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Del Castillo MG, Hernando D, Orini M, Laguna P, Viik J, Bailón R, Pueyo E. QT variability unrelated to RR variability during stress testing for identification of coronary artery disease. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2021; 379:20200261. [PMID: 34689618 DOI: 10.1098/rsta.2020.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 06/13/2023]
Abstract
Stress test electrocardiogram (ECG) analysis is widely used for coronary artery disease (CAD) diagnosis despite its limited accuracy. Alterations in autonomic modulation of cardiac electrical activity have been reported in CAD patients during acute ischemia. We hypothesized that those alterations could be reflected in changes in ventricular repolarization dynamics during stress testing that could be measured through QT interval variability (QTV). However, QTV is largely dependent on RR interval variability (RRV), which might hinder intrinsic ventricular repolarization dynamics. In this study, we investigated whether different markers accounting for low-frequency (LF) oscillations of QTV unrelated to RRV during stress testing could be used to separate patients with and without CAD. Power spectral density of QTV unrelated to RRV was obtained based on time-frequency coherence estimation. Instantaneous LF power of QTV and QTV unrelated to RRV were obtained. LF power of QTV unrelated to RRV normalized by LF power of QTV was also studied. Stress test ECG of 100 patients were analysed. Patients referred to coronary angiography were classified into non-CAD or CAD group. LF oscillations in QTV did not show significant differences between CAD and non-CAD groups. However, LF oscillations in QTV unrelated to RRV were significantly higher in the CAD group as compared with the non-CAD group when measured during the first phases of exercise and last phases of recovery. ROC analysis of these indices revealed area under the curve values ranging from 61 to 73%. Binomial logistic regression analysis revealed LF power of QTV unrelated to RRV, both during the first phase of exercise and last phase of recovery, as independent predictors of CAD. In conclusion, this study highlights the importance of removing the influence of RRV when measuring QTV during stress testing for CAD identification and supports the added value of LF oscillations of QTV unrelated to RRV to diagnose CAD from the first minutes of exercise. This article is part of the theme issue 'Advanced computation in cardiovascular physiology: new challenges and opportunities'.
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Affiliation(s)
| | - David Hernando
- I3A, University of Zaragoza, IIS Aragón, Spain
- CIBER-BBN, Zaragoza, Spain
| | | | - Pablo Laguna
- I3A, University of Zaragoza, IIS Aragón, Spain
- CIBER-BBN, Zaragoza, Spain
| | - Jari Viik
- Tampere University of Technology, Tampere, Finland
| | - Raquel Bailón
- I3A, University of Zaragoza, IIS Aragón, Spain
- CIBER-BBN, Zaragoza, Spain
| | - Esther Pueyo
- I3A, University of Zaragoza, IIS Aragón, Spain
- CIBER-BBN, Zaragoza, Spain
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Zhang H, Wang X, Liu C, Liu Y, Li P, Yao L, Li H, Wang J, Jiao Y. Detection of coronary artery disease using multi-modal feature fusion and hybrid feature selection. Physiol Meas 2020; 41. [PMID: 33080588 DOI: 10.1088/1361-6579/abc323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022]
Abstract
Objective: Coronary artery disease (CAD) is a common fatal disease. At present, an accurate method to screen CAD is urgently needed. This study aims to provide optimal detection models for suspected CAD detection according to the differences in medical conditions, so as to assist physicians to make accurate judgments on suspected CAD patients.Approach: Electrocardiogram (ECG) and phonocardiogram (PCG) signals of 32 CAD patients and 30 patients with chest pain and normal coronary angiograms (CPNCA) were simultaneously collected for this paper. For each subject, the ECG and PCG multi-domain features were extracted, and the results of Holter monitoring, echocardiography (ECHO), and biomarker levels (BIO) were obtained to construct a multi-modal feature set. Then, a hybrid feature selection (HFS) method was developed using mutual information, recursive feature elimination, random forest, and weight of support vector machine to obtain the optimal feature subset. A support vector machine with nested cross-validation was used for classification.Main results: Results showed that the Holter model achieved the best performance as a single-modal feature model with an accuracy of 82.67%. In terms of multi-modal feature models, PCG-Holter, PCG-Holter-ECHO, PCG-Holter-ECHO-BIO, and ECG-PCG-Holter-ECHO-BIO were the optimal bimodal, three-modal, four-modal, and five-modal models, with accuracies of 90.38%, 91.92%, 95.25%, and 96.67%, respectively. Among them, the ECG-PCG-Holter-ECHO-BIO model, which was constructed by combining ECG and PCG signals features with Holter, ECHO, and BIO examination results, achieved the best classification results with an average accuracy, sensitivity, specificity, and F1-measure of 96.67%, 96.67%, 96.67%, and 96.64%, respectively.Significance: The study indicated that multi-modal feature fusion and HFS can obtain more effective information for CAD detection and provide a reference for physicians to diagnose CAD patients.
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Affiliation(s)
- Huan Zhang
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong 250061, People's Republic of China
| | - Xinpei Wang
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong 250061, People's Republic of China
| | - Changchun Liu
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong 250061, People's Republic of China
| | - Yuanyuan Liu
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong 250061, People's Republic of China
| | - Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, United States of America.,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, United States of America
| | - Lianke Yao
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong 250061, People's Republic of China
| | - Han Li
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong 250061, People's Republic of China
| | - Jikuo Wang
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong 250061, People's Republic of China
| | - Yu Jiao
- Institute of Biomedical Engineering, School of Control Science and Engineering, Shandong University, Jinan, Shandong 250061, People's Republic of China
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La Rovere MT, Porta A, Schwartz PJ. Autonomic Control of the Heart and Its Clinical Impact. A Personal Perspective. Front Physiol 2020; 11:582. [PMID: 32670079 PMCID: PMC7328903 DOI: 10.3389/fphys.2020.00582] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
This essay covers several aspects of the autonomic control of the heart, all relevant to cardiovascular pathophysiology with a direct impact on clinical outcomes. Ischemic heart disease, heart failure, channelopathies, and life-threatening arrhythmias are in the picture. Beginning with an overview on some of the events that marked the oscillations in the medical interest for the autonomic nervous system, our text explores specific areas, including experimental and clinical work focused on understanding the different roles of tonic and reflex sympathetic and vagal activity. The role of the baroreceptors, not just for the direct control of circulation but also because of the clinical value of interpreting alterations (spontaneous or induced) in their function, is discussed. The importance of the autonomic nervous system for gaining insights on risk stratification and for providing specific antiarrhythmic protection is also considered. Examples are the interventions to decrease sympathetic activity and/or to increase vagal activity. The non-invasive analysis of the RR and QT intervals provides additional information. The three of us have collaborated in several studies and each of us contributes with very specific and independent areas of expertise. Here, we have focused on those areas to which we have directly contributed and hence speak with personal experience. This is not an attempt to provide a neutral and general overview on the autonomic nervous system; rather, it represents our effort to share and provide the readers with our own personal views matured after many years of research in this field.
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Affiliation(s)
- Maria Teresa La Rovere
- Department of Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Montescano (Pavia), Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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Heravi AS, Etzkorn LH, Urbanek JK, Crainiceanu CM, Punjabi NM, Ashikaga H, Brown TT, Budoff MJ, D'Souza G, Magnani JW, Palella FJ, Berger RD, Wu KC, Post WS. HIV Infection Is Associated With Variability in Ventricular Repolarization: The Multicenter AIDS Cohort Study (MACS). Circulation 2019; 141:176-187. [PMID: 31707799 DOI: 10.1161/circulationaha.119.043042] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV+) have greater risk for sudden arrhythmic death than HIV-uninfected (HIV-) individuals. HIV-associated abnormal cardiac repolarization may contribute to this risk. We investigated whether HIV serostatus is associated with ventricular repolarization lability by using the QT variability index (QTVI), defined as a log measure of QT-interval variance indexed to heart rate variance. METHODS We studied 1123 men (589 HIV+ and 534 HIV-) from MACS (Multicenter AIDS Cohort Study), using the ZioXT ambulatory electrocardiography patch. Beat-to-beat analysis of up to 4 full days of electrocardiographic data per participant was performed using an automated algorithm (median analyzed duration [quartile 1-quartile 3]: 78.3 [66.3-83.0] hours/person). QTVI was modeled using linear mixed-effects models adjusted for demographics, cardiac risk factors, and HIV-related and inflammatory biomarkers. RESULTS Mean (SD) age was 60.1 (11.9) years among HIV- and 54.2 (11.2) years among HIV+ participants (P<0.001), 83% of whom had undetectable (<20 copies/mL) HIV-1 viral load (VL). In comparison with HIV- men, HIV+ men had higher QTVI (adjusted difference of +0.077 [95% CI, +0.032 to +0.123]). The magnitude of this association depended on the degree of viremia, such that in HIV+ men with undetectable VL, adjusted QTVI was +0.064 (95% CI, +0.017 to +0.111) higher than in HIV- men, whereas, in HIV+ men with detectable VL, adjusted QTVI was higher by +0.150 (95% CI, 0.072-0.228) than in HIV- referents. Analysis of QTVI subcomponents showed that HIV+ men had: (1) lower heart rate variability irrespective of VL status, and (2) higher QT variability if they had detectable, but not with undetectable, VL, in comparison with HIV- men. Higher levels of C-reactive protein, interleukin-6, intercellular adhesion molecule-1, soluble tumor necrosis factor receptor 2, and soluble cluster of differentiation-163 (borderline), were associated with higher QTVI and partially attenuated the association with HIV serostatus. CONCLUSIONS HIV+ men have greater beat-to-beat variability in QT interval (QTVI) than HIV- men, especially in the setting of HIV viremia and heightened inflammation. Among HIV+ men, higher QTVI suggests ventricular repolarization lability, which can increase susceptibility to arrhythmias, whereas lower heart rate variability signals a component of autonomic dysfunction.
