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Kondamudi N, Zeleke Y, Rosenblatt A, Hu G, Grubb C, Link MS. The Association of QRS Duration with Risk of Adverse Outcomes in Sex- and Race- Based Subgroups: The Dallas Heart Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.15.23290016. [PMID: 37293027 PMCID: PMC10246055 DOI: 10.1101/2023.05.15.23290016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction We explored sex and race differences in the prognostic implications of QRS prolongation among healthy adults. Methods Participants from the Dallas Heart Study (DHS) free of cardiovascular (CV) disease who underwent ECG testing and cMRI evaluation were included. Multivariable linear regression was used to examine the cross-sectional association of QRS duration with left ventricular (LV) mass, LV ejection fraction (LVEF), and LV end diastolic volume (LVEDV). Association of QRS duration with risk of MACE was evaluated using Cox models. Interaction testing was performed between QRS duration and sex/race respectively for each outcome of interest. QRS duration was log transformed. Results The study included 2,785 participants. Longer QRS duration was associated with higher LV mass, lower LVEF, and higher LVEDV, independent of CV risk factors ([β: 0.21, P<0.001], [β: - 0.13, P<0.001], [β: 0.22, P<0.001] respectively). Men with longer QRS duration were more likely to have higher LV mass and higher LVEDV compared to women (P-int=0.012, P-int=0.01, respectively). Black participants with longer QRS duration were more likely to have higher LV mass as compared to White participants (P-int<0.001). In Cox analysis, QRS prolongation was associated with higher risk of MACE in women (HR = 6.66 [95% CI: 2.32, 19.1]) but not men. This association was attenuated after adjustment for CV risk factors, with a trend toward significance (HR = 2.45 [95% CI: 0.94, 6.39]). Longer QRS duration was not associated with risk of MACE in Black or White participants in the adjusted models. No interaction between sex/race and QRS duration for risk of MACE was observed. Discussion In healthy adults, QRS duration is differentially associated with abnormalities in LV structure and function. These findings inform the use of QRS duration in identifying subgroups at risk for CV disease, and caution against using QRS duration cut offs uniformly for clinical decision making. What is known? QRS prolongation in healthy adults is associated with higher risk of death, cardiovascular disease, and left ventricular hypertrophy. What the study adds? QRS prolongation may reflect a higher degree of underlying LV hypertrophy in Blacks compared to Whites. Longer QRS interval may reflect higher risk of adverse cardiac events, driven by prevalent cardiovascular risk factors. Graphic Abstract Risk of underlying left ventricular hypertrophy in demographic groups based on QRS prolongation.
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Bernardini A, Crotti L, Olivotto I, Cecchi F. Diagnostic and prognostic electrocardiographic features in patients with hypertrophic cardiomyopathy. Eur Heart J Suppl 2023; 25:C173-C178. [PMID: 37125268 PMCID: PMC10132576 DOI: 10.1093/eurheartjsupp/suad074] [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] [Indexed: 05/02/2023]
Abstract
The standard 12-lead electrocardiogram (ECG) represents a cornerstone for the diagnosis and evaluation of hypertrophic cardiomyopathy (HCM), the most common genetically determined heart muscle disease, due to its cost-effectiveness and wide availability. The ECG may surprisingly look normal in 4-6% of adult patients, and in less than 3% of paediatric patients, but it is abnormal in the vast majority of the remaining patients. 'Specific' features comprise pathological Q-waves, deep S-waves in V1-V3, or high R-waves in V4-V6 due to left ventricular hypertrophy with T-wave (TW) depression or negative TWs. Negative giant TWs are often found in apical HCM. However, in many patients, the ECG may only show non-specific ST-T changes with diphasic or flat TWs. An isolated inverted TW in lateral leads (usually aVL) may be the only marker for HCM in some patients. Electrocardiogram helps to diagnose sarcomeric HCM and distinguish it from different phenocopies, such as cardiac amyloidosis, glycogen storage, or Fabry disease. Electrocardiogram may also have a prognostic role, identifying high-risk features that could impact the clinical outcome.
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Affiliation(s)
- Andrea Bernardini
- Cardiology and Electrophysiology Unit, Santa Maria Nuova Hospital, Piazza di Santa Maria Nuova 1, 50122 Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Giovanni Alessandro Brambilla 3, 50134 Florence, Italy
| | - Lia Crotti
- Department of Medicine and Surgery, University Milano Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
- IRCCS Istituto Auxologico Italiano, Department of Cardiology, San Luca Hospital, Piazzale Brescia 20, 20149 Milan, Italy
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Largo Giovanni Alessandro Brambilla 3, 50134 Florence, Italy
- Meyer Children’s Hospital IRCCS, Viale Gaetano Pieraccini 24, 50139 Florence, Italy
| | - Franco Cecchi
- IRCCS Istituto Auxologico Italiano, Department of Cardiology, San Luca Hospital, Piazzale Brescia 20, 20149 Milan, Italy
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Domain G, Chouquet C, Réant P, Bongard V, Vedis T, Rollin A, Mandel F, Delasnerie H, Voglimacci-Stephanopoli Q, Mondoly P, Beneyto M, Cariou E, Fournier P, Delmas C, Galinier M, Carrié D, Lafitte S, Lairez O, Ferrières J, Cochet H, Maury P. Relationships between left ventricular mass and QRS duration in diverse types of left ventricular hypertrophy. Eur Heart J Cardiovasc Imaging 2021; 23:560-568. [PMID: 33842939 DOI: 10.1093/ehjci/jeab063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/27/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Hypertrophic cardiomyopathy (HCM) may be associated with very narrow QRS, while left ventricular hypertrophy (LVH) may increase QRS duration. We investigated the relationships between QRS duration and LV mass (LVM) in subtypes of abnormal LV wall thickness. METHODS AND RESULTS Automated measurement of LVM on MRI was correlated to automated measurement of QRS duration on ECG in HCM, left ventricular non compaction (LVNC), left ventricular hypertrophy (LVH), and controls with healthy hearts. Uni and multivariate analyses were performed between groups including explanatory variables expected to influence LVM and QRS duration. The relationships between QRS duration and LVM were further studied within each group. Two hundred and twenty-one HCM, 28 LVNC, 16 LVH, and 40 controls were retrospectively included. Mean QRS duration was 92 ms for HCM, 104 for LVNC, 110 for LVH, and 92 for controls (P < 0.01). Mean LVM was 100, 90, 108, and 68 g/m2 (P < 0.01). QRS duration, LVM, hypertension, maximal wall thickness, and late gadolinium enhancement were significantly linked to HCM in multivariate analysis (w/wo bundle branch block). An independent negative correlation was found between LVM and QRS duration in the HCM group, while the relationship was reverse in LVNC, LVH, and controls. CONCLUSION QRS duration increases with LVM in LVNC, LVH, or in healthy hearts, while reverse relationship is present in HCM. These relationships were independent from other parameters. These results warrant additional investigations for refining diagnosis criteria for HCM in the future.
