Combined assessment of heart rate recovery and T-wave alternans during routine exercise testing improves prediction of total and cardiovascular mortality: The Finnish Cardiovascular Study

Leino, Johanna; Minkkinen, Mikko; Nieminen, Tuomo; Lehtimäki, Terho; Viik, Jari; Lehtinen, Rami; Nikus, Kjell; Kööbi, Tiit; Turjanmaa, Väinö; Verrier, Richard L.; Kähönen, Mika

doi:10.1016/j.hrthm.2009.08.015

Cited by 42 publications

(53 citation statements)

References 34 publications

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“…MMA-based TWA studies with ambulatory ECG recordings and exercise support the concept that TWA represents a continuum of risk with higher TWA levels indicating greater risk (64–68). With the recommended update factor of one-eighth, TWA ≥60 μ V during routine exercise testing (64–68) and ambulatory ECG monitoring (69–74) indicates severely elevated risk for sudden cardiac death and/or cardiovascular mortality.…”

Section: Methodology For Twa Assessmentmentioning

confidence: 80%

“…The MMA allows microvolt TWA analysis during routine, symptom-limited exercise stress testing (64 – 66,68) and during post-exercise recovery (54,67,68) as well as during ambulatory ECG monitoring (69–74) in the flow of clinical evaluation (Table 2). Risk stratification is based on the peak TWA value throughout the 24-h ambulatory ECG recording or the symptom-limited exercise test.…”

Section: Methodology For Twa Assessmentmentioning

confidence: 99%

“…With the recommended update factor of one-eighth, TWA ≥60 μ V during routine exercise testing (64–68) and ambulatory ECG monitoring (69–74) indicates severely elevated risk for sudden cardiac death and/or cardiovascular mortality. In patients during the early post-MI phase with or without heart failure, a cutpoint of ≥47 μ V also predicted sudden cardiac death (69,70,74).…”

Section: Methodology For Twa Assessmentmentioning

confidence: 99%

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Microvolt T-Wave Alternans

Verrier

Klingenheben

Malík

et al. 2011

Journal of the American College of Cardiology

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377

141

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This consensus guideline was prepared on behalf of the International Society for Holter and Noninvasive Electrocardiology and is cosponsored by the Japanese Circulation Society, the Computers in Cardiology Working Group on e-Cardiology of the European Society of Cardiology, and the European Cardiac Arrhythmia Society. It discusses the electrocardiographic phenomenon of T-wave alternans (TWA) (i.e., a beat-to-beat alternation in the morphology and amplitude of the ST- segment or T-wave). This statement focuses on its physiological basis and measurement technologies and its clinical utility in stratifying risk for life-threatening ventricular arrhythmias. Signal processing techniques including the frequency-domain Spectral Method and the time-domain Modified Moving Average method have demonstrated the utility of TWA in arrhythmia risk stratification in prospective studies in >12,000 patients. The majority of exercise-based studies using both methods have reported high relative risks for cardiovascular mortality and for sudden cardiac death in patients with preserved as well as depressed left ventricular ejection fraction. Studies with ambulatory electrocardiogram-based TWA analysis with Modified Moving Average method have yielded significant predictive capacity. However, negative studies with the Spectral Method have also appeared, including 2 interventional studies in patients with implantable defibrillators. Meta-analyses have been performed to gain insights into this issue. Frontiers of TWA research include use in arrhythmia risk stratification of individuals with preserved ejection fraction, improvements in predictivity with quantitative analysis, and utility in guiding medical as well as device-based therapy. Overall, although TWA appears to be a useful marker of risk for arrhythmic and cardiovascular death, there is as yet no definitive evidence that it can guide therapy.

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Section: Methodology For Twa Assessmentmentioning

confidence: 80%

Section: Methodology For Twa Assessmentmentioning

confidence: 99%

Section: Methodology For Twa Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

Microvolt T-Wave Alternans

Verrier

Klingenheben

Malík

et al. 2011

Journal of the American College of Cardiology

Self Cite

377

141

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“…Several authors have demonstrated the prognostic and predictive role of HR response after exercise testing 18,19,31,32 . Still, few studies were carried out in order to understand the interaction between HRR measures, aerobic fitness and mortality.…”

Section: Discussionmentioning

confidence: 99%

Efeitos da idade e da aptidão aeróbica na recuperação da frequência cardíaca em homens adultos

Trevizani

Benchimol-Barbosa

Nadal

2012

Arq. Bras. Cardiol.

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“…Repolarization alternans (RA), an electrophysiologic phenomenon consisting on everyother-beat changes of the repolarization morphology (amplitude, shape, and, sometimes, polarity) unaccompanied by gross changes in the heart-cycle length, is generally recognized as a promising electrocardiographic (ECG) predictor of sudden cardiac arrest (SCA; Bloomfield et al, 2006, Chow et al 2006, Ikeda et al, 2006, Klingenheben et al, 2000, Leino et al, 2009, Maeda et al, 2009, Narayan, 2006, Rosenbaum et al, 1994, Sakaki et al, 2009, Salerno-Uriarte et al, 2007, Stein et al, 2008, that is one of the leading causes of death in developed countries (over 300,000 lives per year in the U.S.; Montagnana at al., 2008, Zheng et al, 2001). On the ECG tracing, RA consists of an alternation of either the ST-segment (Nearing et al, 1991, Rosenbaum et al, 1994, or the T-wave, or even the U-wave (Habbab & el-Sherif, 1992).…”

Section: Introductionmentioning

confidence: 99%