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Affiliation(s)
- Amir S Heravi
- School of Medicine (A.S.H.), Johns Hopkins University, Baltimore, MD
| | - Lacey H Etzkorn
- Department of Biostatistics (L.H.E., J.K.U., C.M.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jacek K Urbanek
- Department of Biostatistics (L.H.E., J.K.U., C.M.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ciprian M Crainiceanu
- Department of Biostatistics (L.H.E., J.K.U., C.M.C.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine (N.M.P.), Johns Hopkins University, Baltimore, MD
| | - Hiroshi Ashikaga
- Division of Cardiology, Department of Medicine (H.A., R.D.B., K.C.W., W.S.P.), Johns Hopkins University, Baltimore, MD
| | - Todd T Brown
- Division of Endocrinology, Diabetes, and Metabolism (T.T.B.), Johns Hopkins University, Baltimore, MD
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, CA (M.J.B.)
| | - Gypsyamber D'Souza
- Department of Epidemiology (G.D.. W.S.P.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jared W Magnani
- Heart and Vascular Institute, Department of Medicine, University of Pittsburgh, PA (J.W.M.)
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (F.J.P.)
| | - Ronald D Berger
- Division of Cardiology, Department of Medicine (H.A., R.D.B., K.C.W., W.S.P.), Johns Hopkins University, Baltimore, MD
| | - Katherine C Wu
- Division of Cardiology, Department of Medicine (H.A., R.D.B., K.C.W., W.S.P.), Johns Hopkins University, Baltimore, MD
| | - Wendy S Post
- Division of Cardiology, Department of Medicine (H.A., R.D.B., K.C.W., W.S.P.), Johns Hopkins University, Baltimore, MD.,Department of Epidemiology (G.D.. W.S.P.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Christensen L, Turner JR, Peterson GM, Naunton M, Thomas J, Yee KC, Kosari S. Identification of Risk of QT Prolongation by Pharmacists When Conducting Medication Reviews in Residential Aged Care Settings: A Missed Opportunity? J Clin Med 2019; 8:E1866. [PMID: 31689908 PMCID: PMC6912304 DOI: 10.3390/jcm8111866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 11/16/2022] Open
Abstract
QT interval prolongation is associated with torsade de pointes and sudden cardiac death. QT prolongation can be caused by many drugs that are commonly prescribed in elderly residential aged care populations. The aim of this study was to investigate the prevalence of use of QT-prolonging drugs and to identify interventions made by pharmacists to reduce the risk of QT prolongation when conducting medication reviews in aged care. A retrospective analysis of 400 medication reviews undertaken by Australian pharmacists in aged care settings was conducted. The assessment included the risk of QT prolongation due to prescribed medications and other risk factors and the recommendations made by pharmacists to reduce the risk of QT prolongation. There was a high prevalence of the use of QT-prolonging medication, with 23% of residents (92 out of 400) taking at least one medication with a known risk of QT prolongation. Amongst the 945 prescribed drugs with any risk of QT prolongation, antipsychotics were the most common (n = 246, 26%), followed by antidepressants (19%) and proton pump inhibitors (13%). There appeared to be low awareness amongst the pharmacists regarding the risk of QT prolongation with drugs. Out of 400 reviews, 66 residents were categorised as high risk and were taking at least one medication associated with QT prolongation; yet pharmacists intervened in only six instances (9%), mostly when two QT-prolonging medications were prescribed. There is a need to increase awareness amongst pharmacists conducting medication reviews regarding the risk factors associated with QT prolongation, and further education is generally needed in this area.
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Affiliation(s)
- Louise Christensen
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia.
| | - J Rick Turner
- Department of Pharmacy Practice, Campbell University College of Pharmacy & Health Sciences, 239 J.P. Riddle Building, PO Box 1090, Buies Creek, NC 27506, USA.
| | - Gregory M Peterson
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia.
- Faculty of Health, University of Tasmania, Hobart 7005, Tasmania, Australia.
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia.
| | - Jackson Thomas
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia.
| | - Kwang Choon Yee
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia.
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia.
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