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The purpose of this study was to test a hypothesis that T-wave alternans (TWA) is improved in association with an improvement in cardiac sympathetic nervous system and systolic function by oral beta-blocker therapy in patients with non-ischemic heart disease (NIHD). TWA testing, (123)I-metaiodobenzylguanidine (MIBG) imaging and echocardiography were performed at the baseline and 3 months after beta-blocker therapy in 26 patients with NIHD and positive TWA. The alternans voltage (V(alt)), the heart-to mediastinal-ratio on the early (e-H/M) and delayed (d-H/M) images, the washout rate (WR), the left ventricular ejection fraction (LVEF), and the calculated rate of change by beta-blocker therapy in each parameter (ie, deltaV(alt), deltae-H/M, deltad-H/M, deltaWR and deltaLVEF) were measured. After therapy, TWA turned negative in 8 patients (group A) and remained positive in 18 (group B); V(alt) was significantly decreased in group B (p&lt;0.001). In group A, e-H/M, d-H/M and LVEF were significantly increased (e-H/M: p&lt;0.05, d-H/M and LVEF: p&lt;0.01), as were e-H/M and LVEF in group B (p&lt;0.05). There were significant correlations between deltaV(alt) and deltae-H/M (r=-0.61, p&lt;0.01), deltad-H/M (r=-0.82, p&lt;0.0001), deltaWR (r=0.60, p&lt;0.01) and deltaLVEF (r=-0.70, p&lt;0.01). In patients with NIHD, the TWA is improved in association with the improvement in cardiac sympathetic nervous system abnormalities and left ventricular systolic dysfunction by beta-blocker therapy.

circulation journal

Effect of Long-Term Beta-Blocker Therapy on Microvolt-Level T-Wave Alternans in Association With the Improvement of the Cardiac Sympathetic Nervous System and Systolic Function in Patients With Non-Ischemic Heart Disease