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Ker J. The Evolving Science on Sudden Cardiac Death-The Marriage of Left Ventricular Hypertrophy and QT-Dispersion. Echocardiography 2024; 41:e70026. [PMID: 39494959 DOI: 10.1111/echo.70026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 10/23/2024] [Indexed: 11/05/2024] Open
Affiliation(s)
- James Ker
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa
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Stojanović E, Scanlan A, Jakovljević V, Stoičkov V, Radovanović D. Left Ventricular Geometric Pattern Impacts QT Dispersion in Males Athletes and Sedentary Men. Echocardiography 2024; 41:e15937. [PMID: 39347578 DOI: 10.1111/echo.15937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/09/2024] [Accepted: 09/13/2024] [Indexed: 10/01/2024] Open
Abstract
AIM To (1) compare QT dispersion (QTd) and echocardiographic features between athletes with concentric left ventricular (LV) hypertrophy, athletes with eccentric LV hypertrophy, and sedentary controls with a normal LV geometric pattern and (2) quantify associations between QTd and echocardiographic features within these groups. METHODS Male athletes competing in different sports and sedentary men were stratified into groups according to their LV geometric pattern. These groups included eccentric LV hypertrophy (LV index > 115 g/m2, relative wall thickness [RWT] < 0.42) consisting of 38 athletes, concentric LV hypertrophy (LV index > 115 g/m2, RWT > 0.42) consisting of 40 athletes, and normal LV geometric pattern (LV index < 115 g/m2, RWT < 0.42) consisting of 40 sedentary controls. Following a cross-sectional design, participants underwent electrocardiographic (ECG) and echocardiographic screening. Data were compared between groups using one-way analyses of variance with Bonferroni post hoc tests. Associations between corrected QTd and echocardiographic variables were quantified using Pearson correlations. RESULTS Alongside structural disparities between groups, corrected QTd was significantly (p < 0.001) lower in athletes with eccentric LV hypertrophy compared to athletes with concentric LV hypertrophy and sedentary controls. Significant, moderate-to-very-large correlations were found between corrected QTd and interventricular septal wall thickness in athletes with concentric (r = 0.416, p = 0.008) or eccentric LV hypertrophy (r = 0.734, p < 0.001), and sedentary controls (r = 0.464, p = 0.003). CONCLUSION The provided comparative and relationship data may inform the development of more precise approaches for ECG and echocardiographic screening in athletes, particularly in those with concentric LV hypertrophy who may be at greater risk for developing prolonged QTd.
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Affiliation(s)
- Emilija Stojanović
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Faculty of Sport Science, Department of Training and Exercise Science, Ruhr University Bochum, Bochum, Germany
| | - Aaron Scanlan
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Vladimir Jakovljević
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Human Pathology, First Moscow State Medical University IM Sechenov, Moscow, Russian Federation
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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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Bastos RF, Tuleski GLR, Sousa MG. QT interval instability and QRS interval dispersion in healthy cats and cats with a hypertrophic cardiomyopathy phenotype. J Feline Med Surg 2023; 25:1098612X231151479. [PMID: 36745542 PMCID: PMC10812083 DOI: 10.1177/1098612x231151479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Hypertrophic cardiomyopathy (HCM) is the most common heart disease in cats. Electrocardiographic (ECG) analysis can help with the diagnosis of HCM and also in the investigation of the secondary consequences of the disease. This study investigated ECG markers of QT interval variability (total instability [TI], short-term instability [STI], long-term instability [LTI], QT variance [QTv]), mean QT interval (QTa) and QT interval corrected for heart rate (QTac), as well as the duration (QRSd) and dispersion (QRSv) of the QRS interval in healthy cats and in those with HCM. METHODS Data were collected from 63 domestic cats: 40 in the control group and 23 in the HCM group. Fifty consecutive QT intervals were recorded for all cats and then QTa, QTac, QTv, TI, LTI and STI were calculated. QRSd and QRSv were also obtained for all animals. A Mann-Whitney U-test was used for group comparison. Receiver operating characteristic curves were plotted to evaluate the sensitivity and specificity of all markers for HCM. Logistic regression analysis was performed to assess the risks of cats having HCM, based on the studied indexes. RESULTS QTa (P <0.01), QTac (P <0.01), QRSd (P <0.01) and STI (P = 0.02) were higher in the HCM group. QTa >158.8 ms, QTac >27.4 ms and QRSd >0.045 s had an accuracy of 77.4%, 68.2% and 80.9%, respectively, in detecting HCM. Logistic regression showed that cats with QTa >158 ms, QTac >27.4 ms and QRSd >0.045 s had a 1.58-, 1,23- and 6.5-fold higher risk, respectively, of developing HCM. CONCLUSIONS AND RELEVANCE Cats with HCM had higher ventricular instability as assessed by STI and showed a prolongation of the QT and QRS intervals via the QTa, QTac and QRSd markers. These markers show potential as ancillary screening tools for identifying the presence of HCM.
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Affiliation(s)
- Rodrigo Franco Bastos
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Giovana LR Tuleski
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Marlos Gonçalves Sousa
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Brazil
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Quiñones ME, Joseph JK, Dowell S, Moore HJ, Karasik PE, Fonarow GC, Fletcher RD, Cheng Y, Zeng-Treitler Q, Arundel C, Liappis AP, Sheriff HM, Zhang S, Taub DD, Heimall MS, Faselis C, Kerr GS, Ahmed A. Hydroxychloroquine and Risk of Long QT Syndrome in Rheumatoid Arthritis: A Veterans Cohort Study With Nineteen-Year Follow-up. Arthritis Care Res (Hoboken) 2022. [PMID: 36039941 DOI: 10.1002/acr.25005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/14/2022] [Accepted: 08/25/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Recent evidence suggests that hydroxychloroquine use is not associated with higher 1-year risk of long QT syndrome (LQTS) in patients with rheumatoid arthritis (RA). Less is known about its long-term risk, the examination of which was the objective of this study. METHODS We conducted a propensity score-matched active-comparator safety study of hydroxychloroquine in 8,852 veterans (mean age 64 ± 12 years, 14% women, 28% Black) with newly diagnosed RA. A total of 4,426 patients started on hydroxychloroquine and 4,426 started on another nonbiologic disease-modifying antirheumatic drug (DMARD) and were balanced on 87 baseline characteristics. The primary outcome was LQTS during 19-year follow-up through December 31, 2019. RESULTS Incident LQTS occurred in 4 (0.09%) and 5 (0.11%) patients in the hydroxychloroquine and other DMARD groups, respectively, during the first 2 years. Respective 5-year incidences were 17 (0.38%) and 6 (0.14%), representing 11 additional LQTS events in the hydroxychloroquine group (number needed to harm 403; [95% confidence interval (95% CI)], 217-1,740) and a 181% greater relative risk (95% CI 11%-613%; P = 0.030). Although overall 10-year risk remained significant (hazard ratio 2.17; 95% CI 1.13-4.18), only 5 extra LQTS occurred in hydroxychloroquine group over the next 5 years (years 6-10) and 1 over the next 9 years (years 11-19). There was no association with arrhythmia-related hospitalization or all-cause mortality. CONCLUSIONS Hydroxychloroquine use had no association with LQTS during the first 2 years after initiation of therapy. There was a higher risk thereafter that became significant after 5 years of therapy. However, the 5-year absolute risk was very low, and the absolute risk difference was even lower. Both risks attenuated during longer follow-up. These findings provide evidence for long-term safety of hydroxychloroquine in patients with RA.
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Affiliation(s)
| | | | - Sharon Dowell
- Veterans Affairs Medical Center, and Howard University, Washington, DC
| | - Hans J Moore
- Veterans Affairs Medical Center, Georgetown University, George Washington University, Uniformed Services University, and US Department of Veterans Affairs, Washington, DC
| | - Pamela E Karasik
- Veterans Affairs Medical Center, Georgetown University, George Washington University, and Uniformed Services University, Washington, DC
| | | | | | - Yan Cheng
- Veterans Affairs Medical Center and George Washington University, Washington, DC
| | - Qing Zeng-Treitler
- Veterans Affairs Medical Center and George Washington University, Washington, DC
| | - Cherinne Arundel
- Veterans Affairs Medical Center, George Washington University, and Uniformed Services University, Washington, DC
| | - Angelike P Liappis
- Veterans Affairs Medical Center, George Washington University, and Uniformed Services University, Washington, DC
| | - Helen M Sheriff
- Veterans Affairs Medical Center and George Washington University, Washington, DC
| | | | - Daniel D Taub
- Veterans Affairs Medical Center and George Washington University, Washington, DC
| | | | - Charles Faselis
- Veterans Affairs Medical Center, George Washington University, and Uniformed Services University, Washington, DC
| | - Gail S Kerr
- Veterans Affairs Medical Center, Howard University, and Georgetown University, Washington, DC
| | - Ali Ahmed
- Veterans Affairs Medical Center, Georgetown University, and George Washington University, Washington, DC
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The impact of age, type 2 diabetes and hypertension on heart rate variability during rest and exercise at increasing levels of heat stress. Eur J Appl Physiol 2022; 122:1249-1259. [PMID: 35239038 DOI: 10.1007/s00421-022-04916-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In older adults with type 2 diabetes (T2D) and hypertension (HTN), cardiac autonomic modulation is markedly attenuated during exercise-heat stress. However, the extent to which this impairment is evident under increasing levels of heat stress remains unknown. METHODS We examined heart rate variability (HRV), a surrogate of cardiac autonomic modulation, during incremental exercise-heat stress exposures in young (20-30 years) and middle-aged-to-older individuals (50-70 years) without and with T2D and HTN. Thirteen young and healthy (Young, n = 13) and 37 older men without (Older, n = 14) and with HTN (n = 13) or T2D (n = 10) performed 180-min treadmill walking at a fixed metabolic rate (~ 200 W/m2; ~ 3.5 METs) in a differing wet-bulb globe temperature (WBGT; 16 °C, 24 °C, 28 °C, and 32 °C). Electrocardiogram (ECG) and core temperature measurements were recorded throughout. Data were analysed using 5-min averaged epochs following 60-min exercise, which represented the last common timepoint across groups and conditions. RESULTS Ageing did not significantly reduce HRV during increasing exercise-heat stress (all p > 0.050). However, T2D and HTN modified HRV during exercise-heat stress such that Detrended Fluctuation Analysis (DFA) α1 (p = 0.012) and the cardiac sympathetic index (p = 0.037) were decreased compared to Older in all except the warmest WBGT condition (32 °C). CONCLUSION Our unique observations indicate that, relative to their younger counterparts, HRV in healthy older individuals is not perturbed during exercise heat-stress. However, relative to their age-matched healthy counterparts, HRV is reduced during exercise-heat stress in individuals with age-associated chronic conditions, indicative of cardiac autonomic dysfunction.
