Risikostratifizierung für plötzlichen Herztod nach Myokardinfarkt jenseits der LV-Funktion

Zusammenfassung

Der plötzliche Herztod (PHT) ist die häufigste Einzeltodesursache in der westlichen Welt. Insbesondere Patienten nach Myokardinfarkt und mit Herzinsuffizienz weisen ein erhöhtes Risiko auf. Der Nachweis einer hochgradig eingeschränkten linksventrikulären Funktion gilt als der Goldstandard in der Identifikation von Hochrisikopatienten, allerdings sind Sensitivität und Spezifität dieses Kriteriums unzureichend. So werden mehr als zwei Drittel der Patienten, die in der Folgezeit nach Herzinfarkt versterben, nicht korrekt als Hochrisikopatienten identifiziert. Biosignalbasierte Parameter, welche Störungen des kardialen autonomen Nervensystems quantifizieren, erlauben es möglicherweise, Hochrisikopatienten unabhängig von der Pumpleistung des Herzens zu identifizieren. Diese Marker können mittels mathematischer Methoden aus herkömmlichen Oberflächen-EKGs berechnet werden. SMART-MI ist eine randomisierte Interventionsstudie, die einen neuen Ansatz der personalisierten Postinfarkttherapie bei Patienten mit autonomer Dysfunktion und nur moderat eingeschränkter linksventrikulärer Pumpfunktion untersucht.

Abstract

Sudden cardiac death is the leading single cause of death in the western world. Especially patients after myocardial infarction and patients with heart failure are at increased risk. Proof of a severely reduced left ventricular ejection fraction is the gold standard for the identification of high risk patients, however its sensitivity and specificity are insufficient. Thereby two thirds of patients who die following a myocardial infarction, are not correctly identified as high risk patients. Biosignal-based parameters which quantify disturbances of the cardiac autonomous nervous systems may allow identification of high risk patients independently from left ventricular ejection fraction. These markers can be calculated using mathematical methods from a conventional surface ECG. SMART-MI is a randomized trial that evaluates the efficacy of a novel personalized approach to post-infarction treatment based on remote monitoring in patients with cardiac autonomic dysfunction and only moderately reduced left ventricular function.

Schlüsselwörter

Risikostratifizierung - Myokardinfarkt - Periodic Repolarization Dynamics - plötzlicher Herztod - Herzfrequenzvariabilität - Dezelerationskapazität

Key words

myocardial infarction - sudden cardiac death - risk stratification - heart rate variability - periodic repolarization dynamics - deceleration capacity

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