Journal of Electrocardiology
Volume 43, Issue 3 , Pages 251-259, May 2010

Association of Holter-based measures including T-wave alternans with risk of sudden cardiac death in the community-dwelling elderly: the Cardiovascular Health Study☆

  • Phyllis K. Stein, PhD

      Affiliations

    • Washington University School of Medicine, St. Louis, MO, USA
    • Corresponding Author InformationCorresponding author. Washington University School of Medicine HRV Laboratory, 4625 Lindell Blvd, Suite 402, St. Louis, MO 63108, USA.
    • ,
  • Devang Sanghavi, MD

      Affiliations

    • Washington University School of Medicine, St. Louis, MO, USA
    • ,
  • Nona Sotoodehnia, MD

      Affiliations

    • University of Washington, Seattle, WA, USA
    • ,
  • David S. Siscovick, MD, MPh

      Affiliations

    • University of Washington, Seattle, WA, USA
    • ,
  • John Gottdiener, MD

      Affiliations

    • University of Maryland School of Medicine, Baltimore, MD, USA

Received 30 October 2009 published online 25 January 2010.

Abstract 

Background

Sudden cardiac death (SCD) can be the first manifestation of cardiovascular disease. Development of screening methods for higher/lower risk is critical.

Methods

The Cardiovascular Health Study is a population-based study of risk factors for coronary heart disease and stroke those 65 years or older. Forty-nine (of 1649) with usable Holters and in normal sinus rhythm had SCD during follow-up and were matched with 2 controls, alive at the time of death of the case and not experiencing SCD on follow-up. Univariate and multivariate conditional logistic regression determined the association of Holter-based information and SCD.

Results

In univariate models, the upper half of ventricular premature contraction (VPC) counts, abnormal heart rate turbulence, decreased normalized low-frequency power, increased T-wave alternans (TWA), and decreased the short-term fractal scaling exponent (DFA1) were associated with SCD, but time domain heart rate variability was not. In multivariate models, the upper half of VPC counts (odds ratio [OR], 6.6) and having TWA of 37 μV or greater on channel 2 (OR, 4.8) were independently associated with SCD. Also, the upper half of VPC counts (OR, 6.9) and having a DFA1 of less than 1.05 (OR, 5.0) were independently associated with SCD. When additive effects were explored, having both higher VPCs and higher TWA was associated with an OR of 8.2 for SCD compared with 2.6 for having either. Also, having both higher VPCs and lower DFA1 was associated with an OR of 9.6 for SCD compared with 3.1 for having either.

Conclusions

Results support a potential role for 24-hour Holter recordings to identify older adults at increased or lower risk of SCD.

Keywords: Sudden death, Risk stratification, Ambulatory ECG monitoring, Heart rate variability, Heart rate turbulence, T-wave alternans, Arrhythmias, Population-dwelling elderly

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

☆ Disclosures: All authors declare no conflicts of interest and have nothing to declare financially.

PII: S0022-0736(09)00628-1

doi:10.1016/j.jelectrocard.2009.12.009

Journal of Electrocardiology
Volume 43, Issue 3 , Pages 251-259, May 2010

Article Tools

* Image Usage & Resolution