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Relation of T Wave Positivity in Lead aVR to Ischemic Etiology of Cardiomyopathy. Am J Cardiol 2022; 180:17-23. [DOI: 10.1016/j.amjcard.2022.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
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Sedighi S, Fattahi M, Dehghani P, Aslani A, Mehdipour Namdar Z, Hassanzadeh M. aVR ST-segment changes and prognosis of ST-segment elevation myocardial infarction. Health Sci Rep 2021; 4:e387. [PMID: 34622021 PMCID: PMC8485596 DOI: 10.1002/hsr2.387] [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: 06/25/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Clinical importance of aVR lead-related changes in predicting the prognosis of acute myocardial infarction remains uncertain. The present study aimed to assess the value of ST-segment changes in aVR lead and the outcome and sequels of the first episode of acute ST-segment elevation myocardial infarction. METHODS This prospective cohort study was conducted on patients suffering first episode of ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Information was collected through hospital-recorded files reading. The electrocardiogram (ECG) was taken from the patients upon entering the hospital and followed-up for 30 days to assess cardiovascular complications. RESULTS In patients with anterior STEMI, with the use of multivariate analysis, admission aVR ST elevation ≥1 mm was found to be a strong and independent predictor of major cardiovascular adverse events (MACE) within 30 days of discharging (P value for trend .002). In patients with inferior (± RV) ST-segment elevation myocardial infarction (STEMI), with the use of multivariate analysis, admission aVR ST depression ≥1 mm was found to be a strong and independent predictor of MACE within 30 days of discharging (P value for trend .01). CONCLUSION In patients with anterior STEMI, admission aVR STE ≥1 mm was found to be a strong and independent predictor of MACE within 30 days of discharging. On the other hand, in patients with inferior STEMI, aVR ST depression ≥1 mm was found to be a strong and independent predictor of MACE within 30 days of discharging.
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Affiliation(s)
- Sogol Sedighi
- Cardiovascular Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Mustafa Fattahi
- Cardiovascular Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Pooyan Dehghani
- Cardiovascular Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Amir Aslani
- Cardiovascular Research Center Shiraz University of Medical Sciences Shiraz Iran
| | | | - Mani Hassanzadeh
- Cardiovascular Research Center Shiraz University of Medical Sciences Shiraz Iran
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Kurisu S, Nitta K, Watanabe N, Ikenaga H, Ishibashi K, Fukuda Y, Nakano Y. Effects of upright T-wave in lead aVR on left ventricular volume and function derived from ECG-gated SPECT in patients with advanced chronic kidney disease. Ann Nucl Med 2021; 35:1-7. [PMID: 32984938 DOI: 10.1007/s12149-020-01528-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Numerous studies have shown the association between chronic kidney disease (CKD) and adverse cardiac events. We investigated whether or not the upright T-wave in lead aVR (TaVR) could predict left ventricular (LV) volume and function derived from ECG-gated SPECT in patients with advanced CKD. METHODS Two hundred and sixty-one patients with advanced CKD [estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m2] were enrolled. Upright TaVR was defined as a wave with a positive deflection of > 0 mV. Enlarged LV end-diastolic volume (LVEDV) was defined as LVEDV index of > 76 ml/m2 in men and > 57 ml/m2 in women. Reduced LV ejection fraction (LVEF) was defined as LVEF of < 40%. RESULTS Forty-six patients (18%) had upright TaVR, and 215 patients (82%) had negative TaVR. Summed redistribution score (SRS) [ 6 (1-12) vs. 2 (0-5), p < 0.001] and summed difference score (SDS) [4 (1-6) vs. 2 (0-4), p = 0.004] were significantly larger in patients with upright TaVR than those with negative TaVR. Patients with upright TaVR had larger LVEDV index (75 ± 33 ml/m2 vs. 50 ± 18 ml/m2, p < 0.001) and lower LVEF (43 ± 14% vs. 58 ± 11%, p < 0.001) compared to those with negative TaVR. After adjusted for other variables including SRS and SDS, upright TaVR remained a significant predictor of enlarged LVEDV (odds ratio 5.45; 95% CI 2.16-14.22; p < 0.001) and reduced LVEF (odds ratio 4.54; 95% CI 1.70-12.23; p = 0.003). CONCLUSIONS Our data suggested that upright TaVR could predict LV volume and function derived from ECG-gated SPECT in patients with advanced CKD.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
