微伏 T 波交替试验在识别高危或低危心源性猝死患者中的临床应用。
Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death.
机构信息
Cardiology Division, Emory University School of Medicine, Atlanta, Georgia, USA.
出版信息
Heart Rhythm. 2012 Aug;9(8):1256-64.e2. doi: 10.1016/j.hrthm.2012.03.014. Epub 2012 Mar 8.
BACKGROUND
Previous studies have demonstrated that microvolt T-wave alternans (MTWA) testing is a robust predictor of ventricular tachyarrhythmias and sudden cardiac death (SCD) in at-risk patients. However, recent studies have suggested that MTWA testing is not as good a predictor of "appropriate" implantable cardioverter-defibrillator (ICD) therapy as it is a predictor of SCD in patients without ICDs.
OBJECTIVE
To evaluate the utility of MTWA testing for SCD risk stratification in patients without ICDs.
METHODS
Patient-level data were obtained from 5 prospective studies of MTWA testing in patients with no history of ventricular arrhythmia or SCD. In these studies, ICDs were implanted in only a minority of patients and patients with ICDs were excluded from the analysis. We conducted a pooled analysis and examined the 2-year risk for SCD based on the MTWA test result.
RESULTS
The pooled cohort included 2883 patients. MTWA testing was positive in 856 (30%), negative in 1627 (56%), and indeterminate in 400 (14%) patients. Among patients with a left ventricular ejection fraction (LVEF) of ≤35%, annual SCD event rates were 4.0%, 0.9%, and 4.6% among groups with MTWA positive, negative, and indeterminate test results. The SCD rate was significantly lower among patients with a negative MTWA test result than in patients with either positive or indeterminate MTWA test results (P <.001 for both comparisons). In patients with an LVEF of >35%, annual SCD event rates were 3.0%, 0.3%, and 0.3% among the groups with MTWA positive, negative, and indeterminate test results. The SCD rate associated with a positive MTWA test result was significantly higher than that associated with either negative (P <.001) or indeterminate MTWA test results (P = .003).
CONCLUSIONS
In patients without ICDs, MTWA testing is a powerful predictor of SCD. Among patients with an LVEF of ≤35%, a negative MTWA test result is associated with a low risk for SCD. Conversely, among patients with an LVEF of >35%, a positive MTWA test result identifies patients at significantly heightened SCD risk. These findings may have important implications for refining primary prevention ICD treatment algorithms.
背景
先前的研究表明，微伏 T 波交替（MTWA）检测是预测高危患者室性心律失常和心脏性猝死（SCD）的有力指标。然而，最近的研究表明，MTWA 检测在预测无 ICD 患者的 SCD 方面并不像预测 SCD 那样是植入式心脏复律除颤器（ICD）治疗的良好预测指标。
目的
评估 MTWA 检测在无 ICD 患者中的 SCD 风险分层中的效用。
方法
从 5 项 MTWA 检测前瞻性研究中获取患者水平数据，这些研究对象均无室性心律失常或 SCD 病史。在这些研究中，仅少数患者植入了 ICD，且排除了有 ICD 的患者进行分析。我们进行了汇总分析，并根据 MTWA 检测结果检查了 2 年 SCD 风险。
结果
汇总队列包括 2883 例患者。MTWA 检测阳性 856 例（30%），阴性 1627 例（56%），不确定 400 例（14%）。左心室射血分数（LVEF）≤35%的患者中，MTWA 检测阳性、阴性和不确定检测结果组的年 SCD 事件发生率分别为 4.0%、0.9%和 4.6%。MTWA 检测阴性组的 SCD 发生率明显低于 MTWA 检测阳性或不确定组（两者均<.001）。LVEF>35%的患者中，MTWA 检测阳性、阴性和不确定检测结果组的年 SCD 事件发生率分别为 3.0%、0.3%和 0.3%。MTWA 检测阳性结果与阴性（<.001）或不确定 MTWA 检测结果（P=.003）相比，SCD 发生率显著更高。
结论
在无 ICD 的患者中，MTWA 检测是 SCD 的有力预测指标。LVEF≤35%的患者中，MTWA 检测阴性结果与 SCD 风险低相关。相反，LVEF>35%的患者中，MTWA 检测阳性结果提示 SCD 风险显著增加。这些发现可能对完善初级预防 ICD 治疗策略具有重要意义。
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