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The impact of Covid-19 on ECG: A case-control study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.971819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Li Z, Bai X, Han L, Han W, Hu W. Association Between Left Atrial Volume Index and Ventricular Repolarization Heterogeneity: A Cross-Sectional Study of a Healthy Chinese Population. Int J Gen Med 2021; 14:2117-2125. [PMID: 34079353 PMCID: PMC8166315 DOI: 10.2147/ijgm.s310220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Electromechanical coupling may play a significant role in the association between abnormal myocardial mechanics and heterogeneity of repolarization. This study sought to assess the potential relationship between the left atrial volume index (LAVI), which is an important marker of cardiac diastolic function, and ventricular repolarization variables, such as the QT interval, Tpeak-to-Tend (Tpe) interval and Tpe/QT ratio, in an apparently healthy Chinese population. METHODS This was a community-based cross-sectional study conducted in Shenyang, China. A total of 414 healthy subjects aged 35-91 years, including 186 men (44.9%), were enrolled. In addition to performing clinical and laboratory measurements, all subjects underwent comprehensive echocardiography and standard 12-lead electrocardiography. Echocardiographic and electrocardiographic results were analysed separately and in a blinded fashion. Correlation and regression analyses were applied to determine associations. RESULTS Subjects were divided into four groups according to quartile of LAVI levels (<16.0, 16.0-18.9, 19.0-22.5 and >22.5 mL/m2). Ventricular repolarization variables, such as QT interval and QTc interval, gradually increased with the progression from low to high LAVI levels (P<0.05). LAVI was positively and significantly correlated with the QT interval, the QTc interval, and the Tpe interval (P<0.01). After adjusting for age and other possible confounders, LAVI showed significant and independent associations with the QT interval and the QTc interval (P<0.001; P=0.003). CONCLUSION Echocardiographic LAVI is linearly associated with ventricular repolarization variables even in healthy people.
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Affiliation(s)
- Zhidan Li
- Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Xiaojuan Bai
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Lulu Han
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Wen Han
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Weina Hu
- Department of Cardiology, The Fourth Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
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Mansiroglu AK, Coşgun M, Sincer I, Gunes Y. The role of baseline and post-treatment frontal QRS-T angle for detecting arterial blood pressure control. Clin Exp Hypertens 2021; 43:363-367. [PMID: 33605819 DOI: 10.1080/10641963.2021.1890763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: In this study, we aimed to investigate the value of the frontal QRS-T angle (f(QRS-T)) in determining blood pressure control among newly diagnosed hypertensive patients with no left ventricular hypertrophy.Methods: Fifty patients with newly diagnosed hypertension were included in this single-center study. The patients were examined with 12-lead ECGs and 24-hour ambulatory blood pressure monitoring (24 h-ABPM) before and 1 month after antihypertensive treatment.Results: Baseline and post-treatment f(QRS-T) angle values were observed to be similar (38.0 [0.0-174.0] and 37.0 [1.0-139.0], respectively; p = .827). The values of QT minimum (p = .006), QTc mean (p = .030), Tp-e (p = .027), and JTc (p = .010) significantly decreased after control of blood pressure.Conclusions: The f(QRS-T) angle, which can be easily calculated on the ECG, is not a useful tool to determine hypertension control at early stage in newly diagnosed hypertensive patients.
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Affiliation(s)
| | - Mehmet Coşgun
- Department of Cardiology, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Isa Sincer
- Department of Cardiology, Abant Izzet Baysal University Hospital, Bolu, Turkey
| | - Yilmaz Gunes
- Department of Cardiology, Abant Izzet Baysal University Hospital, Bolu, Turkey
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Bağcı A, Aksoy F. The frontal plane QRS-T angle may affect our perspective on prehypertension: A prospective study. Clin Exp Hypertens 2021; 43:402-407. [PMID: 33641548 DOI: 10.1080/10641963.2021.1890766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKROUND The frontal plane QRS-T [f(QRS-T)] angle is an easy marker of myocardial repolarization and was associated with adverse cardiovascular outcomes like prehypertension (PHT). This study was aimed to investigate to evaluate the f(QRS-T) angle in patients with PHT. METHODS We measured f(QRS-T) angle of 70 subjects with PHT, 109 patients with hypertension (HT), and 102 normotensive healthy volunteers. The f(QRS-T) angle was calculated from 12-lead electrocardiography. RESULTS The f(QRS-T) angle was significantly higher in the HT and PHT groups as compared to the control group, but there was no significant difference in the f(QRS-T) angle between the HT and PHT groups. The f(QRS-T) angle was significantly and positively correlated with age, systolic blood pressure (BP) in 24 hours, average BP in 24 hours, pulse pressure in 24 hours, hemoglobin, QT dispersion, TpE distance while was negatively correlated with left ventricular ejection fraction. In multivariable analysis, we showed that systolic BP, average BP in 24 hours, pulse pressure in 24 hours, hemoglobin, QT dispersion, Tpe distance were independent predictors of higher f(QRS-T) angle. CONCLUSIONS The f(QRS-T) angle, a noninvasive measurement analyzing the dysfunction in cardiac conduction system, was increased in subjects with PHT as compared to normotensives, and the subjects with PHT had f(QRS-T) angle as higher as patients with HT did. Our findings are supportive for the hypothesis that disturbances in ventricular repolarization is present in an early stage of essential hypertension.
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Affiliation(s)
- Ali Bağcı
- The Department of Cardiology, Suleyman Demirel University, Medical School, Isparta, Turkey
| | - Fatih Aksoy
- The Department of Cardiology, Suleyman Demirel University, Medical School, Isparta, Turkey
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Gervais AS, Flahault A, Chan T, Bastien-Tardif C, Al-Simaani A, Cloutier A, Luu TM, Abadir S, Nuyt AM. Electrocardiographic features at rest and during exercise in young adults born preterm below 30 weeks of gestation. Pediatr Res 2020; 88:305-311. [PMID: 32120379 DOI: 10.1038/s41390-020-0814-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/20/2020] [Accepted: 02/09/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Preterm birth has adverse consequences on the cardiovascular system. Whether premature birth is associated with conduction and repolarisation abnormalities past childhood and into adulthood still needs to be demonstrated. METHODS We analyzed the ECG of young adults (23.9 ± 3.1 years) born term (≥37 weeks, n = 53) and preterm (<30 weeks, n = 49) at rest, peak exercise and 3 min into recovery during an exercise test on a cycle ergometer. We measured PR, QRS and QT intervals, calculated the corrected QT (QTc), and determined blood calcium, magnesium, potassium and fasting glucose. RESULTS Mean gestational age was 39.7 ± 1.1 and 27.3 ± 1.3 weeks for the term and the preterm groups, respectively. Apart from an increased heart rate at rest in individuals born preterm, no significant difference was found between both groups for any other ECG parameters at rest. None of the participants had a severely prolonged QTc (>500 ms) at rest; exercise revealed severely prolonged QTc in two participants including one in the preterm group. The use of QT-prolonging medications did not influence ECG parameters in either groups. CONCLUSIONS We observed no significant difference in electrocardiographic measurements between young adults born preterm and term. Current results do not support avoidance of QT-prolonging medications in individuals born preterm. IMPACT Preterm birth is associated with adverse cardiovascular consequences in early adulthood, but controversial evidence exists regarding differences in electrocardiographic features between young individuals born term and preterm.This study aims to assess the differences in electrocardiographic features between young adults born term and preterm, at rest and during exercise training.In contrast with previously published data, we observed no significant difference in electrocardiographic measurements between young adults born preterm and term.Our study does not support that preterm birth itself exposes young adults to a higher risk of QT prolongation.Current results do not support avoidance of QT-prolonging medications in individuals born preterm.
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Affiliation(s)
- Anne-Sophie Gervais
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Adrien Flahault
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Tevy Chan
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Camille Bastien-Tardif
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Amy Al-Simaani
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Anik Cloutier
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Thuy Mai Luu
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Sylvia Abadir
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada.,Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Montreal, QC, H1T 1C8, Canada
| | - Anne-Monique Nuyt
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada.
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Yildiz A, Akkaya V, Sahin S, Tükek T, Besler M, Bozfakioglu S, Korkut F. Qt Dispersion and Signal-Averaged Electrocardiogram in Hemodialysis and Capd Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080102100213] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to compare QT dispersion (QTd) and signal-averaged electrocardiogram (SA-ECG) parameters that may predict risk of malignant arrhythmias in patients on hemodialysis (HD), on continuous ambulatory peritoneal dialysis (CAPD), and in controls. Setting Controlled cross-sectional study in a tertiary- care setting. Patients 28 HD (M/F 18/10; mean age 32 ± 9 years), 29 CAPD (M/F 17/12; mean age 34 ± 10 years), and 29 healthy controls (M/F 17/12; mean age 32 ± 8 years) were included. Interventions On ECG, minimum (QTmin) and maximum (QTmax) QT duration and their difference (QTd) were measured. In SA-ECG, duration of filtered QRS, HFLA signals less than 40 μV, and RMS voltage (40 ms) were also measured. Results Higher serum Ca2+ and lower K+ levels were found in CAPD compared to HD. All QT parameters were increased in HD and CAPD compared to controls. QT dispersion was significantly prolonged in HD compared to CAPD. In HD, QTd was correlated with left ventricular (LV) mass index ( r = 0.53, p = 0.004), but not in CAPD ( r = -0.09, p = 0.63). QT dispersion was significantly prolonged in patients with LV hypertrophy compared to patients without hypertrophy on HD (68 ± 18 ms vs 49 ± 18 ms, p = 0.008). In the analysis of SA-ECG, 3 of the 28 (11%) HD and 2 of the 29 (7%) CAPD patients had abnormal late potentials. Patients on HD and CAPD had significantly higher filtered-QRS duration compared to controls (105 ± 15 ms and 104 ± 12 ms vs 95 ± 5 ms, respectively, p = 0.04). Patients with LV hypertrophy had higher filtered-QRS duration compared to patients without hypertrophy (109 ± 12 ms vs 95 ± 8 ms, p < 0.001). Conclusion Dialysis patients had prolonged QTd and increased filtered-QRS duration in SA-ECG compared to controls. Patients on HD had longer QTd than patients on CAPD. QTd has been correlated to LV mass index in HD, but not in CAPD. This difference might be due to the effect of different dialysis modalities on electrolytes, especially the higher serum Ca2+ levels.
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Affiliation(s)
- Alaattin Yildiz
- Division of Nephrology, Department of Internal Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Vakur Akkaya
- Department of Cardiology, Istanbul School of Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Sevgi Sahin
- Division of Nephrology, Department of Internal Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Tufan Tükek
- Department of Cardiology, Istanbul School of Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Mine Besler
- Division of Nephrology, Department of Internal Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Semra Bozfakioglu
- Division of Nephrology, Department of Internal Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
| | - Ferruh Korkut
- Department of Cardiology, Istanbul School of Medicine, Social Security Istanbul Hospital, Istanbul, Turkey
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13
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Li ZD, Bai XJ, Han LL, Han W, Sun XF, Chen XM. Association between ventricular repolarization variables and cardiac diastolic function: A cross-sectional study of a healthy Chinese population. World J Clin Cases 2019; 7:940-950. [PMID: 31119139 PMCID: PMC6509266 DOI: 10.12998/wjcc.v7.i8.940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diastolic electromechanical couple, a well-described phenomenon in symptomatic heart failure, has not been well studied in healthy people. We hypothesized that ventricular repolarization variables, such as the QT interval, Tpeak-to-Tend (Tpe) interval and Tpe/QT ratio, are associated with cardiac diastolic function in the healthy Chinese population.
