Document Detail


Importance of regional specificity of T-wave alternans in assessing risk for cardiovascular mortality and sudden cardiac death during routine exercise testing.
MedLine Citation:
PMID:  21056698     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Johanna Leino; Richard L Verrier; Mikko Minkkinen; Terho Lehtimäki; Jari Viik; Rami Lehtinen; Kjell Nikus; Tiit Kööbi; Väinö Turjanmaa; Mika Kähönen; Tuomo Nieminen
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Publication Detail:
Type:  Journal Article     Date:  2010-11-05
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  8     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  385-90     Citation Subset:  IM    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
Affiliation:
Medical School, University of Tampere, Finland.
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