Document Detail

T-wave alternans predicts mortality in a population undergoing a clinically indicated exercise test.
MedLine Citation:
PMID:  17652105     Owner:  NLM     Status:  MEDLINE    
AIMS: As a part of the Finnish Cardiovascular Study, we tested the hypothesis that T-wave alternans (TWA) predicts mortality in a general population of patients referred for a clinical exercise test. METHODS AND RESULTS: A total of 1037 consecutive patients (mean age+/-SD of 58+/-13 years, 673 men and 364 women) with a clinically indicated exercise test and with technically successful electrocardiographic (ECG) data during a bicycle ergometer test were included in the study. Digital ECGs were recorded and TWA was analysed continuously with the time-domain modified moving average method. The maximum TWA value at heart rate (HR)<125 b.p.m. was derived and its capacity to stratify risk for all-cause death, cardiovascular death, and sudden cardiac death (SCD) was tested. During a follow-up of 44+/-7 months (mean+/-SD), 59 patients died; 34 were due to cardiovascular causes and 20 were due to SCD. In multivariate analysis after adjustment for age, sex, use of beta-blockers, functional class, maximal HR during exercise, previous myocardial infarction, and other common coronary risk factors, the relative risk of TWA>or=65 microV for SCD was 7.4 (95% CI, 2.8-19.4; P<0.001), for cardiovascular mortality 6.0 (95% CI, 2.8-12.8; P<0.001), and for all-cause mortality 3.3 (95% CI, 1.8-6.3; P=0.001). CONCLUSION: Time-domain TWA analysis powerfully predicts mortality in a general population undergoing a clinical exercise test.
Tuomo Nieminen; Terho Lehtimäki; Jari Viik; Rami Lehtinen; Kjell Nikus; Tiit Kööbi; Kari Niemelä; Väinö Turjanmaa; Willi Kaiser; Heini Huhtala; Richard L Verrier; Heikki Huikuri; Mika Kähönen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-07-25
Journal Detail:
Title:  European heart journal     Volume:  28     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-02     Completed Date:  2008-04-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2332-7     Citation Subset:  IM    
Department of Pharmacological Sciences, Medical School, University of Tampere, and Laboratory of Atherosclerosis Genetics, Department of Clinical Chemistry, Tampere University Hospital, Finland.
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MeSH Terms
Arrhythmias, Cardiac / diagnosis,  mortality*
Cardiovascular Diseases / mortality,  prevention & control
Cohort Studies
Death, Sudden, Cardiac / prevention & control
Exercise Test / methods
Follow-Up Studies
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Risk Factors
Comment In:
Eur Heart J. 2007 Nov;28(21):2691; author reply 2691   [PMID:  17934215 ]
Eur Heart J. 2007 Oct;28(19):2303-4   [PMID:  17720992 ]

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