Profile of microvolt T-wave alternans testing in 1003 patients hospitalized with heart failure
Aims Observational studies in selected populations have suggested that microvolt T‐wave alternans (MTWA) testing may identify patients with heart failure (HF) at risk of sudden cardiac death. The aims of this study were to investigate the utility of MTWA testing in an unselected population of patien...
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| Veröffentlicht in: | European journal of heart failure 2012-04, Vol.14 (4), p.377-386 |
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| container_title | European journal of heart failure |
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| creator | Jackson, Colette E. Myles, Rachel C. Tsorlalis, Ioannis K. Dalzell, Jonathan R. Spooner, Richard J. Rodgers, John R. Bezlyak, Vladimir Greenlaw, Nicola Ford, Ian Cobbe, Stuart M. Petrie, Mark C. McMurray, John J.V. |
| description | Aims
Observational studies in selected populations have suggested that microvolt T‐wave alternans (MTWA) testing may identify patients with heart failure (HF) at risk of sudden cardiac death. The aims of this study were to investigate the utility of MTWA testing in an unselected population of patients with HF and to evaluate the clinical characteristics associated with the MTWA results.
Methods and results
A total of 1003 patients hospitalized with decompensated HF were enrolled. MTWA testing was planned 1 month post‐discharge; 648 patients returned for MTWA testing. Mean age was 70.8 ± 10.6 years and 58% were male. Of these patients who returned, 318 (49%) were ineligible for MTWA testing due to atrial fibrillation (AF), pacemaker dependency, or physical inability to undertake the test. Of the MTWA tests, 100 (30%) were positive, 78 (24%) were negative, and 152 (46%) were indeterminate; 112/152 indeterminate tests (74%) occurred because of failure to achieve target heart rate (HR) due to chronotropic incompetence or physical limitations. There were differences in patient characteristics according to MTWA result. Independent predictors of a negative result included younger age and higher left ventricular ejection fraction (LVEF). Independent predictors of a positive result included higher HR during MTWA testing and lower LVEF. Independent predictors of an indeterminate result included older age and history of previous/paroxysmal AF.
Conclusions
Only half of patients with HF are eligible for MTWA testing and the most common result is an indeterminate test. Patients with positive and indeterminate tests have different clinical characteristics. MTWA treadmill testing is not widely applicable in typical HF patients and is unlikely to refine risk stratification for sudden death on a population level. |
| doi_str_mv | 10.1093/eurjhf/hfs010 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_929503271</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>929503271</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4150-2c63adf4b56d2f49e9b9ce6989c6af2f7fc2ca7316cd2c6c1f1445cd2b9848293</originalsourceid><addsrcrecordid>eNp9kE1P3DAQhq2qVfnqsVfkW08BfyWOj2jFslQrQIKKWy2vM24M2WSxHRb49XWVhWNP8x6eeTXzIPSdkhNKFD-FMTy07rR1kVDyCe3TWqqC1EJ8zpnXdaFqwfbQQYwPhFBJCPuK9hjjXEgm99HvmzA43wEeHF57G4bnoUv4rtiaZ8CmSxB600ecICbf_8G-x5QQjjcmeehTxO0QNz6Zzr9Bg7c-tbgFExJ2xndjgCP0xZkuwrfdPES_5ud3s0WxvL64nJ0tCytoSQpmK24aJ1Zl1TAnFKiVslCpWtnKOOaks8wayWllm8xa6qgQZc6r_F3NFD9EP6beTRiexnysXvtooetMD8MYtWKqJJxJmsliIvOvMQZwehP82oRXTYn-Z1RPRvVkNPPHu-ZxtYbmg35XmIFyArZZ4-v_2_T5z8V8Mb-dineH-Jjg5WPPhEddSS5LfX91oWfVspyxW6IF_wvrtJUM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>929503271</pqid></control><display><type>article</type><title>Profile of microvolt T-wave alternans testing in 1003 patients hospitalized with heart failure</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Wiley Free Content</source><source>Alma/SFX Local Collection</source><creator>Jackson, Colette E. ; Myles, Rachel C. ; Tsorlalis, Ioannis K. ; Dalzell, Jonathan R. ; Spooner, Richard J. ; Rodgers, John R. ; Bezlyak, Vladimir ; Greenlaw, Nicola ; Ford, Ian ; Cobbe, Stuart M. ; Petrie, Mark C. ; McMurray, John J.V.</creator><creatorcontrib>Jackson, Colette E. ; Myles, Rachel C. ; Tsorlalis, Ioannis K. ; Dalzell, Jonathan R. ; Spooner, Richard J. ; Rodgers, John R. ; Bezlyak, Vladimir ; Greenlaw, Nicola ; Ford, Ian ; Cobbe, Stuart M. ; Petrie, Mark C. ; McMurray, John J.V.</creatorcontrib><description>Aims
Observational studies in selected populations have suggested that microvolt T‐wave alternans (MTWA) testing may identify patients with heart failure (HF) at risk of sudden cardiac death. The aims of this study were to investigate the utility of MTWA testing in an unselected population of patients with HF and to evaluate the clinical characteristics associated with the MTWA results.
