Microvolt T-wave alternans physiological basis, methods of measurement, and clinical utility--consensus guideline by International Society for Holter and Noninvasive Electrocardiology.
Microvolt T-wave alternans physiological basis, methods of measurement, and clinical utility--consensus guideline by International Society for Holter and Noninvasive Electrocardiology.
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DOI：
10.1016/j.jacc.2011.06.029
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发表时间：
2011-09-20
影响因子：
24
通讯作者：
Rosenbaum, David S.
中科院分区：
文献类型：
--
作者：
Verrier, Richard L.;Klingenheben, Thomas;Malik, Marek;El-Sherif, Nabil;Exner, Derek V.;Hohnloser, Stefan H.;Ikeda, Takanori;Pablo Martinez, Juan;Narayan, Sanjiv M.;Nieminen, Tuomo;Rosenbaum, David S.
关键词：
本共识指南由国际动态心电图及无创心电学会代表编写，并由日本循环学会、欧洲心脏病学会电子心脏病学计算机在心脏病学工作组以及欧洲心律失常学会共同赞助。它探讨了T波交替（TWA）这一心电现象（即ST段或T波形态和振幅的逐搏交替）。本声明重点关注其生理基础、测量技术以及在对危及生命的室性心律失常风险分层中的临床应用。包括频域频谱法和时域修正移动平均法在内的信号处理技术已在超过12000名患者的前瞻性研究中证明了TWA在心律失常风险分层中的作用。大多数同时使用这两种方法的运动相关研究报告称，在左心室射血分数正常以及降低的患者中，心血管死亡和心脏性猝死的相对风险较高。采用修正移动平均法进行动态心电图TWA分析的研究已显示出显著的预测能力。然而，也出现了频谱法的阴性研究，包括两项针对植入式除颤器患者的干预性研究。已进行荟萃分析以深入了解这一问题。TWA研究的前沿领域包括在射血分数正常个体的心律失常风险分层中的应用、通过定量分析提高预测能力以及在指导药物治疗和基于器械的治疗中的应用。总体而言，尽管TWA似乎是心律失常和心血管死亡风险的一个有用标志物，但尚无确凿证据表明它可指导治疗。
This consensus guideline was prepared on behalf of the International Society for Holter and Noninvasive Electrocardiology and is cosponsored by the Japanese Circulation Society, the Computers in Cardiology Working Group on e-Cardiology of the European Society of Cardiology, and the European Cardiac Arrhythmia Society. It discusses the electrocardiographic phenomenon of T-wave alternans (TWA) (i.e., a beat-to-beat alternation in the morphology and amplitude of the ST- segment or T-wave). This statement focuses on its physiological basis and measurement technologies and its clinical utility in stratifying risk for life-threatening ventricular arrhythmias. Signal processing techniques including the frequency-domain Spectral Method and the time-domain Modified Moving Average method have demonstrated the utility of TWA in arrhythmia risk stratification in prospective studies in >12,000 patients. The majority of exercise-based studies using both methods have reported high relative risks for cardiovascular mortality and for sudden cardiac death in patients with preserved as well as depressed left ventricular ejection fraction. Studies with ambulatory electrocardiogram-based TWA analysis with Modified Moving Average method have yielded significant predictive capacity. However, negative studies with the Spectral Method have also appeared, including 2 interventional studies in patients with implantable defibrillators. Meta-analyses have been performed to gain insights into this issue. Frontiers of TWA research include use in arrhythmia risk stratification of individuals with preserved ejection fraction, improvements in predictivity with quantitative analysis, and utility in guiding medical as well as device-based therapy. Overall, although TWA appears to be a useful marker of risk for arrhythmic and cardiovascular death, there is as yet no definitive evidence that it can guide therapy.
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