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Siren M, Koivula K, Eskola MJ, Martiskainen M, Huhtala H, Laurikka J, Mikkelsson J, Järvelä K, Niemelä KO, Punkka O, Karhunen PJ, Nikus KC. The prognostic significance of a positive or isoelectric T wave in lead aVR in patients with acute coronary syndrome and ischemic ECG changes in the presenting ECG - Long-term follow-up data of the TACOS study. J Electrocardiol 2020; 60:131-137. [PMID: 32361088 DOI: 10.1016/j.jelectrocard.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/03/2020] [Accepted: 04/11/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND A positive T wave in lead aVR (aVRT+) is an independent prognostic predictor of cardiovascular mortality in the general population as well as in cardiovascular disease. SUBJECTS AND METHODS We evaluated the prognostic impact of aVRT+ in an ECG recorded as close to hospital discharge as possible in acute coronary syndrome patients (n = 527). We divided the patients into three categories based on the findings in the admission ECG: ST elevation, global ischemia and other ST/T changes. RESULTS In the whole study population, and in all the three ECG subgroups, the 10-year all-cause mortality rate was higher in the aVRT+ group than in the aVRT- group. In Cox regression analysis, the age and gender adjusted hazard ratio (HR) for aVRT+ to predict all-cause mortality in the whole study population was 1.43 (95% confidence interval [CI] 1.12-1.83; p = 0.004). To predict cardiovascular mortality, the age and gender adjusted HR for aVRT+ was 1.54 (95% CI 1.14-2.07; p = 0.005) in the whole study population and 2.07 (95% CI 1.07-4.03; p = 0.032) in the category with other ST/T changes. CONCLUSION In ACS patients with or without ST elevation, but with ischemic ST/T changes in their presenting ECG, a positive or isoelectric T wave in lead aVR in an ECG recorded in the subacute in-hospital stage is associated with all-cause and cardiovascular mortality during long-term follow-up. Clinicians should pay attention to this simple ECG finding at hospital discharge.
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Affiliation(s)
- Marko Siren
- Faculty of Medicine and Health Technology, Tampere University, Finland.
| | - Kimmo Koivula
- Faculty of Medicine and Health Technology, Tampere University, Finland; South-Karelia Central Hospital, Finland
| | | | | | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Finland
| | | | | | - Kati Järvelä
- Heart Center, Tampere University Hospital, Finland
| | | | - Olli Punkka
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Pekka J Karhunen
- Faculty of Medicine and Health Technology, Tampere University, Finland; Fimlab Laboratories Tampere University Hospital, Tampere, Finland
| | - Kjell C Nikus
- Faculty of Medicine and Health Technology, Tampere University, Finland; Heart Center, Tampere University Hospital, Finland
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Ekizler FA, Cay S, Kafes H, Ozeke O, Ozcan F, Topaloglu S, Temizhan A, Aras D. The prognostic value of positive T wave in lead aVR: A novel marker of adverse cardiac outcomes in peripartum cardiomyopathy. Ann Noninvasive Electrocardiol 2019; 24:e12631. [PMID: 30653267 DOI: 10.1111/anec.12631] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/28/2018] [Accepted: 11/03/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is an uncommon complication of pregnancy. Clinical courses of PPCM are markedly heterogeneous. Positive T waves in lead aVR (TaVR) are shown to be associated with adverse cardiac events in several cardiovascular diseases. We aimed to investigate the prevalence and prognostic role of positive TaVR in patients with PPCM. METHODS A total of 82 patients (mean age 29.1 ± 6.3 years) with the diagnosis of PPCM were enrolled. Presentation electrocardiogram (ECG) was investigated for presence of a positive TaVR. The median follow-up duration was 67.0 months. The primary endpoint was defined as composite cardiac events, including cardiac death, arrhythmic events, or persistent left ventricular systolic dysfunction. RESULTS Patients with positive T wave in lead aVR showed higher rates for persistent left ventricular systolic dysfunction, arrhythmic events, and cardiac death compared to patients without it. In multivariate logistic regression analysis, after adjusting for other confounding factors, the presence of positive TaVR was found to be as an independent and strong predictor of primary composite endpoint (odds ratio 6.21, 95% CI 1.45-26.51; p = 0.014). In Kaplan-Meier survival analysis, both primary and secondary endpoints occurred more frequently in the positive TaVR group. Using the cut-off level of 0.25 mV, T-wave amplitude in lead aVR predicted primary endpoint with a sensitivity of 100% and specificity of 100%. CONCLUSION Positive T wave in lead aVR, as a simple and feasible electrocardiographic marker, seems to be a novel predictor of adverse cardiovascular outcomes in patients with PPCM.
