PMID- 17980258
OWN - NLM
STAT- MEDLINE
DCOM- 20071206
LR  - 20071105
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 50
IP  - 19
DP  - 2007 Nov 6
TI  - Prognostic value of T-wave alternans in patients with heart failure due to 
      nonischemic cardiomyopathy: results of the ALPHA Study.
PG  - 1896-904
AB  - OBJECTIVES: The aim of this study was to assess the prognostic value of T-wave 
      alternans (TWA) in New York Heart Association (NYHA) functional class II/III 
      patients with nonischemic cardiomyopathy and left ventricular ejection fraction 
      (LVEF) < or =40%. BACKGROUND: There is a strong need to identify reliable risk 
      stratifiers among heart failure candidates for implantable 
      cardioverter-defibrillator (ICD) prophylaxis. T-wave alternans may identify 
      low-risk subjects among post-myocardial infarction patients with depressed LVEF, 
      but its predictive role in nonischemic cardiomyopathy is unclear. METHODS: Four 
      hundred forty-six patients were enrolled and followed up for 18 to 24 months. The 
      primary end point was the combination of cardiac death + life-threatening 
      arrhythmias; secondary end points were total mortality and the combination of 
      arrhythmic death + life-threatening arrhythmias. RESULTS: Patients with abnormal 
      TWA (65%) compared with normal TWA (35%) tests were older (60 +/- 13 years vs. 57 
      +/- 12 years), were more frequently in NYHA functional class III (22% vs. 19%), 
      and had a modestly lower LVEF (29 +/- 7% vs. 31 +/- 7%). Primary end point rates 
      in patients with abnormal and normal TWA tests were 6.5% (95% confidence interval 
      [CI] 4.5% to 9.4%) and 1.6% (95% CI 0.6% to 4.4%), respectively. Unadjusted and 
      adjusted hazard ratios were 4.0 (95% CI 1.4% to 11.4%; p = 0.002) and 3.2 (95% CI 
      1.1% to 9.2%; p = 0.013), respectively. Hazard ratios for total mortality and for 
      arrhythmic death + life-threatening arrhythmias were 4.6 (p = 0.002) and 5.5 (p = 
      0.004), respectively; 18-month negative predictive values for the 3 end points 
      ranged between 97.3% and 98.6%. CONCLUSIONS: Among NYHA functional class II/III 
      nonischemic cardiomyopathy patients, an abnormal TWA test is associated with a 
      4-fold higher risk of cardiac death and life-threatening arrhythmias. Patients 
      with normal TWA tests have a very good prognosis and are likely to benefit little 
      from ICD therapy.
FAU - Salerno-Uriarte, Jorge A
AU  - Salerno-Uriarte JA
AD  - Dipartimento di Scienze Cardiovascolari, Universita degli Studi dell'Insubria, 
      Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
FAU - De Ferrari, Gaetano M
AU  - De Ferrari GM
FAU - Klersy, Catherine
AU  - Klersy C
FAU - Pedretti, Roberto F E
AU  - Pedretti RF
FAU - Tritto, Massimo
AU  - Tritto M
FAU - Sallusti, Luciano
AU  - Sallusti L
FAU - Libero, Luigi
AU  - Libero L
FAU - Pettinati, Giacinto
AU  - Pettinati G
FAU - Molon, Giulio
AU  - Molon G
FAU - Curnis, Antonio
AU  - Curnis A
FAU - Occhetta, Eraldo
AU  - Occhetta E
FAU - Morandi, Fabrizio
AU  - Morandi F
FAU - Ferrero, Paolo
AU  - Ferrero P
FAU - Accardi, Francesco
AU  - Accardi F
CN  - ALPHA Study Group Investigators
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20071022
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2007 Nov 6;50(19):1905-6. PMID: 17980259
MH  - Aged
MH  - Arrhythmias, Cardiac/*mortality/physiopathology
MH  - Cardiac Output, Low/mortality/physiopathology
MH  - Cardiomyopathy, Dilated/*mortality/physiopathology
MH  - Death, Sudden, Cardiac/epidemiology/prevention & control
MH  - Defibrillators, Implantable
MH  - *Electrocardiography
MH  - Exercise Test
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*mortality/physiopathology
MH  - Heart Rate/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Risk Factors
MH  - Stroke Volume/physiology
MH  - Survival Analysis
MH  - Ventricular Dysfunction, Left/*mortality/physiopathology
EDAT- 2007/11/06 09:00
MHDA- 2007/12/07 09:00
CRDT- 2007/11/06 09:00
PHST- 2007/05/15 00:00 [received]
PHST- 2007/08/09 00:00 [revised]
PHST- 2007/09/07 00:00 [accepted]
PHST- 2007/11/06 09:00 [pubmed]
PHST- 2007/12/07 09:00 [medline]
PHST- 2007/11/06 09:00 [entrez]
AID - S0735-1097(07)02896-3 [pii]
AID - 10.1016/j.jacc.2007.09.004 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2007 Nov 6;50(19):1896-904. doi: 10.1016/j.jacc.2007.09.004. 
      Epub 2007 Oct 22.