Inama Giuseppe, Pedrinazzi Claudio, Durin Ornella, Nanetti Massimiliano, Donato Giorgio, Pizzi Rita, Assanelli Deodato
Department of Cardiology, Ospedale Maggiore, Crema, Italy.
Ann Noninvasive Electrocardiol. 2008 Jan;13(1):14-21. doi: 10.1111/j.1542-474X.2007.00196.x.
Aim of our study is to evaluate the role of T-wave alternans (TWA) to stratify the risk of sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document a possible correlation between TWA and electrophysiological testing (EPS) results.
We studied 85 Ath with VA (61 M, mean age 32 +/- 11 years). In all cases a cardiological evaluation was performed, including TWA and EPS. The patients were evaluated during a follow-up of 30 +/- 21 months. The end point was the occurrence of sudden death (SD) or malignant ventricular tachyarrhythmias (VT).
TWA was negative in 57 Ath (68%), positive in 15 (18%) and indeterminate in 13 (14%). All subjects with negative TWA did not show induction of VT at EPS, with significant correlation between negative TWA and negative EPS (P < 0.001). All Ath with positive TWA also had VT induced by a EPS, with significant correlation (P < 0.001). By contrast, our data did not show significant correlation between indeterminate TWA and positive or negative EPS. However, there was significant correlation between abnormal TWA test (positive + indeterminate) and inducibility of VT at EPS (P < 0.001). During follow-up we observed a significant difference in end point occurrence (VT or SD) between Ath with negative or abnormal TWA and between Ath with negative or positive EPS.
TWA confirm its role as a simple and noninvasive test, and it seems useful for prognostic stratification of Ath with VA.
我们研究的目的是评估T波电交替（TWA）在对患有复杂性室性心律失常（VA）的运动员（Ath）进行心脏性猝死风险分层中的作用，并记录TWA与电生理检查（EPS）结果之间可能存在的相关性。
我们研究了85例患有VA的运动员（61例男性，平均年龄32±11岁）。所有病例均进行了心脏评估，包括TWA和EPS。在30±21个月的随访期间对患者进行评估。终点是猝死（SD）或恶性室性心动过速（VT）的发生。
57例运动员（68%）的TWA为阴性，15例（18%）为阳性，13例（14%）为不确定。所有TWA阴性的受试者在EPS时均未诱发出VT，TWA阴性与EPS阴性之间存在显著相关性（P<0.001）。所有TWA阳性的运动员在EPS时也诱发出了VT，具有显著相关性（P<0.001）。相比之下，我们的数据未显示不确定的TWA与EPS阳性或阴性之间存在显著相关性。然而，异常TWA试验（阳性+不确定）与EPS时VT的诱发性之间存在显著相关性（P<0.001）。在随访期间，我们观察到TWA阴性或异常的运动员与TWA阴性或阳性EPS的运动员在终点事件发生（VT或SD）方面存在显著差异。
TWA证实了其作为一种简单且无创检查的作用，并且似乎对患有VA的运动员进行预后分层有用。
