风险分层与心源性猝死：T 波电交替是否具有临床作用？
Risk stratification for sudden cardiac death: is there a clinical role for T wave alternans?
机构信息
Heart and Vascular Research Center, Case Western Reserve University, Cleveland, Ohio 44109-1998, USA.
出版信息
Heart Rhythm. 2009 Aug;6(8 Suppl):S56-61. doi: 10.1016/j.hrthm.2009.05.025. Epub 2009 Jun 23.
Abstract
The proportion of cardiovascular deaths attributable to sudden cardiac death (SCD) is on the rise. Herein lies the rationale for developing risk stratification strategies to predict who will benefit from prophylactic implantable cardioverter-defibrillator (ICD) implantation. Current guidelines recommend prophylactic ICD therapy in patients with reduced left ventricular ejection fraction (LVEF). However, there are clear limitations in using LVEF alone to decide who should receive an ICD. There is mounting evidence that microvolt-level T-wave alternans (TWA) is an important marker of arrhythmic risk. TWA is appealing because it noninvasively probes the underlying electrophysiological substrate and has been linked to cellular mechanisms for arrhythmias. This review considers the clinical role of TWA for risk stratification of SCD.
摘要
心血管死亡中归因于心源性猝死（SCD）的比例正在上升。这就是制定风险分层策略以预测谁将受益于预防性植入式心脏复律除颤器（ICD）植入的基本原理。目前的指南建议在左心室射血分数（LVEF）降低的患者中进行预防性 ICD 治疗。然而，仅使用 LVEF 来决定谁应该接受 ICD 存在明显的局限性。越来越多的证据表明，微伏级 T 波交替（TWA）是心律失常风险的重要标志物。TWA 很有吸引力，因为它可以无创地探测潜在的电生理基质，并与心律失常的细胞机制有关。这篇综述考虑了 TWA 在 SCD 风险分层中的临床作用。
相似文献
1
Risk stratification for sudden cardiac death: is there a clinical role for T wave alternans?风险分层与心源性猝死：T 波电交替是否具有临床作用？
Heart Rhythm. 2009 Aug;6(8 Suppl):S56-61. doi: 10.1016/j.hrthm.2009.05.025. Epub 2009 Jun 23.
2
3
Lack of Prognostic Value of T-Wave Alternans for Implantable Cardioverter-Defibrillator Benefit in Primary Prevention.T 波电交替对植入式心脏复律除颤器一级预防获益无预后价值。
J Am Heart Assoc. 2024 Jun 4;13(11):e032465. doi: 10.1161/JAHA.123.032465. Epub 2024 May 28.
4
Role of microvolt T-wave alternans in assessment of arrhythmia vulnerability among patients with heart failure and systolic dysfunction: primary results from the T-wave alternans sudden cardiac death in heart failure trial substudy.微伏级T波电交替在心力衰竭和收缩功能障碍患者心律失常易感性评估中的作用：心力衰竭试验子研究中T波电交替与心源性猝死的主要结果
Circulation. 2008 Nov 11;118(20):2022-8. doi: 10.1161/CIRCULATIONAHA.107.748962. Epub 2008 Oct 27.
5
Risk stratification after myocardial infarction: is left ventricular ejection fraction enough to prevent sudden cardiac death?心肌梗死后的风险分层：左心室射血分数是否足以预防心源性猝死？
Eur Heart J. 2013 Jul;34(26):1964-71. doi: 10.1093/eurheartj/eht109. Epub 2013 May 3.
6
Application of microvolt T-wave alternans testing in scheduling implantable cardioverter-defibrillator placement for the primary prevention of sudden cardiac death in patients with left ventricular dysfunction.微伏级T波电交替检测在为左心室功能不全患者安排植入式心脏复律除颤器以预防心脏性猝死一级预防中的应用。
Kardiol Pol. 2015;73(6):429-36. doi: 10.5603/KP.a2014.0216. Epub 2014 Nov 5.
7
Utility of microvolt T-wave alternans to predict sudden cardiac death in patients with cardiomyopathy.微伏级T波电交替在预测心肌病患者心源性猝死中的应用价值。
Curr Opin Cardiol. 2007 Jan;22(1):25-32. doi: 10.1097/HCO.0b013e328011aa49.
