Time-domain T-wave alternans measured from Holter electrocardiograms predicts cardiac mortality in patients with left ventricular dysfunction: A prospective study
Time-domain T-wave alternans measured from Holter electrocardiograms predicts cardiac mortality in patients with left ventricular dysfunction: A prospective study
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DOI：
10.1016/j.hrthm.2008.12.011
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发表时间：
2009-03-01
期刊：
影响因子：
5.5
通讯作者：
Yoshino, Hideaki
中科院分区：
文献类型：
--
作者：
Sakaki, Katsura;Ikeda, Takanori;Yoshino, Hideaki
背景时域T波电交替（TWA）是有用的，以确定患者在心肌梗死后的严重事件的风险。目的本研究的目的是前瞻性地评估时域TWA测量从热心电图在预测心脏死亡率的左心室（LV）dysfunction.METHODS 295例连续的LV功能不全的患者参加了这项研究。将患者分为两组：缺血组（n = 195）和非缺血组（n = 100）。使用改良的移动平均法，根据日常活动期间记录的常规24小时Hotter ECG评估时域TWA。最大时域TWA电压在心率= 65 μ V。主要终点被定义为心脏mortals.Results平均最大时域TWA电压为54 +/- 16 μ V。在390 +/- 212天的随访期间，27例患者（缺血组17例，非缺血组10例）死于心脏原因。53例患者（18%）为时域TWA阳性，242例（82%）为时域TWA阴性。单变量考克斯比例风险分析显示，年龄较大、纽约心脏协会心功能分级III或IV、糖尿病、肾功能不全、非持续性室性心动过速和时域TWA与心源性死亡率相关。在多变量分析中，时域TWA具有最显著的价值（风险比= 17.1，P
BACKGROUND Time-domain T-wave alternans (TWA) is useful for identifying patients at risk for serious events after myocardial infarction.OBJECTIVE The purpose of this study was to prospectively evaluate the utility of time-domain TWA measured from Hotter ECGs in predicting cardiac mortality in patients with left ventricular (LV) dysfunction.METHODS Two hundred ninety-five consecutive patients with LV dysfunction were enrolled in the study. Patients were divided into two groups: the ischemic group (n = 195) and the nonischemic group (n = 100). Time-domain TWA was assessed using the modified moving average method from routine 24-hour Hotter ECGs recorded during daily activity. The maximal time-domain TWA voltage at heart rate = 65 mu V. The primary end-point was defined as cardiac mortality.RESULTS Mean maximal time-domain TWA voltage was 54 +/- 16 mu V. During follow-up of 390 +/- 212 days, 27 patients (17 in the ischemic group and 10 in the nonischemic group) died of cardiac causes. Fifty-three patients (18%) were time-domain TWA positive and 242 (82%) were time-domain TWA negative. Univariate Cox proportional hazards analyses revealed that older age, New York Heart Association functional class III or IV, diabetes, renal dysfunction, nonsustained ventricular tachycardia, and time-domain TWA were associated with cardiac mortality. In multivariate analysis, time-domain TWA had the most significant value (hazard ratio = 17.1, P