The Journal of Heart and Lung Transplantation
Volume 28, Issue 7 , Pages 689-696 , July 2009

Microvolt T-Wave Alternans, Peak Oxygen Consumption, and Outcome in Patients with Severely Impaired Left Ventricular Systolic Function

  • Eiran Z. Gorodeski, MD, MPH

      Affiliations

    • Department of Cardiovascular Medicine of Cleveland Clinic, Cleveland, Ohio
    • ,
  • Daniel J. Cantillon, MD

      Affiliations

    • Department of Cardiovascular Medicine of Cleveland Clinic, Cleveland, Ohio
    • ,
  • Sachin S. Goel, MD

      Affiliations

    • Department of Cardiovascular Medicine of Cleveland Clinic, Cleveland, Ohio
    • ,
  • Elizabeth S. Kaufman, MD

      Affiliations

    • Heart and Vascular Research Center of the MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
    • ,
  • David O. Martin, MD, MPH

      Affiliations

    • Department of Cardiovascular Medicine of Cleveland Clinic, Cleveland, Ohio
    • ,
  • Eileen M. Hsich, MD

      Affiliations

    • Department of Cardiovascular Medicine of Cleveland Clinic, Cleveland, Ohio
    • ,
  • Eugene H. Blackstone, MD

      Affiliations

    • Department of Cardiothoracic Surgery of Cleveland Clinic, Cleveland, Ohio
    • ,
  • Michael S. Lauer, MD

      Affiliations

    • Division of Prevention and Population Sciences of the National Heart, Lung, and Blood Institute (MSL), Bethesda, Maryland
    • Corresponding Author InformationReprint requests: Michael S. Lauer, MD, FACC, FAHA, Director, Division of Prevention and Population Sciences (DPPS), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Rockledge Center II, 6701 Rockledge Dr, Rm 10122, Bethesda, MD 20892. Telephone: 301-435-0422. Fax: 301-480-1864

Received 14 December 2008 ,Revised 22 February 2009 ,Accepted 7 April 2009.