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Affiliation(s)
- Firdevs Aysenur Ekizler
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Habibe Kafes
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Ahmet Temizhan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey
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Yang HJ, Liu X, Qu C, Shi SB, Yang B. Usefulness of upright T wave in lead aVR for predicting short-term prognosis of patients with ischemic stroke. Chronic Dis Transl Med 2018; 4:192-198. [PMID: 30276366 PMCID: PMC6160666 DOI: 10.1016/j.cdtm.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 11/20/2022] Open
Abstract
Background Upright T wave in lead aVR (TaVR) has recently been reported to be associated with cardiovascular death and mortality in general population and in patients with prior cardiovascular disease (CVD). However, the evidence for the predictive ability of TaVR in patients with ischemic stroke (IS) is lacking. Methods A total of 625 consecutive patients with IS (mean age: 66 ± 12 years; 379 male) were enrolled in this study between January 2013 and December 2014. Patients were divided into upright TaVR (≥0 mV; n = 201) and negative TaVR (<0 mV; n = 424) groups. All patients were evaluated with respect to clinical features and in-hospital clinical results. Results Overall, the prevalence of upright TaVR was 32.2% at baseline. Patients with an upright TaVR were older, had a higher percentage of CVD and hypertension, higher level of MB isoenzyme of creatine kinase (CKMB), faster heart rate, higher rate of QT prolongation > 450 ms, higher rate of negative T in lead II, higher rate of negative T in lead V6, higher rate of ST depression, and longer QTc duration. During the mean follow-up period of 20.0 ± 5.8 months, 29 (4.6%) patients experienced all-cause death and 12 (1.9%) patients experienced cardiovascular death, the primary end point. Concomitantly, 94 (15%) patients experienced recurrence of IS, the secondary end point. After adjusting for clinical covariates, upright TaVR was independently associated with all-cause death [hazard ratio (HR): 2.88, 95% confidence intervals (CI): 1.07–7.73], cardiovascular death (HR: 3.04, 95% CI: 1.07–8.64), and IS recurrence (HR: 1.86, 95% CI: 1.08–3.20). Conclusions Upright TaVR in patients with IS is associated with increased mortality and recurrence of IS.
