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Average T-wave alternans activity in ambulatory ECG records predicts sudden cardiac death in patients with chronic heart failure.

Authors :
Monasterio V
Laguna P
Cygankiewicz I
Vázquez R
Bayés-Genís A
de Luna AB
Martínez JP
Source :
Heart rhythm [Heart Rhythm] 2012 Mar; Vol. 9 (3), pp. 383-9. Date of Electronic Publication: 2011 Oct 22.
Publication Year :
2012

Abstract

Background: T-wave alternans (TWA) is a well-documented noninvasive electrocardiographic (ECG) method useful for identifying patients at risk for sudden cardiac death (SCD).<br />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.<br />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 (IAA(90)).<br />Results: Patients were divided into TWA positive (TWA+) and TWA negative (TWA-) groups by setting a cut point of 3.7 μV 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 IAA(90) were associated with SCD with hazard rates of 2.29 (p = .004) and 1.07 per μV (p = .046), respectively.<br />Conclusion: The average TWA activity measured automatically from Holter ECGs predicted SCD in patients with mild-to-moderate chronic heart failure.<br /> (Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1556-3871
Volume :
9
Issue :
3
Database :
MEDLINE
Journal :
Heart rhythm
Publication Type :
Academic Journal
Accession number :
22024149
Full Text :
https://doi.org/10.1016/j.hrthm.2011.10.027