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Profile of microvolt T‐wave alternans testing in 1003 patients hospitalized with heart failure
Author(s) -
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.
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs010
Subject(s) - medicine , t wave alternans , heart failure , ejection fraction , cardiology , indeterminate , atrial fibrillation , ventricular fibrillation , sudden cardiac death , population , mathematics , environmental health , pure mathematics
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.