Abnormal T-Wave Alternans In Coronary Artery Disease Left Ventricle Ejection Fraction >40% With Myocardial Infarction

Abstract

Coronary artery disease (CAD) may present with or without myocardial infarction, with the left ventricle ejection fraction (LVEF) <40% or >40%. Myocardial infarction with LVEF <40% has been reported to cause abnormal T-wave alternans (TWA) value. The data about abnormal TWA value in myocardial infarction with LVEF >40% is still limited. A case-control analytic study was held at Dr. Sardjito general hospital Since March 2021 until April 2022 on adult CAD subjects with LVEF >40%. The TWA value was obtained from treadmill test which was then divided into the case group if the TWA value was abnormal and into the control group if the TWA value was normal. The data about myocardial infarction was retrospectively evaluated afterwards. Hypothesis testing was performed by Chi-Square test. Multivariate analysis using logistic regression test was conducted to determine the effect of confounding variables on TWA value. A total of 124 subjects were included in this study (62 subjects in the case group with abnormal TWA value, and 62 subjects in the control group with normal TWA value) with the mean age of 55,48 ± 8,6 years old and 83,8% were male subjects The proportion of subjects with abnormal TWA value with myocardial infarction and without myocardial infarction were 74,6% and 16,7% respectively. The Chi-Square test showed an association between PAH and abnormal TWA with OR 14,395 (CI 95%: 5,88-35,21; p<0,001). After multivariate analysis, myocardial infarction was the only remaining variable independently associated with abnormal TWA values. Abnormal TWA value occurred more frequently in subjects with myocardial infarction compared to subjects without myocardial infarction, in population of CAD LVEF >40%, with the possibility of 14,395 times more frequent