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Heart Rhythm. 2019 Feb 25. pii: S1547-5271(19)30146-8. doi: 10.1016/j.hrthm.2019.02.024. [Epub ahead of print]

Periodic Repolarization Dynamics as Risk Predictor after Myocardial Infarction: Prospective Validation Study.

Author information

1
Medizinische Klinik und Poliklinik I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany; German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany.
2
Deutsches Herzkompetenz Zentrum, Abteilung Kardiologie, Universitätsklinikum Tübingen, Germany.
3
German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany.
4
Deutsches Herzkompetenz Zentrum, Abteilung Kardiologie, Universitätsklinikum Tübingen, Germany; Department of Cardiology, University Hospital, Basel, Switzerland.
5
Medizinische Klinik und Poliklinik I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany; German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany. Electronic address: axel.bauer@med.uni-muenchen.de.

Abstract

BACKGROUND:

Periodic Repolarization Dynamics (PRD) is a novel electrocardiographic phenomenon that refers to sympathetic-activity associated low-frequency modulations of cardiac repolarization. Retrospective post myocardial infarction (MI) studies revealed that increased PRD indicates increased risk for subsequent death.

OBJECTIVE:

This is the first prospective study to validate PRD in post-MI patients receiving up-to-date treatment.

METHODS:

Four hundred fifty-five survivors of a myocardial infarction (age ≤80 years) in sinus rhythm were enrolled. PRD was assessed from 20-minute ECG recordings (2048 Hz, Porti-TMS) and prospectively dichotomized at 5.75 deg2. Primary and secondary endpoints were total and cardiovascular mortality, respectively. Multivariable analyses additionally included Global Registry of Acute Coronary Events score (dichotomized at >140), left ventricular ejection fraction (dichotomized at ≤35%), diabetes mellitus and deceleration capacity of heart rate (dichotomized at ≤2.5ms). The prognostic power of PRD was evaluated by ROC-curve analysis, cox-regression analysis and the integrated discrimination improvement (IDI) index.

RESULTS:

During median follow-up period of 27 months, 47 patients died. Twenty-three of these deaths were classified as cardiovascular. Increased PRD was significantly associated with both endpoints, yielding areas under ROC-curves of 69.3 % (60.2-77.8%) and 79.1% (69.7-86.7%) for total and cardiovascular mortality, respectively (p<0.001 for both). On multivariable analysis, increased PRD indicated a 2.2-and 9.5-fold risk of total and cardiovascular mortality (p=0.024 and p=0.003, respectively). Addition of PRD to the models significantly improved IDI-index for total (p =0.047) and cardiovascular mortality (p =0.007).

CONCLUSION:

PRD is a strong and independent predictor of total and cardiovascular mortality in post-infarction patients treated by contemporary therapy.

KEYWORDS:

myocardial infarction; periodic repolarization dynamics; risk stratification; sudden cardiac death; sympathetic nervous system

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