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Affiliation(s)
- Hong-Jie Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan 430060, China
| | - Xin Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan 430060, China
| | - Chuan Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan 430060, China
| | - Shao-Bo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan 430060, China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan 430060, China
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Separham A, Sohrabi B, Tajlil A, Pourafkari L, Sadeghi R, Ghaffari S, Nader ND. Prognostic value of positive T wave in lead aVR in patients with non-ST segment myocardial infarction. Ann Noninvasive Electrocardiol 2018; 23:e12554. [PMID: 29676045 PMCID: PMC6931446 DOI: 10.1111/anec.12554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Lead aVR provides prognostic information in various settings in patients with ischemia. We aim to investigate the role of a positive T wave in lead aVR in non-ST segment myocardial infarction (NSTEMI). METHODS In a prospective cohort study, we included 400 patients with NSTEMI. Presentation electrocardiogram (ECG) was investigated for presence of a positive T wave as well as ST segment elevation (STE) in aVR and study variables were compared. Predictors of primary outcome defined as hospital major adverse cardiovascular events (MACE) and secondary outcome, defined as three-vessel coronary disease and/or left main coronary artery stenosis (3VD/LMCA) stenosis in angiography, were determined in multivariate logistic regression analysis. RESULTS Patients with a positive T wave in aVR were significantly older and were more likely to be female. Left ventricular ejection fraction was significantly lower in patients of positive T group. Positive T group was more likely to have 3VD/LMCA stenosis (58.3% vs. 19.8%, p < .001). The prevalence of a positive T wave in aVR was significantly higher in MACE group (54.9 % vs. 24.8%, p < .001). However, in multivariate analysis, it was not an independent predictor of MACE (OR: 1.083 95% CI: [0.496-2.365], p: .841). Though, it was independently associated with presence of 3VD/LMCA stenosis (OR: 3.747 95% CI: [2.058-6.822], p < .001). CONCLUSION Though positive T wave in lead aVR was more common in patients with MACE; it was not an independent predictor. Additionally, a positive T wave in aVR was an independent predictor of 3VD/LMCA stenosis in NSTEMI.
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Affiliation(s)
- Ahmad Separham
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Bahram Sohrabi
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Arezou Tajlil
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Leili Pourafkari
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
- University at BuffaloBuffaloNew York
| | - Robabeh Sadeghi
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Samad Ghaffari
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
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Tanaka Y, Konno T, Tamura Y, Tsuda T, Furusho H, Takamura M, Sakata K, Yamagishi M, Hayashi K. Impact of T wave amplitude in lead aVR on predicting cardiac events in ischemic and nonischemic cardiomyopathy patients with an implantable cardioverter defibrillator. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28440568 DOI: 10.1111/anec.12452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/13/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND T wave amplitudes during ventricular repolarization in the lead aVR (TAaVR) are shown to be associated with adverse cardiac events in patients with several cardiovascular diseases, such as postmyocardial infarction. However, the utility of TAaVR has not been previously evaluated in patients with cardiomyopathy who have received implantable cardioverter defibrillators (ICD). Patients with ischemic or nonischemic cardiomyopathy (ICM or NICM, respectively) and who received an ICD may experience worsening of their condition due to the introduction of electric shock during treatment. This study aimed to investigate the utility of TAaVR in the prediction of cardiac events in ICM or NICM patients with ICD. METHODS Ninety-three consecutive ICM or NICM patients with ICD were retrospectively analyzed (median age: 64 years; male: 77.4%; ICD for secondary prevention: 76.3%; NICM: 64.5%). The median follow-up period was 31 months. The primary endpoint was defined as composite cardiac events, including cardiac death, major ventricular arrhythmic events (MVAE), or hospitalization due to heart failure (HHF). RESULTS Multivariate Cox regression analysis demonstrated that less negative TAaVR (-0.1 mV ≤ TAaVR <0 mV and 0 mV ≤ TAaVR) was independently associated with the primary endpoint (HR: 3.75; 95% confidence interval [CI]: 1.09-23.7; p = .04). Kaplan-Meier curve also revealed that the event free survival rate in the less negative TAaVR group was significantly lower than that in the normal TAaVR group (<-0.1 mV) (p < .01). CONCLUSIONS TAaVR is useful in risk stratification for cardiac events in ICM or NICM patients with ICD.
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Affiliation(s)
- Yoshihiro Tanaka
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Tetsuo Konno
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.,Research and Education Center for Innovative and Preventive Medicine, Kanazawa University, Kanazawa, Japan
| | - Yudai Tamura
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Toyonobu Tsuda
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Hiroshi Furusho
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masayuki Takamura
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masakazu Yamagishi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenshi Hayashi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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Kobayashi A, Misumida N, Aoi S, Kanei Y. Positive T wave in lead aVR as an independent predictor for 1-year major adverse cardiac events in patients with first anterior wall ST-segment elevation myocardial infarction. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28205276 DOI: 10.1111/anec.12442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/13/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Positive T wave in lead aVR has been shown to predict an adverse in-hospital outcome in patients with anterior wall ST-segment elevation myocardial infarction (STEMI). However, the prognostic value of positive T wave in lead aVR on a long-term outcome has not been fully explored. METHODS We performed a retrospective analysis of 190 consecutive patients with first anterior wall STEMI who underwent an emergent coronary angiogram. Patients were divided into those with positive T wave > 0 mV and those with negative T wave ≦ 0 mV in lead aVR. Baseline and angiographic characteristics, and in-hospital revascularization procedures were recorded. In addition, in-hospital and 1-year major adverse cardiac events (MACE) including death, recurrent myocardial infarction, and target vessel revascularization were recorded. RESULTS Among 190 patients, 37 patients (19%) had positive T wave and 153 patients (81%) had negative T wave in lead aVR. Patients with positive T wave had higher rate of left main disease defined as stenosis ≥50% (11% vs. 2%, p = .028) than those with negative T wave. Patients with positive T wave had higher rate of 1-year MACE (38% vs. 13%, p < .001) driven by higher all-cause mortality (27% vs. 5%, p < .001). Positive T wave was an independent predictor for 1-year MACE (OR 2.74; 95% CI 1.04-7.15; p = .04). CONCLUSION Positive T wave in lead aVR was an independent predictor for 1-year MACE in patients with first anterior wall STEMI.
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Affiliation(s)
- Akihiro Kobayashi
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Naoki Misumida
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Shunsuke Aoi
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Yumiko Kanei
- Department of Cardiology, Mount Sinai Beth Israel, New York, NY, USA
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10
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T wave amplitude in lead aVR as a novel diagnostic marker for cardiac sarcoidosis. Heart Vessels 2016; 32:352-358. [DOI: 10.1007/s00380-016-0881-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
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Jaroszyński A, Jaroszyńska A, Siebert J, Dąbrowski W, Niedziałek J, Bednarek-Skublewska A, Zapolski T, Wysokiński A, Załuska W, Książek A, Schlegel TT. The prognostic value of positive T-wave in lead aVR in hemodialysis patients. Clin Exp Nephrol 2015; 19:1157-64. [PMID: 25724127 PMCID: PMC4679784 DOI: 10.1007/s10157-015-1100-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 02/16/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Given that cardiac disease is the leading cause of mortality in hemodialysis (HD) patients, identification of patients at risk for cardiac mortality is crucial. The aim of this study was to determine if positive T-wave amplitude in lead aVR (TaVR) was predictive of cardiovascular (CV) mortality and sudden cardiac death (SCD) in a group of HD patients. METHODS AND RESULTS After exclusion, 223 HD patients were prospectively followed-up for 25.43 ± 3.56 months. Patients were divided into TaVR negative (n = 186) and TaVR positive (n = 37) groups. Myocardial infarction, diabetes and beta-blocker therapy were more frequent in positive TaVR patients. Patients with upright TaVR were older, had higher left ventricular mass index, lower ejection fraction, higher calcium × phosphate product, higher troponin T level, higher prevalence of ST-T abnormalities, and increased width of QRS complex and QT interval, compared with patients with negative TaVR. A Kaplan-Meier analysis showed that the cumulative incidences of CV mortality as well as SCD were higher in patients with positive TaVR compared with those with negative TaVR (log-rank, p < 0.001 in both cases). A multivariate analysis selected age [hazard ratio (HR) 1.71, p < 0.001], heart rate (HR 1.42, p = 0.016), and positive TaVR (HR 2.21, p = 0.001) as well as age (HR 1.88, p < 0.001), and positive TaVR (HR 1.53, p = 0.014) as independent predictors of CV mortality and SCD, respectively. CONCLUSION In HD patients, positive TaVR is an independent and powerful predictor of CV mortality as well as SCD. This simple ECG parameter provides additional information beyond what is available with other known traditional risk factors and allows the identification of patients most at risk of CV events.
