| dc.contributor.advisor | Zabel, Markus Prof. Dr. | |
| dc.contributor.author | Hofschulte, Frank | |
| dc.date.accessioned | 2016-01-25T07:40:55Z | |
| dc.date.available | 2016-02-16T23:50:07Z | |
| dc.date.issued | 2016-01-25 | |
| dc.identifier.uri | http://hdl.handle.net/11858/00-1735-0000-0028-86A1-0 | |
| dc.identifier.uri | http://dx.doi.org/10.53846/goediss-5474 | |
| dc.language.iso | deu | de |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
| dc.subject.ddc | 610 | de |
| dc.title | Prognostische Wertigkeit des T-Wellen-Alternans bei Patienten mit Erstimplantation eines implantierbaren Kardioverter-Defibrillators | de |
| dc.type | doctoralThesis | de |
| dc.title.translated | Predictive value of T-wave alternans in patients who underwent first-time implantable cardioverter-defibrillator implantation | de |
| dc.contributor.referee | Paul, Thomas Prof. Dr. | |
| dc.date.examination | 2016-02-09 | |
| dc.description.abstracteng | Background: The majority of sudden cardiac deaths (SCD) are caused by ventricular (malignant) tachyarrhythmias. An implantable cardioverter-defibrillator (ICD) is a well-established device for primary and secondary prevention of sudden cardiac death. Identifying patients at highest risk for SCD is a challenging task of modern cardiology. There are already well-known risk factors e.g. structural heart failures. Current risk stratification for predicting major arrhythmic is based on invasive and non-invasive apparatus-based diagnostic methods. The microvolt T-wave alternans (MTWA) test is a non-invasive treadmill test which predictive value to identify risk patient for SCD is still uncertain.
Objectives:
The aim of this clinical trial was to determine the predictive value of MTWA for malignant ventricular tachyarrhythmias and all-cause mortality in an unselected, consecutive cohort of patients who underwent first-time ICD implantation.
Methods and Results:
A total of 134 patients (mean age 64 years, mean left ventricular ejection fraction 31 %, 79 % male) who got first-time implanted ICD for primary or secondary prevention underwent a MTWA test shortly before or few days after the intervention in addition to common recommended risk stratification methods. However, indications for implantations were confirmed on present evidence-based guidelines. Over one-half (52 %) of patients had a negative MTWA test. A positive test was observed in 37 %. The remaining patients (11 %) had a so called “indeterminate” test result. Positive and indeterminate tests were subsumed under “non-negative” (63 %). Hence, it was possible to consider individual analysis (positive vs. negative vs. indeterminate) and a dichotomous group analysis (“non-negative” vs. “negative”).
During follow-up (mean follow-up 12 months) there were eight deaths and three patients received an appropriate ICD shock. All patients with appropriate ICD shock had an indeterminate test result. Three deceased patients were tested negative; two had an indeterminate result and three patients had a positive MTWA test. The analysis showed that those individuals with an indeterminate test result had a significantly increased risk for incident appropriate ICD shock (p = 0,007). However, there was no significant difference among the dichotomous group analysis (non-negative vs. negative).
Conclusions:
The findings indicate that an indeterminate MTWA test is a significant prognostic value on the occurrence of appropriate ICD shock in candidates for an ICD. | de |
| dc.contributor.coReferee | Roessler, Markus PD Dr. | |
| dc.contributor.thirdReferee | Oppermann, Martin Prof. Dr. | |
| dc.subject.ger | T-Wellen-Alternans | de |
| dc.subject.ger | Plötzlicher Herztod | de |
| dc.subject.ger | Risikostratifikation | de |
| dc.subject.eng | T-wave alternans | de |
| dc.subject.eng | sudden cardiac death | de |
| dc.subject.eng | risk stratification | de |
| dc.identifier.urn | urn:nbn:de:gbv:7-11858/00-1735-0000-0028-86A1-0-5 | |
| dc.affiliation.institute | Medizinische Fakultät | de |
| dc.subject.gokfull | Medizin (PPN619874732) | de |
| dc.subject.gokfull | Kardiologie (PPN619875755) | de |
| dc.description.embargoed | 2016-02-16 | |
| dc.identifier.ppn | 846451964 | |