Usefulness of Microvolt T-Wave Alternans to Predict Outcomes in Patients With Ischemic Cardiomyopathy Beyond One Year
Abstract
Previous studies have demonstrated that microvolt T-wave alternans (MTWA) screening effectively risk-stratifies patients with ischemic cardiomyopathy. Whether the prognostic utility of MTWA diminishes over 3 years of follow-up remains unknown. In this study, a prospective cohort of 768 patients with ischemic cardiomyopathy (left ventricular ejection fraction <35%) and no previous sustained ventricular arrhythmia was developed, of whom 514 (67%) screened MTWA nonnegative (positive and indeterminate). The mean follow-up period was 18 +/- 11 months. The primary end point was all-cause mortality and appropriate implantable cardioverter-defibrillator shocks. Stratified Cox regression analyses (by implantable cardioverter-defibrillator status) estimated the predictive power of MTWA within each year of follow-up and determined whether this diminished over time. There were 99 deaths (MTWA negative: 21 [8.3%]; MTWA nonnegative: 78 [15.2%]) and 33 appropriate implantable cardioverter-defibrillator shocks (MTWA negative: 3 [4.0%]; MTWA nonnegative: 30 [9.5%]). After multivariate adjustment, a nonnegative MTWA test result was associated with a greater than twofold increased risk for events in each of the 3 years of follow-up (year 1: stratified hazard ratio 2.19, 95% confidence interval 1.10 to 4.34, p = 0.03; year 2: stratified hazard ratio 3.36, 95% confidence interval 1.28 to 8.83, p = 0.01; year 3: stratified hazard ratio 2.06, 95% confidence interval 0.81 to 5.22, p = 0.13). There were no significant interactions between the time periods (year 1 vs year 2: p = 0.47; year 1 vs year 3: p = 0.92). In conclusion, MTWA reliably and consistently predicts mortality and arrhythmic risk throughout the first 2 to 3 years of follow-up. Although these findings need further validation, they suggest that rescreening with MTWA may not need to be performed more frequently than once every 2 years.
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The utility for mortality prediction and arrhythmic risk evaluation of microvolt T-wave alternans was demonstrated in ischemic cardiomyopathy.
“The utility for mortality prediction and arrhythmic risk evaluation of microvolt T-wave alternans was demonstrated in ischemic cardiomyopathy.41”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [41]
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- Authors
- Chan, P. S., Kereiakes, D. J., Bartone, C., & Chow, T.
- Affiliations
- University of Missouri–Kansas City (US)
- Christ Hospital (US)
- Corresponding author
- Chan, Paul S.
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-08
- Volume
- 102
- Issue
- 3
- Pages
- 280-284
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2160809434
- Cited by
- 18
- References
- 20
- Citations by year
- 2023: 1 · 2019: 1 · 2017: 1 · 2016: 1 · 2015: 3 · 2013: 1 · 2012: 2
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical School, University of Michigan
- National Institutes of Health
- Medtronic
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- microvolt T-wave alternans, ischemic cardiomyopathy, prognosis, all-cause mortality, implantable cardioverter-defibrillator shocks, ventricular arrhythmia risk, risk stratification, left ventricular ejection fraction
- MeSH terms
- Aged, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Cardiomyopathies, Regression Analysis, Defibrillators, Implantable, Myocardial Ischemia
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