Document Detail


Predictive value of microvolt T-wave alternans for cardiac death or ventricular tachyarrhythmic events in ischemic and nonischemic cardiomyopathy patients: a meta-analysis.
MedLine Citation:
PMID:  22008495     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background: Microvolt T-wave alternans (MTWA) has been proposed as a predictor of the risk of ventricular tachyarrhythmias (VT) and sudden cardiac death (SCD). Aim of this study was to perform a systematic review of the literature and a meta-analysis of MTWA in primary prevention patients with ischemic and nonischemic cardiomyopathy. Methods: The positive predictive value (PPV), negative predictive value (NPV), and relative risk (RR) of MTWA in predicting death, cardiac death, and SCD during follow-up were reported. Results: Fifteen studies involving 5681 patients (mean age 62 years, mean ejection fraction 32%) were included. The summary PPV during the average 26-month follow-up was 14% (95% CI: 13-15); NPV was 95% (95% CI: 94-96), and the univariate RR was 2.35 (95% CI: 1.68-3.28). The predictive value of MTWA was similar in patients with ischemic and nonischemic cardiomyopathy. The average RR for SCD or VT events of an abnormal MTWA was 2.40, similar to that for cardiac death. When we grouped the studies together depending upon whether beta-blockers were withheld prior to MTWA screening, the beta-blockers group showed an RR of 5.88. By contrast, the group in which beta-blocker therapy was withheld had an RR of 1.63. Conclusion: A positive MTWA determined an approximately 2.5-fold higher risk of cardiac death and life-threatening arrhythmia and showed a very high NPV both in ischemic and nonischemic patients. An abnormal MTWA test was associated with a 5-fold increased risk for cardiac mortality in the low-indeterminate group and about a 6-fold increased risk in beta-blockers group. Ann Noninvasive Electrocardiol 2011;16(4):388-402.
Authors:
Leonardo Calò; Tiziana De Santo; Francesca Nuccio; Luigi Sciarra; Lucia De Luca; Lorenza Mangoni di S Stefano; Enrico Piroli; Lorenzo Zuccaro; Marco Rebecchi; Ermenegildo de Ruvo; Ernesto Lioy
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc     Volume:  16     ISSN:  1542-474X     ISO Abbreviation:  Ann Noninvasive Electrocardiol     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607443     Medline TA:  Ann Noninvasive Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  388-402     Citation Subset:  IM    
Copyright Information:
©2011, Wiley Periodicals, Inc.
Affiliation:
Division of Cardiology, Policlinico Casilino, ASL Roma B, Rome, Italy Medtronic Italia S.p.A., Rome, Italy.
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