Daniłowicz-Szymanowicz Ludmiła, Szwoch Małgorzata, Dąbrowska-Kugacka Alicja, Dudziak Maria, Kozłowski Dariusz, Raczak Grzegorz
Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland.
Department of Noninvasive Cardiac Diagnostics, Medical University of Gdansk, Gdansk, Poland.
Arch Med Sci. 2015 Oct 12;11(5):945-51. doi: 10.5114/aoms.2013.37936. Epub 2014 Jan 10.
Patients with left ventricular ejection fraction (LVEF) ≤ 35% are eligible for implantable cardioverter-defibrillator (ICD) placement in the primary prevention of sudden cardiac death. Nevertheless, other risk factors facilitating the selection of individuals with highest mortality are still sought. The aim of the study was to verify the usefulness of microvolt T-wave alternans (MTWA) testing in the assessment of all-cause mortality and life-threatening ventricular arrhythmias (EVENTs) in these patients. Previous data from the literature are inconclusive.
Patients with LVEF ≤ 35% were eligible if they did not have a history of sustained ventricular arrhythmias, and were treated with β-blockers. Participants underwent MTWA testing and were subsequently followed.
The group consisted of 139 patients. MTWA results were classified as non-negative (MTWA_non-neg) in 93 and negative (MTWA_neg) in 46 patients. During the 14.3 ±8.6 months of follow-up, EVENTs were observed in 21 patients. The 1-year EVENT rate was 16.4% among MTWA_non-neg patients, and 2.6% among MTWA_neg patients (p = 0.006). The sensitivity of the MTWA test was 95.24%, the specificity - 38.14%, the positive predictive value - 21.51% and the negative predictive value - 97.83%.
In the group of patients with left ventricular systolic dysfunction, with the exclusion of patients with the history of life-threatening ventricular arrhythmia and individuals not being on chronic β-adrenolytic therapy, the abnormal result of MTWA testing is associated with significantly increased risk of all-cause mortality and life-threatening ventricular arrhythmia during 1 year of follow-up, thus identifying the individuals at the highest risk.
左心室射血分数（LVEF）≤35%的患者有资格植入植入式心脏复律除颤器（ICD）以进行心脏性猝死的一级预防。然而，仍在寻找有助于选择死亡率最高个体的其他危险因素。本研究的目的是验证微伏级T波电交替（MTWA）检测在评估这些患者全因死亡率和危及生命的室性心律失常（EVENTs）方面的有用性。先前文献中的数据尚无定论。
LVEF≤35%且无持续性室性心律失常病史并接受β受体阻滞剂治疗的患者符合条件。参与者接受MTWA检测，随后进行随访。
该组由139例患者组成。93例患者的MTWA结果分类为非阴性（MTWA_non-neg），46例患者为阴性（MTWA_neg）。在14.3±8.6个月的随访期间，21例患者出现EVENTs。MTWA_non-neg患者的1年EVENT发生率为16.4%，MTWA_neg患者为2.6%（p = 0.006）。MTWA检测的敏感性为95.24%，特异性为38.14%，阳性预测值为21.51%，阴性预测值为97.83%。
在左心室收缩功能障碍患者组中，排除有危及生命室性心律失常病史和未接受慢性β-肾上腺素能阻滞剂治疗的个体，MTWA检测结果异常与随访1年期间全因死亡率和危及生命室性心律失常风险显著增加相关，从而识别出风险最高的个体。