8
Risk stratification of ventricular arrhythmias in patients with systolic heart failure.收缩性心力衰竭患者室性心律失常的危险分层。
Curr Opin Cardiol. 2010 May;25(3):268-75. doi: 10.1097/HCO.0b013e3283387a73.
9
[Negative result of microvolt T-wave alternans test is helpful in scheduling the order of cardioverter-defibrillator implantation in primary prevention of sudden cardiac death in individuals with the left ventricular systolic dysfunction].[微伏级T波交替试验阴性结果有助于安排左心室收缩功能障碍患者心脏性猝死一级预防中植入心脏复律除颤器的顺序]
Pol Merkur Lekarski. 2012 Oct;33(196):193-7.
10
T wave alternans as a predictor of recurrent ventricular tachyarrhythmias in ICD recipients: prospective comparison with conventional risk markers.T波交替变化作为植入式心脏复律除颤器（ICD）植入者复发性室性快速心律失常的预测指标：与传统风险标志物的前瞻性比较
J Cardiovasc Electrophysiol. 1998 Dec;9(12):1258-68. doi: 10.1111/j.1540-8167.1998.tb00101.x.
引用本文的文献
1
Thermal modulation of epicardial Ca2+ dynamics uncovers molecular mechanisms of Ca2+ alternans.热调节心外膜钙动力学揭示钙震荡的分子机制。
J Gen Physiol. 2021 Feb 1;153(2). doi: 10.1085/jgp.202012568.
2
Rate-dependent force, intracellular calcium, and action potential voltage alternans are modulated by sarcomere length and heart failure induced-remodeling of thin filament regulation in human heart failure: A myocyte modeling study.心率依赖性力量、细胞内钙和动作电位电压交替变化受肌节长度和心力衰竭诱导的人类心力衰竭细肌丝调节重塑的影响：一项心肌细胞建模研究。
Prog Biophys Mol Biol. 2016 Jan;120(1-3):270-80. doi: 10.1016/j.pbiomolbio.2015.12.012. Epub 2015 Dec 25.
3
In Vivo and In Silico Investigation Into Mechanisms of Frequency Dependence of Repolarization Alternans in Human Ventricular Cardiomyocytes.人体心室肌细胞复极交替频率依赖性机制的体内及计算机模拟研究
Circ Res. 2016 Jan 22;118(2):266-78. doi: 10.1161/CIRCRESAHA.115.307836. Epub 2015 Nov 24.
4
T-wave alternans and ST depression assessment identifies low risk individuals with ischemic cardiomyopathy in the absence of left ventricular hypertrophy.T波交替和ST段压低评估可识别出无左心室肥厚的缺血性心肌病低风险个体。
Ann Noninvasive Electrocardiol. 2013 Jul;18(4):359-68. doi: 10.1111/anec.12051. Epub 2013 May 3.
5
Microvolt T wave alternans in adults with congenital heart diseases characterized by right ventricle pathology or single ventricle physiology: a case control study.成人右心室病变或单心室生理先天性心脏病患者的毫伏级 T 波电交替：病例对照研究。
BMC Cardiovasc Disord. 2013 Apr 3;13:26. doi: 10.1186/1471-2261-13-26.
6
Role of substrate and triggers in the genesis of cardiac alternans, from the myocyte to the whole heart: implications for therapy.底物和触发因素在心脏交替变化发生过程中的作用，从心肌细胞到整个心脏：对治疗的启示
Circulation. 2012 Jan 24;125(3):539-49. doi: 10.1161/CIRCULATIONAHA.111.033563.
7
The prevalence and the prognostic value of microvolt T-wave alternans in patients with hypertrophic cardiomyopathy.肥厚型心肌病患者中微伏级T波交替的患病率及预后价值
Ann Noninvasive Electrocardiol. 2011 Jul;16(3):276-86. doi: 10.1111/j.1542-474X.2011.00443.x.
8
Deciphering Arrhythmia Mechanisms - Tools of the Trade.解读心律失常机制——行业工具
Card Electrophysiol Clin. 2011 Mar;3(1):11-21. doi: 10.1016/j.ccep.2010.10.013.
