Mechanical Alternans Is Associated with Mortality in Acute Hospitalized Heart Failure: Prospective Mechanical Alternans Study (MAS).
Circ Arrhythm Electrophysiol. 2014 Mar 1;
Authors: Kim R, Cingolani O, Wittstein I, McLean R, Han L, Cheng K, Robinson E, Brinker J, Schulman SS, Berger RD, Henrikson CA, Tereshchenko LG
BACKGROUND: -Acute hospitalized heart failure (AHHF) is associated with 40-50% risk of death or rehospitalization within 6 months post-discharge. Timely (before hospital discharge) risk stratification of AHHF patients is crucial. We hypothesized that mechanical alternans (MA) and T-wave alternans (TWA) is associated with post-discharge outcomes in AHHF patients. . METHODS AND RESULTS: -A prospective cohort study was conducted in the intensive cardiac care unit (ICCU) and enrolled 133 patients (59.6±15.7 y.; 65% men) admitted with AHHF. Surface ECG and peripheral arterial blood pressure waveform via arterial line were recorded continuously during the ICCU stay. MA and TWA were measured by enhanced modified moving average method. All-cause death or heart transplant served as a combined primary endpoint. MA was observed in 28 patients (25%), while TWA was detected in 33 patients (33%). If present, MA was tightly coupled with TWA. Mean TWA amplitude was larger in patients with both TWA and MA, as compared to patients with lone TWA (median 37(IQR 26-61) vs. 22(21-23) μV; P=0.045). After a median of 10 months post-discharge, 42 (38%) patients died and 2 had heart transplants. MA was associated with the primary endpoint in univariable Cox model [HR 1.84(95%CI 1.00-3.40); P=0.05], and after adjustment for left ventricular ejection fraction, NYHA HF class, and implanted ICD/CRT-D device, [HR 2.12 (95%CI 1.13-3.98); P=0.020]. TWA without consideration of simultaneous MA was not significantly associated with primary endpoint (HR 1.42; (95%CI 0.77-2.64); P=0.260).
CONCLUSIONS: -MA is independently associated with outcomes in AHHF. Clinical Trial Information-http://www.clinicaltrials.gov; Unique identifier: NCT01557465.
PMID: 24585716 [PubMed - as supplied by publisher]