Lack of Prognostic Value of T-Wave Alternans for Implantable Cardioverter-Defibrillator Benefit in Primary Prevention

PELLI, Ari, Tuomas V KENTTA, M Juhani JUNTTILA, Cynthia HUBER, Simon SCHLOGL, Markus ZABEL, Marek MALÍK, Rik WILLEMS, Marc A VOS, Markus HARDEN, Tim FRIEDE, Christian STICHERLING a Heikki V HUIKURI. Lack of Prognostic Value of T-Wave Alternans for Implantable Cardioverter-Defibrillator Benefit in Primary Prevention. Journal of the American Heart Association. Hoboken: Wiley-Blackwell, 2024, roč. 13, č. 11, s. 1-9. ISSN 2047-9980. Dostupné z: https://dx.doi.org/10.1161/JAHA.123.032465.

Základní údaje

• Originální název: Lack of Prognostic Value of T-Wave Alternans for Implantable Cardioverter-Defibrillator Benefit in Primary Prevention
• Autoři: PELLI, Ari, Tuomas V KENTTA, M Juhani JUNTTILA, Cynthia HUBER, Simon SCHLOGL, Markus ZABEL, Marek MALÍK (203 Česká republika, domácí), Rik WILLEMS, Marc A VOS, Markus HARDEN, Tim FRIEDE, Christian STICHERLING a Heikki V HUIKURI.
• Vydání: Journal of the American Heart Association, Hoboken, Wiley-Blackwell, 2024, 2047-9980.

Další údaje

• Originální jazyk: angličtina
• Typ výsledku: Článek v odborném periodiku
• Obor: 30201 Cardiac and Cardiovascular systems
• Stát vydavatele: Spojené státy
• Utajení: není předmětem státního či obchodního tajemství
• WWW: URL
• Impakt faktor: Impact factor: 5.400 v roce 2022
• Organizační jednotka: Lékařská fakulta
• Doi: http://dx.doi.org/10.1161/JAHA.123.032465
• UT WoS: 001238385200034
• Klíčová slova anglicky: appropriate shock; heart failure; implantable cardioverter-defibrillator; death; T-wave alternans
• Štítky: 14110211, rivok
• Příznaky: Mezinárodní význam, Recenzováno

Anotace

Background New methods to identify patients who benefit from a primary prophylactic implantable cardioverter-defibrillator (ICD) are needed. T-wave alternans (TWA) has been shown to associate with arrhythmogenesis of the heart and sudden cardiac death. We hypothesized that TWA might be associated with benefit from ICD implantation in primary prevention. Methods and Results In the EU-CERT-ICD (European Comparative Effectiveness Research to Assess the Use of Primary Prophylactic Implantable Cardioverter-Defibrillators) study, we prospectively enrolled 2327 candidates for primary prophylactic ICD. A 24-hour Holter monitor reading was taken from all recruited patients at enrollment. TWA was assessed from Holter monitoring using the modified moving average method. Study outcomes were all-cause death, appropriate shock, and survival benefit. TWA was assessed both as a contiguous variable and as a dichotomized variable with cutoff points <47 mu V and <60 mu V. The final cohort included 1734 valid T-wave alternans samples, 1211 patients with ICD, and 523 control patients with conservative treatment, with a mean follow-up time of 2.3 years. TWA >= 60 mu V was a predicter for a higher all-cause death in patients with an ICD on the basis of a univariate Cox regression model (hazard ratio, 1.484 [95% CI, 1.024-2.151]; P=0.0374; concordance statistic, 0.51). In multivariable models, TWA was not prognostic of death or appropriate shocks in patients with an ICD. In addition, TWA was not prognostic of death in control patients. In a propensity score-adjusted Cox regression model, TWA was not a predictor of ICD benefit. Conclusions T-wave alternans is poorly prognostic in patients with a primary prophylactic ICD. Although it may be prognostic of life-threatening arrhythmias and sudden cardiac death in several patient populations, it does not seem to be useful in assessing benefit from ICD therapy in primary prevention among patients with an ejection fraction of <= 35%.