|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2005; 46:75-82, doi:10.1016/j.jacc.2005.03.059 © 2005 by the American College of Cardiology Foundation |
* Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
Department of Medicine, Mount Sinai Medical Center, New York, New York
Department of Medicine, New York University Medical Center, New York, New York
Manuscript received January 30, 2005; revised manuscript received February 22, 2005, accepted March 22, 2005.
* Reprint requests and correspondence: Dr. Anil Gehi, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, New York 10029. (Email: anil.gehi{at}msnyuhealth.org).
OBJECTIVES: The objective of this study was to perform a meta-analysis of the predictive value of microvolt T-wave alternans (MTWA) testing for arrhythmic events in a wide variety of populations.
BACKGROUND: Previous studies describing the use of MTWA as a predictor of ventricular tachyarrhythmic events have been limited by small sample sizes and disparate populations.
METHODS: Prospective studies of the predictive value of exercise-induced MTWA published between January 1990 and December 2004 were retrieved. Data from each article were abstracted independently by two authors using a standardized protocol. Summary estimates of the predictive value of MTWA were made using a random-effects model.
RESULTS: Data were accumulated from 19 studies (2,608 subjects) across a wide range of populations. Overall, the positive predictive value of MTWA for arrhythmic events was 19.3% at an average of 21 months’ follow-up (95% confidence interval [CI] 17.7% to 21.0%), the negative predictive value was 97.2% (95% CI 96.5% to 97.9%), and the univariate relative risk of an arrhythmic event was 3.77 (95% CI 2.39 to 5.95). There was no difference in predictive value between ischemic and nonischemic heart failure subgroups. The positive predictive value varied depending on the population of patients studied (p < 0.0001).
CONCLUSIONS: Microvolt T-wave alternans testing has significant value for the prediction of ventricular tachyarrhythmic events; however, there are significant limitations to its use. The predictive value of MTWA varies significantly depending on the population studied. Careful standardization is needed for what constitutes abnormal MTWA. The incremental prognostic value of MTWA when used with other methods of risk stratification is unclear.
| ||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  L. Ding, W. Hua, H. Niu, K. Chen, and S. Zhang Primary prevention of sudden cardiac death using implantable cardioverter defibrillators Europace, September 1, 2008; 10(9): 1034 - 1041. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention J. Am. Coll. Cardiol., August 25, 2008; (2008) j.jacc.2008.05.003v1. [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Madias T-wave alterans magnitude, T-wave amplitude, and heart rate. Commentary on "Characterization of T wave alterans with ambulatory electrocardiography". Biol Res Nurs, April 1, 2008; 9(4): 269 - 270. [PDF]
|
|
|
|
|
|
M. B. Harvey and J. W. Buchanan Characterization of T Wave Alternans With Ambulatory Electrocardiography: Response to Commentary Biol Res Nurs, April 1, 2008; 9(4): 271 - 271. [PDF]
|
|
|
|
|
|
M. B. Harvey and J. W. Buchanan Characterization of T Wave Alternans With Ambulatory Electrocardiography Biol Res Nurs, January 1, 2008; 9(3): 223 - 230. [Abstract] [PDF]
|
|
|
|
 |
|
 R. C. Myles, C. E. Jackson, I. Tsorlalis, M. C. Petrie, J. J. V. McMurray, and S. M. Cobbe Is Microvolt T-Wave Alternans the Answer to Risk Stratification in Heart Failure? Circulation, December 18, 2007; 116(25): 2984 - 2991. [Full Text] [PDF]
|
|
|
|
 |
|
