title: Prognostic utility of T-wave alternans in a real-world population of patients with left ventricular dysfunction: the PREVENT-SCD study.
abstract: BACKGROUND
  The predictive value of T-wave alternans (TWA) for lethal ventricular tachyarrhythmia in patients with left ventricular (LV) dysfunction is controversial. Also, long-term arrhythmia risk of patients ineligible for the TWA test is unknown.
  
  
  METHODS
  This was a multicenter, prospective observational study of patients with LV ejection fraction ≤40% due to ischemic or non-ischemic cardiomyopathies, designed to evaluate the prognostic value of TWA for lethal ventricular tachyarrhythmia. The primary end point was a composite of sudden cardiac death, sustained rapid ventricular tachycardia (VT) or ventricular fibrillation (VF), and appropriate defibrillator therapy for rapid VT or VF.
  
  
  RESULTS
  Among 453 patients enrolled in the study, 280 (62%) were eligible for the TWA test. TWA was negative in 82 patients (29%), who accounted for 18% of the total population. The median of follow-up was 36 months. The 3-year event-free rate for the primary end point was significantly higher in TWA-negative patients (97.0%) than in TWA non-negative patients (89.5%, P = 0.037) and those ineligible for the TWA test (84.4%, P = 0.003). Multivariable analysis identified both non-negative TWA [hazard ratio (HR) 4.43; 95% confidence interval (CI) 1.02-19.2; P = 0.047) and ineligibility for the TWA test (HR 6.89; 95% CI 1.59-29.9; P = 0.010) to be independent predictors of the primary end point.
  
  
  CONCLUSIONS
  TWA showed high negative predictive ability for lethal ventricular tachyarrhythmia in patients with LV dysfunction, although the TWA-negative patients accounted for only 18% of the entire population. Those ineligible for the TWA test had the highest risk for lethal ventricular tachyarrhythmia.
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shougoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
authors.forename: Takanori
authors.initials: T
authors.lastname: Ikeda
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yoshino
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hiramatsu
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kazatani
authors.forename: Kohei
authors.initials: K
authors.lastname: Yamashiro
authors.forename: Katsunori
authors.initials: K
authors.lastname: Okajima
authors.forename: Teishi
authors.initials: T
authors.lastname: Kajiya
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Takao
authors.initials: T
authors.lastname: Kato
authors.forename: Satoki
authors.initials: S
authors.lastname: Fujii
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.forename: Koichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Yoshisumi
authors.initials: Y
authors.lastname: Haruna
authors.forename: Takahiro
authors.initials: T
authors.lastname: Doi
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nishio
authors.forename: Neiko
authors.initials: N
authors.lastname: Ozasa
authors.forename: Kei
authors.initials: K
authors.lastname: Nishiyama
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D018572:Disease-Free Survival; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left