A combined anatomic and electrophysiologic substrate based approach for sudden cardiac death risk stratification

Faisal M. Merchant, Hui Zheng, Thomas Bigger, Richard Steinman, Takanori Ikeda, Roberto F E Pedretti, Jorge A. Salerno-Uriarte, Catherine Klersy, Paul S. Chan, Cheryl Bartone, Stefan H. Hohnloser, Jeremy N. Ruskin, Antonis A. Armoundas

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Background Although left ventricular ejection fraction (LVEF) is the primary determinant for sudden cardiac death (SCD) risk stratification, in isolation, LVEF is a sub-optimal risk stratifier. We assessed whether a multi-marker strategy would provide more robust SCD risk stratification than LVEF alone. Methods We collected patient-level data (n = 3355) from 6 studies assessing the prognostic utility of microvolt T-wave alternans (MTWA) testing. Two thirds of the group was used for derivation (n = 2242) and one-third for validation (n = 1113). The discriminative capacity of the multivariable model was assessed using the area under the receiver-operating characteristic curve (c-index). The primary endpoint was SCD at 24 months. Results In the derivation cohort, 59 patients experienced SCD by 24 months. Stepwise selection suggested that a model based on 3 parameters (LVEF, coronary artery disease and MTWA status) provided optimal SCD risk prediction. In the derivation cohort, the c-index of the model was 0.817, which was significantly better than LVEF used as a single variable (0.637, P

Original languageEnglish
Pages (from-to)744-752
Number of pages9
JournalAmerican Heart Journal
Issue number4
Publication statusPublished - Oct 2013


ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Merchant, F. M., Zheng, H., Bigger, T., Steinman, R., Ikeda, T., Pedretti, R. F. E., Salerno-Uriarte, J. A., Klersy, C., Chan, P. S., Bartone, C., Hohnloser, S. H., Ruskin, J. N., & Armoundas, A. A. (2013). A combined anatomic and electrophysiologic substrate based approach for sudden cardiac death risk stratification. American Heart Journal, 166(4), 744-752. https://doi.org/10.1016/j.ahj.2013.06.023