Importance of regional specificity of T-wave alternans in assessing risk for cardiovascular mortality and sudden cardiac death during routine exercise testing
| Autor: | Mikko Minkkinen, Johanna Leino, Kjell Nikus, Mika Kähönen, Rami Lehtinen, Jari Viik, Richard L. Verrier, Väinö Turjanmaa, Terho Lehtimäki, Tiit Kööbi, Tuomo Nieminen |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Left ventricular hypertrophy Risk Assessment Article Sudden cardiac death Interquartile range Heart Conduction System Physiology (medical) Internal medicine medicine Humans Myocardial infarction Aged medicine.diagnostic_test business.industry Hazard ratio Arrhythmias Cardiac T wave alternans Middle Aged medicine.disease Prognosis Confidence interval Death Sudden Cardiac Cardiovascular Diseases Cardiology Electrocardiography Ambulatory Exercise Test Female Cardiology and Cardiovascular Medicine business Electrophysiologic Techniques Cardiac Electrocardiography |
| Zdroj: | Heart rhythm. 8(3) |
| ISSN: | 1556-3871 |
| Popis: | Background T-wave alternans (TWA) indicates increased risk for life-threatening arrhythmias. However, the regional distribution and predictivity of TWA among precordial leads remain unknown. Objective We analyzed the magnitude and prognostic power of TWA in precordial leads separately and in combination during routine exercise stress testing in the largest TWA study conducted to date. Methods The Finnish Cardiovascular Study (FINCAVAS) enrolled consecutive patients (n = 3,598, 56 ± 13 [mean ± standard deviation] years old, 2,164 men, 1,434 women) with a clinically indicated exercise test with bicycle ergometer. TWA was analyzed with the time-domain modified moving average method. Results During a follow-up of 55 months (interquartile range of 35–78 months), 231 patients died; 97 deaths were cardiovascular, and 46 were classified as sudden cardiac deaths (SCDs). In Cox analysis after adjustment for common coronary risk factors, each 20-μV increase in TWA in leads V1–V6 multiplied the hazard ratio for cardiovascular mortality by 1.486-fold (95% confidence interval [CI] 1.127–1.952; P = .005). Each 20-μV increase in TWA in lead V5 amplified the hazard ratio for cardiovascular mortality by 1.545 (95% CI 1.150–2.108; P = .004) and for SCD by 1.576 (95% CI 1.041–2.412; P = .033). Conclusions Maximum TWA monitored from anterolateral precordial lead V5 is the strongest predictor of cardiovascular mortality and SCD during routine exercise testing in our analysis. Higher TWA values indicate greater cardiovascular mortality and SCD risk, supporting the concept that quantification of TWA should receive more attention. |
| Databáze: | OpenAIRE |
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