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Affiliation(s)
- Andrzej Jaroszyński
- Department of Family Medicine, Medical University of Lublin, Staszica 11, 20-081, Lublin, Poland.
| | - Anna Jaroszyńska
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Janusz Siebert
- Department of Family Medicine, University Center for Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Dąbrowski
- Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Jarosław Niedziałek
- Department of Family Medicine, Medical University of Lublin, Staszica 11, 20-081, Lublin, Poland
| | | | - Tomasz Zapolski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
| | - Andrzej Książek
- Department of Nephrology, Medical University of Lublin, Lublin, Poland
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Phan D, Narayanan K, Uy-Evanado A, Teodorescu C, Reinier K, Chugh H, Gunson K, Jui J, Chugh SS. T-wave reversal in the augmented unipolar right arm electrocardiographic lead is associated with increased risk of sudden death. J Interv Card Electrophysiol 2015; 45:141-7. [PMID: 26628059 DOI: 10.1007/s10840-015-0078-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/19/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Repolarization abnormalities are associated with ventricular arrhythmias, and published studies report that a reversal of T wave polarity (positive or flat T wave) in lead aVR may be linked to increased cardiovascular mortality. We evaluated whether a positive or flat T wave in aVR is a risk marker for sudden cardiac death (SCD). METHODS SCD cases from the Oregon Sudden Unexpected Death Study (catchment population ~1 million) were compared to geographic controls with coronary artery disease and no history of SCD. Archived electrocardiograms performed prior and unrelated to the SCD event were evaluated. RESULTS SCD cases (n = 691, 67.6 ± 14.9 years, 69% male) were more likely than controls (n = 663, 66.2 ± 11.6 years, 67% male) to have diabetes (40 vs 32%; p < 0.01), left ventricular ejection fraction (LVEF) ≤35% (27 vs 11 %; p < 0.01), prolonged QTc (≥450 ms; 54 vs 28%; p < 0.01) and positive (19 vs 13%; p < 0.01) or flat T wave (14 vs 7%; p < 0.01) in aVR. On multivariable analysis, a positive/flat T wave in aVR was independently associated with SCD (OR 1.9, 95% CI 1.3-2.8, p < 0.01). However, a positive T wave alone lost statistical significance in patients with LVEF ≤ 35% and QTc ≥ 450 ms. In a subgroup analysis among patients with normal LVEF, QTc, and no diabetes, a positive T wave in aVR (but not a flat T wave) remained associated with SCD (OR 2.8, 95% CI 1.2-6.1, p < 0.01). CONCLUSIONS A positive or flat T wave in lead aVR was associated with SCD in subsets of patients. This simple ECG marker in this often-ignored lead may contribute to enhancement of SCD risk stratification, and warrants further evaluation.
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Affiliation(s)
- Derek Phan
- The Heart Institute, Cedars-Sinai Medical Center, AHSP Third Floor A3100, 127 S. San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Kumar Narayanan
- The Heart Institute, Cedars-Sinai Medical Center, AHSP Third Floor A3100, 127 S. San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Audrey Uy-Evanado
- The Heart Institute, Cedars-Sinai Medical Center, AHSP Third Floor A3100, 127 S. San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Carmen Teodorescu
- The Heart Institute, Cedars-Sinai Medical Center, AHSP Third Floor A3100, 127 S. San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Kyndaron Reinier
- The Heart Institute, Cedars-Sinai Medical Center, AHSP Third Floor A3100, 127 S. San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Harpriya Chugh
- The Heart Institute, Cedars-Sinai Medical Center, AHSP Third Floor A3100, 127 S. San Vicente Blvd, Los Angeles, CA, 90048, USA
| | - Karen Gunson
- Department of Pathology, Oregon Health and Science University, Portland, OR, USA
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, AHSP Third Floor A3100, 127 S. San Vicente Blvd, Los Angeles, CA, 90048, USA.