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Affiliation(s)
- Guillaume Domain
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Cecile Chouquet
- Department of Mathematics, Toulouse Mathematics Institute, Toulouse, France
| | - Patricia Réant
- Department of Cardiology, University Hospital Pessac, Bordeaux, France
| | - Vanina Bongard
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France.,INSERM U 1027, Toulouse, France
| | - Theo Vedis
- Department of Mathematics, Toulouse Mathematics Institute, Toulouse, France
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Franck Mandel
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Hubert Delasnerie
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | | | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Maxime Beneyto
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Eve Cariou
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Clément Delmas
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Michel Galinier
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Stéphane Lafitte
- Department of Cardiology, University Hospital Pessac, Bordeaux, France
| | - Olivier Lairez
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France
| | - Jean Ferrières
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France.,INSERM U 1027, Toulouse, France
| | - Hubert Cochet
- Department of Cardiology, University Hospital Pessac, Bordeaux, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 1 avenue Pr. Jean Poulhès 31400 Toulouse, France.,I2MC, INSERM UMR 1297, Toulouse, France
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Zuo L, Hsi DH, Zhang L, Zhang Q, Shao H, Liu B, Lei C, Ye C, Meng X, Zhang G, Zhou M, Li J, He Y, Guo J, Liu L. Electrocardiographic QRS voltage amplitude improvement by intramyocardial radiofrequency ablation in patients with hypertrophic obstructive cardiomyopathy and one year follow up. J Electrocardiol 2020; 61:164-169. [PMID: 32721657 DOI: 10.1016/j.jelectrocard.2020.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study aimed to determine whether the serial changes of the electrocardiogram is associated with regression of left ventricular hypertrophy (LVH) after Liwen procedure. BACKGROUND Clinical application of the echocardiography-guided percutaneous intramyocardial septal radiofrequency ablation (PIMSRA, Liwen procedure) is an innovative approach to treat hypertrophic obstructive cardiomyopathy (HOCM). METHODS We enrolled 30 consecutive patients with HOCM who had undergone Liwen procedure in our Hypertrophic Cardiomyopathy Center, from June 2016 to January 2018. Electrocardiography (ECG) and echocardiogram were performed before and after Liwen procedure, and at each follow-up (1-week, 1, 3, 6 months and 1 year). The Sokolow-Lyon index (SLi), Q wave, R wave, S wave amplitude of 12-lead ECG and interventricular septal (IVS) thickness, left ventricular mass index (LVMI) by echocardiograms were measured in each patient. The sum of the ECG QRS amplitude on each lead was calculated. The reduction of SLi and QRS amplitude were used as improvement index. RESULTS The ECG leads with most improvement rate of the QRS wave amplitude of all cases were V1 and V2, both at 90%. The QRS wave amplitude in V1 leads and SLi were positively correlated with IVS thickness and LVMI at baseline and 1 year after Liwen procedure, respectively. The reduction of IVS thickness, LVMI and QRS wave amplitude in leads V1 and V2 were significant at one month after ablation and the follow-up period. SLi was significantly decreased at 3 months during the observation period. Similarly, the improvement of ECG QRS wave amplitude after the Liwen procedure tracked the gradual thinning of the IVS and the changes of SLi reflected the regression of LVH. CONCLUSION The QRS wave amplitude reductions in lead V1 and SLi may be good indicators for evaluating the postoperative interventricular septal remodeling of the Liwen procedure.
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Affiliation(s)
- Lei Zuo
- Hypertrophic Cardiomyopathy Center, Department of Ultrasound, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - David H Hsi
- Heart&Vascular Institute, Stamford Hospital, Stamford, CT, USA
| | - Li Zhang
- Lankenau Institute for Medical Research, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Qin Zhang
- Hypertrophic Cardiomyopathy Center, Department of Ultrasound, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hong Shao
- Department of Cardiology, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Bing Liu
- Department of Cardiology, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Changhui Lei
- Hypertrophic Cardiomyopathy Center, Department of Ultrasound, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chuang Ye
- Department of Cardiology, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xin Meng
- Hypertrophic Cardiomyopathy Center, Department of Ultrasound, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guoqing Zhang
- Department of Ultrasound, The Affiliated Hospital of XiJing Hospital, Xi'an, Shaanxi, China
| | - Mengyao Zhou
- Hypertrophic Cardiomyopathy Center, Department of Ultrasound, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jing Li
- Hypertrophic Cardiomyopathy Center, Department of Ultrasound, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yang He
- Xi'an Medical University, Xi'an, Shaanxi, China
| | - Jianying Guo
- Specialty Care Clinic, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
| | - Liwen Liu
- Hypertrophic Cardiomyopathy Center, Department of Ultrasound, XiJing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
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5
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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: 0.8] [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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6
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Prins BP, Mead TJ, Brody JA, Sveinbjornsson G, Ntalla I, Bihlmeyer NA, van den Berg M, Bork-Jensen J, Cappellani S, Van Duijvenboden S, Klena NT, Gabriel GC, Liu X, Gulec C, Grarup N, Haessler J, Hall LM, Iorio A, Isaacs A, Li-Gao R, Lin H, Liu CT, Lyytikäinen LP, Marten J, Mei H, Müller-Nurasyid M, Orini M, Padmanabhan S, Radmanesh F, Ramirez J, Robino A, Schwartz M, van Setten J, Smith AV, Verweij N, Warren HR, Weiss S, Alonso A, Arnar DO, Bots ML, de Boer RA, Dominiczak AF, Eijgelsheim M, Ellinor PT, Guo X, Felix SB, Harris TB, Hayward C, Heckbert SR, Huang PL, Jukema JW, Kähönen M, Kors JA, Lambiase PD, Launer LJ, Li M, Linneberg A, Nelson CP, Pedersen O, Perez M, Peters A, Polasek O, Psaty BM, Raitakari OT, Rice KM, Rotter JI, Sinner MF, Soliman EZ, Spector TD, Strauch K, Thorsteinsdottir U, Tinker A, Trompet S, Uitterlinden A, Vaartjes I, van der Meer P, Völker U, Völzke H, Waldenberger M, Wilson JG, Xie Z, Asselbergs FW, Dörr M, van Duijn CM, Gasparini P, Gudbjartsson DF, Gudnason V, Hansen T, Kääb S, Kanters JK, Kooperberg C, Lehtimäki T, Lin HJ, Lubitz SA, Mook-Kanamori DO, Conti FJ, Newton-Cheh CH, Rosand J, Rudan I, Samani NJ, Sinagra G, Smith BH, Holm H, Stricker BH, Ulivi S, Sotoodehnia N, Apte SS, van der Harst P, Stefansson K, Munroe PB, Arking DE, Lo CW, Jamshidi Y. Exome-chip meta-analysis identifies novel loci associated with cardiac conduction, including ADAMTS6. Genome Biol 2018; 19:87. [PMID: 30012220 PMCID: PMC6048820 DOI: 10.1186/s13059-018-1457-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/23/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Genome-wide association studies conducted on QRS duration, an electrocardiographic measurement associated with heart failure and sudden cardiac death, have led to novel biological insights into cardiac function. However, the variants identified fall predominantly in non-coding regions and their underlying mechanisms remain unclear. RESULTS Here, we identify putative functional coding variation associated with changes in the QRS interval duration by combining Illumina HumanExome BeadChip genotype data from 77,898 participants of European ancestry and 7695 of African descent in our discovery cohort, followed by replication in 111,874 individuals of European ancestry from the UK Biobank and deCODE cohorts. We identify ten novel loci, seven within coding regions, including ADAMTS6, significantly associated with QRS duration in gene-based analyses. ADAMTS6 encodes a secreted metalloprotease of currently unknown function. In vitro validation analysis shows that the QRS-associated variants lead to impaired ADAMTS6 secretion and loss-of function analysis in mice demonstrates a previously unappreciated role for ADAMTS6 in connexin 43 gap junction expression, which is essential for myocardial conduction. CONCLUSIONS Our approach identifies novel coding and non-coding variants underlying ventricular depolarization and provides a possible mechanism for the ADAMTS6-associated conduction changes.
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Affiliation(s)
- Bram P Prins
- Genetics Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, SW17 0RE, UK
- Department of Public Health and Primary Care, MRC/BHF Cardiovascular Epidemiology Unit, University of Cambridge, Strangeways Research Laboratory, Worts' Causeway, Cambridge, CB1 8RN, UK
| | - Timothy J Mead
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, 44195, USA
| | - Jennifer A Brody
- Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, 98101, USA
| | | | - Ioanna Ntalla
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Nathan A Bihlmeyer
- Predoctoral Training Program in Human Genetics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Marten van den Berg
- Department of Medical Informatics Erasmus MC - University Medical Center, P.O. Box 2040, Rotterdam, 3000, CA, The Netherlands
| | - Jette Bork-Jensen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Stefania Cappellani
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", 34137, Trieste, Italy
| | - Stefan Van Duijvenboden
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
| | - Nikolai T Klena
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15201, USA
| | - George C Gabriel
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15201, USA
| | - Xiaoqin Liu
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15201, USA
| | - Cagri Gulec
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15201, USA
| | - Niels Grarup
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Jeffrey Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Leanne M Hall
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Annamaria Iorio
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, 34100, Trieste, Italy
| | - Aaron Isaacs
- CARIM School for Cardiovascular Diseases, Maastricht Center for Systems Biology (MaCSBio), and Department of Biochemistry, Maastricht University, Universiteitssingel 60, Maastricht, 6229 ER, The Netherlands
- Department of Epidemiology, Genetic Epidemiology Unit, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ruifang Li-Gao
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
| | - Honghuang Lin
- Department of Medicine, Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Ching-Ti Liu
- Biostatistics Department, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, 33520, Tampere, Finland
- Department of Clinical Chemistry, Faculty of Medicine and Life Sciences, University of Tampere, 33014, Tampere, Finland
| | - Jonathan Marten
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Hao Mei
- Department of Data Science, School of Population Health, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK); partner site: Munich Heart Alliance, Munich, Germany
| | - Michele Orini
- Mechanical Engineering Department, University College London, London, WC1E 6BT, UK
- Barts Heart Centre, St Bartholomews Hospital, London, EC1A 7BE, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF GCRC, Glasgow, G12 8TA, UK
| | - Farid Radmanesh
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Julia Ramirez
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Antonietta Robino
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", 34137, Trieste, Italy
| | - Molly Schwartz
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15201, USA
| | - Jessica van Setten
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Albert V Smith
- Icelandic Heart Association, 201, Kopavogur, Iceland
- Department of Cardiology, Faculty of Medicine, University of Iceland, 101, Reykjavik, Iceland
| | - Niek Verweij
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Cardiovascular Research Center and Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, 2114.0, USA
| | - Helen R Warren
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Stefan Weiss
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine and Ernst-Moritz-Arndt-University Greifswald, 17475, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research); Partner site Greifswald, 17475, Greifswald, Germany
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - David O Arnar
- deCODE genetics/Amgen, Inc., 101, Reykjavik, Iceland
- Department of Medicine, Landspitali University Hospital, 101, Reykjavik, Iceland
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rudolf A de Boer
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anna F Dominiczak
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Mark Eijgelsheim
- Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Patrick T Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02114, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
- Division of Genomic Outcomes, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Stephan B Felix
- DZHK (German Centre for Cardiovascular Research); Partner site Greifswald, 17475, Greifswald, Germany
- Department of Internal Medicine B - Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Caroline Hayward
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and the Department of Epidemiology, University of Washington, Seattle, WA, 98101, USA
| | - Paul L Huang
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, 02114, USA
| | - J W Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Durrer Center for Cardiogenetic Research, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, 33521, Tampere, Finland
- Department of Clinical Physiology, Faculty of Medicine and Life Sciences, University of Tampere, 33014, Tampere, Finland
| | - Jan A Kors
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, London, WC1E 6BT, UK
- Barts Heart Centre, St Bartholomews Hospital, London, EC1A 7BE, UK
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Man Li
- Division of Nephrology & Hypertension, Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, 84109, USA
| | - Allan Linneberg
- Research Centre for Prevention and Health, Capital Region of Denmark, 2600, Glostrup, Denmark
- Department of Clinical Experimental Research, Rigshospitalet, 2600, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200.0, Copenhagen, Denmark
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Marco Perez
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Annette Peters
- German Centre for Cardiovascular Research (DZHK); partner site: Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Ozren Polasek
- Faculty of Medicine, University of Split, Split, Croatia
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, 98101, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
| | - Olli T Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, 20521, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20014, Turku, Finland
| | - Kenneth M Rice
- Department of Biostatistics, University of Washington, Seattle, WA, 98195, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences and Departments of Pediatrics and Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK); partner site: Munich Heart Alliance, Munich, Germany
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen, Inc., 101, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101, Reykjavik, Iceland
| | - Andrew Tinker
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
| | - André Uitterlinden
- Human Genotyping Facility Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter van der Meer
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Uwe Völker
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine and Ernst-Moritz-Arndt-University Greifswald, 17475, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research); Partner site Greifswald, 17475, Greifswald, Germany
| | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research); Partner site Greifswald, 17475, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Melanie Waldenberger
- German Centre for Cardiovascular Research (DZHK); partner site: Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Research unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Zhijun Xie
- TCM Clinical Basis Institute, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
| | - Folkert W Asselbergs
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
- Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, UK
| | - Marcus Dörr
- DZHK (German Centre for Cardiovascular Research); Partner site Greifswald, 17475, Greifswald, Germany
- Department of Internal Medicine B - Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Cornelia M van Duijn
- Department of Epidemiology, Genetic Epidemiology Unit, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paolo Gasparini
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100, Trieste, Italy
- Division of Experimental Genetics, Sidra Medical and Research Center, Doha, Qatar
| | - Daniel F Gudbjartsson
- deCODE genetics/Amgen, Inc., 101, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, 101, Reykjavik, Iceland
| | - Vilmundur Gudnason
- Icelandic Heart Association, 201, Kopavogur, Iceland
- Department of Cardiology, Faculty of Medicine, University of Iceland, 101, Reykjavik, Iceland
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK); partner site: Munich Heart Alliance, Munich, Germany
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, 33520, Tampere, Finland
- Department of Clinical Chemistry, Faculty of Medicine and Life Sciences, University of Tampere, 33014, Tampere, Finland
| | - Henry J Lin
- The Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
- Division of Medical Genetics, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, 90502, USA
| | - Steven A Lubitz
- Division of Genomic Outcomes, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, 2300RC, The Netherlands
| | - Francesco J Conti
- Dubowitz Neuromuscular Centre, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Christopher H Newton-Cheh
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
- Center for Human Genetic Research and Cardiovascular Research Center, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, 02114, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, 34100, Trieste, Italy
| | - Blair H Smith
- Division of Population Health Sciences, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - Hilma Holm
- deCODE genetics/Amgen, Inc., 101, Reykjavik, Iceland
| | - Bruno H Stricker
- Department of Epidemiology Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Sheila Ulivi
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", 34137, Trieste, Italy
| | - Nona Sotoodehnia
- Division of Cardiology, Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, 98101, USA
| | - Suneel S Apte
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH, 44195, USA
| | - Pim van der Harst
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, the Netherlands
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kari Stefansson
- deCODE genetics/Amgen, Inc., 101, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, 101, Reykjavik, Iceland
| | - Patricia B Munroe
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
- NIHR Barts Cardiovascular Biomedical Research Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Cecilia W Lo
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15201, USA
| | - Yalda Jamshidi
- Genetics Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, SW17 0RE, UK.
- Genetics Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK.
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Chronic phase improvements in electrocardiographic and echocardiographic manifestations of left ventricular hypertrophy after alcohol septal ablation for drug-refractory hypertrophic obstructive cardiomyopathy. Heart Vessels 2017; 33:246-254. [DOI: 10.1007/s00380-017-1053-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
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Eschalier R, Ploux S, Pereira B, Clémenty N, Da Costa A, Defaye P, Garrigue S, Gourraud JB, Gras D, Guy-Moyat B, Leclercq C, Mondoly P, Bordachar P. Assessment of cardiac resynchronisation therapy in patients with wide QRS and non-specific intraventricular conduction delay: rationale and design of the multicentre randomised NICD-CRT study. BMJ Open 2016; 6:e012383. [PMID: 27836874 PMCID: PMC5129079 DOI: 10.1136/bmjopen-2016-012383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Cardiac resynchronisation therapy (CRT) was initially developed to treat patients with left bundle branch block (LBBB). However, many patients with heart failure have a widened QRS but neither left-BBB nor right-BBB; this is called non-specific intraventricular conduction delay (NICD). It is unclear whether CRT is effective in this subgroup of patients. METHODS AND ANALYSIS The NICD-CRT study is a prospective, double-blind, randomised (1:1), parallel-arm, multicentre trial comparing the effects of CRT in patients with heart failure, a reduced left ventricular ejection fraction (LVEF <35%) and NICD, who have been implanted with a device (CRT-pacemaker or CRT-defibrillator) that has or has not been activated. Enrolment began on 15 July 2015 and should finish within 3 years; 40 patients have already been randomised and 11 centres have agreed to participate. The primary end point is the comparison of the proportion of patients improved, unchanged or worsened over the subsequent 12 months. 100 patients per group are required to demonstrate a difference between groups with a statistical power of 90%, a type I error of 0.05% (two-sided) and a loss to follow-up of 10%. This trial will add substantially to the modest amount of existing data on CRT in patients with NICD and should reduce uncertainty for guidelines and clinical practice when added to the pool of current information. ETHICS AND DISSEMINATION Local ethics committee authorisations have been obtained since May 2015. We will publish findings from this study in a peer-reviewed scientific journal and present results at national and international conferences. TRIAL REGISTRATION NUMBER NCT02454439; pre-results.
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Affiliation(s)
- Romain Eschalier
- Cardiology Department, Clermont Université, Université d'Auvergne, Cardio Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, and CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics unit (Clinical Research and Innovation Direction), Clermont-Ferrand, France
| | - Nicolas Clémenty
- Cardiology Department, Trousseau Hospital, François-Rabelais University, Tours, France
| | | | - Pascal Defaye
- Arrhythmia Unit, Cardiology Department, University Hospital, Grenoble, France
| | | | | | - Daniel Gras
- Nouvelles Cliniques Nantaises, Nantes, France
| | - Benoît Guy-Moyat
- Cardiology Department, Limoges University Hospital, Limoges, France
| | - Christophe Leclercq
- Department of Cardiology and Vascular Disease, Pontchaillou Hospital, Rennes, France
| | - Pierre Mondoly
- Federation of Cardiology, University Hospital Rangueil, Toulouse cedex 09, France
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
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9
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Biagini E, Pazzi C, Olivotto I, Musumeci B, Limongelli G, Boriani G, Pacileo G, Mastromarino V, Bacchi Reggiani ML, Lorenzini M, Lai F, Berardini A, Mingardi F, Rosmini S, Resciniti E, Borghi C, Autore C, Cecchi F, Rapezzi C. Usefulness of Electrocardiographic Patterns at Presentation to Predict Long-term Risk of Cardiac Death in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2016; 118:432-9. [PMID: 27289293 DOI: 10.1016/j.amjcard.2016.05.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
The objective of this study was to investigate the prognostic significance of 12-lead electrocardiogram (ECG) patterns in a large multicenter cohort of patients with hypertrophic cardiomyopathy; 1,004 consecutive patients with hypertrophic cardiomyopathy and a recorded standard ECG (64% men, mean age 50 ± 16 years) were evaluated at 4 Italian centers. The study end points were sudden cardiac death (SCD) or surrogates, including appropriate implanted cardiac defibrillator discharge and resuscitated cardiac arrest and major cardiovascular events (including SCD or surrogates and death due to heart failure, cardioembolic stroke, or heart transplantation). Prevalence of baseline electrocardiographic characteristics was: normal ECG 4%, ST-segment depression 56%, pseudonecrosis waves 33%, "pseudo-ST-segment elevation myocardial infarction (STEMI)" pattern 17%, QRS duration ≥120 ms 17%, giant inverted T waves 6%, and low QRS voltages 3%. During a mean follow-up of 7.4 ± 6.8 years, 77 patients experienced SCD or surrogates and 154 patients experienced major cardiovascular events. Independent predictors of SCD or surrogates were unexplained syncope (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.4 to 4.5, p = 0.003), left ventricular ejection fraction <50% (HR 3.5, 95% CI 1.9 to 6.7, p = 0.0001), nonsustained ventricular tachycardia (HR 1.7, 95% CI 1.1 to 2.6, p = 0.027), pseudo-STEMI pattern (HR 2.3, 95% CI 1.4 to 3.8, p = 0.001), QRS duration ≥120 ms (HR 1.8, 95% CI 1.1 to 3.0, p = 0.033), and low QRS voltages (HR 2.3, 95% CI 1.01 to 5.1, p = 0.048). Independent predictors of major cardiovascular events were age (HR 1.02, 95% CI 1.01 to 1.03, p = 0.0001), LV ejection fraction <50% (HR 3.73, 95% CI 2.39 to 5.83, p = 0.0001), pseudo-STEMI pattern (HR 1.66, 95% CI 1.13 to 2.45, p = 0.010), QRS duration ≥120 ms (HR 1.69, 95% CI 1.16 to 2.47, p = 0.007), and prolonged QTc interval (HR 1.68, 95% CI 1.21 to 2.34, p = 0.002). In conclusion, a detailed qualitative and quantitative electrocardiographic analyses provide independent predictors of prognosis that could be integrated with the available score systems to improve the power of the current model.
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10
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Hayashi H, Wu Q, Horie M. Association between Progressive Intraventricular Conduction Disturbance and Cardiovascular Events. PLoS One 2016; 11:e0157412. [PMID: 27391877 PMCID: PMC4938572 DOI: 10.1371/journal.pone.0157412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 05/27/2016] [Indexed: 11/22/2022] Open
Abstract
Background Prolonged QRS duration on electrocardiogram (ECG) has been known as a poor prognostic marker. However, little is known about association between progressive intraventricular conduction disturbance and cardiovascular prognosis. Methods From among a database containing 359,737 12-lead ECG recordings, patients whose QRS duration progressively increased from <120 msec to ≥120 msec were selected using software. The prognosis of patients was searched by medical record. The primary endpoint was defined as heart failure hospitalization. The secondary endpoint was heart failure hospitalization, device implantation, or cardiovascular death. Results A total of 143 patients (100 males; age, 58.9±11.1 years) were enrolled in this study. QRS duration increased by 46.4±13.8 msec, manifesting right bundle branch block (RBBB) in 99 (69.2%) patients and non-RBBB (i.e., left bundle branch block, RBBB with left anterior hemiblock, or nonspecific intraventricular conduction disturbance) in 44 (30.8%). During the follow-up (mean, 16.6±5.3 years), 44 (30.3%), 15 (10.3%), and 6 (4.1%) patients resulted in heart failure hospitalization, device implantation, and cardiovascular death, respectively. Multivariate Cox proportional hazards models revealed that 1) the temporal increase in QRS duration was associated with the primary endpoint (hazard ratio [HR] 1.98; 95% confidence interval [CI] 1.05–3.80; p = 0.04) and the secondary endpoint (HR 2.79; 95% CI 1.55–5.00; p = 0.0001) and 2) the development of non-RBBB was associated with the primary endpoint (HR 3.02; 95% CI 1.59–5.73; p = 0.0001) and the secondary endpoint (HR 2.82; 95% CI 1.57–5.09; p = 0.001). Conclusion The temporal increase in QRS duration and the development of non-RBBB patterns were independently associated with adverse cardiovascular prognosis.
