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1
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Eötvös CA, Avram T, Lazar RD, Zehan IG, Moldovan MP, Schiop-Tentea P, Coseriu G, Sarb A, Gusetu G, Buzdugan E, Chiorescu R, Mocan-Hognogi D, Pop S, Heist EK, Blendea D. Papillary Muscles of the Left Ventricle: Integrating Electrical and Mechanical Dynamics. J Cardiovasc Dev Dis 2024; 12:14. [PMID: 39852292 PMCID: PMC11765973 DOI: 10.3390/jcdd12010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/19/2024] [Accepted: 12/30/2024] [Indexed: 01/26/2025] Open
Abstract
BACKGROUND Papillary muscles are structures integrated into the mitral valve apparatus, having both electrical and mechanical roles. The importance of the papillary muscles (PM) is mainly related to cardiac arrhythmias and mitral regurgitation. The aim of this review is to offer an overview of the anatomy and physiology of the papillary muscles, along with their involvement in cardiovascular pathologies, including arrhythmia development in various conditions and their contribution to secondary mitral regurgitation. METHODS A literature search was performed on PubMed using the following relevant keywords: papillary muscles, mitral valve, arrhythmia, anatomy, and physiology. RESULTS During the cardiac cycle, papillary muscles have continuous dimensional and pressure changes. On one hand, their synchrony or dyssynchrony impacts the process of mitral valve opening and closure, and on the other hand, the pressure changes can trigger electrical instability. There is increased awareness of papillary muscles as an arrhythmic source. Arrhythmias arising from PM were found in patients with or without structural heart disease, via Purkinje fibres, due to increased automaticity or triggered activity. CONCLUSIONS Despite the interest in mitral valve physiology, there are still many unknowns in relation to the papillary muscles, especially with regard to their role in arrhythmogenesis and the pathogenesis of mitral regurgitation.
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Affiliation(s)
- Csilla Andrea Eötvös
- Niculae Stancioiu Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400001 Cluj-Napoca, Romania; (C.A.E.); (T.A.)
| | - Teodora Avram
- Niculae Stancioiu Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400001 Cluj-Napoca, Romania; (C.A.E.); (T.A.)
| | - Roxana Daiana Lazar
- Niculae Stancioiu Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400001 Cluj-Napoca, Romania; (C.A.E.); (T.A.)
| | - Iulia Georgiana Zehan
- Niculae Stancioiu Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400001 Cluj-Napoca, Romania; (C.A.E.); (T.A.)
| | - Madalina Patricia Moldovan
- Niculae Stancioiu Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400001 Cluj-Napoca, Romania; (C.A.E.); (T.A.)
| | - Patricia Schiop-Tentea
- Niculae Stancioiu Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400001 Cluj-Napoca, Romania; (C.A.E.); (T.A.)
| | - Giorgia Coseriu
- Niculae Stancioiu Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400001 Cluj-Napoca, Romania; (C.A.E.); (T.A.)
| | - Adriana Sarb
- Niculae Stancioiu Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400001 Cluj-Napoca, Romania; (C.A.E.); (T.A.)
| | - Gabriel Gusetu
- Rehabilitation Hospital, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400066 Cluj-Napoca, Romania
| | - Elena Buzdugan
- Municipal Hospital, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400139 Cluj-Napoca, Romania
| | - Roxana Chiorescu
- Emergency Clinical County Hospital, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, Romania
| | - Diana Mocan-Hognogi
- Emergency Clinical County Hospital, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, Romania
| | - Sorin Pop
- Emergency Clinical County Hospital, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400347 Cluj-Napoca, Romania
| | - E. Kevin Heist
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA;
| | - Dan Blendea
- Niculae Stancioiu Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400001 Cluj-Napoca, Romania; (C.A.E.); (T.A.)
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Chen XM, Wu Y, Yu J, Wang LC. Postextrasystolic repolarization changes of ventricular premature beats correlate with structural heart disease and suggest prognostic implications. J Electrocardiol 2024; 85:39-45. [PMID: 38843738 DOI: 10.1016/j.jelectrocard.2024.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/28/2024] [Accepted: 05/20/2024] [Indexed: 08/10/2024]
Abstract
Ventricular premature beats (VPBs) can potentially lead to life-threatening arrhythmias, especially in patients with structural heart disease (SHD). However, identifying dangerous VPBs has always been a topic and challenge in clinical research. This study aimed to evaluate the relationship of postextrasystolic repolarization changes of VPBs with SHD and its possible additional prognostic value. 125 cases of frequent VPBs with SHD and 156 cases without SHD were included. VPBs were stratified selected from 24 h Holter recording according to the scale of heart rate. Average QTDV (difference value of QT interval between the first beat follow VPB with beats preceding VPB) and max QTDV were significantly longer in SHD group than that in the non-SHD group. For identifying patients with SHD, the best cutoff value were 19 ms for average QTDV (AUC = 0.931) and 29 ms for max QTDV (AUC = 0.910) respectively. For Tu morphology analysis, PT2 (postextrasystolic T wave amplitude change ≥2 mV), reversed T wave, and Pu (postextrasystolic u wave) change were all highly specific, but low sensitive as identification of SHD. Compared with average QTDV < 19 ms patients, average QTDV ≥ 19 ms patients had significantly larger left heart size and wores left cardiac function. The presence of non-persistent ventricular tachycardia runs was higher in average QTDV ≥ 19 ms group and positive Pu change group than that in control groups. The findings indicated that postextrasystolic repolarization changes of VPBs correlated with SHD and suggested potential value in prognosis asssessment.
