Average T-wave alternans activity in ambulatory ECG records predicts sudden cardiac death in patients with chronic heart failure
Average T-wave alternans activity in ambulatory ECG records predicts sudden cardiac death in patients with chronic heart failure
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DOI：
10.1016/j.hrthm.2011.10.027
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发表时间：
2012-03-01
期刊：
影响因子：
5.5
通讯作者：
Pablo Martinez, Juan
中科院分区：
文献类型：
--
作者：
Monasterio, Violeta;Laguna, Pablo;Pablo Martinez, Juan
背景交替T波(T波Alternans，TWA)是一种公认的无创性心电图检查方法，可用于判断心源性猝死(SCD)患者的心源性猝死(SCD)风险。目的本研究的目的是评价动态心电图长期平均T波交替活动能否为慢性心力衰竭患者提供预后信息。用全自动多导联技术测量TWA的平均活动，并提出两个指标来量化TWA：量化全程平均TWA活动的指标(IAA)，用于定义TWA阳性/阴性测试；以及量化心率在80~90次/分之间的平均TWA活动(IAA90)。结果将患者分为TWA阳性组(TWA(90))和TWA阴性组(TWA-)，IAA的分界点为3.7µV，对应于IAA在人群中分布的第75%。经过48个月的中位随访期，TWA组的心源性死亡和SCD的存活率显著高于对照组(分别为p=0.017和p=.001)。多变量COX比例风险分析显示，TWA+和IAA90均与SCD相关，危险率分别为2.29(p=0.004)和1.07/u V(p=0.046)。结论动态心电图自动测量的平均TWA活性可预测轻中度慢性心力衰竭患者的SCD。
BACKGROUND T-wave alternans (TWA) is a well-documented noninvasive electrocardiographic (ECG) method useful for identifying patients at risk for sudden cardiac death (SCD).OBJECTIVE The purpose of this study was to evaluate whether the long-term average TWA activity on Holter monitoring provides prognostic information in patients with chronic heart failure.METHODS Twenty-four-hour Holter ECGs from 650 ambulatory patients with mild-to-moderate chronic heart failure were analyzed in the study. Average TWA activity was measured by using a fully automated multilead technique, and 2 indices were proposed to quantify TWA: an index quantifying the average TWA activity in the whole recording (IAA), which was used to define a positive/negative TWA test, and an index quantifying the average TWA activity at heart rates between 80 and 90 beats/min (IAA90).RESULTS Patients were divided into TWA positive (TWA(90)) and TWA negative (TWA-) groups by setting a cut point of 3.7 mu V for IAA, corresponding to the 75th percentile of the distribution of IAA in the population. After a median follow-up of 48 months, the survival rate was significantly higher in the TWA-group for cardiac death and SCD (p = .017 and p = .001, respectively). Multivariate Cox proportional hazards analysis revealed that both TWA+ and IAA90 were associated with SCD with hazard rates of 2.29 (p = .004) and 1.07 per mu V (p = .046), respectively.CONCLUSION The average TWA activity measured automatically from Holter ECGs predicted SCD in patients with mild-to-moderate chronic heart failure.