微伏级T波电交替与恶性心律失常和死亡风险的荟萃分析

Meta-analysis of the predictive value of microvolt T-wave alternans for mortality and severe arrhythmia

目的:用荟萃分析系统评价微伏级T波电交替(MTWA)对植入心内除颤器(ICD)的心力衰竭患者恶性心律失常和死亡的预测价值。方法:检索1990-01-2012-07关于运动负荷试验时异常的MTWA对植入ICD心力衰竭患者预后进行预测的前瞻性临床研究。通过χ2统计量结合I2统计量进行异质性检验,用倒方差法固定效应模型分析MTWA对恶性心律失常和死亡的风险,得到合并效应指标风险比(HR)及95%CI。结果:共有6项研究被纳入,总样本量2 551例。其中725例MTWA阳性,766例MTWA阴性,349例MTWA不确定,711例MTWA非阴性(包括阳性和不确定性)。与MTWA阴性的患者比较,MTWA异常的患者发生恶性心律失常和死亡的危险度增加(HR=1.821,95%CI为1.452～2.283,P<0.01)。结论:采用MTWA检测进行危险分层的评估,对心力衰竭患者恶性心律失常事件和死亡有预测价值。

Objective：To explore the predictive value of microvolt T-wave alternans（MTWA） testing for mortality and severe arrhythmic events in heart failure patients with ICD by Meta-analysis.Method：Prospective studies on the predictive value of exercise-induced MTWA published between January 1990 and July 2012 were retrieved.Heterogeneity was analyzed with χ2 and I2.Pooled hazard ratio（HR） and 95%CI were used to estimate the relationship of MTWA and risk of severe arrhythmic events and death by fixed effect model（inverse variance method）.Result：Six studies were included,and the total sample size was 2 551 patients,including 725 positive,766 negative,349 indeterminate,and 711 non-negative（which included both positive and indeterminate tests） MTWA test results.The risk of severe arrhythmic events or mortality was higher in patients with an abnormal MTWA compared to the negative test（HR=1.821,95%CI=1.452 to 2.283,P0.01）.Conclusion：MTWA testing has significant value for the prediction of severe arrhythmic events or mortality in heart failure patients.