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Affiliation(s)
- Xu-Miao Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Yang Wu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China
| | - Jin Yu
- Department of Electrocardiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Li-Chun Wang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China, and Key Laboratory of Assisted Circulation, NHC, Guangzhou, China.
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3
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Chen Z, Jia K, Zheng Y, Zhang N, Wang X, Tse G, Zhang Z, Hu H, Liu T. Electrocardiographic characteristics of bladder cancer patients receiving preoperative chemotherapy combined with immunotherapy. Ann Noninvasive Electrocardiol 2024; 29:e13107. [PMID: 38288514 PMCID: PMC10809286 DOI: 10.1111/anec.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE Patients treated with preoperative chemotherapy and immunotherapy for bladder cancer may be at increased risk of cardiotoxicity and electrophysiological abnormalities. This study aimed to analyze their electrocardiographic (ECG) alterations. METHODS Patients with bladder cancer who were hospitalized and receiving tislelizumab plus nab-paclitaxel (TnP) were enrolled prospectively. ECG, cardiac biomarkers, and echocardiography were performed at baseline and the end of TnP. RESULTS A total of 60 patients (76.7% males), including 30 muscle-invasive and 30 non-muscle-invasive bladder cancer, received three or four cycles of TnP, respectively. Hypertension was the commonest comorbidity (41.7%), and 25 patients (41.7%) were prescribed cardiovascular drugs. In comparison with baseline characteristics, cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were within normal ranges after TnP. However, echocardiographic parameter of left ventricular ejection fraction slightly decreased after TnP (62.81 ± 3.81% to 61.10 ± 4.37%, p = .011). The incidence of abnormal ECG increased from 65.0% at baseline to 76.7%, of which only a higher prevalence of fragmented QRS (fQRS) was observed (33.3% to 50.0%, p = .013; mainly in inferior leads). ECG parameters of QT dispersion (QTd) were prolonged significantly after the regimen (39.50 ± 11.37 to 44.20 ± 15.85 ms, p = .019). CONCLUSION In bladder cancer patients receiving preoperative chemotherapy combined with immunotherapy, the main ECG abnormality was fQRS and QTd, with relatively normal cardiac biomarkers and echocardiographic parameters. Regular ECG screening should be carried out carefully to detect potential cardiotoxicity in the long-term follow-up.
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Affiliation(s)
- Zi‐Liang Chen
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Kai‐Peng Jia
- Department of Urology, The Second Hospital of Tianjin Medical UniversityTianjin Institute of UrologyTianjinChina
| | - Yi Zheng
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Nan Zhang
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Xin Wang
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Gary Tse
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Kent and Medway Medical SchoolCanterburyKentUK
- School of Nursing and Health StudiesHong Kong Metropolitan UniversityHong KongChina
| | - Zhi‐Wei Zhang
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Hai‐Long Hu
- Department of Urology, The Second Hospital of Tianjin Medical UniversityTianjin Institute of UrologyTianjinChina
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
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Asil S, Geneş M, Yaşar S, Fırtına S, Görmel S, Yıldırım E, Gökoğlan Y, Tolunay H, Buğan B, Yaşar AS, Çelik M, Yüksel UÇ, Barçın C, Kabul HK. Atrial and ventricular arrhythmia predictors with electrocardiographic parameters in myocardial infarction with non-obstructive coronary artery disease (MINOCA). Cardiovasc J Afr 2023; 34:206-211. [PMID: 36166395 PMCID: PMC10870316 DOI: 10.5830/cvja-2022-045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The clinical importance and recognition of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasing. Nevertheless, no studies are investigating the risk of atrial fibrillation and ventricular arrhythmia in MINOCA patients. This study aimed to determine the risk of arrhythmia with electrocardiographic predictors in MINOCA patients. METHODS In this study, patients diagnosed with MINOCA and stable out-patients without significant lesions in their coronary arteries were compared. Morphology-voltage-Pwave duration electrocardiography (MPV ECG) score was used to determine atrial arrhythmia risk. QT interval and QT dispersion Tpeak-Tend time and Tpeak-Tend/QT interval were used to determine ventricular arrhythmia risk. RESULTS A total of 155 patients were included in our study. Seventy-seven of these patients were in the MINOCA group. There was no statistically significant difference between the two groups in MPV ECG score (1.95 ± 1.03 vs 1.68 ± 1.14, p = 0.128). P-wave voltage, P-wave morphology and P-wave duration, which are components of the MPV ECG score, were not statistically significantly different. The QRS complex duration (90.21 ± 14.87 vs 82.99 ± 21.59 ms, p = 0.017), ST interval (271.95 ± 45.91 vs 302.31 ± 38.40 ms, p < 0.001), corrected QT interval (438.17 ± 43.80 vs 421.41 ± 28.39, p = 0.005) and QT dispersion (60.75 ± 22.77 vs 34.19 ± 12.95, p < 0.001) were statistically significantly higher in the MINOCA group. The Tpeak-Tend (89.53 ± 32.16 vs 65.22 ± 18.11, p < 0.001), Tpeak-Tend/QT interval (0.2306 ± 0.0813 vs 0.1676 ± 0.0470, p < 0.001) and Tpeak-Tend/corrected QT interval (0.2043 ± 0.6997 vs 0.1551 ± 0.4310, p < 0.001) ratios were also significantly higher in patients with MINOCA. CONCLUSIONS In the MINOCA patients, there was no increase in the risk of atrial fibrillation based on ECG predictors. However, it was shown that there could be a significant increase in the risk of ventricular arrhythmia. We believe this study could be helpful for specific recommendations concerning duration of hospitalisation and follow up in MINOCA patients.
