abstract
presented
at the 1997 ACC
Anaheim, California
March 16-19, 1997
Noninvasive Risk
Stratification in Patients with Congestive Heart Failure: Comparison
of Traditional Risk Markers and T Wave Alternans
J Am Coll Cardio Feb. 1997; Vol. 29/Number 2:
1091-98
Markus Zabel, Andreas Siedow, Thomas Klingenheben,
Gerian Gronefeld, Richard J. Cohen, Stefan H. Hohnloser. J.W.
Goethe University, Frankfurt, Germany
Patients with chronic congestive heart failure (CHF)
are at high risk for malignant ventricular arrhythmias and death.
The following tests were performed for risk stratification in
70 patients with symptomatic CHF (left ventricular ejection fraction
(LVEF) 28 ± 7 %, age 57 ± 10 years, 56 pts with ischemic
CHF, 14 pts non-ischemic CHF): echocardiography or contrast ventriculography
for determination of LVEF, 24 h Holter ECG for quantitation of
arrhythmias and analysis of heart rate variability (HRV), signal
averaged ECG for evaluation of late potentials, detection of T
wave alternans (TWA) from the surface ECG (spectral method during
rest and exercise, n = 52 pts). QT dispersion was determined from
a 12-lead surface ECG. During follow-up of 12 ± 4 months,
13 pts had major clinical events, prospectively defined as death
(n = 3), need for cardiac transplantation (n=4) and occurrence
of VF or sustained VT (n = 6). Patient groups with and without
clinical events were compared by means of an unpaired t-test or
chi-square test/Fisher's exact test (see table for results).
| Pts with events(n=13) | Pts without events(n=57) | p-value | |
| LVEF ± SD (%) | 27 ± 5 | 30 ± 8 | < 0.01 |
| HRV (SDNN) | 80 ± 37 | 87 ± 35 | ns |
| HRV (rMSSD) | 32 ± 23 | 25 ± 13 | ns |
| PVCs/day | 705 | 1140 | ns |
| VT-episodes/day | 3.0 ± 9.0 | 2.6 ± 10.0 | ns |
| Late potentials + | 7/13 (58%) | 30/51 (58%) | ns |
| QT Dispersion (msec) | 66 ± 30 | 64 ± 24 | ns |
| TWA + or ++ | 9/9 (100%) | 26/43 (60%) | < 0.02 |
| TWA ++ | 6/9 (67%) | 11/43 (26%) | < 0.03 |
Conclusion: All diagnostic
tests performed for risk stratification exhibit severe abnormalities
in this population. TWA appears to be a strong risk marker in
patients with CHF.
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