Microscopic systolic pressure alternans in human cardiomyopathy: noninvasive evaluation of a novel risk marker and correlation with microvolt T-wave alternans

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Raja J SelvarajVijay S Chauhan


In patients with severe left ventricular (LV) dysfunction, visible pulsus alternans coincides with visible T-wave alternans (TWA), but a similar relationship has not been described for nonvisible microscopic systolic pressure alternans (MSPA) and microvolt TWA (MTWA). The purpose of this study was to determine the prevalence of MSPA and its relationship to MTWA in patients with cardiomyopathy. Using the spectral method, MSPA was measured from finger pressure during incremental atrial pacing and then validated against MSPA measured from the LV pressure in 12 patients. In 23 other patients with cardiomyopathy (LV ejection fraction <40%), noninvasive MSPA and MTWA were measured simultaneously during incremental atrial pacing. MSPA (<1 mm Hg) was detected in 80% of patients with cardiomyopathy and in 43% of controls. The presence of finger MSPA showed 100% positive concordance with LV MSPA; however, finger MSPA was 20% larger due to peripheral augmentation. Finger MSPA was highly concordant (96% positive concordance and 90% negative concordance) with MTWA. The magnitudes of MSPA and MTWA showed a linear correlation (R = 0.66, P <.001), and the k value, a measure of signal-to-noise ratio, was significantly larger for MSPA compared t...Continue Reading


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Oct 24, 2007·American Journal of Physiology. Heart and Circulatory Physiology·William T Clusin
Aug 6, 2009·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Michael J Cutler, David S Rosenbaum


Mar 4, 2014·Circulation. Arrhythmia and Electrophysiology·Robert KimLarisa G Tereshchenko
Apr 14, 2015·Journal of Pharmacy Practice·Antony Q PhamBrittany Gallagher
Feb 14, 2019·Annals of Biomedical Engineering·Stefan van DuijvenbodenMichele Orini

Related Concepts

Diastolic Blood Pressure
Cardiac Pacing, Artificial
Electrocardiographic Recorders
Monitoring, Physiologic
Severity of Illness Index
Reproducibility of Results
Viral Markers
Survival Rate

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