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Affiliation(s)
- Serkan Asil
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey.
| | - Muhammet Geneş
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Salim Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Serdar Fırtına
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Suat Görmel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Erkan Yıldırım
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Yalçın Gökoğlan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hatice Tolunay
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Barış Buğan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ayşe Saatçi Yaşar
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Murat Çelik
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Uygar Çağdaş Yüksel
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Cem Barçın
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Hasan Kutsi Kabul
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey
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Stoičkov V, Radovanović D, Deljanin-Ilić M, Perišić Z, Pavlović M, Tasić I, Stoičkov I, Golubović M, Scanlan AT, Jakovljević V, Stojanović E. Sport-related differences in QT dispersion and echocardiographic parameters in male athletes. Sci Rep 2023; 13:6770. [PMID: 37185606 PMCID: PMC10130053 DOI: 10.1038/s41598-023-33957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
The aim of this study was to compare QT dispersion (QTd) and echocardiographic parameters in male athletes competing across different sports (long-distance running, volleyball, football, powerlifting, and bodybuilding) and a control population. Significant moderate-strong differences (p < 0.001, [Formula: see text] = 0.52-0.71) were found in corrected QTd, intraventricular septal wall thickness (ISWT), posterior wall thickness (PWT), relative wall thickness (RWT) and LV (left ventricular) index between groups. Corrected QTd, ISWT, PWT, and RWT were significantly (p < 0.001) higher in powerlifters and bodybuilders compared to other athlete groups and controls. While all athlete groups displayed a significantly higher LV index (p < 0.05) compared to controls, corrected QTd was significantly lower (p < 0.001) only in long-distance runners, volleyball athletes, and football athletes compared to controls. Normal or eccentric LV hypertrophy (LVH) was observed in most long-distance runners (58% and 33%), volleyball athletes (50% and 50%), and football athletes (56% and 41%). In contrast, concentric LVH was observed in most powerlifters (58%) and bodybuilders (54%). Advanced LVH, predominantly concentric in nature, appears to be accompanied with increased QTd in powerlifters and bodybuilders. On the other hand, runners, volleyball athletes, and football athletes experienced LVH toward the upper threshold of the normal reference range alongside reduced QTd compared to other groups.