AIM To assess the relationship between ventricular repolarization variables and cardiac diastolic function in apparently healthy Chinese individuals.
METHODS This was a community-based cross-sectional study conducted in Shenyang, China. A total of 414 healthy subjects aged 35-91 years were enrolled. All subjects underwent standard 12-lead electrocardiography (ECG) and comprehensive echocardiography. ECG enabled the measurement of QT and Tpe intervals and Tpe/QT ratio. echocardiographic parameters, such as the ratio of mitral early diastolic inflow velocity (E) and late diastolic inflow velocity (A), E-wave deceleration time, left atrial volume (LAV) and LAV index, were measured to assess diastolic function. E/A < 0.75 was considered to indicate reduced diastolic function. ECG and echocardiography results were analyzed separately and in a blinded fashion. Correlation and regression analyses were applied to determine associations.
RESULTS Ventricular repolarization variables, such as the QTc interval (393.59 ± 26.74 vs 403.86 ± 33.56; P < 0.001), Tpe interval (72.68 ± 12.41 vs 77.26 ± 17.86; P < 0.01), Tpec interval (76.36 ± 13.53 vs 83.32 ± 21.25; P < 0.001) and Tpe/QT ratio (0.19 ± 0.03 vs 0.20 ± 0.04; P < 0.01), were significantly different between the normal diastolic function group and the reduced diastolic function group. Significant associations were found between repolarization variables and diastolic function. After adjusting for all other possible confounders, the QTc and Tpec intervals were significantly associated with the E/A ratio (P = 0.008; P = 0.010). In men, the QTc interval was associated with abnormal diastolic function, and compared to the third QTc tertile, in the second QTc tertile, the odds ratio was 0.257 (95%CI: 0.102–0.649; P = 0.004).
CONCLUSION Repolarization variables are associated with cardiac diastolic function even in healthy people. Moderate levels of the QTc interval exert a protective effect on diastolic dysfunction in men.
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Affiliation(s)
- Zhi-Dan Li
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiao-Juan Bai
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Lu-Lu Han
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Wen Han
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xue-Feng Sun
- Department of Kidney, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
| | - Xiang-Mei Chen
- Department of Kidney, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China
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14
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Romito G, Guglielmini C, Mazzarella MO, Cipone M, Diana A, Contiero B, Baron Toaldo M. Diagnostic and prognostic utility of surface electrocardiography in cats with left ventricular hypertrophy. J Vet Cardiol 2018; 20:364-375. [PMID: 30082249 DOI: 10.1016/j.jvc.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess the ability of electrocardiography (ECG) to predict left ventricular hypertrophy (LVH) in the cat and to investigate the prognostic value of selected ECG variables in cats with LVH. ANIMALS Fifty-seven privately owned cats: 22 clinically healthy cats and 35 cats with LVH. MATERIAL AND METHODS This is a clinical cohort study. Echocardiographic diagnosis and surface ECG were available. Electrocardiography analysis included rhythm diagnosis and specific electrocardiographic measurements. In cats with LVH, cause of death and outcome data were recorded and analyzed using Kaplan-Meier curves. RESULTS The presence of arrhythmia had sensitivity and specificity of 31% and 100%, respectively, for identifying LVH. Among ECG measurements, duration of QT interval (QT) and QT interval corrected for heart rate (QTc) was statistically different between healthy cats and cats with LVH (p = 0.007). Overall, the most accurate cutoffs to identify LVH were QT > 170 ms (sensitivity and specificity 48.3% and 91%, respectively) and QTc > 188 ms (sensitivity and specificity 62% and 77%, respectively). In healthy cats, the highest QT and QTc values were 180 ms and 200 ms, respectively. Mean survival time was 58 days and indeterminable for cats with QT > 180 ms and QT ≤ 180 ms, respectively (p = 0.042) and 125 days and indeterminable for cats with QTc > 200 ms and QTc ≤ 200 ms, respectively (p = 0.017). CONCLUSIONS Arrhythmias as well as prolonged QT and QTc are useful ECG parameters in identifying LVH and predicting survival in affected cats.
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Affiliation(s)
- G Romito
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - C Guglielmini
- Department of Animal Medicine, Production and Health, University of Padua, Italy
| | - M O Mazzarella
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - M Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - A Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - B Contiero
- Department of Animal Medicine, Production and Health, University of Padua, Italy
| | - M Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy.
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15
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Dincgez Cakmak B, Dundar B, Ketenci Gencer F, Turker U, Kanat S. P-wave and QT dispersion in hypertensive disorders of pregnancy. J Matern Fetal Neonatal Med 2018; 32:4051-4059. [PMID: 29792098 DOI: 10.1080/14767058.2018.1481041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Aim: To compare P-wave and QT dispersion values in hypertensive disorders of pregnancy and controls and also in preeclampsia, chronic hypertension, and gestational hypertension separately.Material and methods: We included 140 hypertensive pregnants and 110 healthy age-matched pregnants in this study. The hypertensive pregnants were divided into three subgroups: preeclampsia (n = 43), chronic hypertension (n = 51), and gestational hypertension (n = 46). P-wave and QT dispersion values were compared between groups.Results: Hypertensive pregnants had higher P-wave (41.74 ± 5.51 vs. 37.73 ± 5.62, p < .001) and QTc dispersion (45.44 ± 7.62 vs. 39.77 ± 8.34, p < .001) values. In subgroup analysis, P-wave dispersion and QTc dispersion were different between preeclamptic, chronic hypertensive, and gestational hypertensive patients. Also, they were significantly higher in chronic hypertension as compared to gestational hypertension and they were higher in preeclampsia than in gestational hypertension. No difference was found according to these parameters between preeclampsia and chronic hypertension. In correlation analysis, both P-wave dispersion and QTc dispersion were positively correlated with systolic (r = 0.409, p < .001 and r = 0.306, p < .001) and diastolic blood pressure (r = 0.390, p < .001 and r = 0.287, p < .001) which are main clinical determinants of hypertensive disorders.Conclusion: In clinical practice, chronic hypertensive pregnants are generally followed up in their future life for cardiovascular disorders. Also, we recommend that we must inform and follow preeclamptic patients for future cardiovascular diseases.
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Affiliation(s)
- Burcu Dincgez Cakmak
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
| | - Betul Dundar
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
| | - Fatma Ketenci Gencer
- Department of Obstetrics and Gynecology, Gaziosmanpasa Taksim Research and Training Hospital, Istanbul, Turkey
| | - Ulku Turker
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
| | - Selçuk Kanat
- Department of Cardiology, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
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16
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Wentzel A, Malan L, Scheepers JD, Malan NT. QTc prolongation, increased NT-proBNP and pre-clinical myocardial wall remodeling in excessive alcohol consumers: The SABPA study. Alcohol 2018; 68:1-8. [PMID: 29413668 DOI: 10.1016/j.alcohol.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 12/26/2022]
Abstract
Alcohol contributes greatly to vascular and structural modifications. Due to differences in the metabolism and tolerance of alcohol between ethnic groups, the manner of these modifications may differ. We investigated the association between alcohol consumption - measured via ethnic-specific gamma glutamyl transferase (γ-GT) cut-points - and markers of cardiac perfusion, electrical activity, and pre-clinical structural alterations. A South African target population study was performed in a bi-ethnic cohort (n = 405). Alcohol consumption was determined according to previously defined ethnic-specific γ-GT cut-points, where γ-GT ≥ 19.5 U/L and γ-GT ≥ 55 U/L indicated excessive alcohol consumption in Caucasians and Africans, respectively. Ambulatory 24-h blood pressure and electrocardiograms (ECG), 10-lead ECG left ventricular hypertrophy (LVH), ischemic events, N-terminal pro-brain natriuretic peptide (NT-proBNP), and QTc prolongation were assessed. Fasting blood samples were obtained. A poorer cardio-metabolic profile and mean 24-h hypertensive and ECG-LVH values were evident in high γ-GT groups of both ethnicities, when compared to their low counterparts. The African high γ-GT group reported a higher intake of alcohol and presented significant increases in NT-proBNP (p < 0.001), QTc prolongation (p = 0.008), and ischemic events (p = 0.013). Regression analyses revealed associations between ECG-LVH and NT-proBNP, QTc prolongation, ischemic events, and SBP, in the African high γ-GT group exclusively. High alcohol consumers presented delayed electrical conduction in the heart accompanied by ECG-LVH, ischemic events, and increased vaso-responsiveness, predominantly in Africans. Ultimately, increased left ventricular distension on a pre-clinical level may elevate the risk for future cardiovascular events in this population.
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17
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Djordjević DB, Tasić IS, Kostić SI, Stamenković BN, Djordjević AD, Lović DB. QTc dispersion and Cornell duration product can predict 10-year outcomes in hypertensive patients with left ventricular hypertrophy. Clin Cardiol 2017; 40:1236-1241. [PMID: 29247525 DOI: 10.1002/clc.22815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Persistent and adequate treatment of patients with arterial hypertension leads to more favorable disease outcome. HYPOTHESIS Aside for the present left ventricular hypertrophy (LVH), there are other non-invasive parameters which can represent additional predictors of unfavorable prognosis in patients with essential arterial hypertension during the 10-year follow-up. METHODS A hypertensive group with LVH (124 patients; age 57.0 ± 8.0; 84 males and 40 females) was included in the study and examined noninvasively. Patients used regular medication therapy during the follow-up period. RESULTS During the 10-year follow-up period, unfavorable outcome was recorded for 40 (32.3%) patients. Patients with unfavorable outcome had higher baseline values of left ventricular mass index (178.9 ± 29.5 g/m2 vs 165.5 ± 29.5 g/m2 ; P < 0.05) and QTc dispersion (64.1 ± 24.7 ms vs 54.8 ± 19.4 ms; P < 0.05). Frequency of positive Cornell product was higher in the group of patients with unfavorable outcome (35% vs 22.2%; P < 0.01). Positive Lyon-Sokolow score did not show statistical significance (25% vs 11.9%; P = 0.06). Cornell product (β = 0.234; P < 0.01) and QTc dispersion >65 ms (β = 0.184; P < 0.05) had prognostic significance in LVH (multiple regression analysis: R = 0.314, R = 0.099, adjusted R = 0.084, standard error of the estimate = 0.449, P < 0.05). CONCLUSIONS Patients with a positive Cornell product and larger QTc dispersion had more unfavorable 10-year outcomes compared with other patients with LVH.
