Mechanical alternans is associated with mortality in acute hospitalized heart failure prospective mechanical alternans study (mas)

Robert Kim, Oscar Cingolani, Ilan Wittstein, Rhondalyn McLean, Lichy Han, Kailun Cheng, Elizabeth Robinson, Jeffrey Brinker, Steven S. Schulman, Ronald D. Berger, Charles A. Henrikson, Larisa G. Tereshchenko

    Research output: Contribution to journalArticlepeer-review

    15 Scopus citations


    Background-Acute hospitalized heart failure (AHHF) is associated with 40% to 50% risk of death or rehospitalization within 6 months after discharge. Timely (before hospital discharge) risk stratification of patients with AHHF is crucial. We hypothesized that mechanical alternans (MA) and T-wave alternans (TWA) are associated with postdischarge outcomes in patients with AHHF. Methods and Results-A prospective cohort study was conducted in the intensive cardiac care unit and enrolled 133 patients (59.6±15.7 years; 65% men) admitted with AHHF. Surface ECG and peripheral arterial blood pressure waveform via arterial line were recorded continuously during the intensive cardiac care unit stay. MA and TWA were measured by enhanced modified moving average method. All-cause death or heart transplant served as a combined primary end point. MA was observed in 28 patients (25%), whereas 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 when compared with patients with lone TWA (median, 37 [interquartile range, 26-61] versus 22 [21-23] μV; P=0.045). After a median of 10-month postdischarge, 42 (38%) patients died and 2 had heart transplants. MA was associated with the primary end point in univariable Cox model (hazard ratio, 1.84; 95% confidence interval, 1.00-3.40; P=0.05) and after adjustment for left ventricular ejection fraction, New York Heart Association HF class, and implanted implantable cardioverter defibrillator/ cardiac resynchronization therapy defibrillator (hazard ratio, 2.12 95% confidence interval, 1.13-3.98; P=0.020). TWA without consideration of simultaneous MA was not significantly associated with primary end point (hazard ratio, 1.42; 95% confidence interval, 0.77-2.64; P=0.260). Conclusions-MA is independently associated with outcomes in AHHF.

    Original languageEnglish (US)
    Pages (from-to)259-266
    Number of pages8
    JournalCirculation: Arrhythmia and Electrophysiology
    Issue number2
    StatePublished - Apr 2014


    • Alternans
    • Heart failure
    • Mortality

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Physiology (medical)


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