T wave alternans as a predictor of recurrent ventricular tachyarrhythmias in ICD recipients: Prospective comparison with conventional risk markers
T wave alternans as a predictor of recurrent ventricular tachyarrhythmias in ICD recipients: Prospective comparison with conventional risk markers
复制标题
DOI：
10.1111/j.1540-8167.1998.tb00101.x
复制
发表时间：
1998-12-01
影响因子：
2.7
通讯作者：
Cohen, RJ
中科院分区：
文献类型：
--
作者：
Hohnloser, SH;Klingenheben, T;Cohen, RJ
用于风险分层的T波交替。简介：目前用于脑卒中风险分层的标准是电生理学CEP测试，由于其侵入性，仅限于已知处于高风险的患者。许多无创性检查，如左心室射血分数（LVEF）或心率变异性的测定，已被评估为额外的风险分层，微伏T波电交替（TWA）是一个有前途的新的风险标志物。在低风险或中风险人群中前瞻性评价无创风险标志物需要涉及大量患者的研究，并且在此类研究中，难以记录室性快速性心律失常的发生。在本研究中，我们确定了高风险人群，即植入式心律转复除颤器（ICD）的接受者，并前瞻性地比较了微伏TWA与有创EP测试和其他风险标志物预测室性快速性心律失常复发的能力，如ICD记录的那样。电图。方法和结果：95例有室性快速性心律失常病史并接受ICD植入的患者接受了EP测试、TWA评估以及LVEF、压力反射敏感性、信号平均心电图、24小时霍尔特监测分析和12导联体表心电图QT离散度。本研究的终点是在随访期间首次对电描记图记录的室颤或心动过速进行适当的ICD治疗。Kaplan-Meier生存分析显示，TWA（P < 0.006）和LVEF（P < 0.04）是唯一有意义的单变量风险分层因素，EP检验无统计学意义（P < 0.2）。多变量考克斯回归分析显示，TWA是唯一具有统计学显著性的独立风险因素。结论：微伏TWA测量在预测ICD接受者室性快速性心律失常复发方面优于有创EP测试和其他目前使用的无创风险评估方法。这项研究表明，TWA也可能是一个强大的工具，在低风险或中度风险的患者的风险分层，并需要在这些人群中进行前瞻性评估。
T Wave Alternans for Risk Stratification. Introduction: The current standard for arrhythmic risk stratification is electrophysiologic CEP) testing, which, due to its invasive nature, is limited to patients already known to be at high risk. A number of noninvasive tests, such as determination of left ventricular ejection fraction (LVEF) or heart rate variability, have been evaluated as additional risk stratifiers, Microvolt T wave alternans (TWA) is a promising new risk marker. Prospective evaluation of noninvasive risk markers in low- or moderate-risk populations requires studies involving very large numbers of patients, and in such studies, documentation of the occurrence of ventricular tachyarrhythmias is difficult. In the present study, we identified a high-risk population, recipients of an implantable cardioverter defibrillator (ICD), and prospectively compared microvolt TWA with invasive EP testing and other risk markers with respect to their ability to predict recurrence of ventricular tachyarrhythmias as documented by ICD electrograms.Methods and Results: Ninety-five patients with a history of ventricular tachyarrhythmias undergoing implantation of an ICD underwent EP testing, assessment of TWA, as well as determination of LVEF, baroreflex sensitivity, signal-averaged EGG, analysis of 24-hour Holter monitoring, and QT dispersion from the 12-lead surface EGG. The endpoint of the study was first appropriate ICD therapy for electrogram-documented ventricular fibrillation or tachycardia during follow-up. Kaplan-Meier survival analysis revealed that TWA (P < 0.006) and LVEF (P < 0.04) were the only significant univariate risk stratifiers, EP testing was not statistically significant (P < 0.2). Multivariate Cox regression analysis revealed that TWA was the only statistically significant independent risk factor,Conclusions: Measurement of microvolt TWA compared favorably with both invasive EP testing and other currently used noninvasive risk assessment methods in predicting recurrence of ventricular tachyarrhythmias in ICD recipients. This study suggests that TWA might also be a powerful tool for risk stratification in low- or moderate-risk patients, and needs to be prospectively evaluated in such populations.