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Affiliation(s)
- Viktor Stoičkov
- Institute for Treatment and Rehabilitation "Niska Banja", Clinic for Cardiovascular Diseases, Niš, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Niš, Niš, Serbia
| | | | - Marina Deljanin-Ilić
- Institute for Treatment and Rehabilitation "Niska Banja", Clinic for Cardiovascular Diseases, Niš, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Niš, Niš, Serbia
| | - Zoran Perišić
- Faculty of Medicine, Department of Internal Medicine, University of Niš, Niš, Serbia
- Cardiovascular Diseases Clinic, Clinical Center Niš, Niš, Serbia
| | - Milan Pavlović
- Faculty of Medicine, Department of Internal Medicine, University of Niš, Niš, Serbia
- Cardiovascular Diseases Clinic, Clinical Center Niš, Niš, Serbia
| | - Ivan Tasić
- Institute for Treatment and Rehabilitation "Niska Banja", Clinic for Cardiovascular Diseases, Niš, Serbia
- Faculty of Medicine, Department of Internal Medicine, University of Niš, Niš, Serbia
| | | | - Mlađan Golubović
- Faculty of Medicine, Department of Internal Medicine, University of Niš, Niš, Serbia
- Cardiovascular and Transplant Surgery Clinic, Clinical Center Niš, Niš, Serbia
| | - Aaron T Scanlan
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Vladimir Jakovljević
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Human Pathology, Moscow State Medical University IM Sechenov, Moscow, Russia
| | - Emilija Stojanović
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
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Abdelmegid MAKF, Bakr MM, Shams-Eddin H, Youssef AA, Abdel-Galeel A. Effect of reperfusion strategy on QT dispersion in patients with acute myocardial infarction: Impact on in-hospital arrhythmia. World J Cardiol 2023; 15:106-115. [PMID: 37033680 PMCID: PMC10074997 DOI: 10.4330/wjc.v15.i3.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Myocardial ischemia and ST-elevation myocardial infarction (STEMI) increase QT dispersion (QTD) and corrected QT dispersion (QTcD), and are also associated with ventricular arrhythmia. AIM To evaluate the effects of reperfusion strategy [primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy] on QTD and QTcD in STEMI patients and assess the impact of the chosen strategy on the occurrence of in-hospital arrhythmia. METHODS This prospective, observational, multicenter study included 240 patients admitted with STEMI who were treated with either PPCI (group I) or fibrinolytic therapy (group II). QTD and QTcD were measured on admission and 24 hr after reperfusion, and patients were observed to detect in-hospital arrhythmia. RESULTS There were significant reductions in QTD and QTcD from admission to 24 hr in both group I and group II patients. QTD and QTcD were found to be shorter in group I patients at 24 hr than those in group II (53 ± 19 msec vs 60 ± 18 msec, P = 0.005 and 60 ± 21 msec vs 69+22 msec, P = 0.003, respectively). The occurrence of in-hospital arrhythmia was significantly more frequent in group II than in group I (25 patients, 20.8% vs 8 patients, 6.7%, P = 0.001). Furthermore, QTD and QTcD were higher in patients with in-hospital arrhythmia than those without (P = 0.001 and P = 0.02, respectively). CONCLUSION In STEMI patients, PPCI and fibrinolytic therapy effectively reduced QTD and QTcD, with a higher observed reduction using PPCI. PPCI was associated with a lower incidence of in-hospital arrhythmia than fibrinolytic therapy. In addition, QTD and QTcD were shorter in patients not experiencing in-hospital arrhythmia than those with arrhythmia.
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Affiliation(s)
- Mohamed Aboel-Kassem F Abdelmegid
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
- Department of Cardiology, Sohag Heart and GIT Center, Sohag 85264, Egypt
| | - Mohamed M Bakr
- Department of Cardiology, Assiut Police Hospital, Assiut 71526, Egypt
| | - Hamdy Shams-Eddin
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
| | - Amr A Youssef
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
| | - Ahmed Abdel-Galeel
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
- Department of Cardiology, Qena General Hospital, Qena 92354, Egypt.
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Evaluation of Cardiac Arrhythmia Susceptibility in Pediatric Familial Mediterranean Fever Patients. JOURNAL OF CONTEMPORARY MEDICINE 2023. [DOI: 10.16899/jcm.1232293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Aim: Familial Mediterranean fever is an autoinflammatory disease characterized by attacks of inflammation. Despite treatment, there is evidence of subclinical persistence of inflammation with normal laboratory values. This study was conducted to investigate the cardiac effects of continued subclinical inflammation in children and the predisposition towards arrhythmia in familial Mediterranean fever.
Materials and Methods: Age and sex-matched familial Mediterranean fever patients and healthy controls were compared in terms of demographic, laboratory, echocardiographic and electrocardiographic data. The patients with familial Mediterranean fever were grouped according to disease severity scores and compared in terms of electrocardiographic data that could indicate arrhythmogenesis. Correlation analysis was used to examine the relationship between the electrocardiographic measurements and the clinical and laboratory data.
