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Relationship between Ventricular Dyssynchrony and T‐wave Alternans in Patients with Coronary Artery Disease
Author(s) -
YAN GUOHUI,
WANG MEI,
YUE WENSHENG,
YIU KAIHANG,
ZHI GUANG,
LAU CHUPAK,
WL LEE STEPHEN,
SIU CHUNGWAH,
TSE HUNGFAT
Publication year - 2011
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2011.03183.x
Subject(s) - medicine , cardiology , coronary artery disease , repolarization , odds ratio , confidence interval , sudden cardiac death , ventricular dyssynchrony , heart failure , ejection fraction , cardiac resynchronization therapy , electrophysiology
Coronary artery disease (CAD) is associated with increased dispersion of repolarization and sudden cardiac death. We sought to investigate whether ventricular dyssynchrony is associated with proarrhythmic repolarization dispersion as measured by T‐wave alternans (TWA) in patients with CAD.Methods and Results: We evaluated 154 patients (67 ± 9 years, 123 men) with documented CAD, who underwent exercise treadmill testing and echocardiographic examination. TWA was analyzed continuously during treadmill testing in all standard precordial leads by time‐domain method. Tissue Doppler imaging was performed to measure inter‐ and intraventricular dyssynchrony. Increased TWA ≥ 60μV was observed in 42 (27%) patients. There was higher prevalence of females (31 vs 16%, P = 0.04) and greater body mass index (25.7 ± 2.6 vs 24.6 ± 3.0 kg/m 2 , P = 0.04) in the TWA ≥ 60μV group of patients than the TWA < 60μV group. The index of interventricular dyssynchrony, Ts‐RL, was significantly increased (75.6 ± 37.8 vs 59.9 ± 35.9 ms, P = 0.03) but not intraventricular dyssynchrony (all P > 0.05) in patients with TWA ≥ 60 μV compared with those with TWA < 60 μV. In addition, a weak but significant positive correlation was observed between TWA and Ts‐RL (r = 0.25, P = 0.003). Multivariate analysis revealed that only Ts‐RL (odds ratio 1.02, 95% confidence interval 1.00–1.03, P = 0.013) was independent predictor for increased TWA.Conclusions: Our results demonstrated that interventricular dyssynchrony in patients with CAD is associated with increased TWA. This suggests that interventricular dyssynchrony may contribute to proarrhythmic repolarization dispersion. (PACE 2011; 34:1503–1510)