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Matsukane A, Hayashi T, Tanaka Y, Iwasaki M, Kubo S, Asakawa T, Takahashi Y, Imamura Y, Hirahata K, Joki N, Hase H. Usefulness of an Upright T-Wave in Lead aVR for Predicting the Short-Term Prognosis of Incident Hemodialysis Patients: A Potential Tool for Screening High-Risk Hemodialysis Patients. Cardiorenal Med 2015; 5:267-77. [PMID: 26648943 DOI: 10.1159/000433562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/13/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/AIMS An upright T-wave in lead aVR (aVRT) has recently been reported to be associated with cardiovascular death and mortality among the general population and patients with prior cardiovascular disease (CVD). However, evidence for the predictive ability of aVRT in patients with chronic kidney disease is lacking. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of an upright aVRT for the short-term prognosis in incident hemodialysis patients. METHODS Among 208 patients who started maintenance hemodialysis, 79 with preexisting CVD (CVD cohort) and 129 with no history of CVD (non-CVD cohort), were studied. An upright and non-upright aVRT were defined as a wave with a positive deflection in amplitude of ≥0 mV and a negative deflection in amplitude of <0 mV, respectively. The endpoint was all-cause death. RESULTS Overall, the prevalence of an upright aVRT was 22.6% at baseline. During the mean follow-up period of 2.1 ± 1.0 years, 33 deaths occurred. Cumulative survival rates at 3 years after starting dialysis in patients with an upright and non-upright aVRT were 50.0 and 80.7%, respectively, in the CVD cohort and 92.0 and 91.3%, respectively, in the non-CVD cohort. In the CVD cohort, multivariate Cox regression analysis showed that an upright aVRT was an independent predictor of death after adjusting for confounding variables. CONCLUSION Among Japanese hemodialysis patients at high risk for CVD, an upright aVRT seems to be useful for predicting death.
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Affiliation(s)
- Ai Matsukane
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshihide Hayashi
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yuri Tanaka
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masaki Iwasaki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shun Kubo
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Takasuke Asakawa
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasunori Takahashi
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | | | - Nobuhiko Joki
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hiroki Hase
- Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan
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14
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Al-Zaiti SS, Fallavollita JA, Canty JM, Carey MG. The prognostic value of discordant T waves in lead aVR: A simple risk marker of sudden cardiac arrest in ischemic cardiomyopathy. J Electrocardiol 2015; 48:887-92. [PMID: 26233648 DOI: 10.1016/j.jelectrocard.2015.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Simple and reliable ECG marker(s) for sudden cardiac arrest (SCA) could be very useful in assessing high-risk populations. Since ischemic repolarization abnormalities in the left ventricular (LV) apex are strongly correlated with discordant T waves in lead aVR, we sought to evaluate the clinical and prognostic significance of this feature in ischemic cardiomyopathy. METHODS The PAREPET trial enrolled patients with ischemic cardiomyopathy eligible for a primary prevention implantable cardiac defibrillator (ICD). Those with persistent pacing or left bundle branch block were excluded. Amplitudes of T/aVR were automatically computed from median ECG beats at enrollment and endpoints were blindly adjudicated. RESULTS The sample was mainly composed of older men (n=138, age 65±12, 91% male, EF 29±9%). At enrollment, amplitude of T/aVR significantly correlated with EF, indexed LV end-diastolic volume, B-type natriuretic peptide (BNP), regional scar volume, and PET-quantified denervated myocardium. After a median follow up of 4.2years, there were 23 (17%) adjudicated SCA. In multivariate analysis, the presence of discordant T/aVR (>0mm, n=42, 30%) was a significant and independent predictor of SCA (hazard ratio 2.0 [95% CI 1.0-4.9]) and cardiac death (hazard ratio 1.9 [95% CI 1.0-3.7]). CONCLUSIONS In subjects with ischemic cardiomyopathy, discordant T waves in lead aVR are associated with high-risk clinical parameters including lower ejection fraction, greater ventricular volume, higher BNP, and more denervated myocardium. Furthermore, discordant T/aVR remained an independent predictor of SCA and cardiovascular mortality even after accounting for these prognostic factors.