Results: In the comparison of the two groups, no significant difference was found in the echocardiographic measurements in terms of left ventricular systolic and diastolic functions. According to these data, QT and Tp-e intervals were significantly longer in those with familial Mediterranean fever (p=0.002, p=0.046, respectively). When the patients were classified according to the 3 separate disease severity scores, QT dispersion in the moderate-severe disease group was significantly longer than in the mild disease group (p
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Choi SY, Lee KJ, Kim SC, Lee EH, Lee YM, Kim YB, Yi DY, Kim JY, Kang B, Jang HJ, Hong SJ, Choi YJ, Kim HJ. Cardiac Complications Associated with Eating Disorders in Children: A Multicenter Retrospective Study. Pediatr Gastroenterol Hepatol Nutr 2022; 25:432-440. [PMID: 36148287 PMCID: PMC9482826 DOI: 10.5223/pghn.2022.25.5.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/30/2022] [Accepted: 07/20/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Eating disorders often result in somatic complications, including cardiac abnormalities. Cardiac abnormalities may involve any part of the heart, including the cardiac conduction system, and can lead to sudden cardiac death. The current study aimed to evaluate the incidence of cardiac complications in pediatric patients with eating disorders and their associated factors. METHODS We retrospectively analyzed patients aged 10-18 years who were diagnosed with DSM-V (Diagnostic and Statistical Manual of Mental Disorder-V) eating disorders and underwent electrocardiography (ECG) and/or echocardiography between January 2015 and May 2020. RESULTS In total, 127 patients were included, of whom 113 (89.0%) were female. The median body mass index (BMI) was 15.05±3.69 kg/m2. Overall, 74 patients (58.3%) had ECG abnormalities, with sinus bradycardia being the most common abnormality (91.9%). Patients with ECG abnormalities had significantly lower BMI (14.35±2.78 kg/m2 vs. 16.06± 4.55 kg/m2, p<0.001) than patients without ECG abnormalities, as well as lower phosphorus and higher cholesterol levels. Among the 46 patients who underwent echocardiographic evaluation, 23 (50.0%) had echocardiographic abnormalities, with pericardial effusion being the most common (60.9%). The median left ventricular mass (LVM) and ejection fraction were 67.97±21.25 g and 66.91±28.76%, respectively. LVM and BMI showed a positive correlation (r=0.604, p<0.001). After weight gain, the amount of pericardial effusion was reduced in 3 patients, and 30 patients presented with normal ECG findings. CONCLUSION Cardiac abnormalities are relatively frequent in patients with eating disorders. Physicians should focus on this somatic complication and careful monitoring is required.
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Affiliation(s)
- So Yoon Choi
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Kyung Jae Lee
- Department of Pediatrics, College of Medicine, Hallym University, Chuncheon, Korea
| | - Soon Chul Kim
- Department of Pediatrics, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Eun Hye Lee
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Yoo Min Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yu-Bin Kim
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ju Young Kim
- Department of Pediatrics, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyo-Jeong Jang
- Department of Pediatrics, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Suk Jin Hong
- Department of Pediatrics, Daegu Catholic University School of Medicine, Daegu, Korea
| | - You Jin Choi
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hyun Jin Kim
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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QTc intervals are not prolonged in former ELBW infants at pre-adolescent age. Pediatr Res 2022; 92:848-852. [PMID: 34857877 DOI: 10.1038/s41390-021-01877-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/01/2021] [Accepted: 11/13/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Whether preterm birth is associated with cardiac conduction or repolarization abnormalities in later life is still poorly explored, with conflicting data on QTc prolongation in former extreme low birth weight (ELBW, <1000 g) infants. METHODS Twelve lead electrocardiograms (ECG) at rest, collected in the PREMATurity as predictor of children's Cardiovascular-renal Health (PREMATCH) study in former ELBW cases and term controls during pre-adolescence (8-14 years) were analyzed on corrected QT time (QTc, Bazett) and QT dispersion (QTd). ECG findings were compared between groups (Mann-Whitney), and associations with clinical and biochemical findings were explored (Spearman). In ELBW cases, associations between QTc and perinatal characteristics (at birth, neonatal stay) were explored (Mann-Whitney, Spearman). RESULTS QTc and QTd were similar between 93 ELBW cases and 87 controls [409 (range 360-465) versus 409 (337-460); 40 (0-100) versus 39 (0-110)] ms. Age, height, weight, or body mass index were not associated with the QTc interval, while female sex (median difference 11.4 ms) and lower potassium (r = -0.26) were associated with longer QTc interval. We could not observe any significant association between QTc interval and perinatal characteristics. CONCLUSIONS There were no differences in QTc or QTd between ELBW and term controls in ECGs at rest in pre-adolescents. IMPACT This study aimed to assess the differences in QTc and QTd intervals between extreme low birth weight infants (ELBW) and term controls in electrocardiographic measurements at rest during pre-adolescence. This analysis confirmed the absence of significant differences in QTc or QTd findings between ELBW cases and term controls, while female sex and lower potassium were associated with a prolonged QTc interval. These data suggest that QTc screening strategies-including for pharmacovigilance-should not differentiate between former ELBW cases and term controls. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02147457.
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Ueda Y, Asamoto M, Kariya T, Akai T, Hoshina K, Uchida K. Ventricular fibrillation during carotid endarterectomy and bailout stenting: a case report. JA Clin Rep 2022; 8:26. [PMID: 35357630 PMCID: PMC8971334 DOI: 10.1186/s40981-022-00517-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Carotid artery manipulation is not a special technique but reports of intraoperative ventricular fibrillation are rare. The risk of fatal arrhythmias may be hidden behind routine surgical techniques and anesthetic management. We focused on QT prolongation and QT dispersion. Case presentation A 77-year-old man underwent carotid endarterectomy and bailout stenting. Although there were no obvious preoperative risk factors for intraoperative ventricular tachyarrhythmia, ventricular fibrillation (VF) had occurred during a maneuver of the carotid artery under hypercapnia. QTc was prolonged from 317 ms before surgery to 458 ms before the onset of VF. QTc dispersion between leads II and III was also increased to 50 ms. Hypomagnesemia was noted after resuscitation by electrical defibrillation, adrenaline, and noradrenaline. Conclusions We considered that the combination of multiple risk factors led to the development of ventricular fibrillation. It should be noted that carotid artery manipulation has the potential to cause arrhythmias.