Methods and results
A total of 1003 patients hospitalized with decompensated HF were enrolled. MTWA testing was planned 1 month post‐discharge; 648 patients returned for MTWA testing. Mean age was 70.8 ± 10.6 years and 58% were male. Of these patients who returned, 318 (49%) were ineligible for MTWA testing due to atrial fibrillation (AF), pacemaker dependency, or physical inability to undertake the test. Of the MTWA tests, 100 (30%) were positive, 78 (24%) were negative, and 152 (46%) were indeterminate; 112/152 indeterminate tests (74%) occurred because of failure to achieve target heart rate (HR) due to chronotropic incompetence or physical limitations. There were differences in patient characteristics according to MTWA result. Independent predictors of a negative result included younger age and higher left ventricular ejection fraction (LVEF). Independent predictors of a positive result included higher HR during MTWA testing and lower LVEF. Independent predictors of an indeterminate result included older age and history of previous/paroxysmal AF.
Conclusions
Only half of patients with HF are eligible for MTWA testing and the most common result is an indeterminate test. Patients with positive and indeterminate tests have different clinical characteristics. MTWA treadmill testing is not widely applicable in typical HF patients and is unlikely to refine risk stratification for sudden death on a population level.</description><identifier>ISSN: 1388-9842</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1093/eurjhf/hfs010</identifier><identifier>PMID: 22334727</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Aged ; Analysis of Variance ; Arrhythmias, Cardiac - pathology ; Atrial fibrillation ; Chi-Square Distribution ; Defibrillators, Implantable ; Exercise Test ; Female ; Heart failure ; Heart Failure - pathology ; Heart rate ; Humans ; Implantable cardioverter-defibrillator ; Left ventricular ejection fraction ; Male ; Microvolt T-wave alternans ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Risk Assessment - methods ; Stroke Volume ; Ventricular Function, Left</subject><ispartof>European journal of heart failure, 2012-04, Vol.14 (4), p.377-386</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © 2012 the Authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4150-2c63adf4b56d2f49e9b9ce6989c6af2f7fc2ca7316cd2c6c1f1445cd2b9848293</citedby><cites>FETCH-LOGICAL-c4150-2c63adf4b56d2f49e9b9ce6989c6af2f7fc2ca7316cd2c6c1f1445cd2b9848293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1093%2Feurjhf%2Fhfs010$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1093%2Feurjhf%2Fhfs010$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,1428,27905,27906,45555,45556,46390,46814</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22334727$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jackson, Colette E.</creatorcontrib><creatorcontrib>Myles, Rachel C.</creatorcontrib><creatorcontrib>Tsorlalis, Ioannis K.</creatorcontrib><creatorcontrib>Dalzell, Jonathan R.</creatorcontrib><creatorcontrib>Spooner, Richard J.</creatorcontrib><creatorcontrib>Rodgers, John R.</creatorcontrib><creatorcontrib>Bezlyak, Vladimir</creatorcontrib><creatorcontrib>Greenlaw, Nicola</creatorcontrib><creatorcontrib>Ford, Ian</creatorcontrib><creatorcontrib>Cobbe, Stuart M.</creatorcontrib><creatorcontrib>Petrie, Mark C.</creatorcontrib><creatorcontrib>McMurray, John J.V.</creatorcontrib><title>Profile of microvolt T-wave alternans testing in 1003 patients hospitalized with heart failure</title><title>European journal of heart failure</title><addtitle>European Journal of Heart Failure</addtitle><description>Aims
Observational studies in selected populations have suggested that microvolt T‐wave alternans (MTWA) testing may identify patients with heart failure (HF) at risk of sudden cardiac death. The aims of this study were to investigate the utility of MTWA testing in an unselected population of patients with HF and to evaluate the clinical characteristics associated with the MTWA results.
