Nieminen Tuomo, Lehtimäki Terho, Viik Jari, Lehtinen Rami, Nikus Kjell, Kööbi Tiit, Niemelä Kari, Turjanmaa Väinö, Kaiser Willi, Huhtala Heini, Verrier Richard L, Huikuri Heikki, Kähönen Mika
Department of Pharmacological Sciences, Medical School, University of Tampere, and Laboratory of Atherosclerosis Genetics, Department of Clinical Chemistry, Tampere University Hospital, Finland.
Eur Heart J. 2007 Oct;28(19):2332-7. doi: 10.1093/eurheartj/ehm271. Epub 2007 Jul 25.
As a part of the Finnish Cardiovascular Study, we tested the hypothesis that T-wave alternans (TWA) predicts mortality in a general population of patients referred for a clinical exercise test.
A total of 1037 consecutive patients (mean age+/-SD of 58+/-13 years, 673 men and 364 women) with a clinically indicated exercise test and with technically successful electrocardiographic (ECG) data during a bicycle ergometer test were included in the study. Digital ECGs were recorded and TWA was analysed continuously with the time-domain modified moving average method. The maximum TWA value at heart rate (HR)<125 b.p.m. was derived and its capacity to stratify risk for all-cause death, cardiovascular death, and sudden cardiac death (SCD) was tested. During a follow-up of 44+/-7 months (mean+/-SD), 59 patients died; 34 were due to cardiovascular causes and 20 were due to SCD. In multivariate analysis after adjustment for age, sex, use of beta-blockers, functional class, maximal HR during exercise, previous myocardial infarction, and other common coronary risk factors, the relative risk of TWA>or=65 microV for SCD was 7.4 (95% CI, 2.8-19.4; P<0.001), for cardiovascular mortality 6.0 (95% CI, 2.8-12.8; P<0.001), and for all-cause mortality 3.3 (95% CI, 1.8-6.3; P=0.001).
Time-domain TWA analysis powerfully predicts mortality in a general population undergoing a clinical exercise test.
作为芬兰心血管研究的一部分，我们检验了如下假设：T波交替（TWA）可预测接受临床运动试验的普通患者群体的死亡率。
本研究纳入了1037例连续的患者（平均年龄±标准差为58±13岁，男性673例，女性364例），这些患者均有临床指征需进行运动试验，且在自行车测力计试验期间心电图（ECG）数据采集技术成功。记录数字心电图，并采用时域修正移动平均法连续分析TWA。得出心率（HR）<125次/分钟时的最大TWA值，并测试其对全因死亡、心血管死亡和心源性猝死（SCD）进行风险分层的能力。在44±7个月（平均±标准差）的随访期间，59例患者死亡；34例死于心血管原因，20例死于SCD。在对年龄、性别、β受体阻滞剂使用情况、心功能分级、运动期间最大心率、既往心肌梗死及其他常见冠状动脉危险因素进行校正后的多变量分析中，TWA≥65 μV时SCD的相对风险为7.4（95%CI，2.8 - 19.4；P<0.001），心血管死亡率的相对风险为6.0（95%CI，2.8 - 12.8；P<0.001），全因死亡率的相对风险为3.3（95%CI，1.8 - 6.3；P = 0.001）。
时域TWA分析能有力地预测接受临床运动试验的普通患者群体的死亡率。