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Affiliation(s)
- Hideki Hayashi
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
- * E-mail:
| | - Qi Wu
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
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11
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Wada Y, Aiba T, Matsuyama TA, Nakajima I, Ishibashi K, Miyamoto K, Yamada Y, Okamura H, Noda T, Satomi K, Morita Y, Kanzaki H, Kusano K, Anzai T, Kamakura S, Ishibashi-Ueda H, Shimizu W, Horie M, Yasuda S, Ogawa H. Clinical and Pathological Impact of Tissue Fibrosis on Lethal Arrhythmic Events in Hypertrophic Cardiomyopathy Patients With Impaired Systolic Function. Circ J 2015; 79:1733-41. [PMID: 26016925 DOI: 10.1253/circj.cj-15-0104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The natural history of hypertrophic cardiomyopathy (HCM) varies from an asymptomatic benign course to a poor prognosis. Myocardial fibrosis may play a critical role in ventricular tachyarrhythmias (VT/VF); however, the clinical significance of tissue fibrosis by right ventricular (RV) biopsy in the long-term prognosis of HCM patients remains unclear. METHODS AND RESULTS We enrolled 185 HCM patients (mean age, 57±14 years). The amount of fibrosis (%area) was quantified using a digital microscope. Hemodynamic, echocardiographic, and electrophysiologic parameters were also evaluated. Patients with severe fibrosis had longer QRS duration and positive late potential (LP) on signal-averaged ECG, resulting in a higher incidence of VT/VF. At the 5±4 year follow-up, VT/VF occurred in 31 (17%) patients. Multivariate Cox regression analysis revealed that tissue fibrosis (hazard ratio (HR): 1.65; P=0.003 per 10% increase), lower left ventricular ejection fraction (HR: 0.64; P=0.001 per 10% increase), and positive SAECG (HR: 3.14; P=0.04) led to a greater risk of VT/VF. The combination of tissue fibrosis severity and lower left ventricular ejection fraction could be used to stratify the risk of lethal arrhythmic events in HCM patients. CONCLUSIONS Myocardial fibrosis in RV biopsy samples may contribute to abnormal conduction delay and spontaneous VT/VF, leading to a poor prognosis in HCM patients.
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Affiliation(s)
- Yuko Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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12
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Are the QRS duration and ST depression cut-points from the Seattle criteria too conservative? J Electrocardiol 2015; 48:395-8. [DOI: 10.1016/j.jelectrocard.2015.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Indexed: 11/21/2022]
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13
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Eschalier R, Ploux S, Ritter P, Haïssaguerre M, Ellenbogen KA, Bordachar P. Nonspecific intraventricular conduction delay: Definitions, prognosis, and implications for cardiac resynchronization therapy. Heart Rhythm 2015; 12:1071-9. [DOI: 10.1016/j.hrthm.2015.01.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Indexed: 11/26/2022]
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14
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Debonnaire P, Katsanos S, Joyce E, VAN DEN Brink OVW, Atsma DE, Schalij MJ, Bax JJ, Delgado V, Marsan NA. QRS Fragmentation and QTc Duration Relate to Malignant Ventricular Tachyarrhythmias and Sudden Cardiac Death in Patients with Hypertrophic Cardiomyopathy. J Cardiovasc Electrophysiol 2015; 26:547-55. [PMID: 25648421 DOI: 10.1111/jce.12629] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 01/19/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND QRS fragmentation (fQRS) and prolonged QTc interval on surface ECG are prognostic in various cardiomyopathies other than hypertrophic cardiomyopathy (HCM). The association between fQRS and prolonged QTc duration with occurrence of ventricular tachyarrhythmias or sudden cardiac death (VTA/SCD) in patients with HCM was explored. METHODS AND RESULTS One hundred and ninety-five clinical HCM patients were studied. QTc duration was derived applying Bazett's formula; fQRS was defined as presence of various RSR' patterns, R or S notching and/or >1 additional R wave in any non-aVR lead in patients without pacing or (in)complete bundle branch block. The endpoints comprised SCD, ECG documented sustained VTA (tachycardia or fibrillation) or appropriate implantable cardioverter defibrillator (ICD) therapies (antitachycardia pacing [ATP] or shock) for VTA in ICD recipients (n = 58 [30%]). QT prolonging drugs recipients were excluded. After a median follow-up of 5.7 years (IQR 2.7-9.1), 26 (13%) patients experienced VTA or SCD. Patients with fQRS in ≥3 territories (inferior, lateral, septal, and/or anterior) (p = 0.004) or QTc ≥460 ms (p = 0.009) had worse cumulative survival free of VTA/SCD than patients with fQRS in <3 territories or QTc <460 ms. fQRS in ≥3 territories (ß 4.5, p = 0.020, 95%CI 1.41-14.1) and QTc ≥460 ms (ß 2.7, p = 0.037, 95%CI 1.12-6.33) were independently associated with VTA/SCD. Likelihood ratio test indicated assessment of fQRS and QTc on top of conventional SCD risk factors provides incremental predictive value for VTA/SCD (p = 0.035). CONCLUSIONS Both fQRS in ≥3 territories and QTc duration are associated with VTA/SCD in HCM patients, independently of and incremental to conventional SCD risk factors.
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Affiliation(s)
- Philippe Debonnaire
- Leiden University Medical Centre, Department of Cardiology, Leiden, the Netherlands.,Sint-Jan Hospital Bruges, Department of Cardiology, Bruges, Belgium
| | - Spyridon Katsanos
- Leiden University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | - Emer Joyce
- Leiden University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | | | - Douwe E Atsma
- Leiden University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | - Martin J Schalij
- Leiden University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | - Jeroen J Bax
- Leiden University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | - Victoria Delgado
- Leiden University Medical Centre, Department of Cardiology, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Leiden University Medical Centre, Department of Cardiology, Leiden, the Netherlands
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15
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Mentz RJ, Greiner MA, DeVore AD, Dunlay SM, Choudhary G, Ahmad T, Khazanie P, Randolph TC, Griswold ME, Eapen ZJ, O'Brien EC, Thomas KL, Curtis LH, Hernandez AF. Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study. Circ Heart Fail 2014; 8:243-51. [PMID: 25550439 DOI: 10.1161/circheartfailure.114.001729] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. METHODS AND RESULTS We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. CONCLUSIONS QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities.
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Affiliation(s)
- Robert J Mentz
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.).
| | - Melissa A Greiner
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Adam D DeVore
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Shannon M Dunlay
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Gaurav Choudhary
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Tariq Ahmad
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Prateeti Khazanie
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Tiffany C Randolph
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Michael E Griswold
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Zubin J Eapen
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Emily C O'Brien
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Kevin L Thomas
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Lesley H Curtis
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
| | - Adrian F Hernandez
- From the Department of Medicine, Division of Cardiology, Duke University School of Medicine (R.J.M., A.D.D., T.A., P.K., T.C.R., Z.J.E., E.C.O'B., K.L.T., A.F.H.), and Duke Clinical Research Institute (R.J.M., M.A.G., A.D.D., T.C.R., Z.J.E., E.C.O'B., K.L.T., L.H.C., A.F.H.), Durham, NC; Department of Medicine, Mayo Clinic, Rochester, MN (S.M.D.); Vascular Research Laboratory, Providence VA Medical Center and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (G.C.); and Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS (M.E.G.)
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16
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Whitbeck MG, Charnigo RJ, Shah J, Morales G, Leung SW, Fornwalt B, Bailey AL, Ziada K, Sorrell VL, Zegarra MM, Thompson J, Hosn NA, Campbell CL, Gurley J, Anaya P, Booth DC, Di Biase L, Natale A, Smyth S, Moliterno DJ, Elayi CS. QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure: evidence from the AFFIRM study. Europace 2013; 16:803-11. [PMID: 24368753 DOI: 10.1093/europace/eut335] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The association of QRS duration (QRSd) with morbidity and mortality is understudied in patients with atrial fibrillation (AF). We sought to assess any association of prolonged QRS with increased risk of death or hospitalization among patients with AF. METHODS AND RESULTS QRS duration was retrieved from the baseline electrocardiograms of patients enroled in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study and divided into three categories: <90, 90-119, ≥120 ms. Cox models were applied relating the hazards of mortality and hospitalizations to QRSd. Among 3804 patients with AF, 593 died and 2305 were hospitalized. Compared with those with QRS < 90 ms, patients with QRS ≥ 120 ms, had an increased mortality [hazard ratio (HR) 1.61, 95% confidence interval (CI): 1.29-2.03, P < 0.001] and hospitalizations (HR 1.14, 95% CI: 1.07-1.34, P = 0.043) over an average follow-up of 3.5 years. Importantly, for patients with QRS 90-119 ms, mortality and hospitalization were also increased (HR 1.31, P = 0.005 and 1.11, P = 0.026, respectively). In subgroup analysis based on heart failure (HF) status (previously documented or ejection fraction <40%), mortality was increased for QRS ≥ 120 ms patients with (HR 1.87, P < 0.001) and without HF (HR 1.63, P = 0.02). In the QRS 90-119 ms group, mortality was increased (HR 1.38, P = 0.03) for those with HF, but not significantly among those without HF (HR 1.23, P = 0.14). CONCLUSION Among patients with AF, QRSd ≥ 120 ms was associated with a substantially increased risk for mortality (all-cause, cardiovascular, and arrhythmic) and hospitalization. Interestingly, an increased mortality was also observed among those with QRS 90-119 ms and concomitant HF.
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Affiliation(s)
- Matthew G Whitbeck
- Essentia Heart and Vascular, Department of Cardiology, Fargo, ND 58103, USA
| | - Richard J Charnigo
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Jignesh Shah
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Gustavo Morales
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Steve W Leung
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Brandon Fornwalt
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Alison L Bailey
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Khaled Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Vincent L Sorrell
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Milagros M Zegarra
- Department of Veterans Affairs, North Dakota State University, Fargo, ND 58102, USA
| | - Jenks Thompson
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Neil Aboul Hosn
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Charles L Campbell
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - John Gurley
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Paul Anaya
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - David C Booth
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, Department of Cardiology, Austin, TX 78746, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Department of Cardiology, Austin, TX 78746, USA
| | - Susan Smyth
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - David J Moliterno
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
| | - Claude S Elayi
- Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA
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17
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Delcrè SDL, Di Donna P, Leuzzi S, Miceli S, Bisi M, Scaglione M, Caponi D, Conte MR, Cecchi F, Olivotto I, Gaita F. Relationship of ECG findings to phenotypic expression in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance study. Int J Cardiol 2013; 167:1038-45. [DOI: 10.1016/j.ijcard.2012.03.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 02/01/2012] [Accepted: 03/03/2012] [Indexed: 01/21/2023]
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18
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[ECG diagnostics in competitive athletes. Current implications for preparticipation screening]. Herz 2013; 37:474-84. [PMID: 22695724 DOI: 10.1007/s00059-012-3636-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In young competitive athletes sudden cardiac death frequently occurs as a tragic first manifestation of clinically inapparent underlying structural or electrical cardiac disorders. An increased risk may be reflected by typical electrocardiogram (ECG) alterations preceding symptoms but a correct interpretation is often challenging due to a high prevalence of training-related ECG alterations in competitive athletes mimicking such disorders. Misinterpretation may thus result in either unnecessary disqualification from competitive sports or continuation despite an increased risk or extensive diagnostic work-ups yielding additional equivocal findings. However, as observed in large athlete cohorts in recent years a variety of ECG alterations, such as isolated increased QRS voltage, early repolarization, sinus bradycardia, first degree AV block or incomplete right bundle branch block, represent common variants of ECGs of athletes reflecting physiological and training-related cardiac adaptations. These alterations do not usually require further diagnostic evaluation. In contrast, alterations such as repolarization abnormalities, complete bundle branch block, prolonged QT intervals or pathological Q waves, are strongly suggestive of underlying disorders and require further evaluation even in asymptomatic athletes. Thus, the ECG plays a pivotal role in the prevention of sudden cardiac death in competitive athletes. The present article summarizes current recommendations for the interpretation of athlete ECGs regarding the differentiation between physiological or pathological cardiac adaptation.
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19
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Femenía F, Arce M, Arrieta M, Baranchuk A. Surface fragmented QRS in a patient with hypertrophic cardiomyopathy and malignant arrhythmias: Is there an association? J Cardiovasc Dis Res 2012; 3:32-5. [PMID: 22346143 PMCID: PMC3271679 DOI: 10.4103/0975-3583.91602] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
An 18- year old woman with hypertrophic cardiomyopathy, aborted sudden cardiac death and implanted with an implantable cardioverter defibrillator (ICD), developed progressive fragmentation of her surface 12-lead electrocardiogram (ECG). During the follow-up, she presented with multiple appropriate ICD discharges. Here, we discuss the possible association between surface fragmented ECG and the risk of ventricular arrhythmias in patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- Francisco Femenía
- Unidad de Arritmias. Departamento de Cardiología. Hospital Español de Mendoza. Argentina
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20
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Association of QRS duration and survival in dogs with dilated cardiomyopathy: A retrospective study of 266 clinical cases. J Vet Cardiol 2011; 13:243-9. [DOI: 10.1016/j.jvc.2011.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 08/05/2011] [Accepted: 09/01/2011] [Indexed: 11/23/2022]
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21
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Uberoi A, Stein R, Perez MV, Freeman J, Wheeler M, Dewey F, Peidro R, Hadley D, Drezner J, Sharma S, Pelliccia A, Corrado D, Niebauer J, Estes NAM, Ashley E, Froelicher V. Interpretation of the electrocardiogram of young athletes. Circulation 2011; 124:746-57. [PMID: 21824936 DOI: 10.1161/circulationaha.110.013078] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Abhimanyu Uberoi
- Stanford University School of Medicine, Palo Alto, CA 94305, USA
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22
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Aro AL, Anttonen O, Tikkanen JT, Junttila MJ, Kerola T, Rissanen HA, Reunanen A, Huikuri HV. Intraventricular Conduction Delay in a Standard 12-Lead Electrocardiogram as a Predictor of Mortality in the General Population. Circ Arrhythm Electrophysiol 2011; 4:704-10. [DOI: 10.1161/circep.111.963561] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background—
Prolonged duration of QRS complex in a 12-lead ECG is associated with adverse prognosis in patients with cardiac disease, but its significance is not well established in the general population. In particular, there is a paucity of data on the prognostic significance of nonspecific intraventricular conduction delay in apparently healthy subjects.
Methods and Results—
We evaluated the 12-lead ECGs of 10 899 Finnish middle-aged subjects from the general population (52% of whom were men; mean age 44±8.5 years) between 1966 and 1972 and followed them for 30±11 years. Primary end points were all-cause mortality, cardiac mortality, and arrhythmic death. Prolonged QRS duration was defined as QRS ≥110 ms and intraventricular conduction delay as QRS ≥110 ms, without the criteria of complete or incomplete bundle-branch block. QRS duration ≥110 ms was present in 1.3% (n=147) and intraventricular conduction delay in 0.6% (n=67) of the subjects. Prolonged QRS duration predicted all-cause mortality (multivariate-adjusted relative risk [RR] 1.48; 95% confidence interval [CI] 1.22–1.81;
P
<0.001), cardiac mortality (RR 1.94; CI 1.44–2.63;
P
<0.001), and sudden arrhythmic death (RR 2.14; CI 1.38–3.33;
P
=0.002). Subjects with intraventricular conduction delay had increased all-cause mortality (RR 2.01; CI 1.52–2.66;
P
<0.001), increased cardiac mortality (RR 2.53; CI 1.64–3.90;
P
<0.001), and an elevated risk of arrhythmic death (RR 3.11; CI 1.74–5.54;
P
=0.001). Left bundle-branch block also weakly predicted arrhythmic death (
P
=0.04), but right bundle-branch block was not associated with increased mortality.
Conclusions—
Prolonged QRS duration in a standard 12-lead ECG is associated with increased mortality in a general population, with intraventricular conduction delay being most strongly associated with an increased risk of arrhythmic death.
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Affiliation(s)
- Aapo L. Aro
- From the Division of Cardiology (A.L.A.), Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Internal Medicine (A.L.A., O.A., T.K.), Päijät-Häme Central Hospital, Lahti, Finland; Institute of Clinical Medicine (J.T.T., M.J.J., H.V.H.), Department of Internal Medicine, University of Oulu, Oulu, Finland; and National Institute for Health & Welfare (H.A.R., A.R.), Helsinki, Finland
| | - Olli Anttonen
- From the Division of Cardiology (A.L.A.), Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Internal Medicine (A.L.A., O.A., T.K.), Päijät-Häme Central Hospital, Lahti, Finland; Institute of Clinical Medicine (J.T.T., M.J.J., H.V.H.), Department of Internal Medicine, University of Oulu, Oulu, Finland; and National Institute for Health & Welfare (H.A.R., A.R.), Helsinki, Finland
| | - Jani T. Tikkanen
- From the Division of Cardiology (A.L.A.), Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Internal Medicine (A.L.A., O.A., T.K.), Päijät-Häme Central Hospital, Lahti, Finland; Institute of Clinical Medicine (J.T.T., M.J.J., H.V.H.), Department of Internal Medicine, University of Oulu, Oulu, Finland; and National Institute for Health & Welfare (H.A.R., A.R.), Helsinki, Finland
| | - M. Juhani Junttila
- From the Division of Cardiology (A.L.A.), Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Internal Medicine (A.L.A., O.A., T.K.), Päijät-Häme Central Hospital, Lahti, Finland; Institute of Clinical Medicine (J.T.T., M.J.J., H.V.H.), Department of Internal Medicine, University of Oulu, Oulu, Finland; and National Institute for Health & Welfare (H.A.R., A.R.), Helsinki, Finland
| | - Tuomas Kerola
- From the Division of Cardiology (A.L.A.), Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Internal Medicine (A.L.A., O.A., T.K.), Päijät-Häme Central Hospital, Lahti, Finland; Institute of Clinical Medicine (J.T.T., M.J.J., H.V.H.), Department of Internal Medicine, University of Oulu, Oulu, Finland; and National Institute for Health & Welfare (H.A.R., A.R.), Helsinki, Finland
| | - Harri A. Rissanen
- From the Division of Cardiology (A.L.A.), Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Internal Medicine (A.L.A., O.A., T.K.), Päijät-Häme Central Hospital, Lahti, Finland; Institute of Clinical Medicine (J.T.T., M.J.J., H.V.H.), Department of Internal Medicine, University of Oulu, Oulu, Finland; and National Institute for Health & Welfare (H.A.R., A.R.), Helsinki, Finland
| | - Antti Reunanen
- From the Division of Cardiology (A.L.A.), Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Internal Medicine (A.L.A., O.A., T.K.), Päijät-Häme Central Hospital, Lahti, Finland; Institute of Clinical Medicine (J.T.T., M.J.J., H.V.H.), Department of Internal Medicine, University of Oulu, Oulu, Finland; and National Institute for Health & Welfare (H.A.R., A.R.), Helsinki, Finland
| | - Heikki V. Huikuri
- From the Division of Cardiology (A.L.A.), Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Internal Medicine (A.L.A., O.A., T.K.), Päijät-Häme Central Hospital, Lahti, Finland; Institute of Clinical Medicine (J.T.T., M.J.J., H.V.H.), Department of Internal Medicine, University of Oulu, Oulu, Finland; and National Institute for Health & Welfare (H.A.R., A.R.), Helsinki, Finland
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Effect of dipping status on QRS morphology in patients with hypertension. Blood Press Monit 2010; 15:247-50. [PMID: 20559141 DOI: 10.1097/mbp.0b013e32833c8b22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prolongation of the QRS complex on the surface electrocardiogram (ECG) has been shown to be predictive of cardiovascular outcomes in selected populations. A 'nondipper' blood pressure (BP) profile is currently regarded as a risk factor in its own right for cardiovascular events and target organ damage. The predictive value of ECG parameters in hypertensives with nondipper profile has not been established. METHODS A total of 750 consecutive patients with hypertension who had been evaluated with ambulatory BP monitoring were screened for this study. One hundred and thirty-six patients who had fulfilled the inclusion and exclusion criteria were included in the final analysis. Dipper and nondipper patterns were detected and the maximum QRS duration (QRSd) measured on a 12-lead ECG was recorded. RESULTS There were 70 nondipper and 66 dipper hypertensives. There was no significant difference between the two groups regarding the daytime systolic and diastolic mean BPs, number of medications taken, and the proportion of each class of antihypertensive medications. Other variables were similar between the two groups. QRSd was significantly higher in nondippers than dippers (P=0.006). Correlation analysis revealed that the systolic BP fall at night was inversely and significantly related with QRSd (r=-0.482, P<0.001). Regression analysis further showed that the systolic BP fall at night and age were independent correlates of QRSd. CONCLUSION QRSd on the standard-surface 12-lead ECG was increased in patients with nondipper pattern and furthermore the systolic BP fall at night was independent correlate of QRSd in patients with hypertension.
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Christiaans I, van Engelen K, van Langen IM, Birnie E, Bonsel GJ, Elliott PM, Wilde AAM. Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy: systematic review of clinical risk markers. Europace 2010; 12:313-21. [PMID: 20118111 DOI: 10.1093/europace/eup431] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We performed a systematic literature review of recommended 'major' and 'possible' clinical risk markers for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We searched the Medline, Embase and Cochrane databases for articles published between 1971 and 2007. We included English language reports on HCM patients containing follow-up data on the endpoint (sudden) cardiac death using survival analysis. Analysis was undertaken using the quality of reporting of meta-analyses (QUORUM) statement checklist. The quality was checked using a quality assessment form from the Cochrane Collaboration. Thirty studies met inclusion criteria and passed quality assessment. The use of the six major risk factors (previous cardiac arrest or sustained ventricular tachycardia, non-sustained ventricular tachycardia, extreme left ventricular hypertrophy, unexplained syncope, abnormal blood pressure response, and family history of sudden death) in risk stratification for SCD as recommended by international guidelines was supported by the literature. In addition, left ventricular outflow tract obstruction seems associated with a higher risk of SCD. Our systematic review provides sound evidence for the use of the six major risk factors for SCD in the risk stratification of HCM patients. Left ventricular outflow tract obstruction could be included in the overall risk profile of patients with a marked left ventricular outflow gradient under basal conditions.
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Affiliation(s)
- Imke Christiaans
- Department of Clinical Genetics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Relation of 12-lead electrocardiogram patterns to implanted defibrillator-terminated ventricular tachyarrhythmias in hypertrophic cardiomyopathy. Am J Cardiol 2009; 104:1722-6. [PMID: 19962483 DOI: 10.1016/j.amjcard.2009.07.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 07/21/2009] [Accepted: 07/21/2009] [Indexed: 01/02/2023]
Abstract
Electrocardiographic (ECG) abnormalities are common in hypertrophic cardiomyopathy (HC) and have been associated with the distribution of left ventricular hypertrophy and myocardial fibrosis. Such abnormalities may predispose patients to electrophysiologic instability, ventricular arrhythmias, and sudden cardiac death (SCD). We studied 330 patients with HC who were judged clinically to be at high risk for SCD and therefore received automatic implantable cardioverter-defibrillators (ICDs). Surface 12-lead electrocardiograms acquired at the time of ICD implantation were analyzed and the ECG characteristics of patients with appropriate device interventions for ventricular tachycardia and fibrillation were compared to those patients without appropriate device interventions. The 330 patients were followed for 3.7 +/- 3.0 years after implantation and 57 patients (17%) had appropriate discharges. No differences in the ECG characteristics of patients with and without appropriate device interventions were identified. Markedly increased ECG voltages, QRS duration, left or rightward QRS axis, abnormal Q waves, and QTc or QT dispersion were not associated with appropriate ICD discharge. Conversely, normal electrocardiograms and electrocardiograms normal except for a repolarization abnormality in only 1 anatomic distribution were not associated with freedom from ICD discharge. Moreover, no combination of ECG variables was associated with the likelihood of an appropriate ICD discharge. In conclusion, in a cohort of patients with HC selected because of their high risk for SCD, 12-lead surface electrocardiogram did not predict subsequent appropriate ICD intervention for ventricular tachyarrhythmias and was not useful in risk stratification for sudden death.
