Quan Xiao-Qing, Zhou Hong-Lian, Ruan Lei, Lv Jia-Gao, Yao Ji-Hua, Yao Feng, Huang Kui, Zhang Cun-Tai
Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
BMC Cardiovasc Disord. 2014 Dec 20;14:198. doi: 10.1186/1471-2261-14-198.
Exercise-based spectral T-wave alternans (TWA) has been proposed as a noninvasive tool-identifying patients at risk of sudden cardiac death (SCD) and cardiac mortality. Prior studies have indicated that ambulatory electrocardiogram (AECG)-based TWA is an important alternative platform to exercise for risk stratification of cardiac events. This study sought to review data regarding 24-hour AECG-based TWA and to discuss its potential role in risk stratification of fatal cardiac events across a series of patient risk profiles.
Prospective clinical studies of the predictive value of AECG-based TWA obtained with daily activity published between January 1990 and November 2014 were retrieved. Major endpoints included composite endpoint of SCD, cardiac mortality, and severe arrhythmic events.
Data were accumulated from 5 studies involving a total of 1,588 patients, including 317 positive and 1,271 negative TWA results. Compared with the negative group, positive group showed increased rates of SCD (hazard ratio [HR]: 7.49, 95% confidence interval [CI]: 2.65 to 21.15), cardiac mortality (HR: 4.75, 95% CI: 0.42 to 53.55), and composite endpoint (SCD, cardiac mortality, and severe arrhythmic events, HR: 5.94, 95% CI: 1.80 to 19.63). For the 4 studies evaluating TWA measured using the modified moving average method, the HR associated with a positive versus negative TWA result was 9.51 (95% CI: 4.99 to 18.11) for the composite endpoint.
The positive group of AECG-based TWA has a nearly six-fold risk of severe outcomes compared with the negative group. Therefore, AECG-based TWA provides an accurate means of predicting fatal cardiac events.
基于运动的频谱T波交替（TWA）已被提议作为一种识别有心脏性猝死（SCD）和心脏死亡风险患者的非侵入性工具。先前的研究表明，基于动态心电图（AECG）的TWA是用于心脏事件风险分层的运动的重要替代平台。本研究旨在回顾有关基于24小时AECG的TWA的数据，并讨论其在一系列患者风险概况中对致命心脏事件风险分层的潜在作用。
检索1990年1月至2014年11月间发表的关于基于日常活动获得的AECG的TWA预测价值的前瞻性临床研究。主要终点包括SCD、心脏死亡和严重心律失常事件的复合终点。
数据来自5项研究，共1588例患者，其中TWA结果阳性317例，阴性1271例。与阴性组相比，阳性组的SCD发生率（风险比[HR]：7.49，95%置信区间[CI]：2.65至21.15）、心脏死亡率（HR：4.75，95%CI：0.42至53.55）和复合终点（SCD、心脏死亡和严重心律失常事件，HR：5.94，95%CI：1.80至19.63）均升高。对于4项使用改良移动平均法测量TWA的研究，复合终点的阳性与阴性TWA结果相关的HR为9.51（95%CI：4.99至18.11）。
基于AECG的TWA阳性组与阴性组相比，严重后果的风险几乎高6倍。因此，基于AECG的TWA提供了一种预测致命心脏事件的准确方法。
