Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 89-99 |
| Number of pages | 11 |
| Journal | Clinical Research in Cardiology |
| Volume | 101 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Feb 2012 |
| Externally published | Yes |
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Keywords
- Cardiomyopathy
- Sudden death
- T-wave alternans
- Ventricular arrhythmia
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Prognostic utility of T-wave alternans in a real-world population of patients with left ventricular dysfunction : The PREVENT-SCD study. / Shizuta, Satoshi; Ando, Kenji; Nobuyoshi, Masakiyo; Ikeda, Takanori; Yoshino, Hideaki; Hiramatsu, Shinichi; Kazatani, Yukio; Yamashiro, Kohei; Okajima, Katsunori; Kajiya, Teishi; Kobayashi, Yoshinori; Kato, Takao; Fujii, Satoki; Mitsudo, Kazuaki; Inoue, Koichi; Itoh, Hiroshi; Haruna, Yoshisumi; Doi, Takahiro; Nishio, Yukiko; Ozasa, Neiko; Nishiyama, Kei; Kita, Toru; Morimoto, Takeshi; Kimura, Takeshi.
In: Clinical Research in Cardiology, Vol. 101, No. 2, 02.2012, p. 89-99.Research output: Contribution to journal › Article
}
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 - Itoh, 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
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 -