Yu Hou, Pi-Hua Fang, Yuan Wu, Xiao-Feng Li, Jun Liu, Zhi Li, Sen Lei, Zhang Shu
Clinical Electrophysiology Laboratory and Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng State, Beijing, China.
J Electrocardiol. 2012 Jan-Feb;45(1):60-5. doi: 10.1016/j.jelectrocard.2011.07.015. Epub 2011 Sep 13.
We assessed the value of T-wave alternans (TWA) in prediction of sudden cardiac death (SCD) in patients with acute myocardial infarction (AMI).
Consecutive patients (N = 227) were enrolled and were monitored with 24-hour ambulatory electrocardiogram within 1 to 15 days after AMI. T-wave alternans was identified by a modified moving average (MMA) algorithm computer software. The primary end point was SCD or lethal ventricular arrhythmia. We analyzed the hazard ratios (HRs) using the previously determined 47 μV TWA cutpoint.
During the 16 ± 7-month follow-up, 10 (4.4%) patients died suddenly. T-wave alternans (≥47 μV) predicted SCD (HR, 17.78 [95% confidence interval, 3.75-84.31]; P < .0001). Moreover, patients with 5 or more TWA episodes (≥47 μV) were at higher risk for SCD (HR, 20.75 [95% confidence interval, 5.77-74.57]; P < .0001).
T-wave alternans (≥47 μV) monitored at 1 to 15 days after AMI-predicted heightened risk of SCD. Prediction is improved when the frequency of TWA episodes (≥47 μV) is analyzed.
我们评估了T波交替（TWA）对急性心肌梗死（AMI）患者心脏性猝死（SCD）的预测价值。
连续纳入227例患者，并在AMI后1至15天内进行24小时动态心电图监测。采用改良移动平均（MMA）算法计算机软件识别T波交替。主要终点为SCD或致命性室性心律失常。我们使用先前确定的47 μV TWA切点分析风险比（HR）。
在16±7个月的随访期间，10例（4.4%）患者猝死。T波交替（≥47 μV）可预测SCD（HR，17.78[95%置信区间，3.75 - 84.31]；P <.0001）。此外，TWA发作5次或更多次（≥47 μV）的患者发生SCD的风险更高（HR，20.75[95%置信区间，5.77 - 74.57]；P <.0001）。
AMI后1至15天监测到的T波交替（≥47 μV）可预测SCD风险增加。分析TWA发作（≥47 μV）频率时预测效果更佳。