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Affiliation(s)
| | - James A Fallavollita
- VA WNY Health Care System at Buffalo, Buffalo, NY, USA; Clinical Translational Research Center, Buffalo, NY, USA; Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | - John M Canty
- VA WNY Health Care System at Buffalo, Buffalo, NY, USA; Clinical Translational Research Center, Buffalo, NY, USA; Department of Medicine, University at Buffalo, Buffalo, NY, USA; Department of Physiology & Biophysics, University at Buffalo, Buffalo, NY, USA; Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Mary G Carey
- University of Rochester Medical Center, Rochester, NY, USA
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15
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Abstract
The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome (ACS). Unlike other 11 leads, lead aVR has been long neglected until recent years. However, recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS. ST-segment elevation in lead aVR can be caused by (1) transmural ischemia in the basal part of the interventricular septum caused by impaired coronary blood flow of the first major branch originating from the left anterior descending coronary artery; (2) transmural ischemia in the right ventricular outflow tract caused by impaired coronary blood flow of the large conal branch originating from the right coronary artery; and (3) reciprocal changes opposite to ischemic or non-ischemic ST-segment depression in the lateral limb and precordial leads. On the other hand, ST-segment depression in lead aVR can be caused by transmural ischemia in the inferolateral and apical regions. It has been recently shown that an analysis of T wave in lead aVR also provides useful prognostic information in the general population and patients with prior myocardial infarction. Cardiologists should pay more attention to the tracing of lead aVR when interpreting the 12-lead ECG in clinical practice.
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16
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Chen YC, Huang JH, Lin YK, Hsieh MH, Chen YJ. Gender modulates the aging effects on different patterns of early repolarization. Heart Vessels 2013; 29:249-55. [PMID: 23612859 DOI: 10.1007/s00380-013-0352-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 04/05/2013] [Indexed: 11/25/2022]
Abstract
Distinct patterns of early repolarization (ER) are associated with ventricular fibrillation and arrhythmic death. We evaluated whether gender modulated the aging effects on different ER patterns. We studied manifestations of ER in the anterior, inferior, and lateral leads on standard 12-lead electrocardiography from male (n = 1077) and female (n = 1170) individuals of young (≤44 years), middle-aged (45-64 years), and elderly (≥65 years) subjects. Among a total of 2247 individuals, 543 (24.2 %) subjects had ER and 417 (18.6 %) had single-location ER. Single-location ER occurred less in lateral leads than in anterior or inferior leads (2.1, 7.8, 8.6 %, respectively, p < 0.05). Subjects with inferior ER (n = 193) were older (61 ± 14, 49 ± 14, 54 ± 16 years, respectively, p < 0.05) than those with anterior (n = 176) or lateral (n = 48) ER. In males with ER, the elderly group (n = 22) had fewer instances of anterior ER (34, 59, 80 %, respectively, p < 0.05) than middle-aged (n = 76) or young (n = 59) groups. Elderly males (n = 37) and females (n = 48) had greater instances of inferior ER (57, 32, 19 %, p < 0.05; 86, 62, 46 %, respectively, p < 0.05) than middle-aged males (n = 41) and females (n = 41), and young males (n = 14) and females (n = 12), respectively. In conclusion, gender modulates the aging effects on the occurrences of anterior ER and inferior ER.
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Affiliation(s)
- Yen-Chou Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, 111 Hsin-Lung Road, Sec. 3, Taipei 116, Taipei, Taiwan
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