An Idiotic Cardiology story

[Strength&Speed]

Anyone know about TWA (twave alternans testing)? This test was approved and paid for by the government because it was shown in studies to be equivalent to electrophysiologic testing in further stratifiying who has SCD. Unfortunately, which apparently some very intelligent people didn't realize, is that EP testing doesn't provide incremental benefit in risk stratifying who has SCD. Basically, we have been paying for something because it is as good as another worthless test. At the end of the article, it states...investigators are also thinking about looking into other studies that show family history is an important indicator of cardiac arrest. Meaning....they could have just ASKED THE PATIENT if anyone died in their family from cardiac arrest. But they do that only after they've spent a bagillion dollars on technology. *******es.

Hint: no one makes money off asking the patient questions.......sad sad

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[Myostatin]

Data on TWA testing has not been completely consistent from study to study, i.e. its not a slam dunk, but the majority of observational trials, and multiple prospective trials show a high negative predictive value and modest positive predictive value for TWA, in patients with ischemic (> nonischemic) cardiomyopathy, entirely leaving aside EP testing. Granted a few prospective trials have not shown benefit, but there are potentially trial related reasons for this. While its just one piece of information in a complex decision of who should and shouldn't get an ICD, in equivocal cases TWA testing (noninvasive test, a few hundred at most), is much less expensive than going ahead with an ICD implant (thousands). As for the study you refer to of TWA being equivalent to a family history of sudden cardiac death, I'd like to see that data. The bottom line is that we don't yet have a great risk stratification tool for SCD other than EF - and this needs to be worked on.

 

[Strength&Speed]

Data on TWA testing has not been completely consistent from study to study, i.e. its not a slam dunk, but the majority of observational trials, and multiple prospective trials show a high negative predictive value and modest positive predictive value for TWA, in patients with ischemic (> nonischemic) cardiomyopathy, entirely leaving aside EP testing. Granted a few prospective trials have not shown benefit, but there are potentially trial related reasons for this. While its just one piece of information in a complex decision of who should and shouldn't get an ICD, in equivocal cases TWA testing (noninvasive test, a few hundred at most), is much less expensive than going ahead with an ICD implant (thousands). As for the study you refer to of TWA being equivalent to a family history of sudden cardiac death, I'd like to see that data. The bottom line is that we don't yet have a great risk stratification tool for SCD other than EF - and this needs to be worked on.

Thanks, I was being a little edgy when I wrote that. Good stuff.

 

[Strength&Speed]

The other problem with ICD's is most people do not use them for the first 4-5 yrs anyway. And when they do fire, they have a 10x mortality risk within the next year. And these people are the sickies to start with. Not a good use of 35,000 + dollars if you ask me.