (CS) respectively. No
p
was taking any drug. Ftesults:
RR( ALS
Control
Rest
903:z
Tilt
665*88..
32511’.. . . . .
L MF 4.1f4.0
24*,()......
1W””
11.2fl2.v’
cs
799zt116”’
3ok12’^’
15f7”’
2.6f2.4”
Rest
975k122 759f103’”
5M3 36fl3”’
32zk12 18flS” 27fll”
lO.of12.0” 1.210.9”
Tilt CB 941f137 Tin&?dasvsR%& ‘~rn”~c31 ALsrs c&l/ok *mar “.@O? -kS
17f7”’
ots showed
detxassad
4tktlt” *paav “‘@&x7?
global
HRV
(lower
2.ati.2
SD1 with
impaired
vagal
control (lower MSD. higher LF/F1F during CEi,. F?s with.bulbar signs had Ilk not diirent from pt$ free from bulbar signs. One year later. 16 pts wire died: their SD had bean lower than survived pts SD. both at rest (28k12 vs 37s msec, p
died from witnessed (and 2 unwitnessed) sudden death: their previous 24 hour ambulatoryeledrocardiograrn had shown deeply depressed HRV with HF Bulbar signs did not predict
survival in this population.
Four pts
Significance of T Wave Alternans in Patients with Long QT Syndrome Wojciech Zareba, Arthur J. Moss, W. Jack Hall, Saskia le Cessie, Mark Andrew& Jennifer L. Robinson, and LQTS Study Research Group; University of Rochester Medical Center, Rochester, NY, USA Clinical
The aim of this study was to assess the clinical importance of T wave altemans (TWA) that occur in LQTS pts. Clinical variables and cardiac events (CE: syncope, cardiac arrest or cardiac death) were evaluated in 30 LQTS pts with recorded episodes of TWA, and in 50 comparison LQTS pts without documented TWA, matched for age and QTc value (every 0.025). According to the magnitude of bidirectional changes of consecutive T waves, TWA was categorized as mild (9 p’s) or advanced (21 pts). The independent risk of TWA and advanced TWA for cardiac events were evaluated in a logistic regression model, RESULTS: The clinical characteristics of TWA and non-TWA LQTS pts were similar. CE rates were 77% in TWA pts and 64% in the comparison group without TWA (ns). CE rate in patients with advanced TWA was 86% versus 66% in those without TWA (ns). However, TWA pts had significantly higher number of syncopal episodes than non-TWA pts (mean: 12 versus 3/pt; p=O.O3). Logistic regression analysis revealed that TWA or advanced TWA as single predictorsof CE had nonsignificant odds ratios = 1.79(p435)and decreased markedly 3.10(p=O.l8),respectively. These odds ratios when QTc value was added into the models, further indicating that TWA does not contribute a significant independent risk for cardiac events. CONCLUSION: LQTS patients with TWA have a high rateof cardiac events. However, the increased risk is due primarily to QTc prolongation, and TWA is not an independent risk factor to predict an occurrence of cardiac event
component virtually absent night and day. Thus. HRV seems to be depressed in ASL pts. particularly in sub@% with poor prognosis.
0 15
0 16
Persistent Myocsrdial lschemia as Risk Factor of Sudden Cardiac Death Dalia Pangonyt6, Juozas Bluzhas, Elena StalioraitytB. Institute of Cardiology, Kaunas, Lithuania
Marker of Dispersion as a Interval QT Acute during vulnerability Electrical Ischemia Myocardial A.van de Loo,W.Arendts,H.Just,S.H.Hohn~oaer Medzinische Klinik III.universit;itsklinik Freiburg
To determine the morphological basis of risk indicators of sudden ischemic death, major coronary arteries (CA) and myocardium from 100 males (47.8k.E yrs) who died suddenly (within 6 h) due to “pure” ischemic heart disease, signs of i.e., without clinical pathological and accompanied by cardiovascular or other diseases compensatory hypertrophy of the heart, as well as old and definite recent myocardial infarction, were investigated. morphometric Serial macroscopic, histological and techniques, automatic image analysis (Quantimet 520) of myocardial collagen network inclusive, were used. Severe atherosclerotic narrowing (75% and more) at least of one CA, most commonly of the proximal segments, and symmetric cardiac hypertrophy with mass increment of 28 percent on average were found in 78.3 percent cases. A 3.2 -fold increase in the percentage volume of myocardial fibrillar collagen network, when compared with controls, was revealed, as evidenced by reactive interstitial fibrosis with interstitial space remodelling and not numerous foci of reparative fibrosis. Direct relation between summary maximal CA stenotic lesions and interstitial myocardial fibrosis was also found. Conclusion: the symmetric hypertrophy of the heart, remodelling of the fibrillar collagen matrix and fibrosis are the morphological evidence of persistent ischemia, causing diastolic, and later, systolic dysfunction of left ventricle one of the main risk factor of the sudden cardiac death.
Dispersion(D) of the QT-interval was determined hospitaltime of in standard 12-lead ECG at admission of 33 patients presenting with acute were myocardial infarction (MI) . ECG-intervals a PC-based digitizing measured by means of a utilizing a determined was tablet.QT-D specifically designed software and was defined as QTmax minus Ql'min. Adjusted QT-D (defined as QT_D divided by the square-root of the number of leads evaluated) was also calculated. developing ventricular ECGs of 11 Patients fibrillation(VF) during the course of the first 24 hours were compared to 22 recordings of patients without VF.
~
QT-D as measured from the surface Conclusion: inhomogeneity of indicate ECG appears to during myocardial ventrcular repolarisation ischemia.Computerized determination of QT-D may risk for information useful provide MI ealy stratifikation of patients with acute during the course of hospital stay.