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Hua C, Jiang C, Wang Z, Liu X, Fu H, Lin J, Lv Q, Dong J, Ma C, Du X. Association between anti-SSA autoantibodies and conduction disturbances in heart failure. Heart Rhythm 2024; 21:2583-2590. [PMID: 38848863 DOI: 10.1016/j.hrthm.2024.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Conduction disturbances play an important role in the occurrence and development of heart failure (HF). Studies suggest autoantibodies may attack the conduction system. However, whether autoantibodies are associated with conduction disturbances in patients with HF is unclear. OBJECTIVE The purpose of this study was to assess whether anti-SSA, anti-Ro/Sjögren syndrome-related antigen A antibodies known for congenital atrioventricular block (AVB), is associated with conduction disturbances in patients with HF. METHODS This retrospective observational study used data from patients with HF who were admitted to Beijing Anzhen Hospital between January 2018 and June 2022. Patients who were tested for anti-SSA and had undergone electrocardiographic examination during hospitalization were included. Conduction disturbances, including AVB, bundle branch block (BBB), and intraventricular conduction delay, were confirmed by a cardiologist blinded to anti-SSA status. Univariate and multivariable logistic regression analyses were performed to assess the association between anti-SSA and conduction disturbances. RESULTS A total of 766 patients were included in this study, of whom 70 (9.1%) were anti-SSA positive. Subjects who were anti-SSA positive showed a higher prevalence of AVB (20% vs 10.6%) and BBB (27.3 % vs 10.9 %), including both left BBB and right BBB (all P <.05). After adjusting for known risk factors, anti-SSA was independently associated with AVB (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.18-5.43; P = .03) and BBB (OR 3.15; 95% CI 1.68-5.89; P <.001). CONCLUSION Anti-SSA is independently associated with AVB and BBB in patients with HF. Further study of the role of autoantibodies in the development of conduction abnormalities in patients with HF to generate possible targeted treatments is required.
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Affiliation(s)
- Chang Hua
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Zhiyan Wang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xinru Liu
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Hao Fu
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Jing Lin
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Anzhen Hospital, Beijing, China; Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Changsheng Ma
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xin Du
- Department of Cardiology, Anzhen Hospital, Beijing, China; Heart Health Research Center (HHRC), Beijing, China.
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2
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Harms PP, Elders PPJM, Femke R, Lissenberg-Witte BI, Tan HL, Beulens JWJ, Nijpels G, van der Heijden AA. Longitudinal association of ECG abnormalities with major adverse cardiac events in people with type 2 diabetes: The Hoorn Diabetes Care System cohort. Eur J Prev Cardiol 2023:6982519. [PMID: 36625405 DOI: 10.1093/eurjpc/zwac314] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/15/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
AIMS To investigate the association of (changes in) ECG abnormalities with incident major adverse cardiac events (MACE) in people with type 2 diabetes (T2D) without pre-existing cardiovascular disease (CVD). METHODS A prospective longitudinal study of 11,993 people with T2D without known CVD from the Hoorn Diabetes Care System cohort. Annually repeated measurements (1998-2018), included cardiovascular risk factors, over 70,000 ECGs, and self-reported cardiovascular events. ECG abnormalities were classified according to the Minnesota Classification as prolonged PR duration, prolonged QRS duration, left QRS-axis, QS pattern, ST-segment/T-wave abnormalities, or tall R-wave. The association of ECG abnormalities with MACEs was assessed using time-dependent Cox-regression models, adjusted for time-varying cardiovascular risk factors and medication use (Hazzard Ratios with 95%CIs). RESULTS During a median follow-up of 6.6 (IQR, 3.1-10.7) years, 5445 (45.4%) of the participants had an ECG abnormality (prevalent or incident) at any of the median 6 (IQR, 3-10) annual ECG recordings, and 905 people (7.5%) had a MACE (529 CHD, 250 HF, 126 SCA). After adjustment, most ECG abnormalities were associated with HF: prolonged QRS duration (HR, 4.01 (95%CI, 2.67-6.03)), QS pattern (2.68 (0.85-8.49)), ST-segment/T-wave abnormalities (4.26 (2.67-6.80)), and tall R-wave (2.23 (1.33-3.76)). Only QS pattern (2.69 (1.20-6.03)), and ST-segment/T-wave abnormalities (2.11 (1.48-3.02)) were associated with CHD. These associations were robust across age, sex, hypertension, or estimated CVD risk subgroups. CONCLUSION In people with T2D without pre-existing cardiovascular disease, ECG abnormalities related to decelerated conduction, ischemia and hypertrophy are predominantly early signs of emerging HF, while only abnormalities related to ischemic disorders are signs of CHD.
