Microvolt T-wave alternans complemented with electrophysiologic study for prediction of ventricular tachyarrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: a long-term follow-up study

作     者：She-Liang Xue Xiao-Feng Hou Kang-Yun Sun Yao Wang Zhi-Yong Qian Quan-Peng Wang Si-Peng Shen Hong-Li Yin Rong Zhang Hai-Ping Yin Jian-Gang Zou Xue She-Liang;Hou Xiao-Feng;Sun Kang-Yun;Wang Yao;Qian Zhi-Yong;Wang Quan-Peng;Shen Si-Peng;Yin Hong-Li;Zhang Rong;Yin Hai-Ping;Zou Jian-Gang

作者机构：Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsu 210029China Department of CardiologyThe Affiliated Wujin Hospital of Jiangsu UniversityChangzhouJiangsu 213002China Department of CardiologyThe Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhouJiangsu 215008China Department of BiostatisticsSchool of Public HealthNanjing Medical UniversityNanjingJiangsu 211166China Key Laboratory of Targeted Intervention in Cardiovascular DiseaseCollaborative Inn ovation Center for Cardiovascular Disease Translational MedicineNanjing Medical University NanjingJiangsu 211166China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2019年第132卷第12期

页      面：1406-1413页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：the National Natural Science Foundation of China (No. 81470457) the Frontier Technology of Jiangsu Provincial Science and Technology Department (No. BE2016764). 

主　　题：Modified moving average analysis Microvolt T-wave alternans Electrophysiologic study Ventricular tachyarrhythmia Arrhythmogenic right ventricular cardiomyopathy 

摘      要：Background: The long-term predicted value of microvolt T-wave alternans (MTWA) for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study (EPS) in patients with ARVC. Methods: All patients underwent non-invasive MTWA examination with modified moving average (MMA) analysis and an EPS. A positive event was defined as the first occurrence of sudden cardiac death, documented sustained ventricular tachycardia (VT), ventricular fibrillation, or the administration of appropriate implantable cardioverter defibrillator therapy including shock or antitachycardia pacing. Results: Thirty-five patients with ARVC (age 38.6 ± 11.0 years;28 males) with preserved left ventricular (LV) function were recruited. The maximal TWA value (MaxValt) was 17.0 (11.0–27.0)μV. Sustained VT was induced in 22 patients by the EPS. During a median follow-up of 99.9 ± 7.7 months, 15 patients had positive clinical events. When inducible VT was combined with the MaxValt, the area under the curve improved from 0.739 to 0.797. The receiver operating characteristic curve showed that a MaxValt of 23.5 μV was the optimal cutoff value to identify positive events. The multivariate Cox regression model for survival showed that MTWA (MaxValt, hazard ratio [HR], 1.06;95% confidence interval [CI], 1.01–1.11;P = 0.01) and inducible VT (HR, 5.98;95% CI, 1.33–26.8;P = 0.01) independently predicted positive events in patients with ARVC. Conclusions: MTWA assessment with MMA analysis complemented by an EPS might provide improved prognostic ability in patients with ARVC with preserved LV function during long-term follow-up.