Quantitative T-wave alternans analysis for guiding medical therapy: an underexploited opportunity
Richard L Verrier1, Marek Malik2
1Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA.
Insights
Sudden cardiac death (SCD) is a major challenge. T-wave alternans (TWA) monitoring offers a more reliable method for assessing cardiovascular risk than left ventricular ejection fraction (LVEF), especially in patients with preserved function.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Sudden cardiac death (SCD) is a leading cause of mortality, with 310,000 deaths annually in the US.
- Current risk assessment using left ventricular ejection fraction (LVEF) is unreliable, as many SCD victims have preserved cardiac function.
Purpose of the Study:
- To review the evidence for T-wave alternans (TWA) as a tool for risk stratification in sudden cardiac death.
- To explore the potential of TWA as a therapeutic target.
Main Methods:
- Utilized FDA-cleared methods, including Spectral and Modified Moving Average, for TWA monitoring.
- Analyzed data from over 12,000 individuals with varying LVEF.
Main Results:
- T-wave alternans (TWA) has demonstrated efficacy in assessing cardiovascular mortality risk, including SCD.
- TWA provides valuable risk stratification for both depressed and preserved LVEF populations.
Conclusions:
- T-wave alternans (TWA) is a promising noninvasive index for cardiovascular risk stratification.
- Further investigation into TWA as a therapeutic target is warranted to reduce SCD.
Abstract:
Reducing the toll of sudden cardiac death (SCD) remains a major challenge in cardiology, as it is the leading cause of adult mortality in the industrially developed world, claiming 310,000 lives annually in the United States alone. The main contemporary noninvasive index of cardiovascular risk, left ventricular ejection fraction (LVEF), has not proved adequately reliable, as the majority of individuals who die suddenly have relatively preserved cardiac mechanical function. Monitoring of T-wave alternans (TWA), a beat-to-beat fluctuation in ST-segment or T-wave morphology, is an attractive approach to risk stratification on both scientific and clinical grounds, as this ECG phenomenon has been shown using the FDA-cleared Spectral and Modified Moving Average methods to assess risk for cardiovascular mortality including SCD in studies enrolling >12,000 individuals with depressed or preserved LVEF. The evidence supporting TWA as a therapeutic target is reviewed.
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