title: Enhanced predictive power of quantitative TWA during routine exercise testing in the Finnish Cardiovascular Study.
abstract: BACKGROUND
  We examined whether quantification of T-wave alternans (TWA) enhances this parameter's capacity to evaluate the risk for total and cardiovascular mortality and sudden cardiac death (SCD).
  
  
  RESULTS
  The Finnish Cardiovascular Study (FINCAVAS) enrolled consecutive patients (n = 2,119; 1,342 men and 777 women) with a clinically indicated exercise test with bicycle ergometer. TWA (time domain-modified moving average method) was analyzed from precordial leads, and the results were grouped in increments of 10 microV. Hazard ratios (HR) for total and cardiovascular mortality and SCD were estimated for preexercise, routine exercise, and postexercise stages. Cox regression analysis was performed. During follow-up of 47.1 +/- 12.9 months (mean +/- standard deviation [SD]), 126 patients died: 62 were cardiovascular deaths, and 33 of these deaths were sudden. During preexercise, TWA >or= 20 microV predicted the risk for total and cardiovascular mortality (maximum HR >4.4 at 60 microV, P < 0.02 for both). During exercise, HRs of total and cardiovascular mortality were significant when TWA measured >or=50 microV, with 90 microV TWA yielding maximum HRs for total and cardiovascular death of 3.1 (P = 0.03) and 6.4 (P = 0.002), respectively. During postexercise, TWA >or=60 microV indicated risk for total and cardiovascular mortality, with maximum HR of 3.4 at 70 microV (P = 0.01) for cardiovascular mortality. SCD was strongly predicted by TWA levels >or=60 microV during exercise, with maximum HR of 4.6 at 60 microV (P = 0.002), but was not predicted during pre- or postexercise.
  
  
  CONCLUSIONS
  Quantification of TWA enhances its capacity for determination of the risk for total and cardiovascular mortality and SCD in low-risk populations. Its prognostic power is superior during exercise compared to preexercise or postexercise.
authors.affiliation: Medical School, University of Tampere, Tampere, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Minkkinen
authors.forename: Mika
authors.initials: M
authors.lastname: Kähönen
authors.forename: Jari
authors.initials: J
authors.lastname: Viik
authors.forename: Kjell
authors.initials: K
authors.lastname: Nikus
authors.forename: Terho
authors.initials: T
authors.lastname: Lehtimäki
authors.forename: Rami
authors.initials: R
authors.lastname: Lehtinen
authors.forename: Tiit
authors.initials: T
authors.lastname: Kööbi
authors.forename: Väinö
authors.initials: V
authors.lastname: Turjanmaa
authors.forename: Willi
authors.initials: W
authors.lastname: Kaiser
authors.forename: Richard L
authors.initials: RL
authors.lastname: Verrier
authors.forename: Tuomo
authors.initials: T
authors.lastname: Nieminen
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D004562:Electrocardiography; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors