T-Wave Alternans Measured by 24-Hour Ambulatory Recordings Rather Than Exercise Stress Tests as a Risk Stratification Marker in Patients With Long QT Syndrome.

Autor: Yang J; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China., Luo J; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China., Li K; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China., Li D; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China., Lv T; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China., Liu F; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China., Liu Y; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China., She F; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China., He R; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China., Zhang P; Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing China.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Jul 16; Vol. 13 (14), pp. e033619. Date of Electronic Publication: 2024 Jul 09.
DOI: 10.1161/JAHA.123.033619
Abstrakt: Background: Few small-sample studies have quantified the T-wave alternans (TWA) value by 24-hour ambulatory recordings or exercise stress tests in patients with long QT syndrome (LQTS). The cutoff point of TWA ≥47 μV was based on patients with myocardial infarction. In our study, we aimed to (1) evaluate the association of TWA with life-threatening arrhythmic events (LAEs); (2) compare the predictive model of LAEs according to the TWA value measured by 24-hour ambulatory recordings and exercise stress tests; and (3) propose a cutoff point for the high risk of LAEs in patients with LQTS.
Methods and Results: The study cohort included 110 patients with LQTS referred to our hospital, and the primary outcome was LAEs. Thirty-one patients with LQTS (31/110 [28.2%]) developed LAEs during the following 24 (12-47) months. Peak TWA value quantified from 12 leads by 24-hour ambulatory recordings in patients with LQTS with LAEs (LQTS-LAEs group) was significantly higher than LQTS without LAEs (LQTS-non-LAEs group) (64.0 [42.0-86.0] μV versus 43.0 [36.0-53.0] μV; P <0.01). There was no statistical difference in TWA value measured by exercise stress tests between the 2 groups (69.0 [54.5-127.5] μV versus 68.5 [53.3-99.8] μV; P =0.871). The new cutoff point of the peak TWA value measured by 24-hour ambulatory recordings was 55.5 μV, with a sensitivity of 75.0% and a specificity of 78.6%. A univariate Cox regression analysis revealed that TWA value ≥55.5 μV was a strong predictor of LAEs (hazard ratio [HR], 4.5 [2.1-9.6]; P <0.001]. A multivariate Cox regression analysis indicated that TWA value ≥55.5 μV remained significant (HR, 2.7 [1.1-6.8]; P =0.034).
Conclusions: Peak TWA measured by 24-hour ambulatory recordings was a more favorable risk stratification marker than exercise stress tests for patients with LQTS.
Databáze: MEDLINE
Externí odkaz: