Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Biedersteiner Str. 29, 80802 Munich, Germany.
Eur Heart J. 2017 Jul 14;38(27):2110-2118. doi: 10.1093/eurheartj/ehx161.
To test the value of Periodic Repolarization Dynamics (PRD), a recently validated electrocardiographic marker of sympathetic activity, as a novel approach to predict sudden cardiac death (SCD) and non-sudden cardiac death (N-SCD) and to improve identification of patients that profit from ICD-implantation.
We included 856 post-infarction patients with left-ventricular ejection fraction (LVEF) ≤30% of the MADIT-II trial in sinus rhythm. Of these, 507 and 348 patients were randomized to ICD or conventional treatment. PRD was assessed from multipolar 10-min baseline ECGs. Primary and secondary endpoints were total mortality, SCD and N-SCD. Multivariable analyses included treatment group, QRS-duration, New York Heart Association classification, blood-urea nitrogen, diabetes mellitus, beta-blocker therapy and LVEF. During follow-up of 20.4 months, 119 patients died (53 SCD and 36 N-SCD). On multivariable analyses, increased PRD was a significant predictor of mortality (standardized coefficient 1.37[1.19-1.59]; P < 0.001) and SCD (1.40 [1.13-1.75]; P = 0.003) but also predicted N-SCD (1.41[1.10-1.81]; P = 0.006). While increased PRD predicted SCD in conventionally treated patients (1.61[1.23-2.11]; P < 0.001), it was predictive of N-SCD (1.63[1.28-2.09]; P < 0.001) and adequate ICD-therapies (1.20[1.03-1.39]; P = 0.017) in ICD-treated patients. ICD-treatment substantially reduced mortality in the lowest three PRD-quartiles by 53% (P = 0.001). However, there was no effect in the highest PRD-quartile (mortality increase by 29%; P = 0.412; P < 0.001 for difference) as the reduction of SCD was compensated by an increase of N-SCD.
In post-infarction patients with impaired LVEF, PRD is a significant predictor of SCD and N-SCD. Assessment of PRD is a promising tool to identify post-MI patients with reduced LVEF who might benefit from intensified treatment.
测试周期性复极动力学（PRD）的价值，这是一种最近经过验证的交感活动心电图标志物，作为预测心脏性猝死（SCD）和非心脏性猝死（N-SCD）的新方法，并改善对受益于 ICD 植入的患者的识别。
我们纳入了 MADIT-II 试验中左心室射血分数（LVEF）≤30%的 856 例梗死后患者，窦性心律。其中，507 例和 348 例患者被随机分配至 ICD 或常规治疗组。从多极 10 分钟基线心电图评估 PRD。主要和次要终点是总死亡率、SCD 和 N-SCD。多变量分析包括治疗组、QRS 持续时间、纽约心脏协会分级、血尿素氮、糖尿病、β受体阻滞剂治疗和 LVEF。在 20.4 个月的随访期间，119 例患者死亡（53 例 SCD 和 36 例 N-SCD）。在多变量分析中，PRD 增加是死亡率（标准化系数 1.37[1.19-1.59]；P<0.001）和 SCD（1.40 [1.13-1.75]；P=0.003）的显著预测因子，但也预测了 N-SCD（1.41[1.10-1.81]；P=0.006）。虽然 PRD 增加预测了常规治疗患者的 SCD（1.61[1.23-2.11]；P<0.001），但它也预测了 N-SCD（1.63[1.28-2.09]；P<0.001）和适当的 ICD 治疗（1.20[1.03-1.39]；P=0.017）。ICD 治疗可使最低三个 PRD 四分位数的死亡率降低 53%（P=0.001）。然而，在最高 PRD 四分位数中没有效果（死亡率增加 29%；P=0.412；P<0.001 用于差异），因为 SCD 的减少被 N-SCD 的增加所补偿。
在 LVEF 受损的梗死后患者中，PRD 是 SCD 和 N-SCD 的重要预测因子。PRD 评估是一种有前途的工具，可以识别 LVEF 降低的 MI 后患者，这些患者可能受益于强化治疗。
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