Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death
Background Previous studies have demonstrated that microvolt T-wave alternans (MTWA) testing is a robust predictor of ventricular tachyarrhythmias and sudden cardiac death (SCD) in at-risk patients. However, recent studies have suggested that MTWA testing is not as good a predictor of “appropriate”...
| Main Authors: | , , , , , , , , , |
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| 格式: | Article |
| 語言: | en_US |
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Elsevier
2016
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| 在線閱讀: | http://hdl.handle.net/1721.1/102580 https://orcid.org/0000-0002-5573-0137 |
| _version_ | 1826213282962210816 |
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| author | Merchant, Faisal M. Ikeda, Takanori Pedretti, Roberto F.E. Salerno-Uriarte, Jorge A. Chow, Theodore Chan, Paul S. Bartone, Cheryl Hohnloser, Stefan H. Cohen, Richard J. Armoundas, Antonis A. |
| author2 | Institute for Medical Engineering and Science |
| author_facet | Institute for Medical Engineering and Science Merchant, Faisal M. Ikeda, Takanori Pedretti, Roberto F.E. Salerno-Uriarte, Jorge A. Chow, Theodore Chan, Paul S. Bartone, Cheryl Hohnloser, Stefan H. Cohen, Richard J. Armoundas, Antonis A. |
| author_sort | Merchant, Faisal M. |
| collection | MIT |
| description | Background
Previous studies have demonstrated that microvolt T-wave alternans (MTWA) testing is a robust predictor of ventricular tachyarrhythmias and sudden cardiac death (SCD) in at-risk patients. However, recent studies have suggested that MTWA testing is not as good a predictor of “appropriate” implantable cardioverter-defibrillator (ICD) therapy as it is a predictor of SCD in patients without ICDs.
Objective
To evaluate the utility of MTWA testing for SCD risk stratification in patients without ICDs.
Methods
Patient-level data were obtained from 5 prospective studies of MTWA testing in patients with no history of ventricular arrhythmia or SCD. In these studies, ICDs were implanted in only a minority of patients and patients with ICDs were excluded from the analysis. We conducted a pooled analysis and examined the 2-year risk for SCD based on the MTWA test result.
Results
The pooled cohort included 2883 patients. MTWA testing was positive in 856 (30%), negative in 1627 (56%), and indeterminate in 400 (14%) patients. Among patients with a left ventricular ejection fraction (LVEF) of ≤35%, annual SCD event rates were 4.0%, 0.9%, and 4.6% among groups with MTWA positive, negative, and indeterminate test results. The SCD rate was significantly lower among patients with a negative MTWA test result than in patients with either positive or indeterminate MTWA test results (P <.001 for both comparisons). In patients with an LVEF of >35%, annual SCD event rates were 3.0%, 0.3%, and 0.3% among the groups with MTWA positive, negative, and indeterminate test results. The SCD rate associated with a positive MTWA test result was significantly higher than that associated with either negative (P <.001) or indeterminate MTWA test results (P = .003).