Methods and results
A total of 1003 patients hospitalized with decompensated HF were enrolled. MTWA testing was planned 1 month post‐discharge; 648 patients returned for MTWA testing. Mean age was 70.8 ± 10.6 years and 58% were male. Of these patients who returned, 318 (49%) were ineligible for MTWA testing due to atrial fibrillation (AF), pacemaker dependency, or physical inability to undertake the test. Of the MTWA tests, 100 (30%) were positive, 78 (24%) were negative, and 152 (46%) were indeterminate; 112/152 indeterminate tests (74%) occurred because of failure to achieve target heart rate (HR) due to chronotropic incompetence or physical limitations. There were differences in patient characteristics according to MTWA result. Independent predictors of a negative result included younger age and higher left ventricular ejection fraction (LVEF). Independent predictors of a positive result included higher HR during MTWA testing and lower LVEF. Independent predictors of an indeterminate result included older age and history of previous/paroxysmal AF.
Conclusions
Only half of patients with HF are eligible for MTWA testing and the most common result is an indeterminate test. Patients with positive and indeterminate tests have different clinical characteristics. MTWA treadmill testing is not widely applicable in typical HF patients and is unlikely to refine risk stratification for sudden death on a population level.</description><subject>Aged</subject><subject>Analysis of Variance</subject><subject>Arrhythmias, Cardiac - pathology</subject><subject>Atrial fibrillation</subject><subject>Chi-Square Distribution</subject><subject>Defibrillators, Implantable</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - pathology</subject><subject>Heart rate</subject><subject>Humans</subject><subject>Implantable cardioverter-defibrillator</subject><subject>Left ventricular ejection fraction</subject><subject>Male</subject><subject>Microvolt T-wave alternans</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Stroke Volume</subject><subject>Ventricular Function, Left</subject><issn>1388-9842</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1P3DAQhq2qVfnqsVfkW08BfyWOj2jFslQrQIKKWy2vM24M2WSxHRb49XWVhWNP8x6eeTXzIPSdkhNKFD-FMTy07rR1kVDyCe3TWqqC1EJ8zpnXdaFqwfbQQYwPhFBJCPuK9hjjXEgm99HvmzA43wEeHF57G4bnoUv4rtiaZ8CmSxB600ecICbf_8G-x5QQjjcmeehTxO0QNz6Zzr9Bg7c-tbgFExJ2xndjgCP0xZkuwrfdPES_5ud3s0WxvL64nJ0tCytoSQpmK24aJ1Zl1TAnFKiVslCpWtnKOOaks8wayWllm8xa6qgQZc6r_F3NFD9EP6beTRiexnysXvtooetMD8MYtWKqJJxJmsliIvOvMQZwehP82oRXTYn-Z1RPRvVkNPPHu-ZxtYbmg35XmIFyArZZ4-v_2_T5z8V8Mb-dineH-Jjg5WPPhEddSS5LfX91oWfVspyxW6IF_wvrtJUM</recordid><startdate>201204</startdate><enddate>201204</enddate><creator>Jackson, Colette E.</creator><creator>Myles, Rachel C.</creator><creator>Tsorlalis, Ioannis K.</creator><creator>Dalzell, Jonathan R.</creator><creator>Spooner, Richard J.</creator><creator>Rodgers, John R.</creator><creator>Bezlyak, Vladimir</creator><creator>Greenlaw, Nicola</creator><creator>Ford, Ian</creator><creator>Cobbe, Stuart M.</creator><creator>Petrie, Mark C.</creator><creator>McMurray, John J.V.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201204</creationdate><title>Profile of microvolt T-wave alternans testing in 1003 patients hospitalized with heart failure</title><author>Jackson, Colette E. ; Myles, Rachel C. ; Tsorlalis, Ioannis K. ; Dalzell, Jonathan R. ; Spooner, Richard J. ; Rodgers, John R. ; Bezlyak, Vladimir ; Greenlaw, Nicola ; Ford, Ian ; Cobbe, Stuart M. ; Petrie, Mark C. ; McMurray, John J.V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4150-2c63adf4b56d2f49e9b9ce6989c6af2f7fc2ca7316cd2c6c1f1445cd2b9848293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Analysis of Variance</topic><topic>Arrhythmias, Cardiac - pathology</topic><topic>Atrial fibrillation</topic><topic>Chi-Square Distribution</topic><topic>Defibrillators, Implantable</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - pathology</topic><topic>Heart rate</topic><topic>Humans</topic><topic>Implantable cardioverter-defibrillator</topic><topic>Left ventricular ejection fraction</topic><topic>Male</topic><topic>Microvolt T-wave alternans</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Stroke Volume</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jackson, Colette E.