{"id":"45e587291c61","type":"article","url":"https://hartvaat.nl/2017/07/14/voorspelling-van-plotse-versus-niet-plotse-hartdood-na-mi-met-verminderde-lvef/","title":"Voorspelling van plotse versus niet-plotse hartdood na MI met verminderde LVEF","title_en":"Prediction of sudden and non-sudden cardiac death in post-infarction patients with reduced left ventricular ejection fraction by periodic repolarization dynamics: MADIT-II substudy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx161","source_url":"https://doi.org/10.1093/eurheartj/ehx161","authors":["Konstantinos D Rizas","Scott McNitt","Wolfgang Hamm","Steffen Massberg","Stefan Kääb","Wojciech Zareba","Jean-Philippe Couderc","Axel Bauer"],"significance":6,"published":"2017-07-14","source_date":"2017-07-14","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study tested Periodic Repolarization Dynamics (PRD), a novel ECG marker of sympathetic activity, for predicting sudden versus non-sudden cardiac death in post-MI patients with reduced LVEF, exploring improved risk stratification for ICD candidacy.","created":"2026-07-03T10:26:47Z","updated":"2026-07-03T13:26:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die plotse versus niet-plotse hartdood probeerde te voorspellen bij post-MI-patiënten met verminderde LVEF middels periodegramanalyse. Relevant voor ICD-indicatiestelling.","abstract_original":"AIMS: 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. METHODS AND RESULTS: 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. CONCLUSION: 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."}