Author + information
- Benjamin Scirica,
- Tuomo Nieminen,
- Jose RM Pegler,
- Caio Tavares,
- Vitor PF Pagotto,
- Alexandre F. Kanas,
- Marcel F. Sobrado,
- Bruce Nearing,
- Ji Cho,
- David Morrow,
- Luiz Belardinelli and
- Richard Verrier
In stable pts, T-wave alternans (TWA) predicts mortality, although the relationship in pts with NSTEACS is not well described. Ranolazine, a late INa inhibitor, modulates repolarization and has antiarrhythmic properties.
Maximum TWA was calculated by Modified Moving Average method in cases and age/sex-matched controls with EF <40% and VT ≥8 beats or SCD from MERLIN-TIMI 36 trial. All pts received standard therapy for NSTEACS plus ranolazine (N=109) or placebo (N=101) and had continuous ECG (cECG) recording for up to 7 days at admission. cECGs from 210 pts on Day 1 and 156 of these pts on Day 6 were interpretable for analysis after excluding pts with AF or ectopy.
Median max TWA on Day 1 was 35 µV (IQR 28,43). TWA ≥47 µV (established cutpoint) on Day 1 correlated with 1-year mortality, CV death, and VT ≥4 beats (Table). On Day 6, median TWA was 36 µV (IQR 27,46). TWA ≥43 on Day 6 was associated with 1-year CV death (OR 4.50, 95%CI 1.4-14.3, p=0.011) in pts treated with placebo but not in pts treated with ranolazine (HR 0.30, 95% CI 0.04-2.6, p=0.27; p interaction 0.039). Overall, ranolazine did not reduce TWA between Days 1 and 6, although exploratory analyses suggest a reduction in TWA in pts with elevated baseline TWA ≥47µV.
(1) In pts with NSTEACS, TWA ≥47 µV on Day 1 is associated with increased risk of total and CV mortality and NSVT at 1 year; (2) In pts with persistently elevated TWA, treatment with ranolazine may modify risk of mortality over 1 year, although further validation is needed.
Odds Ratios of T-wave alternans for different endpoints
|Day 1||Odds Ratio||Lower limit of 95% CI||Upper limit of 95% CI||p value|
|VT ≥4 beats||2.4||1.1||5.0||0.024|
|CVD + VT ≥4 beats||2.3||1.1||5.0||0.034|
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Ventricular Arrhythmias in Cardiomyopathy
Abstract Category: 7. Arrhythmias: VT
Presentation Number: 1104-33
- 2013 American College of Cardiology Foundation