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Affiliation(s)
- Dragan B Djordjević
- Medical Faculty, Department of Internal Medicine, University of Niš, Niš, Serbia.,Department of Cardiology, Institute for Treatment and Rehabilitation Niška Banja, Niš, Serbia
| | - Ivan S Tasić
- Medical Faculty, Department of Internal Medicine, University of Niš, Niš, Serbia.,Department of Cardiology, Institute for Treatment and Rehabilitation Niška Banja, Niš, Serbia
| | - Svetlana I Kostić
- Department of Cardiology, Institute for Treatment and Rehabilitation Niška Banja, Niš, Serbia
| | - Bojana N Stamenković
- Medical Faculty, Department of Internal Medicine, University of Niš, Niš, Serbia.,Department of Rheumatology, Institute for Treatment and Rehabilitation Niška Banja, Niš, Serbia
| | | | - Dragan B Lović
- Department of Cardiology, Clinic for Internal Diseases Intermedica, Niš, Serbia; and Veterans Affairs Medical Center, Washington, District of Columbia
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18
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Barbosa Neto O, da Mota GR, De Sordi CC, Resende EAMR, Resende LAPR, Vieira da Silva MA, Marocolo M, Côrtes RS, de Oliveira LF, Dias da Silva VJ. Long-term anabolic steroids in male bodybuilders induce cardiovascular structural and autonomic abnormalities. Clin Auton Res 2017; 28:231-244. [DOI: 10.1007/s10286-017-0470-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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19
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Tanriverdi Z, Unal B, Eyuboglu M, Bingol Tanriverdi T, Nurdag A, Demirbag R. The importance of frontal QRS-T angle for predicting non-dipper status in hypertensive patients without left ventricular hypertrophy. Clin Exp Hypertens 2017; 40:318-323. [DOI: 10.1080/10641963.2017.1377214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
| | - Baris Unal
- Clinic of Cardiology, Cumra State Hospital, Konya, Turkey
| | - Mehmet Eyuboglu
- Department of Cardiology, Ilke Medicine Center, Izmir, Turkey
| | - Tugba Bingol Tanriverdi
- Department of Anesthesiology, Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey
| | - Abdullah Nurdag
- Clinic of Cardiology, Balikligol State Hospital, Sanliurfa, Turkey
| | - Recep Demirbag
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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20
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Mattioli AV, Bonatti S, Mattioli G. Left Atrial Anatomy and Function After Conversion From Atrial Fibrillation in Hypertrophic Hearts. Angiology 2016; 57:717-23. [PMID: 17235112 DOI: 10.1177/0003319706295490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the study was to evaluate the influence of left ventricular (LV) hypertrophy on left atrial (LA) electrical and mechanical function after cardioversion atrial fibrillation (A-Fib) of brief duration. Study group A included 100 patients with a first diagnosis of hypertension who had a moderate LV hypertrophy. The patient population included 64 men and 36 women with a mean age of 55 ±7 years who were hospitalized because of A-Fib and were cardioverted with external DC shock. Control group B included 100 patients without cardiac hypertrophy cardioverted because of lone A-Fib. Atrial function and size were assessed by Doppler echocardiography and the following parameters were measured: transmitral peak A velocity, atrial filling fraction, atrial ejection force, peak E velocity, deceleration time, and isovolumic relaxation time, LA maximal and minimal volume, and LV cardiac mass index. Baseline echocardiography showed that LA diameters and volumes were enlarged in all patients during A-Fib. After the restoration of sinus rhythm LA diameters and volumes decreased and the reduction was more evident in group B compared to group A. LA function as a continuous variable was negatively related to LV mass index ( r = -0.77), LA diameter ( r = -0.66 and r = -0.69 for the superoinferior diameter), LA maximal volume ( r = -0.61) and LA minimal volume ( r = -0.55) (all p<0.01). Atrial ejection force as a continuous variable was positively related to age ( r =0.78), peak A wave velocity ( r =0.71), systolic blood pressure ( r =0.51), and IVRT ( r =0.41) (all p<0.01). Hypertrophy influenced the recovery of atrial function after cardioversion of A-Fib. Atrial function was reduced in patients with LV hypertrophy even after A-Fib of brief duration.
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21
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Wasson S, Reddy HK, Dohrmann ML. Current Perspectives of Electrical Remodeling and Its Therapeutic Implications. J Cardiovasc Pharmacol Ther 2016; 9:129-44. [PMID: 15309249 DOI: 10.1177/107424840400900208] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Electrical remodeling involves alterations in the electrophysiologic milieu of myocardium in various disease states, such as ventricular hypertrophy, heart failure, atrial tachyarrhythmias, myocardial ischemia, and infarction that are associated with cardiac arrhythmias. Although research in this area dates back to early part of the 19th century, we still lack the exact knowledge of ionic remodeling, the role of various genes and channel proteins, and their relevance for the newer antiarrhythmic therapies. Structural remodeling may also have an impact on the electrical remodeling process, although differences in both structural and electrical remodeling are associated with different disease states. Various electrophysiologic, cellular, and structural alterations, including anisotropic conduction, increased intracellular calcium levels, and gap junction remodeling predispose to increased dispersion of action potential duration and refractoriness. This constitutes a favorable substrate for early and late afterdepolarizations and reentrant arrhythmias. Studying the role of ionic remodeling in the initiation and propagation of cardiac arrhythmias has significant relevance for developing newer antiarrhythmic therapies, for identifying patients at risk of developing fatal arrhythmias, and for implementing effective preventive measures. Further research is required to understand the specific effects of individual ion channel remodeling, to understand the signal transduction mechanisms, and to address whether detrimental effects of electrical remodeling can be altered.
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Affiliation(s)
- Sanjeev Wasson
- Division of Cardiology, University of Missouri Hospital, Columbia, Missouri 65212, USA
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22
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Modulation of the QT interval duration in hypertension with antihypertensive treatment. Hypertens Res 2015; 38:447-54. [DOI: 10.1038/hr.2015.30] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/27/2014] [Accepted: 11/12/2014] [Indexed: 11/08/2022]
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23
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Eltayeb AA, Ahmad FA, Sayed DM, Osama AM. Subclinical vascular endothelial dysfunctions and myocardial changes with type 1 diabetes mellitus in children and adolescents. Pediatr Cardiol 2014; 35:965-74. [PMID: 24595824 DOI: 10.1007/s00246-014-0883-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/05/2014] [Indexed: 01/11/2023]
Abstract
Vascular endothelial dysfunction, accelerated thickening of arterial intima, and changes in ventricular functions contribute to increased cardiovascular morbidity in type 1 diabetes mellitus (T1DM). This study aimed to investigate the functional-structural changes in the arteries and myocardium together with affection of highly sensitive C-reactive protein (hsCRP), circulating endothelial cells (CECs), and vitamin C levels in children with T1DM. Also, to test the association with early atherosclerotic changes. The study included 30 children with a diagnosis of T1DM and 30 healthy subjects matched by sex, age, and body mass index. Serum lipids, HbA1c, hsCRP, vitamin C, and CECs were detected. Corrected QT interval (QTc), cardiac dimensions, and left ventricular (LV) functions were assessed using conventional echocardiography. Noninvasive ultrasound was used to measure brachial artery flow-mediated dilation (FMD) responses and carotid intima-media thickness (IMT). The QTc interval was significantly higher in the diabetic patients than in the control subjects (P < 0.001). The findings showed LV diastolic dysfunction as reflected by significantly lower early peak flow velocity, decreased E/A ratio, increased early filling deceleration time (DcT), and prolonged isovolumic relaxation time (IVRT) (P < 0.001 for each). The children with diabetes had a significantly lower FMD response, increased IMT, lower vitamin C level, higher hsCRP, and higher CEC compared with the control subjects (P < 0.001 for each). A positive correlation between CEC and HbA1c was found (P = 0.004). An alteration in myocardial function and endothelial dysfunction may begin early with the association of early atherosclerotic changes. These changes are accelerated when glycemic control is poor. The authors recommend early and close observation of children with diabetes for any alterations in cardiac and vascular endothelial function. Vitamin C supplementation may reduce the risk of complications.
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Affiliation(s)
- Azza A Eltayeb
- Pediatric Department, PICU, Children University Hospital, Assiut University, B.O, 71111, Assiut, Egypt,
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Khaledifar A, Momeni A, Hasanzadeh K, Amiri M, Sedehi M. Association of Corrected QT and QT Dispersion with Echocardiographic and Laboratory Findings in Uremic Patients under Chronic Hemodialysis. J Cardiovasc Echogr 2014; 24:78-82. [PMID: 28465910 PMCID: PMC5353447 DOI: 10.4103/2211-4122.143972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Cardiovascular disease is the most common cause of mortality in dialysis patients. Chronic renal failure and hemodialysis (HD) patients may have longer corrected QT (QTc) interval compared with the normal population. Long QTc interval may be a predictor of ventricular arrhythmia and cardiovascular mortality in these patients and hence the aim of this study was the evaluation of the relationship between QTc interval and some echocardiographic findings and laboratory exam results in HD patients. Materials and Methods: In a cross-sectional study, 60 HD patients with age >18 years and the dialysis duration >3 months were enrolled. Blood samples were taken, and electrocardiography and echocardiography were done before the dialysis session in the patients. Results: Mean age of the patients was 56.15 ± 14.6 years. QTc interval of the patients was 0.441 ± 0.056 s and QT dispersion (QTd) was 64.17 ± 25.93 ms. There was no statistically significant relationship between QTc interval and QTd with duration of dialysis, body mass index, age, and gender (P > 0.05). There was also no significant relationship between QTc interval and QTd with mitral regurgitation, tricuspid regurgitation and aortic insufficiency (P > 0.05). In addition, QTc interval and QTd of the patients had not any correlation with serum parathormon and serum Ca, K, HCO3 (P > 0.05). Conclusion: Based on our results, in HD patients, QTc interval and QTd were not correlated with echocardiographic findings or laboratory exam results. Therefore, it can be concluded that QTc interval prolongation probably has not any correlation with cardiac mortality of the HD patients.
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Affiliation(s)
- Arsalan Khaledifar
- Department of Internal Medicine, Nephrology Division, Shahrekord University of Medical Sciences, Iran
| | - Ali Momeni
- Department of Internal Medicine, Nephrology Division, Shahrekord University of Medical Sciences, Iran
| | - Katayoun Hasanzadeh
- Department of Internal Medicine, Nephrology Division, Shahrekord University of Medical Sciences, Iran
| | - Masoud Amiri
- Department of Epidemiology and Biostatistics, Social Health Determinants Research Center, Shahrekord University of Medical Sciences, Iran
| | - Morteza Sedehi
- Department of Biostatistics and Epidemiology, School of Health, Shahrekord University of Medical Sciences, Iran
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25
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Voulgari C, Pagoni S, Tesfaye S, Tentolouris N. The spatial QRS-T angle: implications in clinical practice. Curr Cardiol Rev 2014; 9:197-210. [PMID: 23909632 PMCID: PMC3780345 DOI: 10.2174/1573403x113099990031] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 03/19/2013] [Indexed: 12/14/2022] Open
Abstract
The ventricular gradient (VG) as a concept was conceived in the 1930s and its calculation yielded information that was not otherwise obtainable. The VG was not utilized by clinicians at large because it was not easy to understand and its computation time-consuming. The contemporary spatial QRS-T angle is based on the concept of the VG and defined as its mathematical and physiological integral. Its current major clinical use is to assess the cardiac primary repolarization abnormalities in 3-dimensional spatial vectorial plans which are normally untraced in the presence of secondary electrophysiological activity in a 2-dimensional routine electrocardiogram (ECG). Currently the calculation of the spatial QRS-T angle can be easily computed on the basis of a classical ECG and contributes to localization of arrhythmogenic areas in the heart by assessing overall and local heterogeneity of the myocardial ventricular action potention duration. Recent population-based studies suggest that the spatial QRS-T angle is a dominant ECG predictor of future cardiovascular events and death and it is superior to more conventional ECG parameters. Its assessment warrants consideration for intensified primary and secondary cardiovascular prevention efforts and should be included in everyday clinical practice. This review addresses the nature and diagnostic potential of the spatial QRS-T angle. The main focus is its role in ECG assessment of dispersion of repolarization, a key factor in arrythmogeneity.
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Affiliation(s)
- Christina Voulgari
- First Department of Propaudeutic Internal Medicine, “Laiko” General Hospital, Athens University Medical School, Greece.
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26
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Antonakis V, Tsioufis C, Tsiachris D, Andrikou I, Fantaki M, Dagres N, Vrachnis N, Stefanadis C. Associations of Hemodynamic Load and Ventricular Repolarization in Patients With Newly Diagnosed Essential Hypertension: A Long-Term Follow-Up Study. J Clin Hypertens (Greenwich) 2014; 16:219-24. [DOI: 10.1111/jch.12275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Velissaris Antonakis
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Costas Tsioufis
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Dimitris Tsiachris
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Ioannis Andrikou
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Maria Fantaki
- Second Cardiology Department; University of Athens; Attikon University Hospital; Athens Greece
| | - Nikos Dagres
- Second Cardiology Department; University of Athens; Attikon University Hospital; Athens Greece
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Somaratne JB, Whalley GA, Bagg W, Doughty RN. Early detection and significance of structural cardiovascular abnormalities in patients with Type 2 diabetes mellitus. Expert Rev Cardiovasc Ther 2014; 6:109-25. [DOI: 10.1586/14779072.6.1.109] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Namdar M, Biaggi P, Stähli B, Bütler B, Casado-Arroyo R, Ricciardi D, Rodríguez-Mañero M, Steffel J, Hürlimann D, Schmied C, de Asmundis C, Chierchia GB, Sarkozy A, Lüscher TF, Jenni R, Duru F, Paulus WJ, Brugada P. A novel electrocardiographic index for the diagnosis of diastolic dysfunction. PLoS One 2013; 8:e79152. [PMID: 24223898 PMCID: PMC3818461 DOI: 10.1371/journal.pone.0079152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 07/28/2013] [Indexed: 11/28/2022] Open
Abstract
Background Although the assessment of diastolic dysfunction (DD) is an integral part of routine cardiologic examinations, little is known about associated electrocardiographic (ECG) changes. Our aim was to investigate a potential role of ECG indices for the recognition of patients with DD. Methods and Results ECG parameters correlating with echocardiographic findings of DD were retrospectively assessed in a derivation group of 172 individuals (83 controls with normal diastolic function, 89 patients with DD) and their diagnostic performance was tested in a validation group of 50 controls and 50 patients. The patient group with a DD Grade 1 and 2 showed longer QTc (422±24ms and 434±32ms vs. 409±25ms, p<0.0005) and shorter Tend–P and Tend–Q intervals, reflecting the electrical and mechanical diastole (240±78ms and 276±108ms vs. 373±110ms, p<0.0001; 409±85ms and 447±115ms vs. 526±119ms, p<0.0001). The PQ–interval was significantly longer in the patient group (169±28ms and 171±38ms vs. 153±22ms, p<0.005). After adjusting for possible confounders, a novel index (Tend–P/[PQxAge]) showed a high performance for the recognition of DD, stayed robust in the validation group (sensitivity 82%, specificity 93%, positive predictive value 93%, negative predictive value 82%, accuracy 88%) and proved a substantial added value when combined with the indexed left atrial volume (LAESVI, sensitivity 90%, specificity 92%, positive predictive value 95%, negative predictive value 86%, accuracy 91%). Conclusions A novel electrocardiographic index Tend–P/(PQxAge) demonstrates a high diagnostic accuracy for the diagnosis of DD and yields a substantial added value when combined with the LAESVI.
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Affiliation(s)
- Mehdi Namdar
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- * E-mail:
| | - Patric Biaggi
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Barbara Stähli
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Bernhard Bütler
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Rubén Casado-Arroyo
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Danilo Ricciardi
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Moisés Rodríguez-Mañero
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Jan Steffel
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - David Hürlimann
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Christian Schmied
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
| | - Thomas F. Lüscher
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Rolf Jenni
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Firat Duru
- Cardiovascular Centre, Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Walter J. Paulus
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Pedro Brugada
- Heart Rhythm Management Centre, Cardiovascular Division, UZ Brussel — VUB, Brussels, Belgium
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Guney M, Ozkok A, Caliskan Y, Pusuroglu H, Yazici H, Tepe S, Oflaz H, Yildiz A. QT dispersion predicts mortality and correlates with both coronary artery calcification and atherosclerosis in hemodialysis patients. Int Urol Nephrol 2013; 46:599-605. [PMID: 24036935 DOI: 10.1007/s11255-013-0549-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE QT dispersion (QTd) was shown to be an independent predictor of mortality in hemodialysis (HD) patients. It may be hypothesized that coronary artery calcification is related to QTd in HD patients because widespread calcification may also involve the cardiac conducting system in these patients. In this study, we aimed to investigate the relationships of corrected QTd (QTcd) with coronary artery calcification score (CACS), carotid plaque score (CPS) and possible influence of these parameters on survival of HD patients. METHODS Seventy-two HD patients (33 male, 39 female) were enrolled into the study. Mean age of the patients was 44 ± 12 years. Mean follow-up duration was 77 ± 24 months. CACS was determined by computed tomography. QTcd values were calculated as the difference of maximum and minimum QT intervals. Left ventricular mass index (LVMI) and CPS were measured by echocardiography. RESULTS QTcd was significantly correlated with CACS (r = 0.233, p = 0.049), CPS (r = 0.354, p = 0.003) and LVMI (p = 0.011, r = 0.299). CPS was found to be significantly higher in the group with high QTcd (>60 ms) [2 (1-4) versus 0 (0-1), p = 0.02]. CACS was significantly correlated with age (r = 0.44, p < 0.001), LVMI (r = 0.52, p < 0.001) and CPS (r = 0.32, p = 0.003). In Kaplan-Meier analysis, survival of patients with high QTcd was significantly lower than the patients with low QTcd. In Cox regression analysis for predicting mortality, age, serum albumin and QTcd were found to be the independent predictors of mortality. CONCLUSIONS QTcd independently predicted mortality, and it was significantly associated with coronary artery calcification, left ventricular hypertrophy and atherosclerosis in HD patients.
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Affiliation(s)
- Murat Guney
- Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Fatih, 34093, Istanbul, Turkey
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Akintunde AA, Oyedeji AT, Familoni OB, Ayodele OE, Opadijo OG. QT Interval prolongation and dispersion: Epidemiology and clinical correlates in subjects with newly diagnosed systemic hypertension in Nigeria. J Cardiovasc Dis Res 2012; 3:290-5. [PMID: 23233773 PMCID: PMC3516009 DOI: 10.4103/0975-3583.102705] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The use of easily obtainable clinical and laboratory parameters to identify hypertensive patients with increased cardiovascular risk in resource limited settings cannot be overemphasized. Prolongation of QT intervals and increased dispersion has been associated with increased risk of cardiovascular death. The study aimed at describing the epidemiology of QT interval abnormalities among newly diagnosed hypertensive subjects and associated clinical correlates. MATERIALS AND METHODS One hundred and forty newly diagnosed hypertensive subjects and 70 controls were used for this study. Clinical and sociodemographic characteristics were obtained. Twelve lead resting electrocardiography, QT dispersion, heart rate corrected minimum and maximum QT intervals were determined manually. Increased QTcmax was defined at QTcmax >440msec. QT parameters were compared between various groups. SPSS 16.0 was used for data analysis. RESULTS The hypertensive subjects were well matched in age and gender distribution with controls. QTmax and QTcmax were significantly higher among hypertensive subjects than controls (379.7±45.1 vs. 356.7±35.6, 447.5± 49.0 vs. 414.5 ±34.7 ms, respectively, P<0.05). QTd and QTcd were also significantly higher among hypertensive subjects than controls (62.64±25.65 vs. 46.1±17.2, 73.8 ±30.0 vs. 52.5±18.8, respectively, P<0.05). Seventy three (52.14%) of the hypertensive subjects had QTcmax >440ms compared to 21.43% of controls, P=0.01. Increased QTc dispersion was present in 36.4% of hypertensive subjects. Hypertensive subjects with QT abnormalities had significantly higher mean waist hip ratio, mean body mass index and a higher proportion of smoking than controls. CONCLUSION QT prolongation and increased QTc dispersion are common among newly diagnosed hypertensive Nigerians and seem to be significantly associated with obesity. Effective antihypertensive therapy and control of obesity are important management modality for newly diagnosed hypertensive patients.
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Affiliation(s)
- Adeseye A Akintunde
- Department of Internal Medicine, LadokeAkintola University of Technology, Ogbomoso, Oyo State, Nigeria
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Hutchings DC, Sankaranarayanan R, Venetucci L. Ventricular arrhythmias complicating hypertrophic cardiomyopathy. Br J Hosp Med (Lond) 2012; 73:502-8. [DOI: 10.12968/hmed.2012.73.9.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hypertrophic cardiomyopathy is the most common genetic cardiovascular disorder and the leading cause of sudden cardiac death in the young. This article reviews the ventricular arrhythmias associated with hypertrophic cardiomyopathy, the difficulties in risk stratification, and current and future therapeutic strategies.
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Affiliation(s)
- David C Hutchings
- Department of Cardiac Physiology, University of Manchester, Manchester M13 9NT
| | - Rajiv Sankaranarayanan
- Electrophysiology and British Heart Foundation Clinical Research Fellow, University of Manchester, Manchester
| | - Luigi Venetucci
- British Heart Foundation Intermediate Clinical Fellow, University of Manchester, Manchester
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Marjamaa A, Oikarinen L, Porthan K, Ripatti S, Peloso G, Noseworthy PA, Viitasalo M, Nieminen MS, Toivonen L, Kontula K, Peltonen L, Havulinna AS, Jula A, O'Donnell CJ, Newton-Cheh C, Perola M, Salomaa V. A common variant near the KCNJ2 gene is associated with T-peak to T-end interval. Heart Rhythm 2012; 9:1099-103. [PMID: 22342860 PMCID: PMC3690340 DOI: 10.1016/j.hrthm.2012.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND T-peak to T-end (TPE) interval on the electrocardiogram is a measure of myocardial dispersion of repolarization and is associated with an increased risk of ventricular arrhythmias. The genetic factors affecting the TPE interval are largely unknown. OBJECTIVE To identify common genetic variants that affect the duration of the TPE interval in the general population. METHODS We performed a genome-wide association study on 1870 individuals of Finnish origin participating in the Health 2000 Study. The TPE interval was measured from T-peak to T-wave end in leads II, V(2), and V(5) on resting electrocardiograms, and the mean of these TPE intervals was adjusted for age, sex, and Cornell voltage-duration product. We sought replication for a genome-wide significant result in the 3745 subjects from the Framingham Heart Study. RESULTS We identified a locus on 17q24 that was associated with the TPE interval. The minor allele of the common variant rs7219669 was associated with a 1.8-ms shortening of the TPE interval (P = 1.1 × 10(-10)). The association was replicated in the Framingham Heart Study (-1.5 ms; P = 1.3 × 10(-4)). The overall effect estimate of rs7219669 in the 2 studies was -1.7 ms (P = 5.7 × 10(-14)). The common variant rs7219669 maps downstream of the KCNJ2 gene, in which rare mutations cause congenital long and short QT syndromes. CONCLUSION The common variant rs7219669 is associated with the TPE interval and is thus a candidate to modify repolarization-related arrhythmia susceptibility in individuals carrying the major allele of this polymorphism.
