T Wave Alternans is a Predictor of Death in Patients with Congestive Heart Failure

Simona Sarzi Braga, MD, Raffaella Vaninetti*, MD, Antonio Laporta, MD, Anna Picozzi, MD, and Roberto FE Pedretti, MD.

IRCCS Fondazione Salvatore Maugeri, Divisione di Cardiologia, Istituto Scientifico di Tradate, Tradate (VA), Italy.

* Ospedale di Circolo di Varese, Università degli Studi dell’Insubria, Varese (VA), Italy.

Running head:   T wave alternans in congestive heart failure


Few data are available about the prognostic role of T wave Alternans in patients with congestive heart failure. To assess the ability of T wave Alternans, used alone or in combination with other risk markers, to predict cardiac death in decompensated patients, we enrolled 46 patients, mean age 59 ± 9, males 89 %, ischemic etiology 61 %, NYHA class III 35 %, left ventricular ejection fraction 29 ± 7 %. After 1.6 years follow-up, 7 patients died from cardiac death (16 %), non sudden in 6 (86 %) and sudden in 1 (14 %). T wave Alternans was positive in 24 (52 %), negative in 13 (28 %), indeterminate in 9 patients (20 %). T wave Alternans was positive in all patients with events (100 %) but only in 16 of 37 patients without (41 %) (p = 0.02). Other predictors of cardiac death were O2 consumption at the peak of exercise (p = 0.03), standard deviation of all NN intervals (p = 0.05) and Wedge pressure (p = 0.03). When Receiver Operator Characteristics curves were calculated, the highest area (0.73) was found for O2 consumption at the peak of exercise considering the single variables and for O2 consumption at the peak of exercise plus T wave Alternans (0.79) for combination of them; the comparison of the two Receiver Operator Characteristics curves did not reach statistical difference (p = 0.5). In conclusion, this is the first study reporting that T wave Alternans can predict cardiac death, with a marginal additional prognostic power when used in combination with measurement of O2 consumption at the peak of exercise.



T wave Alternans; congestive heart failure; cardiac death; risk stratification