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Average T-wave alternans activity in ambulatory ECG records predicts sudden cardiac death in patients with chronic heart failure.
- 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.)
- Subjects :
- Aged
Death, Sudden, Cardiac etiology
Female
Heart Rate
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Risk Assessment methods
Risk Factors
Spain epidemiology
Survival Rate
Arrhythmias, Cardiac diagnosis
Arrhythmias, Cardiac etiology
Arrhythmias, Cardiac mortality
Death, Sudden, Cardiac prevention & control
Electrocardiography, Ambulatory methods
Electrocardiography, Ambulatory standards
Heart Failure complications
Heart Failure diagnosis
Heart Failure mortality
Subjects
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