Trial reportThe Journal of clinical investigation2014
Sympathetic activity-associated periodic repolarization dynamics predict mortality following myocardial infarction.
Trial report in The Journal of clinical investigation, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 2 registered trials, which are not on this map. Cited by 55 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Autonomic Regulation Trial (ART)
Implantable Cardiac Monitors in High-risk Post-infarction Patients With Cardiac Autonomic Dysfunction and Moderately Reduced Left Ventricular Ejection Fraction
Who cites it
55 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Angiotensin Receptor-Neprilysin Inhibitor Is Associated With Improved Cardiac Autonomic Function in Heart Failure.Journal of the American Heart Association · 2024Trial
- Trial
- Impact of energy drink versus coffee consumption on periodic repolarization dynamics: an interventional study.European journal of nutrition · 2022Trial
- Comparison of autonomic stress reactivity in young healthy versus aging subjects with heart disease.PloS one · 2019Trial
- 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.European heart journal · 2017Trial
- Shock index and modified shock index at discharge as predictors of long-term mortality after myocardial infarction: results from the Augsburg Myocardial Infarction Registry.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Automatic measurement of short-term variability of repolarization on human intracardiac electrograms predicts VT/VF events.Heart rhythm O2 · 2026Article
- Relevance of supraventricular ectopy in predicting atrial fibrillation after embolic stroke of undetermined source.International journal of cardiology. Heart & vasculature · 2026Article
- Synergistic predictive value of dynamic glycemic trajectories and variability metrics for 28-day mortality in critically ill heart failure.Scientific reports · 2026Article
- Cardiac autonomic function in elderly patients with and without atrial fibrillation.European heart journal open · 2026Article
- Sex-specific differences in the prognostic value of ischemic pre-hospital ECGs.Frontiers in cardiovascular medicine · 2026Article
- Article
- Traditional and advanced electrocardiographic measures of autonomic function in the population-based KORA-F3 study.European journal of epidemiology · 2025Article
- Cardiac autonomic function score: a novel risk stratification tool in the cardiac intensive care unit based on periodic repolarization dynamics and deceleration capacity of heart rate (LMU-eICU study).European heart journal. Digital health · 2025Article
- Positive association between stress hyperglycemia ratio and ICU mortality in patients with pulmonary embolism: A retrospective study.PloS one · 2025Article
- The effect of vagal nerve stimulation treatment on autonomic nervous system in patients with refractory epilepsy.Frontiers in neurology · 2025Article
- High-density isochronal repolarization mapping and re-entry vulnerability estimation for scar-related ventricular tachycardia ablation: mechanistic basis, clinical application, and challenges.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Review
- Biomarker Periodic Repolarization Dynamics Indicates Enhanced Risk for Arrhythmias and Sudden Cardiac Death in Myocardial Infarction in Pigs.Journal of the American Heart Association · 2024Article
- Simultaneous assessment of stress hyperglycemia ratio and glycemic variability to predict mortality in patients with coronary artery disease: a retrospective cohort study from the MIMIC-IV database.Cardiovascular diabetology · 2024Article
Corrections and comments
- Erratum issued
Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEnhanced sympathetic activity at the ventricular myocardium can destabilize repolarization, increasing the risk of death. Sympathetic activity is known to cluster in low-frequency bursts; therefore, we hypothesized that sympathetic activity induces periodic low-frequency changes of repolarization. We developed a technique to assess the sympathetic effect on repolarization and identified periodic components in the low-frequency spectral range (≤0.1 Hz), which we termed periodic repolarization dynamics (PRD).
methodsWe investigated the physiological properties of PRD in multiple experimental studies, including a swine model of steady-state ventilation (n=7) and human studies involving fixed atrial pacing (n=10), passive head-up tilt testing (n=11), low-intensity exercise testing (n=11), and beta blockade (n=10). We tested the prognostic power of PRD in 908 survivors of acute myocardial infarction (MI). Finally, we tested the predictive values of PRD and T-wave alternans (TWA) in 2,965 patients undergoing clinically indicated exercise testing.
resultsPRD was not related to underlying respiratory activity (P<0.001) or heart-rate variability (P=0.002). Furthermore, PRD was enhanced by activation of the sympathetic nervous system, and pharmacological blockade of sympathetic nervous system activity suppressed PRD (P≤0.005 for both). Increased PRD was the strongest single risk predictor of 5-year total mortality (hazard ratio 4.75, 95% CI 2.94-7.66; P<0.001) after acute MI. In patients undergoing exercise testing, the predictive value of PRD was strong and complementary to that of TWA.
conclusionWe have described and identified low-frequency rhythmic modulations of repolarization that are associated with sympathetic activity. Increased PRD can be used as a predictor of mortality in survivors of acute MI and patients undergoing exercise testing.
trial registrationClinicalTrials.gov NCT00196274.
fundingThis study was funded by Angewandte Klinische Forschung, University of Tübingen (252-1-0).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.