Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death.
Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death.
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DOI：
10.1016/j.hrthm.2012.03.014
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发表时间：
2012-08
期刊：
影响因子：
5.5
通讯作者：
Armoundas AA
中科院分区：
文献类型：
--
作者：
Merchant FM;Ikeda T;Pedretti RF;Salerno-Uriarte JA;Chow T;Chan PS;Bartone C;Hohnloser SH;Cohen RJ;Armoundas AA
Previous studies have demonstrated that microvolt T-wave alternans (MTWA) testing is a robust predictor of ventricular tachyarrhythmias and sudden cardiac death (SCD) in at-risk patients. However, recent studies have suggested that MTWA testing is not as good a predictor of “appropriate” implantable cardioverter-defibrillator (ICD) therapy as it is a predictor of SCD in patients without ICDs. We sought to evaluate the utility of MTWA testing for SCD risk stratification in patients without ICDs. Patient-level data were obtained from five prospective studies of MTWA testing in patients with no history of ventricular arrhythmia or SCD. In these studies, ICDs were implanted in only a minority of patients and patients with ICDs were excluded from the analysis. We conducted a pooled analysis and examined the 2-year risk for SCD based on MTWA test result. The pooled cohort included 2883 patients. MTWA testing was positive in 856 (30%), negative in 1627 (56%) and indeterminate in 400 (14%) patients. Among patients with LVEF ≤ 35%, annual SCD event rates were 4.0%, 0.9% and 4.6% among the MTWA positive, negative and indeterminate groups. The SCD rate was significantly lower among patients with a negative MTWA test compared to either the positive or the indeterminate groups (p<0.001 for both comparisons). In patients with LVEF > 35%, annual SCD event rates were 3.0%, 0.3% and 0.3% among the MTWA positive, negative and indeterminate groups. The SCD rate associated with a positive test was significantly higher than either the negative (p<0.001) or the indeterminate groups (p=0.003). In patients without ICDs, MTWA testing is a powerful predictor of SCD. Among patients with LVEF ≤ 35%, a negative MTWA test is associated with a low risk for SCD. Conversely, among patients with LVEF > 35%, a positive MTWA test identifies patients at significantly heightened SCD risk. These findings may have important implications for refining primary prevention ICD treatment algorithms.
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