9
Novel algorithm for identifying T-wave current density alternans using synthesized 187-channel vector-projected body surface mapping.使用合成的187通道矢量投影体表映射识别T波电流密度交替的新算法。
Heart Vessels. 2011 Mar;26(2):160-7. doi: 10.1007/s00380-010-0042-z. Epub 2010 Oct 30.
10
Minimizing repolarization-related proarrhythmic risk in drug development and clinical practice.最小化药物研发和临床实践中与复极相关的致心律失常风险。
Drugs. 2010 Mar 26;70(5):573-603. doi: 10.2165/11535230-000000000-00000.
本文引用的文献
1
Targeted SERCA2a gene expression identifies molecular mechanism and therapeutic target for arrhythmogenic cardiac alternans.靶向 SERCA2a 基因表达鉴定心律失常性心脏交替的分子机制和治疗靶点。
Circ Arrhythm Electrophysiol. 2009 Dec;2(6):686-94. doi: 10.1161/CIRCEP.109.863118.
2
Can we alternate between T-wave alternans testing methods?我们可以在T波交替检测方法之间交替使用吗？
Heart Rhythm. 2009 Mar;6(3):338-40. doi: 10.1016/j.hrthm.2009.01.002. Epub 2009 Jan 9.
3
Time-domain T-wave alternans measured from Holter electrocardiograms predicts cardiac mortality in patients with left ventricular dysfunction: a prospective study.从动态心电图测量的时域T波交替变化可预测左心室功能不全患者的心脏死亡率：一项前瞻性研究。
Heart Rhythm. 2009 Mar;6(3):332-7. doi: 10.1016/j.hrthm.2008.12.011. Epub 2008 Dec 7.
4
The ABCD (Alternans Before Cardioverter Defibrillator) Trial: strategies using T-wave alternans to improve efficiency of sudden cardiac death prevention.ABCD（心脏复律除颤器前交替现象）试验：利用T波交替现象提高心脏性猝死预防效率的策略。
J Am Coll Cardiol. 2009 Feb 10;53(6):471-9. doi: 10.1016/j.jacc.2008.08.077.
5
Evidence regarding clinical use of microvolt T-wave alternans.关于微伏级T波交替变化临床应用的证据。
Heart Rhythm. 2009 Mar;6(3 Suppl):S36-44. doi: 10.1016/j.hrthm.2008.10.011. Epub 2008 Oct 11.
6
Explaining the clinical manifestations of T wave alternans in patients at risk for sudden cardiac death.解释心脏性猝死高危患者T波交替的临床表现。
Heart Rhythm. 2009 Mar;6(3 Suppl):S22-8. doi: 10.1016/j.hrthm.2008.10.007. Epub 2008 Oct 10.
7
T-wave alternans in the sudden cardiac death in heart failure trial population: signal or noise?心力衰竭试验人群心源性猝死中的T波交替：信号还是噪声？
Circulation. 2008 Nov 11;118(20):2015-8. doi: 10.1161/CIRCULATIONAHA.108.818286.
8
Does microvolt T-wave alternans testing predict ventricular tachyarrhythmias in patients with ischemic cardiomyopathy and prophylactic defibrillators? The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) trial.微伏级T波交替变化检测能否预测缺血性心肌病和预防性植入除颤器患者的室性快速心律失常？MASTER（心肌梗死后患者风险分层的微伏级T波交替变化检测）试验。
J Am Coll Cardiol. 2008 Nov 11;52(20):1607-15. doi: 10.1016/j.jacc.2008.08.018.
9
Role of microvolt T-wave alternans in assessment of arrhythmia vulnerability among patients with heart failure and systolic dysfunction: primary results from the T-wave alternans sudden cardiac death in heart failure trial substudy.微伏级T波电交替在心力衰竭和收缩功能障碍患者心律失常易感性评估中的作用：心力衰竭试验子研究中T波电交替与心源性猝死的主要结果
Circulation. 2008 Nov 11;118(20):2022-8. doi: 10.1161/CIRCULATIONAHA.107.748962. Epub 2008 Oct 27.
10
Intracellular Ca alternans: coordinated regulation by sarcoplasmic reticulum release, uptake, and leak.细胞内钙交替变化：由肌浆网释放、摄取和渗漏进行协调调节。
Biophys J. 2008 Sep 15;95(6):3100-10. doi: 10.1529/biophysj.108.130955. Epub 2008 Jun 6.
Zotero 插件