A positive ambulatory ECG-based T-wave alternans result was associated with a nearly six-fold increased risk of sudden cardiac death, cardiac mortality, and severe arrhythmic events compared to a negative result (HR 5.94).
Meta-Analysis (n=1,588)
Does positive ambulatory ECG-based T-wave alternans predict sudden cardiac death and cardiac mortality compared to negative TWA?
Ambulatory ECG-based T-wave alternans is a strong predictor of fatal cardiac events, with positive results indicating a nearly six-fold increased risk compared to negative results.
Hazard Ratio: 5.94 (95% CI 1.8–19.63)
Tasa de eventos absoluta: 28% vs 9%
BACKGROUND: Exercise-based spectral T-wave alternans (TWA) has been proposed as a noninvasive tool-identifying patients at risk of sudden cardiac death (SCD) and cardiac mortality. Prior studies have indicated that ambulatory electrocardiogram (AECG)-based TWA is an important alternative platform to exercise for risk stratification of cardiac events. This study sought to review data regarding 24-hour AECG-based TWA and to discuss its potential role in risk stratification of fatal cardiac events across a series of patient risk profiles. METHODS: Prospective clinical studies of the predictive value of AECG-based TWA obtained with daily activity published between January 1990 and November 2014 were retrieved. Major endpoints included composite endpoint of SCD, cardiac mortality, and severe arrhythmic events. RESULTS: Data were accumulated from 5 studies involving a total of 1,588 patients, including 317 positive and 1,271 negative TWA results. Compared with the negative group, positive group showed increased rates of SCD (hazard ratio HR: 7.49, 95% confidence interval CI: 2.65 to 21.15), cardiac mortality (HR: 4.75, 95% CI: 0.42 to 53.55), and composite endpoint (SCD, cardiac mortality, and severe arrhythmic events, HR: 5.94, 95% CI: 1.80 to 19.63). For the 4 studies evaluating TWA measured using the modified moving average method, the HR associated with a positive versus negative TWA result was 9.51 (95% CI: 4.99 to 18.11) for the composite endpoint. CONCLUSIONS: The positive group of AECG-based TWA has a nearly six-fold risk of severe outcomes compared with the negative group. Therefore, AECG-based TWA provides an accurate means of predicting fatal cardiac events.
Quan et al. (Mon,) conducted a meta-analysis in Risk of sudden cardiac death and cardiac mortality (n=1,588). Positive ambulatory ECG-based T-wave alternans (TWA) vs. Negative ambulatory ECG-based TWA was evaluated on Composite endpoint of sudden cardiac death, cardiac mortality, and severe arrhythmic events (HR 5.94, 95% CI 1.80 to 19.63). A positive ambulatory ECG-based T-wave alternans result was associated with a nearly six-fold increased risk of sudden cardiac death, cardiac mortality, and severe arrhythmic events compared to a negative result (HR 5.94).