Conclusions
In patients without ICDs, MTWA testing is a powerful predictor of SCD. Among patients with an LVEF of ≤35%, a negative MTWA test result is associated with a low risk for SCD. Conversely, among patients with an LVEF of >35%, a positive MTWA test result identifies patients at significantly heightened SCD risk. These findings may have important implications for refining primary prevention ICD treatment algorithms. |
| first_indexed | 2024-09-23T15:46:36Z |
| format | Article |
| id | mit-1721.1/102580 |
| institution | Massachusetts Institute of Technology |
| language | en_US |
| last_indexed | 2024-09-23T15:46:36Z |
| publishDate | 2016 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | mit-1721.1/1025802022-09-29T16:04:25Z Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death Merchant, Faisal M. Ikeda, Takanori Pedretti, Roberto F.E. Salerno-Uriarte, Jorge A. Chow, Theodore Chan, Paul S. Bartone, Cheryl Hohnloser, Stefan H. Cohen, Richard J. Armoundas, Antonis A. Institute for Medical Engineering and Science Harvard University--MIT Division of Health Sciences and Technology Cohen, Richard J. Armoundas, Antonis A. Background Previous studies have demonstrated that microvolt T-wave alternans (MTWA) testing is a robust predictor of ventricular tachyarrhythmias and sudden cardiac death (SCD) in at-risk patients. However, recent studies have suggested that MTWA testing is not as good a predictor of “appropriate” implantable cardioverter-defibrillator (ICD) therapy as it is a predictor of SCD in patients without ICDs. Objective To evaluate the utility of MTWA testing for SCD risk stratification in patients without ICDs. Methods Patient-level data were obtained from 5 prospective studies of MTWA testing in patients with no history of ventricular arrhythmia or SCD. In these studies, ICDs were implanted in only a minority of patients and patients with ICDs were excluded from the analysis. We conducted a pooled analysis and examined the 2-year risk for SCD based on the MTWA test result. Results The pooled cohort included 2883 patients. MTWA testing was positive in 856 (30%), negative in 1627 (56%), and indeterminate in 400 (14%) patients. Among patients with a left ventricular ejection fraction (LVEF) of ≤35%, annual SCD event rates were 4.0%, 0.9%, and 4.6% among groups with MTWA positive, negative, and indeterminate test results. The SCD rate was significantly lower among patients with a negative MTWA test result than in patients with either positive or indeterminate MTWA test results (P <.001 for both comparisons). In patients with an LVEF of >35%, annual SCD event rates were 3.0%, 0.3%, and 0.3% among the groups with MTWA positive, negative, and indeterminate test results. The SCD rate associated with a positive MTWA test result was significantly higher than that associated with either negative (P <.001) or indeterminate MTWA test results (P = .003). Conclusions In patients without ICDs, MTWA testing is a powerful predictor of SCD. Among patients with an LVEF of ≤35%, a negative MTWA test result is associated with a low risk for SCD. Conversely, among patients with an LVEF of >35%, a positive MTWA test result identifies patients at significantly heightened SCD risk. These findings may have important implications for refining primary prevention ICD treatment algorithms. National Institute on Aging (Grant 1R21AG035128) National Institutes of Health (U.S.) (Grant 1RO1HL103961) Center for Integration of Medicine and Innovative Technology 2016-05-22T22:57:50Z 2016-05-22T22:57:50Z 2012-03 Article http://purl.org/eprint/type/JournalArticle 15475271 http://hdl.handle.net/1721.1/102580 Merchant, Faisal M., Takanori Ikeda, Roberto F.E. Pedretti, Jorge A. Salerno-Uriarte, Theodore Chow, Paul S. Chan, Cheryl Bartone, Stefan H. Hohnloser, Richard J. Cohen, and Antonis A. Armoundas. “Clinical Utility of Microvolt T-Wave Alternans Testing in Identifying Patients at High or Low Risk of Sudden Cardiac Death.” Heart Rhythm 9, no. 8 (August 2012): 1256–1264.e2. https://orcid.org/0000-0002-5573-0137 en_US http://dx.doi.org/10.1016/j.hrthm.2012.03.014 Heart Rhythm Creative Commons Attribution-NonCommercial-NoDerivs License http://creativecommons.org/licenses/by-nc-nd/4.0/ application/pdf Elsevier PMC |
| spellingShingle | Merchant, Faisal M. Ikeda, Takanori Pedretti, Roberto F.E. Salerno-Uriarte, Jorge A. Chow, Theodore Chan, Paul S. Bartone, Cheryl Hohnloser, Stefan H. Cohen, Richard J. Armoundas, Antonis A. Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death |
| title | Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death |
| title_full | Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death |
| title_fullStr | Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death |
| title_full_unstemmed | Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death |
| title_short | Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death |
| title_sort | clinical utility of microvolt t wave alternans testing in identifying patients at high or low risk of sudden cardiac death |
| url | http://hdl.handle.net/1721.1/102580 https://orcid.org/0000-0002-5573-0137 |
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