Date of Award


Author's School

College of Arts & Sciences

Author's Department/Program



Background: Both depression and T-wave alternans (TWA), an abnormality seen on the electrocardiogram, are associated with increased mortality in cardiac patients. It is unknown whether significant TWA might help explain excess mortality among depressed cardiac patients or whether gender affects the magnitude of TWA.

Methods: N=135 patients were selected from the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Holter substudy and all patients who died (N=40) of any cause were matched by age and gender with one survivor who had major depression and one who had no/minor depression. Twenty-four hour ambulatory Holter recordings that had been obtained from post-discharge monitoring of patients admitted for acute myocardial infarction (AMI) were re-analyzed in order to measure TWA using the modified moving average (MMA) method. Results were compared between survivors and non-survivors as well as between depressed and non-depressed and male and female patients using t-tests for continuous and chi-square analyses for categorical variables.

Results: Males had significantly higher average TWA (p=0.050) or higher maximum TWA on either channel (p=0.031) with data restricted to patients with measurable TWA on both channels. Survivors had a trend for higher TWA compared to non-survivors, which became significant on channel 2 (p=0.030). When the analysis was limited to patients with no/minor depression, survivors had significantly higher average TWA (p=0.047) and maximum TWA (p=0.014) on channel 2 than non-survivors. Among patients with major depression, there were no differences by gender in TWA parameters. Further studies are needed to elucidate whether depression might abolish the effect of gender on TWA in this patient population.

Conclusion: TWA does not appear to be associated with major depression in post-MI patients and is unlikely to explain the increased mortality found in this group.


English (en)

Advisor/Committee Chair

Phyllis K. Stein, PhD

Advisor/Committee Chair's Department

Division of Cardiology, Washington University School of Medicine

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