Post-Exercise Assessment of Cardiac Repolarization Alternans in Patients With Coronary Artery Disease Using the Modified Moving Average Method

ObjectivesWe sought to evaluate the utility of T-wave alternans (TWA) assessment in the immediate post-exercise period to identify and validate cutpoints for the modified moving average (MMA) assessment method.BackgroundThe presence of TWA is associated with an increased risk of cardiovascular death (CVD). The immediate post-exercise period, where increased physiologic stress and minimal surface artifact coexist, appears ideal to implement the MMA method.MethodsA test (n = 322) and validation cohort (n = 681) provided 1,003 patients with coronary artery disease (CAD). We assessed TWA immediately after exercise. The outcomes, CVD and mortality, were adjudicated independent of the TWA results.ResultsDuring 48 months of follow-up 85 deaths, 54 categorized as CVD (64%), were observed. A linear relationship between the magnitude of TWA and the risk of CVD was identified. As a continuous measure TWA voltage was equivalent to ejection fraction in predicting the risk of CVD. To facilitate clinical application, a sensitive, modest predictive accuracy (20 μV) and a specific, greater predictive accuracy MMA cutpoint (60 μV) were identified and validated. Each cutpoint was associated with a 2.5-fold greater risk of CVD, independent of other important variables, including ejection fraction.ConclusionsPost-exercise assessment of TWA using the MMA method is a strong, independent predictor of risk in patients with CAD. The 20-μV cutpoint (87% sensitivity) appears to be most suitable in higher-risk patients, whereas the 60-μV cutpoint (95% specificity) appears more appropriate when TWA is used as a single screening test in those at lower risk. (Assessment of Noninvasive Methods to Identify Patients at Risk of Serious Arrhythmias After a Heart Attack; NCT00399503

Spectral analysis of muscle fiber images as a means of assessing sarcomere heterogeneity.

A new image-analysis-based method is described for assessing sarcomere heterogeneity in skinned rabbit psoas muscle fiber segments. This method consists of off-line, two-dimensional Fourier spectral analysis of video-taped muscle images. Local sarcomere length is assessed by partitioning the muscle images into half and quarter images spanning the original image and analyzing the associated spectra. The spectra are analyzed in two different ways, yielding two measures of sarcomere length. The first measure is obtained by calculating and inverting the centroid frequency of the first-order peak associated with each two-dimensional Fourier spectrum. The second measure is obtained in a similar manner, the only difference being that the two-dimensional spectra are first collapsed into one-dimensional line spectra by summing the pixels perpendicular to the fiber axis. Comparison of the two measures provides a measure of striation skewness that cannot be obtained by other image analysis based methods that determine sarcomere length by analyzing selected line luminance profiles

A program for developing a comprehensive mathematical description of the crossbridge cycle of muscle.

We describe a computer modeling system for determining the changes of force, fraction of attached crossbridges, and crossbridge flux rate through a specifiable transition in response to length changes imposed on a crossbridge model of muscle. The crossbridge cycle is divided into multiple attached and detached states. The rates of transition from one state to another are defined by rate coefficients that can either be constant or vary with the position of the crossbridge relative to the thin-filament attachment site. This scheme leads to a system of differential equations defining the rates of change for the fractions of bridges in each state. Solutions for this system of equations are obtained at specified times during and after a length change using a method for systems with widely varying time constants (C. W. Gear, 1971, Numerical Initial Value Problems in Ordinary Differential Equations, Prentice-Hall, Englewood Cliffs, NJ). Crossbridges are divided into discrete populations that differ both in their axial displacement with respect to thin filament attachment sites and with respect to the twist of the actin helix. Separate solutions are made for the individual populations and are then averaged to obtain the ensemble response. Force is determined as the sum of the product of the force associated with each state multiplied by the fraction of bridges in that state. A measure of metabolic rate is determined as the net flux through one of the crossbridge transitions. When the force-extension characteristics of the individual crossbridges are linear and the filaments are noncompliant the fraction of attached bridges is equivalent to sarcomere stiffness. To illustrate the operation of the program, we also describe here some results obtained with a simplified scheme