Nicht-invasive Risikostratifikation für den plötzlichen Herztod bei Patienten mit angeborenem Herzfehler
Non-invasive Riskstratification for Sudden Cardiac Death in Patients with Congenital Heart Disease
by Sabine Roth
Date of Examination:2018-12-04
Date of issue:2018-12-03
Advisor:Prof. Dr. Markus Zabel
Referee:PD Dr. Michael Steinmetz
Referee:Prof. Dr. Martin Oppermann
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Description:Nicht-invasive Risikostratifikation für den plötzlichen Herztod bei Patienten mit angeborenem Herzfehler
Abstract
English
Background: The assessment of the risk of sudden cardiac death by non-invasive markers is well established for patients with myocardial infarction and ischemic cardiomyopathy. Up to now it has not been investigated for patients with congenital heart disease. Objectives: The aim of this study was to verify if there are similar results of non-invasive risk markers in a pediatric cardiology study population as in patients with myocardial infarction and ischemic cardiomyopathy. Methods: A total of 41 pediatric cardiology patients with a perceived risk for malignant arrhythmias underwent the assessment of late potentials (fQRS, RMS, LAS), T-Wave-Alternans (TWA, max. neg. HR), heart rate variability (HRV, SDNN=standard deviation of RR-intervals), heart rate turbulence (HRT, TO=turbulence onset, TS=turbulence slope) and deceleration capacity. There were two control groups. One group of 16 healthy students and one of 33 post myocardial infarction patients. There also was a mean follow up of 3.6 years for death, resuscitation and appropriate ICD-shocks. Results: The healthy student group had all over normal values. The pediatric cardiology patients displayed pathological findings which were more pronounced in patients with increasing severity of the basic disease. During 3.6 years of mean follow up there was one resuscitation in the pediatric cardiology study cohort and eight deaths and two appropriate ICD-shocks in the post myocardial infarction patients group. Conclusion: The established noninvasive risk markers showed pathological findings in the pediatric cardiology patients. But there were no significant differences associated with endpoints during our long term follow up.
Keywords: risk stratification; sudden cardiac death; T-Wave-Alternans; heart rate variability; heart rate turbulence; late potentials; congenital heart disease
Schlagwörter: angeborener Herzfehler; Risikostratifikation; plötzlicher Herztod; T-Wellen-Alternans; Herzfrequenzvariabilität; Herzfrequenzturbulenz; Spätpotentiale