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Affiliation(s)
- Annukka Marjamaa
- Research Program in Molecular Medicine, University of Helsinki, Helsinki, Finland.
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Jang W, Kim YJ, Choi K, Lim HG, Kim WH, Lee JR. Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair. Eur J Cardiothorac Surg 2012; 42:e1-8. [DOI: 10.1093/ejcts/ezs219] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abdal-Barr MG, Safwat M, Nammas W. Would corrected QT dispersion predict left ventricular hypertrophy in hypertensive patients? Blood Press 2012; 21:249-54. [PMID: 22428608 DOI: 10.3109/08037051.2012.668663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS We explored whether QT corrected dispersion (QTcD) can identify left ventricular hypertrophy (LVH) in hypertensives. METHODS We enrolled 100 hypertensive patients (study group) and 30 normotensive subjects (control group). Echocardiography was performed to measure left ventricular mass and left ventricular mass index. Electrocardiogram was performed to measure QTcD. RESULTS LVH was present in 42 patients (42%) of the study group, none among controls. Hypertensive patients had significantly greater indices of LVH and QTcD compared with controls (p <0.001 for all). Similarly, among hypertensive patients, those with LVH had a significantly greater QTcD compared with those without (p <0.001). Pearson's correlation coefficient test demonstrated strongly positive correlations between QTcD and the indices of LVH (p <0.001 for all). Analysis of the receiver operating characteristic curves identified 60 ms as the optimal cut-off value of QTcD that best predicts LVH in hypertensives. Using this value, QTcD was able to predict LVH with a sensitivity of 92.9% and specificity 98.2%. CONCLUSIONS QTcD is significantly increased in hypertensive patients with LVH compared with those without, being strongly correlated with the indices of LVH. A QTcD cut-off value of 60 ms predicted LVH in hypertensive patients with a high sensitivity and specificity.
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Kayrak M, Acar K, Gul EE, Abdulhalikov T, Bağlıcaklıoğlu M, Sonmez O, Kaya Z, Arı H. Electrocardiographic findings in patients with polycythemia vera. Int J Med Sci 2012; 9:93-102. [PMID: 22211096 PMCID: PMC3245418 DOI: 10.7150/ijms.9.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 11/23/2011] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The 12-lead surface electrocardiogram (ECG) is a useful tool to predict both atrial and ventricular arrhythmias via P-wave and QT measurements and its derivatives. Polycythemia vera (PV) is a chronic myeloproliferative disorder associated with cardiovascular events. The aim of this study was to assess ECG findings of patients with PV. METHOD AND MATERIALS Sixty patients with PV (34 male, mean age 58±11 years) and 60 age and gender-matched healthy volunteers were enrolled into the study. From the 12-lead surface ECG, P-wave and both conventional QT measurements and transmyocardial repolarization parameters (T(peak)-T(end) interval (T(p)-T(e)) and derivatives) were evaluated digitally by two experienced cardiologists. In addition, a novel parameter, Pi was calculated digitally as the standard deviation of the P-wave duration across the 12 ECG leads. RESULTS QT duration and corrected QT interval were significantly longer in the PV group compared to healthy controls (p<0.01 and p<0.01, respectively). The T(p)-T(e) was longer and the T(p)-T(e)/QT ratio was significantly higher in the PV group compared to the controls. P-wave analyses showed that all P-wave parameters including Pmax, Pmin, P dispersion, and Pi were significantly prolonged in PV patients compared to the controls. The increase of both T(p)-T(e )and P max in the PV group was independent of age, BMI, diabetes and hypertension, gender, systolic blood pressure, hemoglobin, hematocrit, left atrial dimension, left ventricular end-diastolic diameter and early deceleration time in a univariate analysis of co-variance model (F=11.097, p=0.001 and F=31.537, p=0.0001, respectively). CONCLUSION The present study demonstrated that PV may be associated with electrocardiographic abnormalities of both atrium and ventricle.
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Affiliation(s)
- Mehmet Kayrak
- Department of Cardiology, Meram School of Medicine, Selcuk University, Konya, Turkey
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Wilcox JE, Rosenberg J, Vallakati A, Gheorghiade M, Shah SJ. Usefulness of electrocardiographic QT interval to predict left ventricular diastolic dysfunction. Am J Cardiol 2011; 108:1760-6. [PMID: 21907948 DOI: 10.1016/j.amjcard.2011.07.050] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 07/20/2011] [Accepted: 07/20/2011] [Indexed: 12/20/2022]
Abstract
Whether a normal electrocardiogram excludes left ventricular (LV) diastolic dysfunction (DD) and whether electrocardiographic parameters are associated with DD is unknown. We therefore sought to investigate the relation between electrocardiographic parameters and DD. We first evaluated 75 consecutive patients referred for echocardiography for clinical suspicion of heart failure (phase 1). Electrocardiography and comprehensive echocardiography were performed on all patients and were analyzed separately in a blinded fashion. Receiver operating characteristic curves and multivariate regression analyses were used to determine which electrocardiographic parameters were most closely associated with DD. Next, we prospectively validated our results in 100 consecutive, unselected patients undergoing echocardiography (phase 2). In phase 1 of our study, the mean age was 59 ± 14 years, 41% were women, 31% had coronary disease, 53% had hypertension, and 25% had diabetes. The mean ejection fraction was 54 ± 15%, and 64% had DD. Of all the electrocardiographic parameters, the QTc interval was most closely associated with DD. QTc was inversely associated with E' velocity (r = -0.54, p <0.0001), and the area under the receiver operating characteristic curve for QTc as a predictor of DD was 0.82. QTc prolongation was independently associated with reduced E' velocity (p = 0.021 after adjustment for age, gender, medications, QRS duration, and ejection fraction). In phase 2 of our study QTc was the electrocardiographic parameter most associated with reduced E' velocity (435 ± 31 vs 419 ± 24 ms; p = 0.004), confirming our phase 1 study findings. In conclusion, QTc prolongation was the electrocardiographic marker most predictive of DD and was independently associated with DD.
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Affiliation(s)
- Jane E Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Yang KC, Jay PY, McMullen JR, Nerbonne JM. Enhanced cardiac PI3Kα signalling mitigates arrhythmogenic electrical remodelling in pathological hypertrophy and heart failure. Cardiovasc Res 2011; 93:252-62. [PMID: 22038742 DOI: 10.1093/cvr/cvr283] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIMS Cardiac hypertrophy and heart failure are associated with QT prolongation and lethal ventricular arrhythmias resulting from decreased K(+) current densities and impaired repolarization. Recent studies in mouse models of physiological cardiac hypertrophy revealed that increased phosphoinositide-3-kinase-α (PI3Kα) signalling results in the up-regulation of K(+) channels and the normalization of ventricular repolarization. The experiments here were undertaken to test the hypothesis that increased PI3Kα signalling will counteract the adverse electrophysiological remodelling associated with pathological hypertrophy and heart failure. METHODS AND RESULTS In contrast to wild-type mice, left ventricular (LV) hypertrophy, induced by transverse aortic constriction (TAC), did not result in prolongation of ventricular action potentials or QT intervals in mice with cardiac-specific expression of constitutively active PI3Kα (caPI3Kα). Indeed, repolarizing K(+) currents and K(+) channel subunit transcripts were increased in caPI3Kα + TAC LV myocytes in proportion to the TAC-induced cellular hypertrophy. Congestive heart failure in a transgenic model of dilated cardiomyopathy model is accompanied by prolonged QT intervals and ventricular action potentials, reduced K(+) currents and K(+) channel transcripts. Increased PI3Kα signalling, but not renin-angiotensin system blockade, in this model also results in increased K(+) currents and improved ventricular repolarization. CONCLUSION In the setting of pathological hypertrophy or heart failure, enhanced PI3Kα signalling results in the up-regulation of K(+) channel subunits, normalization of K(+) current densities and preserved ventricular function. Augmentation of PI3Kα signalling, therefore, may be a useful and unique strategy to protect against the increased risk of ventricular arrhythmias and sudden death associated with cardiomyopathy.
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Affiliation(s)
- Kai-Chien Yang
- Department of Developmental Biology, Washington University Medical School, 660 South Euclid Avenue Box 8103, St Louis, MO 63110-1093, USA
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Lader JM, Vasquez C, Bao L, Maass K, Qu J, Kefalogianni E, Fishman GI, Coetzee WA, Morley GE. Remodeling of atrial ATP-sensitive K⁺ channels in a model of salt-induced elevated blood pressure. Am J Physiol Heart Circ Physiol 2011; 301:H964-74. [PMID: 21724863 DOI: 10.1152/ajpheart.00410.2011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hypertension is associated with the development of atrial fibrillation; however, the electrophysiological consequences of this condition remain poorly understood. ATP-sensitive K(+) (K(ATP)) channels, which contribute to ventricular arrhythmias, are also expressed in the atria. We hypothesized that salt-induced elevated blood pressure (BP) leads to atrial K(ATP) channel activation and increased arrhythmia inducibility. Elevated BP was induced in mice with a high-salt diet (HS) for 4 wk. High-resolution optical mapping was used to measure atrial arrhythmia inducibility, effective refractory period (ERP), and action potential duration at 90% repolarization (APD(90)). Excised patch clamping was performed to quantify K(ATP) channel properties and density. K(ATP) channel protein expression was also evaluated. Atrial arrhythmia inducibility was 22% higher in HS hearts compared with control hearts. ERP and APD(90) were significantly shorter in the right atrial appendage and left atrial appendage of HS hearts compared with control hearts. Perfusion with 1 μM glibenclamide or 300 μM tolbutamide significantly decreased arrhythmia inducibility and prolonged APD(90) in HS hearts compared with untreated HS hearts. K(ATP) channel density was 156% higher in myocytes isolated from HS animals compared with control animals. Sulfonylurea receptor 1 protein expression was increased in the left atrial appendage and right atrial appendage of HS animals (415% and 372% of NS animals, respectively). In conclusion, K(ATP) channel activation provides a mechanistic link between salt-induced elevated BP and increased atrial arrhythmia inducibility. The findings of this study have important implications for the treatment and prevention of atrial arrhythmias in the setting of hypertensive heart disease and may lead to new therapeutic approaches.
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Affiliation(s)
- Joshua M Lader
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York 10016, USA
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Izumi R, Shinohata R, Ohmaru N, Kitawaki T, Usui S, Ikeda S, Kusachi S. QT Dispersion Measured by Automatic Computerized 12-Lead Electrocardiography Contributes Significantly to Detection of Left Ventricular Hypertrophy in Japanese Patients. J Int Med Res 2011; 39:51-63. [DOI: 10.1177/147323001103900107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study assessed the diagnostic value of QT dispersion for left ventricular hypertrophy (LVH) as determined by echocardiography. The QT and QRS interval parameters were determined automatically using computerized 12-lead electrocardiography in 153 Japanese outpatients. Corrected QT dispersion (QTcD) and maximal QRS duration (MaxQRS) were significantly correlated with left ventricular mass index. The sum of QTcD and MaxQRS showed the highest correlation with left ventricular mass index among QT and QRS interval parameters and their combinations. The cut-off points for LVH discrimination in this study were different to those reported in Western, mainly Caucasian, populations, suggesting the need for ethnicity-specific LVH detection criteria. A scoring system derived from multiple logistic regression analysis, employing a combination of QTcD, QRS time–voltage product and ST-T change, showed a specificity of 86.3%. It was concluded that QTcD, in addition to QRS time–voltage product and ST-T change, improved the detection of LVH.
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Affiliation(s)
- R Izumi
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
- Clinical Physiology Test Department, Kawasaki Medical College Hospital, Kurashiki, Japan
| | - R Shinohata
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - N Ohmaru
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - T Kitawaki
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - S Usui
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - S Ikeda
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - S Kusachi
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
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Yang KC, Foeger NC, Marionneau C, Jay PY, McMullen JR, Nerbonne JM. Homeostatic regulation of electrical excitability in physiological cardiac hypertrophy. J Physiol 2010; 588:5015-32. [PMID: 20974681 DOI: 10.1113/jphysiol.2010.197418] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pathological biomechanical stresses cause cardiac hypertrophy, which is associated with QT prolongation and arrhythmias. Previous studies have demonstrated that repolarizing K(+) current densities are decreased in pressure overload-induced left ventricular hypertrophy, resulting in action potential and QT prolongation. Cardiac hypertrophy also occurs with exercise training, but this physiological hypertrophy is not associated with electrical abnormalities or increased arrhythmia risk, suggesting that repolarizing K(+) currents are upregulated, in parallel with the increase in myocyte size, to maintain normal cardiac function. To explore this hypothesis directly, electrophysiological recordings were obtained from ventricular myocytes isolated from two mouse models of physiological hypertrophy, one produced by swim-training of wild-type mice and the other by cardiac-specific expression of constitutively active phosphoinositide-3-kinase-p110α (caPI3Kα). Whole-cell voltage-clamp recordings revealed that repolarizing K(+) current amplitudes were higher in ventricular myocytes isolated from swim-trained and caPI3Kα, compared with wild-type, animals. The increases in K(+) current amplitudes paralleled the observed cellular hypertrophy, resulting in normalized or increased K(+) current densities. Electrocardiographic parameters, including QT intervals, as well as ventricular action potential waveforms in swim-trained animals/myocytes were indistinguishable from controls, demonstrating preserved electrical function. Additional experiments revealed that inward Ca(2+) current amplitudes/densities were also increased in caPI3Kα, compared with WT, left ventricular myocytes. The expression of transcripts encoding K(+), Ca(2+) and other ion channel subunits was increased in swim-trained and caPI3Kα ventricles, in parallel with the increase in myocyte size and with the global increases in total cellular RNA expression. In contrast to pathological hypertrophy, therefore, the functional expression of repolarizing K(+) (and depolarizing Ca(2+)) channels is increased with physiological hypertrophy, reflecting upregulation of the underlying ion channel subunit transcripts and resulting in increased current amplitudes and the normalization of current densities and action potential waveforms. Taken together, these results suggest that activation of PI3Kα signalling preserves normal myocardial electrical functioning and could be protective against the increased risk of arrhythmias and sudden death that are prevalent in pathological cardiac hypertrophy.
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Affiliation(s)
- Kai-Chien Yang
- Department of Developmental Biology, Washington University Medical School, St Louis, MO 63110-1093, USA
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Kaya CT, Gurlek A, Altin T, Kilickap M, Karabulut HG, Turhan S, Ozcan O, Bokesoy I, Oral D, Erol C. The relationship between angiotensin converting enzyme gene I/D polymorphism and QT dispersion in patients with hypertrophic cardiomyopathy. J Renin Angiotensin Aldosterone Syst 2010; 11:192-7. [PMID: 20478904 DOI: 10.1177/1470320310368190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) is characterized by disorganized myocardial architecture, and may cause ventricular arrhythmias and sudden death. The angiotensin-converting enzyme (ACE) with two deletion alleles (DD genotype) has been proposed to be associated with increased myocardial collagen content. We evaluated QT dispersion (QTd), which reflects regional differences in ventricular repolarization, in HCM patient and controls among the three different ACE genotypes. MATERIALS AND METHODS Sixty-three patients with HCM and 20 healthy subjects were included in the study. QT parameters were measured from 12 lead electrocardiograms. ACE genotypes were determined from the DNA extracted from peripheral blood by a polymerase chain reaction (PCR) method. QT parameters were compared among the three ACE genotypes both in HCM patients and controls. RESULTS Median ages were similar in HCM and control groups. QTd and corrected QTd (QTcd) were significantly greater in the HCM group compared with the controls. The frequencies of each genotype were similar in both groups. Although QTd and QTcd did not differ among the three genotypes in the control subjects, they were significantly greater in patients with DD genotype compared with other genotypes in the HCM group. CONCLUSION QTd and QTcd are increased in patients with HCM, especially in those with the DD genotype.
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Affiliation(s)
- Cansin Tulunay Kaya
- Departments of Cardiology, Ankara University School of Medicine, Ankara, Turkey
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Abstract
Abuse of anabolic androgenic steroids (AAS) has been linked to a variety of different cardiovascular side effects. In case reports, acute myocardial infarction is the most common event presented, but other adverse cardiovascular effects such as left ventricular hypertrophy, reduced left ventricular function, arterial thrombosis, pulmonary embolism and several cases of sudden cardiac death have also been reported. However, to date there are no prospective, randomized, interventional studies on the long-term cardiovascular effects of abuse of AAS. In this review we have studied the relevant literature regarding several risk factors for cardiovascular disease where the effects of AAS have been scrutinized:(1) Echocardiographic studies show that supraphysiologic doses of AAS lead to both morphologic and functional changes of the heart. These include a tendency to produce myocardial hypertrophy (Fig. 3), a possible increase of heart chamber diameters, unequivocal alterations of diastolic function and ventricular relaxation, and most likely a subclinically compromised left ventricular contractile function. (2) AAS induce a mild, but transient increase of blood pressure. However, the clinical significance of this effect remains modest. (3) Furthermore, AAS confer an enhanced pro-thrombotic state, most prominently through an activation of platelet aggregability. The concomitant effects on the humoral coagulation cascade are more complex and include activation of both pro-coagulatory and fibrinolytic pathways. (4) Users of AAS often demonstrate unfavorable measurements of vascular reactivity involving endothelial-dependent or endothelial-independent vasodilatation. A degree of reversibility seems to be consistent, though. (5) There is a comprehensive body of evidence documenting that AAS induce various alterations of lipid metabolism. The most prominent changes are concomitant elevations of LDL and decreases of HDL, effects that increase the risk of coronary artery disease. And finally, (6) the use of AAS appears to confer an increased risk of life-threatening arrhythmia leading to sudden death, although the underlying mechanisms are still far from being elucidated. Taken together, various lines of evidence involving a variety of pathophysiologic mechanisms suggest an increased risk for cardiovascular disease in users of anabolic androgenic steroids.
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Affiliation(s)
- Paul Vanberg
- Chief Physician/Senior Cardiologist, Oslo University Hospital - Aker, Trondheimsveien 235, 0514-Oslo University Hospital, Oslo, Norway.
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Effect of telmisartan on QT interval variability and autonomic control in hypertensive patients with left ventricular hypertrophy. Biomed Pharmacother 2009; 64:516-20. [PMID: 20044234 DOI: 10.1016/j.biopha.2009.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 09/24/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The aim of the study was to examine the effect of the antihypertensive AT1 receptors antagonist telmisartan on cardiovascular autonomic function and QT dispersion in hypertensive patients with LVH. METHODS Twenty-five patients (18 males and seven women, mean age 49.8±5.2 years) with mild essential arterial hypertension and LVH were compared with 25 age-matched healthy controls. All the participants underwent a complete clinical examination, including electrocardiogram for QT interval measurements and 24h ambulatory ECG monitoring for measurement of heart rate variability. The ECG, 24h ambulatory ECG, and echocardiogram were repeated after eight weeks of treatment. RESULTS At baseline, hypertensive patients showed QT dispersion (p<0.001) and QTc dispersion (p<0.001) significantly higher than control subjects. An eight-week telmisartan treatment significantly reduced blood pressure (p<0.0001), without significant change in left ventricular mass. Telmisartan-based treatment induced an increased vagal activity without significant change of sympathetic activity and a reduction of QT dispersion (p<0.001) and QTc dispersion (p<0.001). CONCLUSIONS These data suggest that therapy with telmisartan significantly improves the sympathovagal balance increasing parasympathetic activity, and cardiac electrical stability reducing the heterogeneity of ventricular repolarization in hypertensive subjects. These effects could contribute to reduce arrhythmias as well as sudden cardiac death in at-risk hypertensive patients.
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Dimopoulos S, Nicosia F, Turini D, Zulli R. Prognostic evaluation of QT-dispersion in elderly hypertensive and normotensive patients. Pacing Clin Electrophysiol 2009; 32:1381-1387. [PMID: 19712075 DOI: 10.1111/j.1540-8159.2009.02510.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND QT-corrected interval dispersion (QTcD) is an indirect index of increased heterogeneity of ventricular repolarization. However, the prognostic value of (QTcD) in elderly hypertensive and normotensive patients has not been thoroughly investigated yet. METHODS The study population consisted of 60 consecutive patients (34 males/26 females; mean age: 63+/-11 years) with mild to moderate essential arterial hypertension and 48 consecutive age-matched healthy subjects (24 males/24 females; 65+/-16 years). QTcD was measured by a 12-lead electrocardiogram (ECG) as the difference between maximum and minimum QT-interval, corrected for heart rate. Ventricular arrhythmias were recorded by a 24-hour Holter ECG and classified by a modified Lown's score (range: 0-6). Left ventricular mass was measured echocardiographically and indexed by body surface area [left ventricular mass index (LVMI)]. Nine patients were lost during the follow-up period. Patients were followed up for 54+/-9 months, and the primary end-point was the major cardiovascular events (including cardiac mortality). RESULTS Major cardiovascular events occurred in 22 patients (22%). Patients with QTcD>or=45 ms (n=35) had a higher rate of major cardiovascular events (43% vs 11%; log rank: 14.8; P<0.001), a higher LVMI (146+/-29 vs 104+/-21 g/m2; P<0.001), greater values of systolic and diastolic blood pressure (154+/-16 vs 144+/-18 mmHg; P<0.01 and 92+/-10 vs 88+/-8 mmHg; P<0.05, respectively), a higher number of premature ventricular beats (354+/-870 vs 113+/-301; P<0.05), and a greater Lown's score (3.7+/-1.9 vs 1.4+/-1.8; P<0.05) than patients with QTcD<45 ms. QTcD (>or=or<45 ms) was an independent predictor of major cardiovascular events (odds ratio: 4.9; 95% confidence interval: 2.0-12.1; P=0.001) after adjustment for LVMI, Lown's score (>or=or<3), age (>or=or<65 years), and QTc max (>or=or<437 ms). CONCLUSIONS QTcD is an independent predictor of major cardiovascular events in elderly hypertensive and normotensive patients and might be used in their risk stratification.
