T-wave alternans as an arrhythmic risk stratifier: state of the art.

T-wave alternans as an arrhythmic risk stratifier: state of the art.
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DOI:
10.1007/s11886-013-0398-7
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发表时间:
2013-09
影响因子:
3.7
通讯作者:
Armoundas, Antonis A.
Armoundas, Antonis A.
中科院分区:
医学3区
文献类型:
--
作者:
Merchant, Faisal M.;Sayadi, Omid;Moazzami, Kasra;Puppala, Dheeraj;Armoundas, Antonis A.

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微伏水平t波交替(MTWA)是心室复极化阶段的一种搏动变异性现象,在中长期随访中与室性心动过速事件(VTE)和心源性猝死(SCD)的风险增加密切相关。最近的观察还表明,MTWA强度的升高可能与静脉血栓栓塞的短期风险密切相关。在亚细胞和细胞水平上,钙转运过程的扰动可能在交替发生中起主要作用,然后继发导致动作电位形态和持续时间(APD)的交替。因此,MTWA可能不仅在风险分层中起作用,更重要的是在静脉血栓栓塞的发病机制中起作用。在本文中,我们概述了在了解MTWA发病机制方面的最新进展,以及t波交替检测在临床风险分层中的应用。我们还重点介绍了MTWA的新兴临床应用。
Microvolt level T-wave alternans (MTWA), a phenomenon of beat-to-beat variability in the repolarization phase of the ventricles, has been closely associated with an increased risk of ventricular tachyarrhythmic events (VTE) and sudden cardiac death (SCD) during medium- and long-term follow-up. Recent observations also suggest that heightened MTWA magnitude may be closely associated with short-term risk of impending VTE. At the sub-cellular and cellular level, perturbations in calcium transport processes likely play a primary role in the genesis of alternans, which then secondarily lead to alternans of action potential morphology and duration (APD). As such, MTWA may play a role not only in risk stratification but also more fundamentally in the pathogenesis of VTE. In this paper, we outline recent advances in understanding the pathogenesis of MTWA and also the utility of T-wave alternans testing for clinical risk stratification. We also highlight emerging clinical applications for MTWA.
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