• Cardiology Clinical Trials
• Inflammatory Disease

A noninvasive microvolt T-wave alternans (TWA) test in patients with nonischemic cardiomyopathy can identify patients who do not need an implantable cardiac defibrillator (ICD), said Gaetano M. De Ferrari, MD, of San Matteo Hospital, Pavia, Italy, who presented the results of the T-Wave Alternans in Patients with Heart Failure Trial (ALPHA). ALPHA enrolled 446 patients with New York Heart Association (NYHA) class 2 and 3 heart failure with cardiomyopathy of nonischemic origin and left ventricular ejection fraction (LVEF) of <40%. Patients underwent TWA testing and were followed for 18 to 24 months. Abnormal tests were observed in 65% and normal tests in 35% of patients.

Patients with an abnormal TWA test had a four-fold higher risk of the primary endpoint—cardiac death and life-threatening arrhythmias (p=.001). They also had a four-fold higher total risk of death (p=.002), and a five-fold higher risk of arrhythmic death, life-threatening arrhythmias, and hospitalizations (p=.004). The negative predictive value for the primary endpoint was 98.7% at 12 months and 97.3% at 18 months.

“Patients with a normal TWA test have a very good prognosis and are unlikely to benefit from ICD therapy,” Dr. De Ferrari said.

• © 2007 MD Conference Express