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Affiliation(s)
- Peter P Harms
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Petra P J M Elders
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Rutters Femke
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Boelelaan 1117, Amsterdam, The Netherlands
| | - Hanno L Tan
- Amsterdam UMC location University of Amsterdam, Clinical and Experimental Cardiology, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences research institute, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Joline W J Beulens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Giel Nijpels
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Amber A van der Heijden
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Medicine, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health research institute, Amsterdam, The Netherlands
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3
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Golany T, Radinsky K, Kofman N, Litovchik I, Young R, Monayer A, Love I, Tziporin F, Minha I, Yehuda Y, Ziv-Baran T, Fuchs S, Minha S. Physicians and Machine-Learning Algorithm Performance in Predicting Left-Ventricular Systolic Dysfunction from a Standard 12-Lead-Electrocardiogram. J Clin Med 2022; 11:6767. [PMID: 36431244 PMCID: PMC9699306 DOI: 10.3390/jcm11226767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
Abstract
Early detection of left ventricular systolic dysfunction (LVSD) may prompt early care and improve outcomes for asymptomatic patients. Standard 12-lead ECG may be used to predict LVSD. We aimed to compare the performance of Machine Learning Algorithms (MLA) and physicians in predicting LVSD from a standard 12-lead ECG. By utilizing a dataset of 13,820 pairs of ECGs and echocardiography, a deep residual convolutional neural network was trained for predicting LVSD (ejection fraction (EF) < 50%) from ECG. The ECGs of the test set (n = 850) were assessed for LVSD by the MLA and six physicians. The performance was compared using sensitivity, specificity, and C-statistics. The interobserver agreement between the physicians for the prediction of LVSD was moderate (κ = 0.50), with average sensitivity and specificity of 70%. The C-statistic of the MLA was 0.85. Repeating this analysis with LVSD defined as EF < 35% resulted in an improvement in physicians’ average sensitivity to 84% but their specificity decreased to 57%. The MLA C-statistic was 0.88 with this threshold. We conclude that although MLA outperformed physicians in predicting LVSD from standard ECG, prior to robust implementation of MLA in ECG machines, physicians should be encouraged to use this approach as a simple and readily available aid for LVSD screening.
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Affiliation(s)
- Tomer Golany
- Taub Faculty of Computer Sciences, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Kira Radinsky
- Taub Faculty of Computer Sciences, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Natalia Kofman
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv 6997801, Israel
- Department of Cardiology, Shamir Medical Center, Be’er-Yaakov 7033001, Israel
| | - Ilya Litovchik
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv 6997801, Israel
- Department of Cardiology, Shamir Medical Center, Be’er-Yaakov 7033001, Israel
| | - Revital Young
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv 6997801, Israel
- Department of Cardiology, Shamir Medical Center, Be’er-Yaakov 7033001, Israel
| | - Antoinette Monayer
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv 6997801, Israel
- Department of Cardiology, Shamir Medical Center, Be’er-Yaakov 7033001, Israel
| | - Itamar Love
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv 6997801, Israel
- Department of Cardiology, Shamir Medical Center, Be’er-Yaakov 7033001, Israel
| | - Faina Tziporin
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv 6997801, Israel
- Department of Cardiology, Shamir Medical Center, Be’er-Yaakov 7033001, Israel
| | - Ido Minha
- Department of Mathematics and Computer Science, The Open University, Raanana 4353701, Israel
| | - Yakir Yehuda
- Taub Faculty of Computer Sciences, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventative Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shmuel Fuchs
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv 6997801, Israel
- Department of Cardiology, Shamir Medical Center, Be’er-Yaakov 7033001, Israel
| | - Sa’ar Minha
- Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv 6997801, Israel
- Department of Cardiology, Shamir Medical Center, Be’er-Yaakov 7033001, Israel
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4
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Braggion-Santos MF, Moreira HT, Volpe GJ, Koenigkam-Santos M, Marin-Neto JA, Schmidt A. Electrocardiogram abnormalities in chronic Chagas cardiomyopathy correlate with scar mass and left ventricular dysfunction as assessed by cardiac magnetic resonance imaging. J Electrocardiol 2022; 72:66-71. [PMID: 35344746 DOI: 10.1016/j.jelectrocard.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Abstract
Electrocardiographic (ECG) abnormalities are frequently identified in Chronic Chagas cardiomyopathy (CCC) patients and advanced abnormalities are related to a worse prognosis. Cardiac Magnetic Resonance (CMR) can precisely assess ventricular systolic dysfunction and quantify myocardial fibrosis (MF), both identified as prognostic factors. We sought to investigate if ECG abnormalities in CCC patients were associated with more severe myocardial involvement as evaluated by CMR. METHODS CCC patients with 12‑lead ECG and CMR closely obtained were included. ECG analysis evaluated rhythm, presence, and type of intraventricular conduction disturbances (IVCD) and, ventricular premature beats (VPB). CMR short-axis cine and late gadolinium enhancement images were evaluated to obtain left and right ventricular ejection fractions and MF mass, respectively. Statistical significance was set in 5%. RESULTS 194 CCC patients (98 women, 56 ± 14 years) were evaluated, and no IVCD was detected in 71. The most common IVCD was the association of right bundle branch block and left anterior fascicular block (RBBB+LAFB) in 58 patients, followed by isolated RBBB in 34, isolated LAFB in 17, and left bundle branch block (LBBB) in 14 patients. Of patients with no IVCD, 63% had MF and the burden of fibrosis (no IVCD - 7.4 ± 8.6%; RBBB - 6.6 ± 6.5%; p = 1.00), as well as left ventricular ejection fraction (LVEF) (no IVCD - 52 ± 14%; RBBB - 55 ± 10%; p = 1.00) were similar to patients with isolated RBBB. Left conduction system impairment was associated with lower LVEF (LAFB - 39 ± 15%; RBBB+LAFB- 41 ± 15%; and LBBB - 35 ± 15%; p < 0.001) and more MF (RBBB+LAFB - 12.2 ± 10.4%; LBBB - 10.6 ± 7.5%; and LAFB - 12.0 ± 7.0%; p < 0.001). The univariable model showed that the presence of MF was related to RBBB+LAFB (OR 5.0; p = 0.001) and VPB (OR 6.3; p = 0.014). After adjustment for age, gender, and different risk factors in a multivariable model, the same findings were still significantly related to CMR myocardial fibrosis (RBBB+LAFB OR 5.0; p = 0.002 / VPB OR 6.9; p = 0.015). CONCLUSIONS ECG without IVCD does not exclude serious cardiac abnormalities in CCC, and isolated RBBB seems to have a benign course. The presence of VPB and left branch conduction impairment, especially LAFB associated with RBBB, indicate a more severe cardiac involvement.
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Affiliation(s)
- Maria Fernanda Braggion-Santos
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Henrique T Moreira
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Gustavo J Volpe
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Marcel Koenigkam-Santos
- Department of Radiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - André Schmidt
- Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirao Preto, Brazil.
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5
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O’Connor M, Ho SY, McCarthy KP, Gatzoulis M, Wong T. Left bundle pacing in transposition of the great arteries with previous atrial redirection operation. HeartRhythm Case Rep 2022; 8:176-179. [PMID: 35492840 PMCID: PMC9039560 DOI: 10.1016/j.hrcr.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Matthew O’Connor
- Department of Electrophysiology, Royal Brompton Hospital, London, United Kingdom
- Adult Congenital Heart Centre, Royal Brompton Hospital, London, United Kingdom
| | - S. Yen Ho
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
| | - Karen P. McCarthy
- Cardiac Morphology Unit, Royal Brompton Hospital, London, United Kingdom
| | - Michael Gatzoulis
- Adult Congenital Heart Centre, Royal Brompton Hospital, London, United Kingdom
| | - Tom Wong
- Department of Electrophysiology, Royal Brompton Hospital, London, United Kingdom
- Adult Congenital Heart Centre, Royal Brompton Hospital, London, United Kingdom
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6
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Aiken AV, Goldhaber JI, Chugh SS. Delayed intrinsicoid deflection: Electrocardiographic harbinger of heart disease. Ann Noninvasive Electrocardiol 2022; 27:e12940. [PMID: 35176188 PMCID: PMC9107081 DOI: 10.1111/anec.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 01/18/2023] Open
Abstract
Delayed intrinsicoid deflection (DID) is an emerging electrocardiogram (ECG) marker of major clinical significance that is increasingly getting attention. Intrinsicoid deflection measures ventricular depolarization in the initial portion of the QRS complex, and DID is defined as an R wave peak time of ≥50 ms in leads V5 and V6 . Prior studies have identified an independent association between DID and cardiovascular conditions such as left ventricular hypertrophy, heart failure, and sudden cardiac death. The exact mechanism that results in DID remains unknown. Animal models indicate that DID may result from abnormal calcium and potassium conductance as well as extracellular matrix remodeling. DID remains an ECG marker of interest given its potential predictive value of underlying cardiovascular pathology and adverse events. This review provides an update on the proposed mechanisms and associations, as well as the clinical and research implications of DID.
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7
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Akbilgic O, Butler L, Karabayir I, Chang PP, Kitzman DW, Alonso A, Chen LY, Soliman EZ. ECG-AI: electrocardiographic artificial intelligence model for prediction of heart failure. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:626-634. [PMID: 34993487 PMCID: PMC8715759 DOI: 10.1093/ehjdh/ztab080] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 01/30/2023]
Abstract
AIMS Heart failure (HF) is a leading cause of death. Early intervention is the key to reduce HF-related morbidity and mortality. This study assesses the utility of electrocardiograms (ECGs) in HF risk prediction. METHODS AND RESULTS Data from the baseline visits (1987-89) of the Atherosclerosis Risk in Communities (ARIC) study was used. Incident hospitalized HF events were ascertained by ICD codes. Participants with good quality baseline ECGs were included. Participants with prevalent HF were excluded. ECG-artificial intelligence (AI) model to predict HF was created as a deep residual convolutional neural network (CNN) utilizing standard 12-lead ECG. The area under the receiver operating characteristic curve (AUC) was used to evaluate prediction models including (CNN), light gradient boosting machines (LGBM), and Cox proportional hazards regression. A total of 14 613 (45% male, 73% of white, mean age ± standard deviation of 54 ± 5) participants were eligible. A total of 803 (5.5%) participants developed HF within 10 years from baseline. Convolutional neural network utilizing solely ECG achieved an AUC of 0.756 (0.717-0.795) on the hold-out test data. ARIC and Framingham Heart Study (FHS) HF risk calculators yielded AUC of 0.802 (0.750-0.850) and 0.780 (0.740-0.830). The highest AUC of 0.818 (0.778-0.859) was obtained when ECG-AI model output, age, gender, race, body mass index, smoking status, prevalent coronary heart disease, diabetes mellitus, systolic blood pressure, and heart rate were used as predictors of HF within LGBM. The ECG-AI model output was the most important predictor of HF. CONCLUSIONS ECG-AI model based solely on information extracted from ECG independently predicts HF with accuracy comparable to existing FHS and ARIC risk calculators.
