Correlation between TW alternants and hemodynamic parameters in cardiac failure of non-ischemic dilatative cardiomyopathy

G. Pettinati, L. Manca, E De Santis, G. Storti

Division of Cardiology, “F Ferrari” Hospital, Casarano (Italy)

4th International MESPE Congress (Malaga 22 - 24 september 2005) Reprints from: Mediterranean Journal of Pacing and Electrophisyology. Volume n.7 2005

Recent studies showed TW alternants (TWA) is a marker for severe ventricular arrhythmias and sudden death in ischemic cardiomyopathy. It’s still not clear the role of TWA in cardiac faiiure of non-ischemic dilatative cardiomy­opathy. he main cause of death being the failure of the pump function of the heart as opposed to sudden death due to arrhythmia.

Aim of the study: To investigate the correlation between TWA and hemodynamic parameters as ejection fraction (EF), oxygen consumption (VO₂ max) and cardiac volumes (V Td) in a patient population affected by cardiac failure and non-ischemic dilatative cardiomyopathy.

Methods: 30 patients (20 M, 10 F) with mean age 65 ± 10 years affected by non-ischemic dilatative cardiomyopathy were studied. Patients were classified according to NHYA functional class II (17) and III (13). All patients underwent coronary angiography (negative for all patients), cardiac ultrasonography, ergospirometry and holter ECG. TWA was measured by the Cambridge Heart System with the ergometer and was considered to be positive achieving 1.9 mV at heart rate 110/min.

Results: 14 (46.6%) patients had positive or indeterminate TWA. Results are indicated in the following table:

Non-sustained ventricular tachycardia (Lown grade IV B) was present in 7 patients of the positive TWA group (50%) and in 2 patients of the negative TWA group (12%).

Two deaths occurred during the follow up period (8 months ± 4) in the positive TWA group (14%) and none in the negative TWA group. A patient in the positive TWA group was transplanted.

Conchtsions: In cardiac failure of non-ishemic dilatative cardiomyopathy we couldn’t find any correlation between TWA and hemodynamic parameters. TWA is a reliable marker for ventricular arrhythmias, but does not correlate to left ventricular function.

However, more extensive studies are required.