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Title: Electrocardiography for risk stratification of sudden cardiac death in chronic kidney disease
Author: Poulikakos, Dimitrios
ISNI:       0000 0004 6060 9985
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2015
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Sudden cardiac death accounts for one fourth of deaths in prevalent dialysis patients yet risk stratification for targeted preventive treatment remains an unmet clinical need. This thesis belongs to the field of non-invasive electrophysiology and its goal is to investigate if electrocardiographic monitoring during dialysis can provide subject specific profiles of selected indices of repolarisation and cardiac autonomic modulation derived with computerised analysis of the surface electrocardiogram that would be suitable for risk stratification purposes for sudden cardiac death in dialysis patients. To this end the following objectives were set: a) test the intrasubject reproducibility of selected repolarisation descriptors and of spectral parameters of heart rate variability (HRV) during 5 dialysis sessions, b) investigate their relationship with clinical and laboratory parameters associated with increased cardiovascular risk, c) examine the interrelationship between cardiac autonomic regulation and repolarisation indices, and d) follow up the study population for major arrhythmic events. The thesis is organised in a manner that allows selected chapters based on published articles to be read in their own right. A literature review on the epidemiology and possible underlying mechanisms of ventricular arrhythmias in chronic kidney disease is presented in Chapter 2. Chapter 3 deals with aspects of the study design and methodology. Chapter 4 includes the results on intrasubject stability of selected repolarisation descriptors. Chapter 5 reports on repolarisation descriptors in patients that suffered major arrhythmic events after a follow up period of 18 months. Chapter 6 reports on sex dependent association between HRV and pulse pressure and Chapter 7 reports an association between HRV and bone mineral abnormalities. T.he interrelationship between HRV and the studied repolarisation indices is investigated in Chapter 8. In Chapter 9 the future research plan is briefly outlined and Chapter 10 summarises and concludes the thesis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available