 W. Jung and B. Schumacher What is the role of risk stratification for sudden death in the defibrillator era? Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I59 - I65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Salerno-Uriarte, G. M. De Ferrari, C. Klersy, R. F.E. Pedretti, M. Tritto, L. Sallusti, L. Libero, G. Pettinati, G. Molon, A. Curnis, et al. Prognostic Value of T-Wave Alternans in Patients With Heart Failure Due to Nonischemic Cardiomyopathy: Results of the ALPHA Study J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1896 - 1904. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Nieminen, T. Lehtimaki, J. Viik, R. Lehtinen, K. Nikus, T. Koobi, K. Niemela, V. Turjanmaa, W. Kaiser, H. Huhtala, et al. T-wave alternans during exercise testing calculated by the method of 'modified moving average': reply Eur. Heart J., November 1, 2007; 28(21): 2691 - 2692. [Full Text] [PDF]
|
|
|
|
|
|
T. Nieminen, T. Lehtimaki, J. Viik, R. Lehtinen, K. Nikus, T. Koobi, K. Niemela, V. Turjanmaa, W. Kaiser, H. Huhtala, et al. T-wave alternans predicts mortality in a population undergoing a clinically indicated exercise test Eur. Heart J., October 1, 2007; 28(19): 2332 - 2337. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Klingenheben Microvolt T-Wave Alternans for Arrhythmia Risk Stratification in Left Ventricular Dysfunction: Which Patients Benefit? J. Am. Coll. Cardiol., July 10, 2007; 50(2): 174 - 175. [Full Text] [PDF]
|
|
|
|
|
|
A. M. Russo and F. E. Marchlinski Should Microvolt T-Wave Alternans Be Utilized Routinely in Selecting Patients for Prophylactic Implantable Cardioverter-Defibrillator Insertion in the Setting of Ischemic Heart Disease? J. Am. Coll. Cardiol., January 2, 2007; 49(1): 59 - 61. [Full Text] [PDF]
|
|
|
|
|
|
T. Chow, D. J. Kereiakes, C. Bartone, T. Booth, E. J. Schloss, T. Waller, E. Chung, S. Menon, B. K. Nallamothu, and P. S. Chan Microvolt T-Wave Alternans Identifies Patients With Ischemic Cardiomyopathy Who Benefit From Implantable Cardioverter-Defibrillator Therapy J. Am. Coll. Cardiol., January 2, 2007; 49(1): 50 - 58. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Ikeda, H. Yoshino, K. Sugi, K. Tanno, H. Shimizu, J. Watanabe, Y. Kasamaki, A. Yoshida, and T. Kato Predictive Value of Microvolt T-Wave Alternans for Sudden Cardiac Death in Patients With Preserved Cardiac Function After Acute Myocardial Infarction: Results of a Collaborative Cohort Study J. Am. Coll. Cardiol., December 5, 2006; 48(11): 2268 - 2274. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. S. Kaufman, D. M. Bloomfield, R. C. Steinman, P. B. Namerow, O. Costantini, R. J. Cohen, and J. T. Bigger Jr "Indeterminate" Microvolt T-Wave Alternans Tests Predict High Risk of Death or Sustained Ventricular Arrhythmias in Patients With Left Ventricular Dysfunction J. Am. Coll. Cardiol., October 3, 2006; 48(7): 1399 - 1404. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. N. Weiss, A. Karma, Y. Shiferaw, P.-S. Chen, A. Garfinkel, and Z. Qu From Pulsus to Pulseless: The Saga of Cardiac Alternans Circ. Res., May 26, 2006; 98(10): 1244 - 1253. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Chow, D. J. Kereiakes, C. Bartone, T. Booth, E. J. Schloss, T. Waller, E. S. Chung, S. Menon, B. K. Nallamothu, and P. S. Chan Prognostic Utility of Microvolt T-Wave Alternans in Risk Stratification of Patients With Ischemic Cardiomyopathy J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1820 - 1827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Chan, B. K. Nallamothu, and T. Chow Microvolt T-Wave Alternans: Where Do We Go From Here? J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1736 - 1736. [Full Text] [PDF]
|
|
|
|
|
|
A. K. Gehi and J. A. Gomes Reply J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1736 - 1737. [Full Text] [PDF]
|
|
|
|
|
|
S. M. Narayan T-Wave Alternans and the Susceptibility to Ventricular Arrhythmias J. Am. Coll. Cardiol., January 17, 2006; 47(2): 269 - 281. [Abstract] [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
