Ambulatory ECG-based T-wave alternans predicts sudden cardiac death in high-risk post-MI patients with left ventricular dysfunction in the EPHESUS study
Ambulatory ECG-based T-wave alternans predicts sudden cardiac death in high-risk post-MI patients with left ventricular dysfunction in the EPHESUS study
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DOI：
10.1111/j.1540-8167.2008.01225.x
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发表时间：
2008-10-01
影响因子：
2.7
通讯作者：
Deedwania, Prakash
中科院分区：
文献类型：
--
作者：
Stein, Phyllis K.;Sanghavi, Devang;Deedwania, Prakash
异常TWA预测以弗所人猝死。背景：运动微伏t波交替（TWA）可识别心源性猝死（SCD）风险。TWA可以用修正移动平均（MMA）方法从动态心电图（AECGs）中测量。AECGs的MMA TWA是否预测心肌梗死后左心室功能障碍（LVD）患者的SCD尚不清楚。方法：以弗所纳入住院的心肌梗死后合并心力衰竭和/或糖尿病合并LVD的患者。在随机分配药物治疗前，493例患者获得了aecg。其中46人死于心血管疾病，包括18人死于SCD。随访结束时存活的患者（N = 92）与46名基于年龄、性别和糖尿病的非幸存者配对。使用MARSPC系统（GE Healthcare, Milwaukee， WI， USA）分析MMA TWA。对导联V-1和V-3对应的AECG通道取无伪影周期的三个最高TWA值的平均值。SCD预测采用预先指定的47 μ V切点进行测试，并在最大限度地区分SCD患者与幸存者或非SCD的切点进行测试。结果：SCD患者两导联TWA均较高（P = 47）， V-1组与RR = 5.2 （95%CI = 1.8 ~ 13.6, P = 0.002）相关，V-3组与RR = 5.5 （95%CI = 2.2 ~ 13.8, P < 0.001）相关。V-1期TWA的最佳切点为>= 43 mu V （RR = 5.9 [95%CI = 2.2 ~ 15.8, P < 0.001]）。V-3最佳切点为>= 47 μ m，两导联TWA均大于最佳切点与SCD的RR = 7.1相关（95%CI = 2.7-18.3, P < 0.001）， 18例患者中有11例死于SCD。结论：以aecg为基础，以MMA测量的TWA是心肌梗死后伴有左室功能障碍的高危患者SCD的有力预测指标。
Abnormal TWA Predicts Sudden Death in EPHESUS. Background: Exercise microvolt T-wave alternans (TWA) identifies sudden cardiac death (SCD) risk. TWA can be measured from ambulatory ECGs (AECGs) using modified moving average (MMA) method. Whether MMA TWA from AECGs predicts SCD in post-MI patients with left ventricular dysfunction (LVD) is unknown.Methods: EPHESUS enrolled hospitalized post-MI patients with heart failure and/or diabetes with LVD. Before randomization to drug treatment, AECGs were obtained in 493 patients. Of them, 46 died of cardiovascular causes, including 18 of SCD. Patients alive at end of follow-up (N = 92) were matched with 46 nonsurvivors based on age, gender, and diabetes. MMA TWA was analyzed using MARSPC system (GE Healthcare, Milwaukee, WI, USA). The three highest TWA values from artifact-free periods were averaged for AECG channels corresponding to leads V-1 and V-3. SCD prediction was tested with a prespecified 47 mu V cutpoint and at a cutpoint maximizing the separation between SCD patients versus survivors or non-SCD.Results: TWA in either lead was higher for patients with SCD (P = 47 mu V was associated with RR = 5.2 (95%CI = 1.8-13.6, P = 0.002) in V-1 and RR = 5.5 (95%CI = 2.2-13.8, P < 0.001) in V-3 for SCD. The optimal cutpoint for TWA in V-1 was >= 43 mu V (RR = 5.9 [95%CI = 2.2-15.8, P < 0.001]). The optimal cutpoint in V-3 was >= 47 mu V. TWA greater than the optimal cutpoint in either lead was associated with RR = 7.1 (95%CI = 2.7-18.3, P < 0.001) for SCD, with 11 out of 18 patients dying of SCD.Conclusions: AECG-based TWA measured with MMA is a powerful predictor of SCD in high-risk post-MI patients with LV dysfunction.