| Impaired exercise capacity predicts sudden cardiac death in a low-risk population: enhanced specificity with heightened T-wave alternans. | |
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MedLine Citation:
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PMID: 19301163 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: Because sudden cardiac death (SCD) is due to cardiac electrical instability, we postulated that prediction of this mode of death by exercise capacity will be enhanced by combined assessment with T-wave alternans (TWA), an index of repolarization abnormality. MATERIAL AND METHODS: The Finnish Cardiovascular Study enrolled consecutive patients (n=2,044) with a routine clinically indicated exercise test. Exercise capacity was measured in metabolic equivalents (METs) and TWA by time-domain modified moving average method. RESULTS: During 47.2+/-12.8-month follow-up (mean+/-SD) 120 patients died; 58 were cardiovascular deaths, and 29 were SCD. In multivariate analysis after adjustment for sex, age, smoking, use of beta-blockers, as well as other common coronary risk factors, the relative risk of patients whose exercise capacity was depressed (MET < 8) was 8.8 (95% CI 2.0-38.9, P=0.004) for SCD. The combination of low exercise capacity (MET < 8) and elevated TWA (> or =65 microV) yielded relative risks for SCD of 36.1 (6.3-206.0, P<0.001), for cardiovascular mortality of 21.1 (6.7-66.2, P<0.001), and for all-cause mortality of 7.8 (3.5-17.4, P<0.001) over patients with neither factor. CONCLUSIONS: Reduced exercise capacity, particularly in combination with heightened TWA, indicating enhanced cardiac electrical instability, powerfully predicts risk for SCD in patients referred for exercise testing. |
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Authors:
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Mikko Minkkinen; Tuomo Nieminen; Richard L Verrier; Johanna Leino; Terho Lehtimäki; Jari Viik; Rami Lehtinen; Kjell Nikus; Tiit Kööbi; Väinö Turjanmaa; Mika Kähönen |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of medicine Volume: 41 ISSN: 1365-2060 ISO Abbreviation: Ann. Med. Publication Date: 2009 |
Date Detail:
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Created Date: 2009-05-13 Completed Date: 2009-06-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8906388 Medline TA: Ann Med Country: Sweden |
Other Details:
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Languages: eng Pagination: 380-9 Citation Subset: IM |
Affiliation:
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Medical School, University of Tampere, Tampere, Finland. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Arrhythmias, Cardiac
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mortality,
physiopathology* Death, Sudden, Cardiac / epidemiology* Electrocardiography* Exercise Test / methods* Exercise Tolerance / physiology* Female Finland / epidemiology Follow-Up Studies Humans Male Middle Aged Population Surveillance* Prognosis Retrospective Studies Risk Factors Survival Rate / trends Time Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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