Document Detail

Combined prognostic value of peak O(2) uptake and microvolt level T-wave alternans in patients with idiopathic dilated cardiomyopathy.
MedLine Citation:
PMID:  17188766     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Despite the great improvement in clinical management of patients with idiopathic dilated cardiomyopathy (DCM), sudden cardiac death (SCD) and death due to worsening heart failure (HF) remain a challenging problem. The assessment of oxygen consumption (peakVO(2)) has been recognized as an independent marker of mortality. Nevertheless peakVO(2) is not helpful in the risk stratification of SCD. Given this limitation, the association with another non-invasive test able to predict SCD such as microvolt level T-wave alternans (MTWA) would be useful. OBJECTIVES: To determine the combined predictive value of peakVO(2) and MTWA in patients with DCM. METHODS: Seventy consecutive DCM patients were prospectively investigated. PeakVO(2) and MTWA were determined during bicycle exercise testing. Primary composite study end-point was defined as major cardiac events (MCE): total cardiac death or documented sustained VT/VF (including appropriate ICD shock). Secondary end-point was defined as arrhythmic events (AE): SCD or documented sustained VT/VF. RESULTS: Thirty-nine patients (55%) had a peakVO(2)<10 ml/kg/min, while 40 patients (57%) showed an abnormal MTWA test. During an average follow-up of 19.2+/-10.7 months, 11 MCE of which 6 AE have been documented. Among patients with abnormal MTWA and peakVO(2)<10 ml/kg/min 8 MCE of which 5 AE occurred while among patients with normal MTWA and peakVO(2)> or =10 ml/kg/min no event occurred. From multivariate analysis, the combined prognostic value of MTWA and peakVO(2) achieved statistical significance for MCE (p=0.03, HR 0.28, 95% CI 0.12-0.95) and for AE (p=0.05, HR 0.39, 95% CI 0.18-0.99) while MTWA alone was a significant predictor of AE (p=0.04, HR 0.32, 95% CI 0.14-0.93). CONCLUSIONS: Our results suggest that only the association of MTWA and peakVO(2), but not the two single tests, is a significant prognostic marker of both MCE and AE in DCM patients. However, MTWA alone confirms its predictive power as arrhythmic risk stratifier in this population.
Massimo Baravelli; Cecilia Fantoni; Silvia Rogiani; Stefania Farina; Claudio Anzà; Valeria Caltabiano; Teresio Forzani; Jorge A Salerno-Uriarte
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Publication Detail:
Type:  Journal Article     Date:  2006-12-26
Journal Detail:
Title:  International journal of cardiology     Volume:  121     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-27     Completed Date:  2007-09-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  23-9     Citation Subset:  IM    
Department of Cardiovascular Sciences, Ospedale di Circolo and Fondazione Macchi, Universitá dell'Insubria, Varese, Italy. <>
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MeSH Terms
Arrhythmias, Cardiac / physiopathology*
Cardiomyopathy, Dilated / mortality,  physiopathology*
Death, Sudden, Cardiac*
Electrophysiologic Techniques, Cardiac*
Exercise Test
Follow-Up Studies
Middle Aged
Oxygen Consumption / physiology*
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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