</creatorcontrib><creatorcontrib>Myles, Rachel C.</creatorcontrib><creatorcontrib>Tsorlalis, Ioannis K.</creatorcontrib><creatorcontrib>Dalzell, Jonathan R.</creatorcontrib><creatorcontrib>Spooner, Richard J.</creatorcontrib><creatorcontrib>Rodgers, John R.</creatorcontrib><creatorcontrib>Bezlyak, Vladimir</creatorcontrib><creatorcontrib>Greenlaw, Nicola</creatorcontrib><creatorcontrib>Ford, Ian</creatorcontrib><creatorcontrib>Cobbe, Stuart M.</creatorcontrib><creatorcontrib>Petrie, Mark C.</creatorcontrib><creatorcontrib>McMurray, John J.V.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jackson, Colette E.</au><au>Myles, Rachel C.</au><au>Tsorlalis, Ioannis K.</au><au>Dalzell, Jonathan R.</au><au>Spooner, Richard J.</au><au>Rodgers, John R.</au><au>Bezlyak, Vladimir</au><au>Greenlaw, Nicola</au><au>Ford, Ian</au><au>Cobbe, Stuart M.</au><au>Petrie, Mark C.</au><au>McMurray, John J.V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Profile of microvolt T-wave alternans testing in 1003 patients hospitalized with heart failure</atitle><jtitle>European journal of heart failure</jtitle><addtitle>European Journal of Heart Failure</addtitle><date>2012-04</date><risdate>2012</risdate><volume>14</volume><issue>4</issue><spage>377</spage><epage>386</epage><pages>377-386</pages><issn>1388-9842</issn><eissn>1879-0844</eissn><abstract>Aims
Observational studies in selected populations have suggested that microvolt T‐wave alternans (MTWA) testing may identify patients with heart failure (HF) at risk of sudden cardiac death. The aims of this study were to investigate the utility of MTWA testing in an unselected population of patients with HF and to evaluate the clinical characteristics associated with the MTWA results.
Methods and results
A total of 1003 patients hospitalized with decompensated HF were enrolled. MTWA testing was planned 1 month post‐discharge; 648 patients returned for MTWA testing. Mean age was 70.8 ± 10.6 years and 58% were male. Of these patients who returned, 318 (49%) were ineligible for MTWA testing due to atrial fibrillation (AF), pacemaker dependency, or physical inability to undertake the test. Of the MTWA tests, 100 (30%) were positive, 78 (24%) were negative, and 152 (46%) were indeterminate; 112/152 indeterminate tests (74%) occurred because of failure to achieve target heart rate (HR) due to chronotropic incompetence or physical limitations. There were differences in patient characteristics according to MTWA result. Independent predictors of a negative result included younger age and higher left ventricular ejection fraction (LVEF). Independent predictors of a positive result included higher HR during MTWA testing and lower LVEF. Independent predictors of an indeterminate result included older age and history of previous/paroxysmal AF.
Conclusions
Only half of patients with HF are eligible for MTWA testing and the most common result is an indeterminate test. Patients with positive and indeterminate tests have different clinical characteristics. MTWA treadmill testing is not widely applicable in typical HF patients and is unlikely to refine risk stratification for sudden death on a population level.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>22334727</pmid><doi>10.1093/eurjhf/hfs010</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of heart failure, 2012-04, Vol.14 (4), p.377-386 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Wiley Free Content; Alma/SFX Local Collection |
| subjects | Aged Analysis of Variance Arrhythmias, Cardiac - pathology Atrial fibrillation Chi-Square Distribution Defibrillators, Implantable Exercise Test Female Heart failure Heart Failure - pathology Heart rate Humans Implantable cardioverter-defibrillator Left ventricular ejection fraction Male Microvolt T-wave alternans Predictive Value of Tests Prognosis Prospective Studies Risk Assessment - methods Stroke Volume Ventricular Function, Left |
| title | Profile of microvolt T-wave alternans testing in 1003 patients hospitalized with heart failure |
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