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Khalilian MR, Ziaratban M, Alizadeh P, Norouzi AR, Shirvani A. Comparison of QT dispersion before and after PDA device closure in pediatrics. Ann Noninvasive Electrocardiol 2022; 27:e12945. [PMID: 35267238 PMCID: PMC9107093 DOI: 10.1111/anec.12945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Numerous studies have shown that QT dispersion (QTd) can be a suitable criterion for risk assessment of arrhythmia in patients with congenital heart disease. Pulmonary arterial hypertension (PAH) increases the risk of cardiac arrhythmia by changing ventricular repolarization homogeneity. In this study, we assessed QTd changes after PDA device closure and the effect of PAH on these changes. Methods Between October 2018 and March 2021, 97 patients (48 males; 49 females; mean age 31.36 ± 4.26 months; range 3 months to 14 years) who satisfied the primary inclusion criteria and did not meet the exclusion criteria and underwent PDA device closure intervention were included in the study. Echocardiography was performed before the procedure. QT corrected (QTc), and QTd and PR intervals were measured according to the patients’ standard 12‐lead ECGs in two periods, preoperative (1 day) and after (3 months). Results In the general group, QTc and QTd decreased significantly after PDA closure. Based on our classification of the patients in two groups of high PAP and normal PAP, the three parameters QTc, QTd, and PR interval were assessed separately in the two groups. All three parameters decreased significantly in the normal PAP and high PAP groups. Conclusions However, a left‐to‐right shunt through the patent ductus arteriosus can affect ventricular repolarization; this effect seems to be particularly more significant when there is pulmonary hypertension.
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Affiliation(s)
- Mohammad Reza Khalilian
- Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Ziaratban
- Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parinaz Alizadeh
- Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Reza Norouzi
- Pediatric Respiratory Diseases Research Center (PRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Increased QT Dispersion and High Risk of Ventricular Arrhythmias is Associated with Hyperuricemia in Individuals with Normal Renal Function. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2021. [DOI: 10.2478/jce-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aim: Uric acid elevation has been shown to be an important risk factor for cardiovascular and cerebrobascular disease. QT dispersion (QTd) is a parameter that shows the heterogeneity of ventricular repolarization and can be calculated noninvasively from surface electrocardiography. Increased QTd has been associated with severe arrhythmia and risk of sudden death in many patients and disease groups. In this context, we aimed to investigate the effect of uric acid levels on QTd and the effects of decrease in uric acid levels on QTd.
Methods: A total of 225 patients with normal renal function were included in the study; 133 of these patients were hyperuricemic (>7 mg/dL), and the remaining 72 patients were normouricemic (Group 1). The hyperuricemic patients were randomly divided into 2 groups, one group (n = 67) was given placebo (Group 2) for 4 months, and the remaining 66 patients were given allopurinol 300 mg/day (Group 3).
Results: Hyperuricemic patients had higher hsCRP and QTd and lower eGFR values compared to the normouricemic control group. After 4 months of treatment, 66 patients treated with allopurinol showed a significant decrease in serum uric acid, systolic and diastolic blood pressure, and hsCRP levels, and a significant increase in eGFR. Although the QTd values in the treatment group did not decrease to the same levels as in the normouricemic control group, a statistically significant decrease was found compared to their baseline values. In hyperuricemic control and normouricemic control patients, there were no differences in the levels of uric acid, hsCRP, eGFR, systolic and diastolic blood pressure, and QTd values compared to baseline values.
Conclusions: There was a significant association between elevated serum uric acid and QTd, as well as with inflammatory biomarkers. Also, patients who had received hypouricemic therapy during the follow-up period presented a significant decrease in inflammatory markers as well as QTd. This indicates the beneficial effects of decreasing uric acid levels in decreasing the risk for future major adverse events related to ventricular arrhythmias.
