TY - JOUR
T1 - Prognostic utility of T-wave alternans in a real-world population of patients with left ventricular dysfunction
T2 - The PREVENT-SCD study
AU - Shizuta, Satoshi
AU - Ando, Kenji
AU - Nobuyoshi, Masakiyo
AU - Ikeda, Takanori
AU - Yoshino, Hideaki
AU - Hiramatsu, Shinichi
AU - Kazatani, Yukio
AU - Yamashiro, Kohei
AU - Okajima, Katsunori
AU - Kajiya, Teishi
AU - Kobayashi, Yoshinori
AU - Kato, Takao
AU - Fujii, Satoki
AU - Mitsudo, Kazuaki
AU - Inoue, Koichi
AU - Ito, Hiroshi
AU - Haruna, Yoshisumi
AU - Doi, Takahiro
AU - Nishio, Yukiko
AU - Ozasa, Neiko
AU - Nishiyama, Kei
AU - Kita, Toru
AU - Morimoto, Takeshi
AU - Kimura, Takeshi
N1 - Funding Information:
We are indebted to the clinical research coordinators () for their invaluable contributions to the data collection. This study was supported by Medtronic Japan Co., Ltd.; Fukuda Denshi; Roche Diagnostics K. K.; Dainippon Sumitomo Pharma Co., Ltd.; and Mitsubishi Kagaku Iatron, Inc. The study sponsors were not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
PY - 2012/2
Y1 - 2012/2
N2 - Background: The predictive value of T-wave alternans (TWA) for lethal ventricular tachyarrhythmia in patients with left ventricular (LV) dysfunction is controversial. Also, long-term arrhythmia risk of patients ineligible for the TWA test is unknown. Methods: This was a multicenter, prospective observational study of patients with LV ejection fraction ≤40% due to ischemic or non-ischemic cardiomyopathies, designed to evaluate the prognostic value of TWA for lethal ventricular tachyarrhythmia. The primary end point was a composite of sudden cardiac death, sustained rapid ventricular tachycardia (VT) or ventricular fibrillation (VF), and appropriate defibrillator therapy for rapid VT or VF. Results: Among 453 patients enrolled in the study, 280 (62%) were eligible for the TWA test. TWA was negative in 82 patients (29%), who accounted for 18% of the total population. The median of follow-up was 36 months. The 3-year event-free rate for the primary end point was significantly higher in TWA-negative patients (97.0%) than in TWA non-negative patients (89.5%, P = 0.037) and those ineligible for the TWA test (84.4%, P = 0.003). Multivariable analysis identified both non-negative TWA [hazard ratio (HR) 4.43; 95% confidence interval (CI) 1.02-19.2; P = 0.047) and ineligibility for the TWA test (HR 6.89; 95% CI 1.59-29.9; P = 0.010) to be independent predictors of the primary end point. Conclusions: TWA showed high negative predictive ability for lethal ventricular tachyarrhythmia in patients with LV dysfunction, although the TWA-negative patients accounted for only 18% of the entire population. Those ineligible for the TWA test had the highest risk for lethal ventricular tachyarrhythmia.
AB - Background: The predictive value of T-wave alternans (TWA) for lethal ventricular tachyarrhythmia in patients with left ventricular (LV) dysfunction is controversial. Also, long-term arrhythmia risk of patients ineligible for the TWA test is unknown. Methods: This was a multicenter, prospective observational study of patients with LV ejection fraction ≤40% due to ischemic or non-ischemic cardiomyopathies, designed to evaluate the prognostic value of TWA for lethal ventricular tachyarrhythmia. The primary end point was a composite of sudden cardiac death, sustained rapid ventricular tachycardia (VT) or ventricular fibrillation (VF), and appropriate defibrillator therapy for rapid VT or VF. Results: Among 453 patients enrolled in the study, 280 (62%) were eligible for the TWA test. TWA was negative in 82 patients (29%), who accounted for 18% of the total population. The median of follow-up was 36 months. The 3-year event-free rate for the primary end point was significantly higher in TWA-negative patients (97.0%) than in TWA non-negative patients (89.5%, P = 0.037) and those ineligible for the TWA test (84.4%, P = 0.003). Multivariable analysis identified both non-negative TWA [hazard ratio (HR) 4.43; 95% confidence interval (CI) 1.02-19.2; P = 0.047) and ineligibility for the TWA test (HR 6.89; 95% CI 1.59-29.9; P = 0.010) to be independent predictors of the primary end point. Conclusions: TWA showed high negative predictive ability for lethal ventricular tachyarrhythmia in patients with LV dysfunction, although the TWA-negative patients accounted for only 18% of the entire population. Those ineligible for the TWA test had the highest risk for lethal ventricular tachyarrhythmia.
KW - Cardiomyopathy
KW - Sudden death
KW - T-wave alternans
KW - Ventricular arrhythmia
UR - http://www.scopus.com/inward/record.url?scp=84860839228&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84860839228&partnerID=8YFLogxK
U2 - 10.1007/s00392-011-0368-2
DO - 10.1007/s00392-011-0368-2
M3 - Article
C2 - 21960418
AN - SCOPUS:84860839228
VL - 101
SP - 89
EP - 99
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
SN - 1861-0684
IS - 2
ER -