Patients With Dilated Cardiomyopathy Who Have Recovered Normal Ventricular Function Remain at Increased Risk for Sudden Death

Presentation Start/End Time:

Sunday, Mar 30, 2008, 1:00 PM - 2:00 PM

Topic:

Myocardial Function/Heart Failure--Clinical Pharmacological Treatment

Author Block:

Philip F. Binkley, Haseeb Jafri, The Ohio State Univeristy Heart and Lung Institute, Columbus, OH, The Ohio State University Division of Cardiovascular Medicine, Columbus, OH

Keywords:

Heart failure,Sudden death

Background: Patients with dilated cardiomyopathy (DCM) are at increased risk for sudden cardiac death (SCD). It is not known whether recovery of normal left ventricular systolic function (LVF) eliminates this risk. Microvolt T Wave Alternans (MTWA) is associated with an increased risk of SCD, and its absence has a 90% negative predictive value for SCD. Hypothesis: Patients who have a history of DCM and have recovered normal LVF (EF >40%) in response to medical therapy remain at risk for SCD.Methods: 21 patients were identified as having a history of DCM as well as a MTWA test result. Of these, 13 had recovered normal LVF. The rate of non-negative MTWA tests in these patients was compared with the expected frequency of non-negative tests in normals ( 11%) and with patients with DCM who did not recover normal LVF. Results: Of the patients who recovered normal LVF, 4 were found to have a non-negative test result (p < 0.05 compared to expected). The proportion of non-negative tests in patient with recovered LVF did not differ from that in patients with DCM who did not regain normal LVF(Chi-Square p = 0.78). The odds of a non-negative test did not differ between the two groups when adjusting for age, gender, race or etiology of DCM.
Conclusion: These findings suggest the risk of SCD persists in patients with DCM despite restoration of normal ventricular function in response to medical therapy. This patient population should be carefully evaluated for the risk of SCD through non-invasive and potentially invasive means.

Microvolt T Alternans vs LV Function
	Non-Negative	Negative	Total
Not Recovered	3	5	8
Recovered	4	9	13
Total	7	14	21

Learning Objective 1:

Define use of microvolt t wave alternans

Learning Objective 2:

describe the frequency of a non-negative microvolt t wave alternans test in nomral subjects

Learning Objective 3:

Describe the frequency at which LV function returns to nomral in patients with dilated cardiomyopathy