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Khalilian MR, Ghasemi A, Khazaei N, Khoshkhou S, Mahmoudi E. Repolarization disparity as a predictor of response to Head up Tilt-table Test in pediatric syncope. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1397-1403. [PMID: 34181271 DOI: 10.1111/pace.14305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/01/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Head up Tilt-table Test (HUTT) is a practical examination of the most common type of pediatrics syncope. The electrocardiographic (ECG) changes during this test, show the autonomic defects that cause neuraly-mediated syncope in response to tilting process. METHODS All pediatric syncope patients referred to our center in a 1-year period, were included in the study. HUTT was performed and patients were classified into two groups of Negative and Positive HUTT results, and the latter group was subclassified as three subgroups of "vasodepressor", "cardioinhibitory" and "mixed type" responses to HUTT. QT and corrected QT (QTc) dispersion was measured by the baseline standard 12-lead ECG obtained before HUTT. RESULTS Eighty-six patients with a mean age of 12.19 ± 5.34 were included. Patients with positive HUTT were significantly younger and male gender was more prevalent in this group. Mean QT dispersion was significantly higher in patients with positive HUTT result and also in patients with mixed response to HUTT compared to isolated vasodepressor response. Duration of QTc interval did not change between different study groups. Reciever-Operating-Characteristic (ROC) analysis showed that QT dispersion higher than 32 ms is a significant predictor of positive HUTT result (with 92% sensitivity and 98% specificity) and values higher than 40 ms can predict the mixed type of response to HUTT (with 84% sensitivity and 63% specificity). CONCLUSIONS Baseline myocardial repolarization disparity significantly correlates with susceptibility to symptomatic vasovagal syncope. This pathology seems to play its role mainly via excessive vagotonic response to sympathetic activation during HUTT process (known as cardioinhibitory response).
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Affiliation(s)
- Mohammad Reza Khalilian
- Department of Pediatrics, School of Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolrahim Ghasemi
- Department of Pediatrics, School of Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narges Khazaei
- Department of Pediatrics, School of Medicine, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Khoshkhou
- Department of Pediatrics, School of Medicine, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Mahmoudi
- Department of Pediatrics, School of Medicine, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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HARBALIOĞLU H, GENC O, ALICI G, QUİSİ A, YILDIRIM A. Features on ECG During Admission May Predict In-hospital Events for COVID-19 Patients. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.922646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ciobanu A, Gheorghe GS, Inţă OM, Zhou J, Zhang Q, Tse G. Mutual Information Reveals Non-linear Relationships between Electrocardiographic Conduction or Repolarization Indices and Mechanical Dispersion by Speckle-Tracking Echocardiography in the General Population. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1408-1420. [PMID: 33622621 DOI: 10.1016/j.ultrasmedbio.2021.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
Electrical inhomogeneities can lead to regional heterogeneity in left ventricular contraction. We investigated the correlation between electrocardiographic parameters of conduction and/or repolarization and myocardial longitudinal strain-derived parameters in a general population. Mean and dispersion (maximum-minimum) values were calculated for the electrocardiographic indices: QT interval, Tpeak-Tend interval (Tpe), JTpeak interval (JTp), JTend interval (JTe), QTpeak interval (QTp). Mechanical dispersion was assessed using the standard deviation (SD) of time-to-peak longitudinal strains (MDSD) and the difference between the longest time and shortest time to peak strain (MDdelta) by speckle-tracking echocardiography. A total of 59 patients, 60 ± 12 y, were included. Tpe, Tpe/QT, Tpe/JTp and Tpe/JTe correlated well with MDSD and MDdelta (r ≥ 0.43, p < 0.001). Mutual information revealed significant non-linear relationships between most of the electrocardiographic indices measured and mechanical dispersion. In conclusion, there is a moderate linear correlation between electrocardiographic indices reflecting repolarization heterogeneities and speckle tracking-assessed mechanical dispersion.
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Affiliation(s)
- Ana Ciobanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, Bucharest, Romania.
| | - Gabriela Silvia Gheorghe
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, Bucharest, Romania
| | - Oana Mihaela Inţă
- Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, Bucharest, Romania
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong S.A.R., China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong S.A.R., China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
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Keskin G, Karaman ST, Basat O. Evaluation of the relationship between the level of addiction and exhaled carbon monoxide levels with QT dispersion in smokers. Tob Induc Dis 2021; 19:22. [PMID: 33815033 PMCID: PMC8010797 DOI: 10.18332/tid/133053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smoking increases the risk of arrhythmia. QT dispersion (QTd) is an important indicator for the determination of ventricular arrhythmia. In this study, we aimed to determine the arrhythmia risk by evaluating QTd in smokers and to assess the relationship between the level of nicotine addiction and carbon monoxide (CO) level in the expiratory air. METHODS This study was designed as a single-center, cross-sectional study. Among the chronic smokers referred to the Smoking Cessation Clinic of a tertiary hospital between October 2019 and January 2020, all those who had no risk factors for cardiac arrhythmias, except smoking, were included in the study. Sociodemographic data and smoking characteristics of the participants were collected and exhaled CO levels were measured. QT intervals were measured in all leads by using a 12-lead standard electrocardiogram (ECG), and heart rate corrected QT (QTc) intervals, QT dispersion (QTd), and corrected QT dispersion (QTcd) were calculated. RESULTS The mean age of the 250 patients was 37.2±9.3 years and the majority of patients (65%) were male. The mean amount of smoking was 25.74±16.03 packs/year and the mean value of CO was 12.36±7.06 ppm. The mean QTd was 23.83±13.12 ms, and the mean QTcd was 26.63±15.02 ms. A statistically significant relationship was found between QTd and QTcd and level of addiction, consumption of sticks/day and packs/year, and exhaled CO values (all p<0.001). CONCLUSIONS It was found that as the level of addiction, cigarette use amount, exhaled CO levels, and BMI increased in smokers, QT dispersion and arrhythmia risk increased.
