Document Detail

Enhanced predictive power of quantitative TWA during routine exercise testing in the Finnish Cardiovascular Study.
MedLine Citation:
PMID:  19175840     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: We examined whether quantification of T-wave alternans (TWA) enhances this parameter's capacity to evaluate the risk for total and cardiovascular mortality and sudden cardiac death (SCD). METHODS AND RESULTS: The Finnish Cardiovascular Study (FINCAVAS) enrolled consecutive patients (n = 2,119; 1,342 men and 777 women) with a clinically indicated exercise test with bicycle ergometer. TWA (time domain-modified moving average method) was analyzed from precordial leads, and the results were grouped in increments of 10 microV. Hazard ratios (HR) for total and cardiovascular mortality and SCD were estimated for preexercise, routine exercise, and postexercise stages. Cox regression analysis was performed. During follow-up of 47.1 +/- 12.9 months (mean +/- standard deviation [SD]), 126 patients died: 62 were cardiovascular deaths, and 33 of these deaths were sudden. During preexercise, TWA >or= 20 microV predicted the risk for total and cardiovascular mortality (maximum HR >4.4 at 60 microV, P < 0.02 for both). During exercise, HRs of total and cardiovascular mortality were significant when TWA measured >or=50 microV, with 90 microV TWA yielding maximum HRs for total and cardiovascular death of 3.1 (P = 0.03) and 6.4 (P = 0.002), respectively. During postexercise, TWA >or=60 microV indicated risk for total and cardiovascular mortality, with maximum HR of 3.4 at 70 microV (P = 0.01) for cardiovascular mortality. SCD was strongly predicted by TWA levels >or=60 microV during exercise, with maximum HR of 4.6 at 60 microV (P = 0.002), but was not predicted during pre- or postexercise. CONCLUSION: Quantification of TWA enhances its capacity for determination of the risk for total and cardiovascular mortality and SCD in low-risk populations. Its prognostic power is superior during exercise compared to preexercise or postexercise.
Mikko Minkkinen; Mika Kähönen; Jari Viik; Kjell Nikus; Terho Lehtimäki; Rami Lehtinen; Tiit Kööbi; Väinö Turjanmaa; Willi Kaiser; Richard L Verrier; Tuomo Nieminen
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-10-11
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  20     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-01     Completed Date:  2009-06-25     Revised Date:  2009-07-28    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  408-15     Citation Subset:  IM    
Medical School, University of Tampere, Tampere, Finland.
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MeSH Terms
Cardiovascular Diseases / diagnosis*,  etiology,  mortality*,  physiopathology
Death, Sudden, Cardiac / epidemiology*,  etiology
Exercise Test / methods*
Finland / epidemiology
Heart Rate*
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Risk Assessment
Risk Factors
Time Factors
Comment In:
J Cardiovasc Electrophysiol. 2009 Jun;20(6):E65; author reply E64   [PMID:  19470034 ]

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

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