Prognostic utility of T-wave alternans in a real-world population of patients with left ventricular dysfunction: The PREVENT-SCD study

Satoshi Shizuta, Kenji Ando, Masakiyo Nobuyoshi, Takanori Ikeda, Hideaki Yoshino, Shinichi Hiramatsu, Yukio Kazatani, Kohei Yamashiro, Katsunori Okajima, Teishi Kajiya, Yoshinori Kobayashi, Takao Kato, Satoki Fujii, Kazuaki Mitsudo, Koichi Inoue, Hiroshi Itoh, Yoshisumi Haruna, Takahiro Doi, Yukiko Nishio, Neiko OzasaKei Nishiyama, Toru Kita, Takeshi Morimoto, Takeshi Kimura

Research output: Contribution to journalArticle

14 Citations (Scopus)

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 languageEnglish
Pages (from-to)89-99
Number of pages11
JournalClinical Research in Cardiology
Volume101
Issue number2
DOIs
Publication statusPublished - Feb 2012
Externally publishedYes

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Left Ventricular Dysfunction
Population
Tachycardia
Ventricular Fibrillation
Ventricular Tachycardia
Confidence Intervals
Defibrillators
Sudden Cardiac Death
Cardiomyopathies
Stroke Volume
Observational Studies
Cardiac Arrhythmias
Prospective Studies

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 journalArticle

Shizuta, S, Ando, K, Nobuyoshi, M, Ikeda, T, Yoshino, H, Hiramatsu, S, Kazatani, Y, Yamashiro, K, Okajima, K, Kajiya, T, Kobayashi, Y, Kato, T, Fujii, S, Mitsudo, K, Inoue, K, Itoh, H, Haruna, Y, Doi, T, Nishio, Y, Ozasa, N, Nishiyama, K, Kita, T, Morimoto, T & Kimura, T 2012, 'Prognostic utility of T-wave alternans in a real-world population of patients with left ventricular dysfunction: The PREVENT-SCD study', Clinical Research in Cardiology, vol. 101, no. 2, pp. 89-99. https://doi.org/10.1007/s00392-011-0368-2
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. / Prognostic utility of T-wave alternans in a real-world population of patients with left ventricular dysfunction : The PREVENT-SCD study. In: Clinical Research in Cardiology. 2012 ; Vol. 101, No. 2. pp. 89-99.
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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.",
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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

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