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Affiliation(s)
- Gamze Keskin
- Gaziosmanpaşa Training and Research Hospital, Department of Family Medicine, University of Health Sciences, Istanbul, Turkey
| | - Sibel Tunç Karaman
- Gaziosmanpaşa Training and Research Hospital, Department of Family Medicine, University of Health Sciences, Istanbul, Turkey
| | - Okcan Basat
- Gaziosmanpaşa Training and Research Hospital, Department of Family Medicine, University of Health Sciences, Istanbul, Turkey
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Shi H, Jiang X. Correlation Between QTc Prolongation and Obstructive Sleep Apnea in Patients with Type 2 Diabetes Mellitus. Med Sci Monit 2020; 26:e926954. [PMID: 32853184 PMCID: PMC7478427 DOI: 10.12659/msm.926954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) plays an important role in the progression of cardiovascular disease (CVD), and is a common symptom in patients with type 2 diabetes mellitus (T2DM). Prolongation of corrected QT interval (QTc) reflects ventricular arrhythmias and CVD. The aim of this study was to explore the relationship between OSA and QTc in T2DM patients and to evaluate the potential application of QTc in clinical practice. MATERIAL AND METHODS A total of 358 T2DM patients were involved in this study. OSA was diagnosed with apnea-hypopnea index ≥5 by full-night polysomnography and QTc was measured by a 12-lead electrocardiogram (ECG). Patients were grouped into 2 groups based on median QTc, and clinical data were studied. Logistic regression analysis was used to investigate the association between OSA and QTc with adjusted age, sex, body mass index (BMI), hypertension, total bilirubin (TBL), and smoking history. RESULTS Among 358 T2DM patients, 59.2% had OSA. Compared to those in the QTc <418 ms group, older patients, females, patients with higher BMI, and OSA patients in the QTc ≥418 ms group were more likely to have OSA (p<0.05). Correlation analysis suggested that OSA was associated with longer QTc (OR: 2.355, 95% CI: 1.529-3.626, p<0.001). For T2DM patients with QTc ≥418 ms, older patients (OR: 1.042, 95% CI: 1.042-1.064, p<0.001), females (OR: 2.36, 95% CI: 1.371-4.063, p<0.01), and patients with higher BMI (OR: 1.113, 95% CI: 1.037-1.195, p<0.01) were significantly more likely to have OSA. CONCLUSIONS In this cross-sectional study, we found that the presence and severity of OSA was associated with QTc prolongation in 358 patients with T2DM, and age, female sex, and BMI appear to be independent risk factors for OSA and CVD.
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Affiliation(s)
- Huan Shi
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
| | - Xiaohong Jiang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China (mainland)
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ECG Changes in Melanoma Patients Undergoing Cancer Therapy-Data From the ECoR Registry. J Clin Med 2020; 9:jcm9072060. [PMID: 32630003 PMCID: PMC7408861 DOI: 10.3390/jcm9072060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022] Open
Abstract
We aimed to evaluate whether therapy with immune checkpoint inhibitors (ICI) leads to changes in electrocardiogram (ECG) parameters in melanoma patients. We retrospectively examined 41 patients (46% women, age 61 ± 12years) with advanced melanoma (stage III/IV) before and during ICI treatment from our “Essen Cardio-oncology Registry” (ECoR). ECGs were analyzed before and 4–12 weeks after therapy started (follow-up, 90 ± 51 days). Heart rate, PR time, QRS duration and duration of the corrected QT (QTc) interval were recorded. QT dispersion (QTd) was calculated. Heart rate, PR time, QRS and QTc did not differ when comparing values before and after therapy started. QTd was prolonged after therapy started (32 ± 16 ms vs. 47 ± 19 ms, n = 41, p < 0.0001). Subgroup analyses revealed prolonged QTd in patients that received a combination immunotherapy with ipilimumab and nivolumab (31 ± 14 ms vs. 50 ± 14 ms, n = 21, p < 0.0001), while QTd in patients with anti–programmed death 1 (PD-1) inhibitor monotherapy did not change after therapy started. QTd is prolonged in patients under ICI combination therapy, potentially signaling an increased susceptibility to ventricular arrhythmias.
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Karadeniz C. Editorial to "Association of QT dispersion with mortality and arrhythmic events-A meta-analysis of observational studies". J Arrhythm 2020; 36:116-117. [PMID: 32071629 PMCID: PMC7011803 DOI: 10.1002/joa3.12265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/03/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Cem Karadeniz
- Department of Pediatric Cardiology & Pediatric Arrhythmia and ElectrophysiologyKatip Celebi UniversityIzmirTurkey
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