PROGNOSTIC SIGNIFICANCE OF T WAVE ALTERNANS

T 波交替的预后意义

• 批准号: 6645446
• 负责人: JOHN THOMAS BIGGER
• 金额: $ 42.63万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-15 至 2006-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6645446
• 关键词: arrhythmia; bioimaging /biomedical imaging; cardiovascular disorder diagnosis; cardiovascular disorder epidemiology; clinical research; congestive heart failure; diagnosis design /evaluation; disease /disorder proneness /risk; electrocardiography; heart electrical activity; human subject; prognosis; sudden cardiac death

DESCRIPTION (Verbatim from Applicant's Abstract): Sudden cardiac death accounts for approximately 400,000 deaths each year in the United States and remains a health problem of epidemic proportions. Most sudden cardiac deaths are caused by fatal ventricular arrhythmias. An effort aimed at the primary prevention of sudden cardiac death requires efficient identification of patients who are at high enough risk for having these arrhythmias to warrant aggressive prophylactic therapy. A number of recently completed, randomized clinical trials have demonstrated that an implantable cardiac defibrillator (ICD) can prevent sudden cardiac death in a highly selected group of high-risk patients. When these trials are viewed together, the only patients in whom the prophylactic implantation of an ICD has proven benefit are those patients identified by documented, spontaneous or inducible, sustained ventricular arrhythmias. Two randomized treatment trials (MADIT II, SCD-HEFT) are currently testing the hypothesis that implantation of an ICD will reduce mortality in patients with congestive heart failure (CHF) and left ventricular dysfunction without any further risk stratification. However, the implications of these two trials-implantation of an ICD in every patient with CHF-are unlikely to be accepted either by the medical community or by health care payers. More efficient methods of risk stratification will be necessary to identify those patients with CHF who are most likely to benefit from prophylactic treatment with an ICD. It has recently been shown that T Wave Alternans (TWA) measured during exercise is strongly associated with inducible monomorphic CVT and with subsequent spontaneous arrhythmic events. This preliminary data suggest that TWA may be an efficient and non-invasive surrogate for electrophysiologic testing to screen patients who may be at high-risk for sudden cardiac death. The purpose of this study is to evaluate the prognostic significance of TWA in a prospective epidemiologic natural history study. Ultimately, the planning of a randomized treatment trial that utilizes TWA in some combination with other risk factors to select patients at high-risk for sudden cardiac death requires answers to a number of questions from an unbiased natural history study. What is the magnitude of the increase in risk of having an arrhythmic event if TWA is present? Is the increase in risk similar for those patients with ischemic and non-ischemic cardiomyopathy? What is the relationship between TWA and the other risk factors (EF, NSVT, and RR variability)? Is the association between TWA and arrhythmic events independent of these other risk factors? What is the most clinically efficient method of combining risk factors to identify a group of patients at high-risk for having an arrhythmic event? The research described in this grant application will provide the data necessary to answer these questions.

描述（逐字研究来自申请人的摘要）：突然心脏死亡帐户 在美国，每年约有40万人死亡，仍然是 流行比例的健康问题。大多数突然的心脏死亡是造成的 通过致命性心律不齐。旨在主要预防的努力 猝死需要有效地识别 有足够的高风险使这些心律不齐以保持积极性 预防性治疗。许多最近完成的随机临床 试验表明，可植入的心脏除颤器（ICD）可以 防止一群高危患者组中心脏猝死。 当一起查看这些试验时，唯一的患者 ICD的预防性植入已被证明是这些患者 由记录，自发或诱导，持续性心室确定 心律不齐。 目前正在测试两项随机治疗试验（MADIT II，SCD-HEFT） 假设ICD植入将降低患者的死亡率 充血性心力衰竭（CHF）和左心室功能障碍没有任何 进一步的风险分层。但是，这两个的含义 每位CHF患者中ICD的试验 - 不太可能是 被医学界或医疗保健付款人接受。更多的 必须有效的风险分层方法来识别这些方法 CHF患者最有可能受益于预防治疗 与ICD。 最近已经显示，锻炼过程中测量的T WAVE替代品（TWA） 与诱导的单态CVT密切相关，随后 自发性心律失常事件。此初步数据表明TWA可能是 用于电生理测试到筛网的有效和非侵入性替代物 可能因心脏突然死亡而处于高风险的患者。 这项研究的目的是评估TWA在 一项前瞻性流行病学自然史研究。最终，计划 一项随机治疗试验，将TWA与其他结合在一起 选择高风险患者猝死的风险因素需要 从公正的自然历史研究中回答了许多问题。什么 如果TWA，发生心律不齐的风险增加的幅度是 在场吗？那些缺血患者的风险增加是否相似 和非缺血性心肌病？ TWA和TWA之间的关系是什么 其他风险因素（EF，NSVT和RR变异性）？是 TWA和心律不齐的事件与这些其他风险因素无关？什么是 大多数临床上有效的合并风险因素来识别一组的方法 高危患者因心律不齐而发生吗？研究描述 在本赠款中，应用程序将提供回答这些的必要数据 问题。