T‐Wave Alternans Measured by 24‐Hour Ambulatory Recordings Rather Than Exercise Stress Tests as a Risk Stratification Marker in Patients With Long QT Syndrome
Background Few small‐sample studies have quantified the T‐wave alternans (TWA) value by 24‐hour ambulatory recordings or exercise stress tests in patients with long QT syndrome (LQTS). The cutoff point of TWA ≥47 μV was based on patients with myocardial infarction. In our study, we aimed to (1) eval...
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Wiley
2024-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.033619 |
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| author | Jing Yang Jiangying Luo Kun Li Dan Li Tingting Lv Fulan Liu Yuanwei Liu Fei She Rong He Ping Zhang |
| author_facet | Jing Yang Jiangying Luo Kun Li Dan Li Tingting Lv Fulan Liu Yuanwei Liu Fei She Rong He Ping Zhang |
| author_sort | Jing Yang |
| collection | DOAJ |
| description | Background Few small‐sample studies have quantified the T‐wave alternans (TWA) value by 24‐hour ambulatory recordings or exercise stress tests in patients with long QT syndrome (LQTS). The cutoff point of TWA ≥47 μV was based on patients with myocardial infarction. In our study, we aimed to (1) evaluate the association of TWA with life‐threatening arrhythmic events (LAEs); (2) compare the predictive model of LAEs according to the TWA value measured by 24‐hour ambulatory recordings and exercise stress tests; and (3) propose a cutoff point for the high risk of LAEs in patients with LQTS. Methods and Results The study cohort included 110 patients with LQTS referred to our hospital, and the primary outcome was LAEs. Thirty‐one patients with LQTS (31/110 [28.2%]) developed LAEs during the following 24 (12–47) months. Peak TWA value quantified from 12 leads by 24‐hour ambulatory recordings in patients with LQTS with LAEs (LQTS–LAEs group) was significantly higher than LQTS without LAEs (LQTS–non‐LAEs group) (64.0 [42.0–86.0] μV versus 43.0 [36.0–53.0] μV; P<0.01). There was no statistical difference in TWA value measured by exercise stress tests between the 2 groups (69.0 [54.5–127.5] μV versus 68.5 [53.3–99.8] μV; P=0.871). The new cutoff point of the peak TWA value measured by 24‐hour ambulatory recordings was 55.5 μV, with a sensitivity of 75.0% and a specificity of 78.6%. A univariate Cox regression analysis revealed that TWA value ≥55.5 μV was a strong predictor of LAEs (hazard ratio [HR], 4.5 [2.1–9.6]; P<0.001]. A multivariate Cox regression analysis indicated that TWA value ≥55.5 μV remained significant (HR, 2.7 [1.1–6.8]; P=0.034). Conclusions Peak TWA measured by 24‐hour ambulatory recordings was a more favorable risk stratification marker than exercise stress tests for patients with LQTS. |
| format | Article |
| id | doaj-art-e9696c8c30b143d4878a6ca9d03464d6 |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-e9696c8c30b143d4878a6ca9d03464d62025-08-20T03:10:10ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-07-01131410.1161/JAHA.123.033619T‐Wave Alternans Measured by 24‐Hour Ambulatory Recordings Rather Than Exercise Stress Tests as a Risk Stratification Marker in Patients With Long QT SyndromeJing Yang0Jiangying Luo1Kun Li2Dan Li3Tingting Lv4Fulan Liu5Yuanwei Liu6Fei She7Rong He8Ping Zhang9Department of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaDepartment of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaDepartment of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaDepartment of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaDepartment of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaDepartment of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaDepartment of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaDepartment of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaDepartment of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaDepartment of Cardiology Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University Beijing ChinaBackground Few small‐sample studies have quantified the T‐wave alternans (TWA) value by 24‐hour ambulatory recordings or exercise stress tests in patients with long QT syndrome (LQTS). The cutoff point of TWA ≥47 μV was based on patients with myocardial infarction. In our study, we aimed to (1) evaluate the association of TWA with life‐threatening arrhythmic events (LAEs); (2) compare the predictive model of LAEs according to the TWA value measured by 24‐hour ambulatory recordings and exercise stress tests; and (3) propose a cutoff point for the high risk of LAEs in patients with LQTS. Methods and Results The study cohort included 110 patients with LQTS referred to our hospital, and the primary outcome was LAEs. Thirty‐one patients with LQTS (31/110 [28.2%]) developed LAEs during the following 24 (12–47) months. Peak TWA value quantified from 12 leads by 24‐hour ambulatory recordings in patients with LQTS with LAEs (LQTS–LAEs group) was significantly higher than LQTS without LAEs (LQTS–non‐LAEs group) (64.0 [42.0–86.0] μV versus 43.0 [36.0–53.0] μV; P<0.01). There was no statistical difference in TWA value measured by exercise stress tests between the 2 groups (69.0 [54.5–127.5] μV versus 68.5 [53.3–99.8] μV; P=0.871). The new cutoff point of the peak TWA value measured by 24‐hour ambulatory recordings was 55.5 μV, with a sensitivity of 75.0% and a specificity of 78.6%. A univariate Cox regression analysis revealed that TWA value ≥55.5 μV was a strong predictor of LAEs (hazard ratio [HR], 4.5 [2.1–9.6]; P<0.001]. A multivariate Cox regression analysis indicated that TWA value ≥55.5 μV remained significant (HR, 2.7 [1.1–6.8]; P=0.034). Conclusions Peak TWA measured by 24‐hour ambulatory recordings was a more favorable risk stratification marker than exercise stress tests for patients with LQTS.https://www.ahajournals.org/doi/10.1161/JAHA.123.03361924‐hour ambulatory recordingscutoff pointexercise stress testslife‐threatening arrhythmic eventslong QT syndromeT‐wave alternans |
| spellingShingle | Jing Yang Jiangying Luo Kun Li Dan Li Tingting Lv Fulan Liu Yuanwei Liu Fei She Rong He Ping Zhang T‐Wave Alternans Measured by 24‐Hour Ambulatory Recordings Rather Than Exercise Stress Tests as a Risk Stratification Marker in Patients With Long QT Syndrome Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 24‐hour ambulatory recordings cutoff point exercise stress tests life‐threatening arrhythmic events long QT syndrome T‐wave alternans |
| title | T‐Wave Alternans Measured by 24‐Hour Ambulatory Recordings Rather Than Exercise Stress Tests as a Risk Stratification Marker in Patients With Long QT Syndrome |
| title_full | T‐Wave Alternans Measured by 24‐Hour Ambulatory Recordings Rather Than Exercise Stress Tests as a Risk Stratification Marker in Patients With Long QT Syndrome |
| title_fullStr | T‐Wave Alternans Measured by 24‐Hour Ambulatory Recordings Rather Than Exercise Stress Tests as a Risk Stratification Marker in Patients With Long QT Syndrome |
| title_full_unstemmed | T‐Wave Alternans Measured by 24‐Hour Ambulatory Recordings Rather Than Exercise Stress Tests as a Risk Stratification Marker in Patients With Long QT Syndrome |
| title_short | T‐Wave Alternans Measured by 24‐Hour Ambulatory Recordings Rather Than Exercise Stress Tests as a Risk Stratification Marker in Patients With Long QT Syndrome |
| title_sort | t wave alternans measured by 24 hour ambulatory recordings rather than exercise stress tests as a risk stratification marker in patients with long qt syndrome |
| topic | 24‐hour ambulatory recordings cutoff point exercise stress tests life‐threatening arrhythmic events long QT syndrome T‐wave alternans |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.033619 |
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