Risk Stratification for Sudden Cardiac Death in Dilated Cardiomyopathy Using Microvolt-Level T-Wave Alternans

概要

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Predicting sudden cardiac death(SCD) in patients with dilated cardiomyopathy(DCM) is difficult, so the present study evaluated the efficacy of microvolt-level T-wave alternans(TWA) and compared it with conventional parameters for prospective risk stratification of SCD in patients with DCM. Eighty-two patients with DCM (53±15 years old, 67 M/15F) underwent assessment of TWA, left ventricular end-diastolic diameter(LVDd), left ventricular ejection fraction(LVEF), signal-averaged ECG, and analysis of 24-h Holter monitoring and QT dispersion(QTd). The endpoint of the study was defined as either SCD or documented sustained ventricular tachycardia/ventricular fibrillation(SVT/VF) during the follow-up period. During an average follow-up period of 24 months, 1 patient died suddenly and 9 patients had SVT/VF. Kaplan-Meier survival analysis showed that TWA, LVEF (<__-35%), nonsustained ventricular tachycardia, and QTd (>90 ms) were significant univariate risk stratifiers (p<0.005, p<0.005, p<0.005, and p<0.05, respectively). Multivariate Cox regression analysis showed that TWA and the LVEF were statistically significant independent risk stratifiers (p<0.05 and p<0.01, respectively). A combination of TWA and LVEF identified high risk DCM patients (p<0.01); TWA for the electrical substrate and the LVEF for the hemodynamic function.
社団法人日本循環器学会の論文
2001-01-20