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Presentation Time:
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11/10/2004 10:45:00 AM
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Title:
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Patients With a Nonischemic Cardiomyopathy and a Negative T-Wave
Alternans Stress Test Are at a Low Risk of Death
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Keywords:
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Sudden death,Cardiomyopathies,Clinical trials
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Author Block:
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Otto Costantini, Elizabeth S Kaufman, Metrohealth Med Ctr/Case
Western Reserve Univ, Cleveland, OH; Daniel M Bloomfield, Richard C
Steinman, Pearila B Namerow, Michael K Parides, J. Thomas Bigger Jr,
Columbia Univ College of Physicians and Surgeons, New York City, NY; for
the "CHF-TWA" Investigators
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Disclosure Block:
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O. Costantini, None; E.S. Kaufman, None; D.M.
Bloomfield, Cambridge Heart Inc H. Speakers bureau; R.C.
Steinman, None; P.B. Namerow, None; M.K. Parides,
None; J. Bigger, None.
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Unlabeled/unapproved:
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There are no unlabeled/unapproved uses of drugs or products
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Background: Patients with
dilated non-ischemic cardiomyopathy (NI-CM) are at increased risk for
sudden cardiac death. Because of low specificity, traditional
risk-stratifying measures poorly predict which of these patients are at
lowest risk and would least benefit from ICD prophylaxis. T-Wave Alternans
(TWA) exercise testing has been shown to identify patients with coronary
artery disease at low risk of death. We therefore hypothesized that a
negative TWA test would identify patients with NI-CM at low risk of death. Methods:
We conducted a prospective epidemilologic study of 282 patients with a
left ventricular ejection fraction (LVEF) ≤0.40 and dilated NI-CM.
Patients with atrial fibrillation, New York Heart Association Class IV
heart failure, or sustained ventricular tachyarrhythmias were excluded. All
patients had a TWA test. The primary endpoint of the study was actuarial
all-cause mortality at 2 years. Results: Mean age was 51±13 years,
mean LVEF was 0.23±0.08, and the mean follow-up was 16.4 months. TWA
testing was normal (negative) in 95 patients (34%), and abnormal (positive
or indeterminate) in 187 patients (66%). None of the patients with a normal
TWA test and 12 patients with an abnormal TWA test (8.6%) died
(P≤0.02, Figure).
Conclusions: In patients with NI-CM, a normal TWA test predicts a
low 2 year all-cause mortality. ICD prophylaxis in these patients may not
be needed.
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