左室功能不全的患者中微伏T波电交替与死亡或持续性室性心律失常风险的关系  

Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction

作　　者：Bloomfield D.M Bigger J.T Steinman R.C. 赵君 

机构地区：[1]Data Coordinating Center, MTWA in CHF Study, Columbia University Medical Center, 630West 168th Street, New York, NY 10032, United States,Dr.

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2006年第5期54-54,共1页

摘　　要：OBJECTIVES: This study hypothesized that microvolt T-wave alternans(MTWA) improves selection of patients for implantable cardioverter-defibrillator(ICD) prophylaxis, especially by identifying patients who are not likely to benefit. BACKGROUND: Many patients with left ventricular dysfunction are now eligible for prophylactic ICDs, but most eligible patients do not benefit; MTWA testing has been proposed to improve patient selection. METHODS: Our study was conducted at 11 clinical centers in the U.S. Patients were eligible if they had a left ventricular ejection fraction(LVEF) ≤ 0.40 and lacked a history of sustained ventricular arrhythmias; patients were excluded for atrial fibrillation, unstable coronary artery disease, or New York Heart Association functional class IV heart failure. Participants underwent an MTWA test and then were followed for about two years. The primary outcome was all-cause mortality or non-fatal sustained ventricular arrhythmias. RESULTS: Ischemic heart disease was present in 49% , mean LVEF was 0.25, and 66% had an abnormal MTWA test. During 20± 6 months of follow-up, 51 end points(40 deaths and 11 non-fatal sustained ventricular arrhythmias) occurred. Comparing patients with normal and abnormal MTWA tests, the hazard ratio for the primary end point was 6.5 at two years(95% confidence interval 2.4 to 18.1, p< 0.001). Survival of patients with normal MTWA tests was 97.5% at two years. The strong association between MTWA and the primary end point was similar in all subgroups tested. CONCLUSIONS: Among patients with heart disease and LVEF ≤ 0.40, MTWA can identify not only a high-risk group, but also a low-risk group unlikely to benefit from ICD prophylaxis.OBJECTIVES： This study hypothesized that microvolt T-wave altemans（MTWA） improves selection of patients for implantable cardioverter-defibrillator（ICD） prophylaxis, especially by identifying patients who are not likely to benefit. BACKGROUND： Many patients with left ventricular dysfunction are now eligible for prophylactic ICDs, but most eligible patients do not benefit; MTWA testing has been proposed to improve patient selection. METHODS： Our study was conducted at 11 clinical centers in the U. S. Patients were eligible if they had a left ventricular ejection fraction（LVEF） ≤0.40 and lacked a history of. sustained ventricular arrhythmias; patients were excluded for atrial fibrillation, unstable coronary artery disease, or New York Heart Association functional class Ⅳ heart failure.

关 键 词：持续性室性心律失常 左室功能不全 T波电交替 植入埋藏式心脏复律除颤器 患者 不稳定性冠状动脉疾病 风险 左室射血分数 NYHA 非致死性 

分 类 号：R541.71[医药卫生—心血管疾病] R541[医药卫生—内科学]