References 

  1. Myles RC, Jackson CE, Tsorlalis I, Petrie MC, McMurray JJ, Cobbe SM. Is microvolt T-wave alternans the answer to risk stratification in heart failure?. Circulation. 2007;116:2984–2991
  2. Chow T, Kereiakes DJ, Onufer J, et al. Does microvolt T-wave alternans testing predict ventricular tachyarrhythmias in patients with ischemic cardiomyopathy and prophylactic defibrillators? (The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) trial). J Am Coll Cardiol. 2008;52:1607–1615
  3. Mancini D, LeJemtel T, Aaronson K. Peak VO(2): a simple yet enduring standard. Circulation. 2000;101:1080–1082
  4. Narayan SM. T-wave alternans and the susceptibility to ventricular arrhythmias. J Am Coll Cardiol. 2006;47:269–281
  5. Gehi AK, Stein RH, Metz LD, Gomes JA. Microvolt T-wave alternans for the risk stratification of ventricular tachyarrhythmic events: a meta-analysis. J Am Coll Cardiol. 2005;46:75–82
  6. Sarzi Braga S, Vaninetti R, Laporta A, Picozzi A, Pedretti RF. T wave alternans is a predictor of death in patients with congestive heart failure. Int J Cardiol. 2004;93:31–38
  7. Baravelli M, Fantoni C, Rogiani S, et al. Combined prognostic value of peak O(2) uptake and microvolt level T-wave alternans in patients with idiopathic dilated cardiomyopathy. Int J Cardiol. 2007;121:23–29
  8. Bloomfield DM, Bigger JT, Steinman RC, et al. Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction. J Am Coll Cardiol. 2006;47:456–463
  9. Bloomfield DM, Steinman RC, Namerow PB, et al. Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy: a solution to the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II conundrum. Circulation. 2004;110:1885–1889
  10. Gold MR, Ip JH, Costantini O, Poole JE, et al. Role of microvolt T-wave alternans in assessment of arrhythmia vulnerability among patients with heart failure and systolic dysfunction: primary results from the T-wave alternans sudden cardiac death in heart failure trial substudy. Circulation. 2008;118:2022–2028
  11. Bloomfield DM, Hohnloser SH, Cohen RJ. Interpretation and classification of microvolt T wave alternans tests. J Cardiovasc Electrophysiol. 2002;13:502–512
  12. Hohnloser SH, Ikeda T, Bloomfield DM, Dabbous OH, Cohen RJ. T-wave alternans negative coronary patients with low ejection and benefit from defibrillator implantation. Lancet. 2003;362:125–126
  13. Hohnloser SH, Klingenheben T, Bloomfield D, Dabbous O, Cohen RJ. Usefulness of microvolt T-wave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy: results from a prospective observational study. J Am Coll Cardiol. 2003;41:2220–2224
  14. Kaufman ES, Bloomfield DM, Steinman RC, et al. “Indeterminate” microvolt T-wave alternans tests predict high risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction. J Am Coll Cardiol. 2006;48:1399–1404
  15. O'Neill JO, Young JB, Pothier CE, Lauer MS. Peak oxygen consumption as a predictor of death in patients with heart failure receiving beta-blockers. Circulation. 2005;111:2313–2318
  16. Robbins M, Francis G, Pashkow FJ, et al. Ventilatory and heart rate responses to exercise: better predictors of heart failure mortality than peak oxygen consumption. Circulation. 1999;100:2411–2417
  17. Lauer MS, Blackstone EH, Young JB, Topol EJ. Cause of death in clinical research: time for a reassessment?. J Am Coll Cardiol. 1999;34:618–620
  18. Curb JD, Ford CE, Pressel S, Palmer M, Babcock C, Hawkins CM. Ascertainment of vital status through the National Death Index and the Social Security Administration. Am J Epidemiol. 1985;121:754–766
  19. Newman TB, Brown AN. Use of commercial record linkage software and vital statistics to identify patient deaths. J Am Med Inform Assoc. 1997;4:233–237
  20. Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA. 2000;284:1392–1398
  21. United Network for Organ Sharing. Policy 3.7: Organ distribution: allocation of thoracic organs; Dec 14, 2006. http://www.unos.org/PoliciesandBylaws2/policies/pdfs/policy_9.pdfAccessed: Apr 19, 2007
  22. Kaplan EL. Nonparametric estimation from incomplete observations. MP J Am Stat Assn. 1958;457–481
  23. O'Neill JO, Young JB, Pothier CE, Lauer MS. Severe frequent ventricular ectopy after exercise as a predictor of death in patients with heart failure. J Am Coll Cardiol. 2004;44:820–826
  24. Harrell FE, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996;15:361–387
  25. Harrell FE. Regression modeling strategies with applications to linear models, logistic regression, and survival analysis. New York, NY: Springer-Verlag; 2001;
  26. Harrell FE, Califf RM, Pryor DB, Lee KL, Rosati RA. Evaluating the yield of medical tests. JAMA. 1982;247:2543–2546
  27. Kattan MW. Judging new markers by their ability to improve predictive accuracy. J Natl Cancer Inst. 2003;95:634–635
  28. Braitman LE, Rosenbaum PR. Rare outcomes, common treatments: analytic strategies using propensity scores. Ann Intern Med. 2002;137:693–695
  29. D'Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265–2281
  30. Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127:757–763
  31. Parsons L. Reducing bias in a propensity score matched-pair sample using greedy matching techniques. http://www2.sas.com/proceedings/sugi26/p214-26.pdfAccessed Apr 20, 2009
  32. Gum PA, Thamilarasan M, Watanabe J, Blackstone EH, Lauer MS. Aspirin use and all-cause mortality among patients being evaluated for known or suspected coronary artery disease: a propensity analysis. JAMA. 2001;286:1187–1194
  33. Hsich E, Chadalavada S, Krishnaswamy G, et al. Long-term prognostic value of peak oxygen consumption in women versus men with heart failure and severely impaired left ventricular systolic function. Am J Cardiol. 2007;100:291–295
  34. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation. 1991;83:778–786
  35. Lauer MS, Mehta R, Pashkow FJ, Okin PM, Lee K, Marwick TH. Association of chronotropic incompetence with echocardiographic ischemia and prognosis. J Am Coll Cardiol. 1998;32:1280–1286
  36. Lauer MS, Francis GS, Okin PM, Pashkow FJ, Snader CE, Marwick TH. Impaired chronotropic response to exercise stress testing as a predictor of mortality. JAMA. 1999;281:524–529
  37. Frolkis JP, Pothier CE, Blackstone EH, Lauer MS. Frequent ventricular ectopy after exercise as a predictor of death. N Engl J Med. 2003;348:781–790
  38. Salerno-Uriarte JA, De Ferrari GM, Klersy C, et al. Prognostic value of T-wave alternans in patients with heart failure due to nonischemic cardiomyopathy: results of the ALPHA Study. J Am Coll Cardiol. 2007;50:1896–1904

 This work was funded by National Heart, Lung, and Blood Institute grant CAN# 8324207.

PII: S1053-2498(09)00231-9

doi: 10.1016/j.healun.2009.04.009

The Journal of Heart and Lung Transplantation
Volume 28, Issue 7 , Pages 689-696 , July 2009

Article Tools

* Image Usage & Resolution