PREVENT-SCD
trial, presented at the
PREVENT-SCD (PRospective EValuation of VENtricular Tachyarrhythmic
Events and Sudden Cardiac Death in Patients with Left Ventricular Dysfunction),
a prospective multi-center study of patients with cardiomyopathy
and ejection fraction of 40% or lower, enrolled a total of 453 patients from 38
institutions in
At a median
follow-up time of 36 months, patients with an abnormal MTWA test were 4.4 times
more likely to experience a life-threatening arrhythmia or SCD than those with
a normal test. The 3-year negative predictive value was reported to be 97.0%,
indicating that patients with a normal or negative MTWA test are at low risk
for experiencing sudden death.
"MTWA has a
very high negative predictive value for lethal arrhythmias in this population,”
said Dr.
This trial further
confirms the predictive value of MTWA in patients with
Additional details
that were included in the poster but not the abstract:
·
The NPV at one-year
was 100%; at two years, 98.6%.
·
Unlike MASTER, a
small percentage of patients had an ICD (25%) and the majority of endpoint
events were SCD or resuscitated VF (not ICD shocks).
·
Of 280 patients
tested, 29% were negative for MTWA – very similar to the breakout for other
studies like
·
Interestingly, the
patients who were ineligible for the MTWA test were also at higher risk.
Most of these were due to atrial fibrillation, but others
were due to inability to exercise or being pacemaker dependent. In the
real world, some of these patients could have been tested via pharmacologic
testing or AV sequential pacing thereby reducing the number of truly ineligible
patients, but those methodologies were not used in this study.
These results are an
important confirmation of the value of MTWA testing and further demonstrate
that, in trials not dominated by ICD shocks as the endpoint, the data supports
the predictive value of MTWA for SCD. The authors are pursuing
publication and we should see the full paper out early next year.