MASTER Trial Inclusion
Criteria
Prior MI
LVEF ≤ 30%
≥ 18 years of age
MASTER Trial Overview
Enrollment (n=654)
Baseline Clinical Data, MTWA Testing, ICD Implant
35 w/o valid MTWA test
44 w/ other exclusion
Clinical follow-up every 6 months
(Minimum F/U 2 years)
Repeat MTWA testing every 12 months
Analysis cohort (n=575)
MTWA Testing
Cambridge Heart CH2000 or Heartwave
Treadmill exercise recommended method
MTWA tests interpreted by Core Lab,
blinded to patient characteristics and
outcomes
Protocol required repeat testing of all
MTWA indeterminates (unless medical
justification supplied)
MTWA positive and indeterminate
combined (“non-negative”) for primary
outcome analysis
Baseline MTWA
Classification
400
350
300
250
200
150
100
50
0
68
293
214
MTWA Neg
Negative (37%)
MTWA Non-Neg
Positive (51%)
Indeterminate (12%)
Primary Endpoint Events
LTVTE
ICD Rx
SCD
Negative
Non-neg
(n=214)
(n=361)
22 (10.3%) 48 (13.3%)
20
43
2
5
LTVTE HR = 1.26, CI = 0.76-2.09, p = 0.37
MTWA and Total Mortality
Total mortality
Sudden cardiac
Non-sudden cardiac
Non-cardiac
Unknown
Negative
(n=214)
13 (6%)
3 (23%)
5 (39%)
3 (23%)
2 (15%)
Non-neg
(n=361)
46 (13%)
7 (15%)
17 (37%)
15 (33%)
7 (15%)
Total Mortality HR = 2.04, CI = 1.10-3.78, p = 0.02
Conclusions
In ICD treated patients with prior MI and
LVEF ≤ 30%, LTVTE does not differ
according to MTWA classification.
However, total mortality is higher in MTWA
non-negative patients.
Study Implications
MTWA testing should not be used to
withhold device therapy in MADIT-II
indicated patients.
The biological explanation(s) for excess
mortality in non-negative MTWA patients
requires further study.