Rizas Konstantinos D, Hamm Wolfgang, Kääb Stefan, Schmidt Georg, Bauer Axel
Munich University Clinic, Munich, Germany; Deutsches Zentrum für Herzkreislaufforschung (DZHK), Munich, Germany.
Deutsches Zentrum für Herzkreislaufforschung (DZHK), Munich, Germany; Technical University of Munich, Munich, Germany.
Arrhythm Electrophysiol Rev. 2016 May;5(1):31-6. doi: 10.15420/aer.2015:30:2.
Periodic repolarisation dynamics (PRD) refers to low-frequency (≤0.1Hz) modulations of cardiac repolarisation instability. Spontaneous PRD can be assessed non-invasively from 3D high-resolution resting ECGs. Physiological and experimental studies have indicated that PRD correlates with efferent sympathetic nerve activity, which clusters in low-frequency bursts. PRD is increased by physiological provocations that lead to an enhancement of sympathetic activity, whereas it is suppressed by pharmacological β-blockade. Electrophysiological studies revealed that PRD occurs independently from heart rate variability. Increased PRD under resting conditions is a strong predictor of mortality in post-myocardial infarction (post-MI) patients, yielding independent prognostic value from left-ventricular ejection fraction (LVEF), heart rate variability, the Global Registry of Acute Coronary Events score and other established risk markers. The predictive value of PRD is particularly strong in post-MI patients with preserved LVEF (>35 %) in whom it identifies a new high-risk group of patients. The upcoming Implantable Cardiac Monitors in High-Risk Post-Infarction Patients with Cardiac Autonomic Dysfunction and Moderately Reduced Left Ventricular Ejection Fraction (SMART-MI) trial will test prophylactic strategies in high-risk post-MI patients with LVEF 36-50 % identified by PRD and deceleration capacity of heart rate (NCT02594488).
周期性复极动力学（PRD）是指心脏复极不稳定性的低频（≤0.1Hz）调制。可从三维高分辨率静息心电图无创评估自发性PRD。生理和实验研究表明，PRD与传出交感神经活动相关，后者以低频爆发形式聚集。导致交感神经活动增强的生理刺激会使PRD增加，而药理学β受体阻滞剂则会抑制PRD。电生理研究表明，PRD的发生独立于心率变异性。静息状态下PRD增加是心肌梗死后（post-MI）患者死亡率的强预测指标，其具有独立于左心室射血分数（LVEF）、心率变异性、急性冠状动脉事件全球注册评分及其他既定风险标志物的预后价值。PRD的预测价值在LVEF保留（>35%）的心肌梗死后患者中尤为显著，它能识别出一组新的高危患者。即将开展的“心肌梗死后心脏自主神经功能障碍和左心室射血分数中度降低的高危患者植入式心脏监测器（SMART-MI）”试验将测试针对由PRD和心率减速能力识别出的LVEF为36-50%的高危心肌梗死后患者的预防策略（NCT02594488）。