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Affiliation(s)
- Stavros Dimopoulos
- Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece.
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Voulgari C, Tentolouris N. Assessment of the Spatial QRS-T Angle by Vectorcardiography: Current Data and Perspectives. Curr Cardiol Rev 2009; 5:251-62. [PMID: 21037841 PMCID: PMC2842956 DOI: 10.2174/157340309789317850] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 03/26/2009] [Accepted: 03/31/2009] [Indexed: 01/19/2023] Open
Abstract
The concept of the ventricular gradient (VG) was conceived in the 1930s and its calculation yielded information that was not otherwise obtainable. The VG was not utilized by clinicians at large because it was not easy to understand and its computation time-consuming. Spatial vectorcardiography is based on the concept of the VG. Its current major clinical use is to identify primary [heterogeneity of ventricular action potential (VAP) morphology] in the presence of secondary [heterogeneity in ventricular depolarization instants] T-wave abnormalities in an ECG. Nowadays, the calculation of the spatial VG can be computed on the basis of a regular routine ECG and contributes to localization of arrhythmogenic areas in the heart by assessing overall and local VAP duration heterogeneity. Recent population-based studies suggest that the spatial VG is a dominant ECG predictor of future cardiovascular events and death and it is superior to more conventional ECG parameters. Its assessment warrants consideration for intensified primary and secondary prevention efforts and can be included in everyday clinical practice. This review addresses the nature and diagnostic potential of the spatial VG. The main focus is the role of the spatial VG in ECG assessment of dispersion of repolarization, a key factor in arrhythmogeneity.
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Affiliation(s)
| | - Nicholas Tentolouris
- 1st Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital Athens, Greece
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Klimas J, Stankovicova T, Kyselovic J, Bacharova L. Prolonged QT Interval Is Associated with Blood Pressure Rather Than Left Ventricular Mass in Spontaneously Hypertensive Rats. Clin Exp Hypertens 2009; 30:475-85. [DOI: 10.1080/10641960802443399] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jan Klimas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic
| | - Tatiana Stankovicova
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic
| | - Jan Kyselovic
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic
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Batur MK, Açil T, Onalan O, Yildirir A, Ovünç K, Kabakci G, Oto A, Ozkutlu H, Nazli N, Gürsel G, Kes S. Is ventricular repolarization heterogeneity a cause of serious ventricular tachyarrhythmias in aortic valve stenosis? Clin Cardiol 2009; 23:449-52. [PMID: 10875037 PMCID: PMC6654880 DOI: 10.1002/clc.4960230615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND It is well known that there is a close relation between sudden cardiac death and serious ventricular tachyarrhythmias in patients with aortic valve stenosis (AS). QT dispersion (QTd) reflects the ventricular repolarization heterogeneity and has been proposed as an indicator for ventricular arrhythmias. HYPOTHESIS This study investigated the QTd and its relevance to the clinical and echocardiographic variables. METHODS In all, 51 patients (33 men, 18 women, mean age 56 +/- 12) with isolated AS and 51 age- and gender-matched healthy controls comprised the study group. Left ventricular mass index (LVMI) was calculated by the Devereux formula, and we used continuous-wave Doppler (n = 15) and cardiac catheterization (n = 36) for the determination of the maximum aortic valve pressure gradient (PG). RESULTS Corrected QTd (QTcd) (89 +/- 39 vs. 49 +/- 15 ms, p < 0.001) and LVMI (176 +/- 69 g/m2 vs. 101 +/- 28 g/m2, p < 0.001) in patients with AS were significantly different from those in the control group. The group of 21 patients had a significantly greater number of 24-h mean ventricular premature beats (VPB) and mean number of couplet VT episodes than did the control group (p < 0.05). QTcd also correlated significantly well with LVMI (r = 0.58, p < 0.001), PG (r = 0.41, p = 0.003), and number of 24-h VPB (r = 0.56, p = 0.008). With respect to symptoms (e.g., angina, syncope, and dyspnea) patients without symptoms (n = 19) displayed less QTcd (71 +/- 31 vs. 100 +/- 39 ms, p = 0.007) and less LVMI (144 +/- 80 g/m2 vs. 195 +/- 57 g/m2, p = 0.01) than patients with symptoms. Statistical analysis was similar for all variables with uncorrected QTd values. CONCLUSION We found that ventricular repolarization heterogeneity was greater in patients with AS than in controls. Our findings also showed that QTd in the patient group correlates well with LVMI, severity of AS, and PG. The present results suggest that serious ventricular arrhythmias in patients with AS may be due to spatial ventricular repolarization abnormality.
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Affiliation(s)
- M K Batur
- Hacettepe Medical School, Department of Cardiology, Ankara, Turkey
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Dilaveris P, Gialafos E, Poloniecki J, Hnatkova K, Richter D, Andrikopoulos G, Lazaki E, Gialafos J, Malik M. Changes of the T-wave amplitude and angle: an early marker of altered ventricular repolarization in hypertension. Clin Cardiol 2009; 23:600-6. [PMID: 10941547 PMCID: PMC6654945 DOI: 10.1002/clc.4960230811] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The heterogeneity of ventricular repolarization is an important proarrhythmic factor. QT dispersion has been proposed to reflect the inhomogeneity of ventricular repolarization, but a poor reproducibility limits its clinical applicability. Reliable noninvasive methods to quantify abnormalities in ventricular repolarization are still lacking. The T-loop morphology analysis is a novel method aimed at quantifying ventricular repolarization. HYPOTHESIS To test the ability of the T-loop morphology analysis to discriminate between hypertensive patients and healthy subjects, 105 hypertensive patients (mean age 63.6 +/- 12.3 years) and 110 healthy controls (mean age 49.7 +/- 14.3 years) were evaluated. METHODS The maximum QT interval (QT maximum), the minimum QT interval (QT minimum), and their difference (QT dispersion) were calculated from a digitally recorded 12-lead electrocardiogram (ECG) in both study groups. X, Y, and Z leads were reconstructed from the 12-lead ECG, and the amplitude of the maximum T vector (T amplitude) and the angle between the maximum T vector and X axis (T angle) were calculated from the projection of the T loop in the frontal plane. RESULTS T amplitude (p < 0.001), T angle (p = 0.05), and QT dispersion (p = 0.04) were significantly different between hypertensive patients and controls, while QT maximum (p = 0.14) and QT minimum (p = 0.35) did not differ between the groups. T amplitude was the only marker which differed between hypertensive patients without ECG criteria for left ventricular hypertrophy and controls (p = 0.002). CONCLUSIONS T-loop features and particularly T amplitude are significantly different between hypertensive patients and healthy controls and may serve as early markers of repolarization abnormalities in a hypertensive population.
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Affiliation(s)
- P Dilaveris
- Department of Cardiological Sciences, St. George's Hospital Medical School, London, England
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Dimopoulos S, Nicosia F, Donati P, Prometti P, De Vecchi M, Zulli R, Grassi V. QT dispersion and left ventricular hypertrophy in elderly hypertensive and normotensive patients. Angiology 2008; 59:605-612. [PMID: 18388029 DOI: 10.1177/0003319707310276] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Inhomogeneity of ventricular repolarization as detected by QT dispersion may be a potential leading mechanism of sudden death in hypertensive and normotensive (age related) left ventricular hypertrophy. Aim of this study was to investigate QT dispersion, ventricular arrhythmias, and left ventricular mass index in elderly hypertensive and normotensive patients. Study population consisted of 60 consecutive patients (sex: 34 men/26 women; age: 63 +/- 11 years) with essential arterial hypertension and 48 age and sex-matched control subjects (24 men/24 women; 64 +/- 16 years). Measurements included QTc dispersion, ventricular arrhythmias, and left ventricular hypertrophy. Hypertensive patients had greater left ventricular mass index (P = .006) and higher QTc dispersion (P = .004) than controls. Left ventricular hypertrophy was diagnosed in 57 (31 men/26 women) of all subjects. These patients had higher blood pressure (P < .05), Lown's score (P < .001), and QTc dispersion (P < .001). QTc dispersion and Lown's score were independent predictors of left ventricular mass index (P < .001). Conclusively, QTc dispersion is a strong indicator of left ventricular mass index and might be used in risk stratification of hypertensive and normotensive elderly patients.
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Affiliation(s)
- Stavros Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece.
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Porthan K, Virolainen J, Hiltunen TP, Viitasalo M, Väänänen H, Dabek J, Hannila-Handelberg T, Toivonen L, Nieminen MS, Kontula K, Oikarinen L. Relationship of electrocardiographic repolarization measures to echocardiographic left ventricular mass in men with hypertension. J Hypertens 2007; 25:1951-7. [PMID: 17762661 DOI: 10.1097/hjh.0b013e328263088b] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Arterial hypertension often leads to an increase in left ventricular mass (LVM). Marked left ventricular hypertrophy (LVH) is associated with potentially arrhythmogenic ventricular repolarization abnormalities, which may contribute to the increased risk of sudden cardiac death in this disorder. We studied whether electrocardiographic repolarization changes are already detectable in mild LVM increase associated with hypertension. METHODS In 220 men (mean age 51+/-6 years) attending the GENRES hypertension study, we measured QT intervals (QTend and QTpeak), T-wave peak to T-wave end (TPE) intervals, and novel T-wave morphology parameters (principal component analysis ratio, T-wave morphology dispersion, total cosine R-to-T, and T-wave residuum) from a digital standard 12-lead electrocardiogram, and related them to echocardiographically determined LVM. RESULTS In this group of moderately hypertensive men, the mean LVM index (LVMI; LVM divided by body surface area) was 99+/-19 g/m2, with only 18% of the subjects showing evidence of echocardiographic LVH (LVMI>116 g/m2). LVMI correlated significantly with QT intervals (r=0.16-0.21, P=0.018-0.002), TPE intervals (r=0.23-0.27, P<0.001), and T-wave morphology parameters (r=0.22-0.39, P<0.001). Except for the QTpeak interval, the relationship between LVMI and electrocardiographic repolarization parameters was independent in multivariate analyses. CONCLUSION Altered electrocardiographic ventricular repolarization, indicating reduced repolarization reserve and possibly increased repolarization heterogeneity, is already present in hypertensive men with only mild LVM increase. At a population level, this may carry important risk implications for the large group of hypertensive patients.
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Affiliation(s)
- Kimmo Porthan
- Department of Cardiology, Helsinki University Central Hospital, Finland.
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