ABSTRACT
BACKGROUND AND OBJECTIVES: The prevention of sudden death in patients with a myocardial infarction (MI) remains the therapeutic target. T-wave alternans is as a heart rate dependent measure of repolarization, which correlates with ventricular arrhythmia vulnerability. The goals of this study were to clarify whether microvolt-level T-wave alternans (mTWA) can predict lethal arrhythmic events, and compare their role with other risk indices in predicting lethal events following a MI. SUBJECTS AND METHODS: The mTWA was analyzed in 78 MI patients, using a power-spectral method during bicycle exercise testing. Additionally, the left ventricular ejection fraction (EF), late potentials (LP) and heart rate variability were also measured. RESULTS: The mTWA was positive in 16 patients (21%), negative in 36 (46%) and indeterminate in 21 (33%). Lethal arrhythmic events developed in 7 patients (3 sudden deaths, 3 ventricular tachycardia and 1 ventricular fibrillation), during a mean follow-up of 12+/-3 months. The event rate was significantly higher in patients with a positive mTWA (relative risk 12.0, 95% CI 1.2 to 118.1, p=0.01) or lower EF (<40%)(relative risk 11.0, CI 1.9 to 65.0, p=0.002). The mTWA test exhibited the highest sensitivity, relative risk and negative predictive value, but the lowest specificity; positive predictive values were observed compared with the EF or a combination of the two indices. CONCLUSION: mTWA was closely related to the occurrence of lethal arrhythmic events in patients with a MI. Therefore, mTWA with a lower EF could be a useful screening test for the prediction of potentially lethal arrhythmic events following a MI.
Subject(s)
Humans , Arrhythmias, Cardiac , Death, Sudden , Death, Sudden, Cardiac , Exercise Test , Follow-Up Studies , Heart Rate , Mass Screening , Myocardial Infarction , Sensitivity and Specificity , Stroke Volume , Tachycardia, Ventricular , Ventricular FibrillationABSTRACT
Squamous cell carcinoma of the ovary is rare and usually arise from preexisting cystic teratomas, endometriosis or Brenner tumors which undergo carcinomatous degeneration in their epithelial elements. Some of squamous cell carcinoma of the ovary is known to be associated with cervical neoplasm, but the pathogenesis is still unknown. Recently we experienced one case of ovarian squamous cell carcinoma in patients with microinvasive squamous cell carcinoma of uterine cervix. We report this case with possible pathogenesis and brief review of literatures.