Prävalenz und Korrelation von Parametern der Risikostratifizierung für den plötzlichen Herztod im ICD-Patientenkollektiv

Prevalence and correlation of risk stratifiers for sudden cardiac death in patients with ICD

by Christian Holger Hohmann
Doctoral thesis
Date of Examination:2018-02-12
Date of issue:2018-01-26
Advisor:Prof. Dr. Markus Zabel
Referee:Prof. Dr. Markus Zabel
Referee:PD Dr. Ulrich Krause
Referee:Prof. Dr. Bernhard Danner
Persistent Address: http://dx.doi.org/10.53846/goediss-6696

 

 

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Abstract

English

Sudden cardiac death (SCD) is a common cause of death and appears about 70.000 times a year in Germany. Implantable cardioverter defibrillators (ICDs) are an important treatment. Many people with ICD never receive an appropriate shock. For patient saftey and reduction of costs new risk stratifiers are needed. Feasibility and frequency of pathologic values of risk stratifiers like Microvolt T-Wave Alternans (MTWA), NT-proBNP and Holter Variables (Heart Rate Variability [HRV], Heart Rate Turbulence[HRT], Deceleration  Capacity [DC], PVC, VT)  are being investigated and correlated with each other.  In conclusion there was a high frequency of pathologic values of NT-proBNP, MTWA, HRV, HRT, DC, VES and VT in this high risk population. Non-negative MTWA results correlated strongly with parameters of heart failure. The data indicates that there may be an interaction between TWA and HRT with autonomic nervous system.  Fort he first time it was possible to show that HRV is completely independent from TWA results in ICD-patients probably because of less vagal influence on myocardial repolarization. All parameters of HRV correlate with each other except of LF/HF. Determination of all results might not more be necessary. The Deceleration Capacity, a rather new risk stratifier, needs more examination. DC showed a correlation to almost all other stratifiers except SDNN. Therefore several (patho-)physiological processes seem to have impact on the Deceleration Capacity. Further studies are needed to examine these stratifiers (in combination) in order for an outcome to be determined.
Keywords: sudden cardiac death; Heart Rate Variability; T-Wave Alternans; Heart Rate Turbulence; autonomic nervous system; NT-proBNP; Deceleration Capacity
Schlagwörter: plötzlicher Herztod; Herzfrequenzturbulenz; NT-proBNP; Herzfrequenzvariabilität
 
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