Post-Exercise Assessment of Cardiac Repolarization Alternans in Patients With Coronary Artery Disease Using the Modified Moving Average Method
| Autor: | Fincavas Investigators, Linda Ellis, Kjell Nikus, Jari Viik, Derek V. Exner, Michael P. Slawnych, Rami Lehtinen, Mika Kähönen, Refine, Katherine M. Kavanagh, Sandeep Aggarwal, Terho Lehtimäki, Darlene Ramadan, Tuomo Nieminen |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Stress testing Coronary Disease risk stratification 030204 cardiovascular system & hematology Lower risk Risk Assessment Coronary artery disease Electrocardiography 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine medicine Humans 030212 general & internal medicine Myocardial infarction Exercise Aged repolarization Ejection fraction medicine.diagnostic_test business.industry Middle Aged stress testing Prognosis medicine.disease 3. Good health myocardial infarction Predictive value of tests Exercise Test Cardiology Female ambulatory ECG Cardiology and Cardiovascular Medicine Risk assessment business |
| Zdroj: | Journal of the American College of Cardiology. 53:1130-1137 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2008.12.026 |
| Popis: | Objectives We sought to evaluate the utility of T-wave alternans (TWA) assessment in the immediate post-exercise period to identify and validate cutpoints for the modified moving average (MMA) assessment method. Background The presence of TWA is associated with an increased risk of cardiovascular death (CVD). The immediate post-exercise period, where increased physiologic stress and minimal surface artifact coexist, appears ideal to implement the MMA method. Methods A test (n = 322) and validation cohort (n = 681) provided 1,003 patients with coronary artery disease (CAD). We assessed TWA immediately after exercise. The outcomes, CVD and mortality, were adjudicated independent of the TWA results. Results During 48 months of follow-up 85 deaths, 54 categorized as CVD (64%), were observed. A linear relationship between the magnitude of TWA and the risk of CVD was identified. As a continuous measure TWA voltage was equivalent to ejection fraction in predicting the risk of CVD. To facilitate clinical application, a sensitive, modest predictive accuracy (20 μV) and a specific, greater predictive accuracy MMA cutpoint (60 μV) were identified and validated. Each cutpoint was associated with a 2.5-fold greater risk of CVD, independent of other important variables, including ejection fraction. Conclusions Post-exercise assessment of TWA using the MMA method is a strong, independent predictor of risk in patients with CAD. The 20-μV cutpoint (87% sensitivity) appears to be most suitable in higher-risk patients, whereas the 60-μV cutpoint (95% specificity) appears more appropriate when TWA is used as a single screening test in those at lower risk. (Assessment of Noninvasive Methods to Identify Patients at Risk of Serious Arrhythmias After a Heart Attack; NCT00399503 ) |
| Databáze: | OpenAIRE |
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