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Perez M, Fonda H, Le VV, Mitiku T, Ray J, Freeman JV, Ashley E, Froelicher VF. Adding an electrocardiogram to the pre-participation examination in competitive athletes: a systematic review. Curr Probl Cardiol 2009; 34:586-662. [PMID: 19887232 DOI: 10.1016/j.cpcardiol.2009.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
No matter how rare, the death of young athletes is a tragedy. Can it be prevented? The European experience suggests that adding the electrocardiogram (ECG) to the standard medical and family history and physical examination can decrease cardiac deaths by 90%. However, there has not been a randomized trial to demonstrate such a reduction. While there are obvious differences between the European and American experiences with athletes including very differing causes of athletic deaths, some would highlight the European emphasis on public welfare vs the protection of personal rights in the USA. Even the authors of this systematic review have differing interpretation of the data: some of us view screening as a hopeless battle against Bayes, while others feel that the ECG can save lives. What we all agree on is that the USA should implement the American Heart Association 12-point screening recommendations and that, before ECG screening is mandated, we need to gather more data and optimize ECG criteria for screening young athletes.
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Hummel SL, Skorcz S, Koelling TM. Prolonged electrocardiogram QRS duration independently predicts long-term mortality in patients hospitalized for heart failure with preserved systolic function. J Card Fail 2009; 15:553-60. [PMID: 19700130 PMCID: PMC3769218 DOI: 10.1016/j.cardfail.2009.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 02/11/2009] [Accepted: 02/19/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prolonged electrocardiogram (ECG) QRS duration (>or=120 ms) is a risk factor for death in systolic heart failure, but its effects in heart failure with preserved systolic function (HFPSF) have not been extensively studied. We hypothesized that prolonged ECG QRS duration would independently predict long-term mortality in hospitalized HFPSF patients. METHODS AND RESULTS We analyzed 872 HFPSF patients (defined as left ventricular ejection fraction >or=50%) admitted to Michigan community hospitals between 2002 and 2004 and followed for a median of 660 days. We used Cox proportional hazards models to assess mortality hazard for prolonged QRS duration (>or=120 ms) on the last available predischarge ECG, first on a univariable basis and then after multivariable adjustment for other known risk factors. Prolonged QRS duration increased univariable all-cause mortality (HR 1.71; 95% CI 1.33-2.19, P < .001) and after multivariable adjustment (HR 1.31; 95% CI 1.01-1.71, P=.04). The univariable effect size was larger in younger patients. In multivariable models, there was no significant interaction between prolonged QRS and age, hypertension, or coronary artery disease status. CONCLUSIONS Prolonged QRS duration (>or=120 ms) on a predischarge ECG is an independent and consistent predictor of long-term mortality in hospitalized HFPSF patients.
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Affiliation(s)
- Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Arribas Leal JM, Pascual-Figal DA, Ahumada Vidal M, Marín Ortuño F, Gutiérrez García F, García-Puente del Corral J, Ruipérez Abizanda JA, Torres Martínez G, Valdés Chávarri M, Arcas Meca R. QRS duration and early hemodynamic instability after coronary revascularization surgery. Rev Esp Cardiol 2009; 62:652-9. [PMID: 19480761 DOI: 10.1016/s1885-5857(09)72229-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES The duration of the QRS interval measured by ECG is a marker of ventricular dysfunction and indicates a poor prognosis. Its value in patients undergoing coronary revascularization surgery has not been established. METHODS The study involved 203 consecutive patients (age 64+/-9 years, 74% male) scheduled for elective coronary surgery. The maximum QRS duration measured on a preoperative 12-lead ECG was recorded. Hemodynamic instability was defined as the occurrence of cardiac death, heart failure, or a need for intravenous inotropic drugs or intra-aortic balloon counterpulsation during the postoperative period. RESULTS The occurrence of hemodynamic instability (n=94, 46%) was associated with a longer preoperative QRS duration (97.5+/-21.14 ms vs 88.5+/-16.9 ms; P=.001). The QRS duration was also longer in patients who developed heart failure (n=23; 104.3+/-22.9 ms vs. 91.1+/-18.5 ms; P=.002), needed inotropic drugs (n=77; 96.5+/-20.5 ms vs. 90.1+/-18.2 ms; P=.007) or developed postoperative atrial fibrillation (n=58; 98.2+/-23.8 ms vs. 90.4+/-17.0 ms; P=.018). Bundle branch block was associated with a greater need for intra-aortic balloon counterpulsation (29% vs 12%; P=.012) or inotropic drugs (58% vs 35%; P=.014) and a higher incidence of hemodynamic instability (69% vs 42%; P=.006). Multivariate analysis identified the following independent predictors of hemodynamic instability: QRS duration (adjusted odds ratio [OR] per 10 ms=1.49; 95% confidence interval [CI], 1.11-2; P=.007), the lack of an arterial graft (OR=3.6; 95% CI, 1.14-11.6; P=.029) and extracorporeal circulation time (OR per min=1.013; 95% CI, 1.003-1.023; P=.013). CONCLUSIONS The intraventricular conduction delay, or QRS duration, was associated with a higher risk of postoperative hemodynamic instability following coronary surgery.
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Affiliation(s)
- José M Arribas Leal
- Servicio de Cirugía Cardiovascular, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
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Arribas Leal JM, Pascual-Figal DA, Ahumada Vidal M, Marín Ortuño F, Gutiérrez García F, García-Puente del Corral J, Ruipérez Abizanda JA, Torres Martínez G, Valdés Chávarri M, Arcas Meca R. Duración del QRS y deterioro hemodinámico precoz tras cirugía de revascularización coronaria. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71332-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Satoh H, Matoh F, Shiraki K, Saitoh T, Odagiri K, Saotome M, Urushida T, Katoh H, Takehara Y, Sakahara H, Hayashi H. Delayed enhancement on cardiac magnetic resonance and clinical, morphological, and electrocardiographical features in hypertrophic cardiomyopathy. J Card Fail 2009; 15:419-27. [PMID: 19477402 DOI: 10.1016/j.cardfail.2008.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 10/09/2008] [Accepted: 11/26/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND The clinical, morphological, and electrocardiographical relevance of delayed enhancement (DE) in cardiac magnetic resonance (CMR) was studied in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS A total of 56 patients underwent both gadolinium-enhanced CMR and 12-lead electrocardiogram. The CMR demonstrated DE at the left ventricular (LV) wall in 39 patients. The patients with DE included more cases with dilated phase of HCM, higher New York Heart Association (NYHA) classes and incidence of ventricular tachyarrhythmias (VT), lower LV ejection fraction (LVEF) and mean LV wall thickness (WT), and a larger ratio of maximum to minimum LVWT. The QRS duration was prolonged and the QRS axis deviated toward left with increases in the DE volume (r = 0.58 and r = 0.41, P < .01). Abnormal Q waves were present in 5 patients and the location coincided with the DE segments in 4 patients, but the concordance was not significant. The amplitude of T waves correlated with the ratio of the apex to basal LVWT (r = 0.38, P < .01) and was more negative in cases with DE at the apex. CONCLUSIONS In HCM, the DE was associated with higher NYHA classes and prevalence of VT, impaired global LV function and asymmetrical hypertrophy, and conduction disturbance, abnormal Q waves, and giant negative T waves.
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Affiliation(s)
- Hiroshi Satoh
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Japan.
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Abstract
PURPOSE OF REVIEW Sudden cardiac death (SCD) is a rare but tragic event in children. This review highlights the important advances in this field during the last year, both in the understanding of the underlying diseases and in improvements in the management of patients at risk for SCD. RECENT FINDINGS The study of SCD has focused on several major themes: progress in understanding the causes and treatments of genetic cardiovascular diseases, improved management of patients with congenital heart disease with SCD risk, treatment strategies for SCD risk reduction in patients with cardiomyopathies, and defining guidelines for athletic preparticipation screening. SUMMARY With advances in understanding of the causes and risk factors for SCD, management of children at risk for SCD continues to improve. This includes improved clinical criteria for identifying SCD risk as well as optimizing management strategies such as exercise restriction, antiarrhythmic medications, and implantable cardioverter defibrillator therapy.
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