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Affiliation(s)
- Oguz Akbilgic
- Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S 1st Street, Maywood, IL 60153, USA
- Sections on Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, USA
| | - Liam Butler
- Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S 1st Street, Maywood, IL 60153, USA
| | - Ibrahim Karabayir
- Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, 2160 S 1st Street, Maywood, IL 60153, USA
- Departmet of Econometrics, Kirklareli University, 3 Kayalı Kampüsü Kofçaz, Kirklareli, Turkey, Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, 160 Dental Circle, Chapel Hill, NC 27599, USA
| | - Patricia P Chang
- Sections on Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, USA
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, USA
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE Atlanta, GA, 30322, USA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 401 East River Parkway, Minneapolis, MN 55455, USA
| | - Elsayed Z Soliman
- Sections on Cardiovascular Medicine and Geriatrics, Department of Internal Medicine, Wake Forest School of Medicine, 475 Vine Street, Winston-Salem, NC 27101, USA
- Internal Medicine, Epidemiological Cardiology Research Center, Sections on Cardiovascular Medicine, Wake Forest School of Medicine, 525 Vine Street, Winston-Salem, NC 27101, USA
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8
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Wannamethee SG, Papacosta O, Lennon L, Hingorani A, Whincup P. Adult height and incidence of atrial fibrillation and heart failure in older men: The British Regional Heart Study. IJC HEART & VASCULATURE 2021; 35:100835. [PMID: 34286063 PMCID: PMC8274296 DOI: 10.1016/j.ijcha.2021.100835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 12/05/2022]
Abstract
Aims Taller stature has been associated with increased risk of atrial fibrillation (AF). AF and heart failure (HF) often co-occur but the association between height and risk of HF in older adults has not been well studied. We have examined the association between height and incident AF and incident HF in older adults. Methods Prospective study of 3346 men aged 60–79 years with no diagnosed HF, myocardial infarction or stroke at baseline (1998–2000) followed up for a mean period of 16 years, in whom there were 294 incident HF cases and 456 incident AF. Men were divided into 5 height groups: <168.2, 168.2–172.5, 172.6–176.9, 177.0–183.0 and >183.0 cms based on the 25th, 50th, 75th and 95th centiles distribution of height. Results CVD risk factors tended to decrease with increasing height but a positive association was seen between height and electrocardiographic QRS duration and incident AF. Both short stature (<168.2 cm) and tall stature (>183.0 cm) was associated with significantly increased risk of HF in age-adjusted analysis compared to those in the second height quartile [HR (95 %CI) = 1.62 (1.15, 2.26) and 2.04 (1.23, 3.39) respectively]. In short men the increased risk remained after adjustment for adverse CVD risk factors; in tall men the association was largely associated with AF and QRS duration. Conclusion Tall stature is associated with significantly increased risk of AF leading to increased risk of HF. Short stature was associated with increased HF risk which was not explained by known adverse CVD risk factors.
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Key Words
- AF, atrial fibrillation
- Atrial fibrillation
- CHD, coronary heart disease
- CRP, C-reactive protein
- CVD, cardiovascular disease
- ECG, electrocardiogram
- Epidemiology
- FEV1, forced expiratory volume in 1 s
- HF, heart failure
- Heart failure
- Height
- LVH, left ventricular hypertrophy
- MI, myocardial infarction
- NT-proBNP, N-terminal pro-brain natriuretic peptide
- SBP, systolic blood pressure
- hsTnT, high sensitive troponin T
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Affiliation(s)
- S Goya Wannamethee
- Department Primary Care and Population Health, UCL London, United Kingdom
| | - Olia Papacosta
- Department Primary Care and Population Health, UCL London, United Kingdom
| | - Lucy Lennon
- Department Primary Care and Population Health, UCL London, United Kingdom
| | - Aroon Hingorani
- Institute of Cardiovascular Sciences, UCL, London, United Kingdom
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, United Kingdom
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9
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Scott Binder M, Roda RH, Corse AM, Sidhu S, Stewart S, Barth AS. Prevalence of heart disease in patients with mitochondrial abnormalities on skeletal muscle biopsy. Ann Clin Transl Neurol 2021; 8:825-830. [PMID: 33638621 PMCID: PMC8045917 DOI: 10.1002/acn3.51327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Mitochondrial DNA mutations are associated with an increased risk of heart disease. Whether an increased prevalence of cardiovascular disease is present in patients presenting with mitochondrial abnormalities on skeletal muscle biopsy remains unknown. This study was designed to determine the prevalence of cardiac conduction disease and structural heart disease in patients presenting with mitochondrial abnormalities on skeletal muscle biopsy. Methods This is a retrospective cohort study of 103 patients with mitochondrial abnormalities on skeletal muscle biopsy who were referred for evaluation of muscle weakness at a single tertiary care referral center from 2012 to 2018. Of these patients, 59 (57.3%) had an electrocardiogram available and were evaluated for the presence of conduction disease. An echocardiogram was available in 43 patients (42%) who were evaluated for the presence of structural heart disease. The prevalence of cardiac disease was compared to control cohort populations (Framingham and the Atherosclerosis Risk in Communities, ARIC cohorts). Results Mitochondrial abnormalities associated with cardiac conduction disease (defined as QRS duration ≥ 120 msec) were present in 8.9%, versus 2.0% (p < 0.001) in the Framingham population and 2.6% (p = 0.003) in the ARIC cohort. LV systolic dysfunction (LVEF ≤ 50%) was present in 11.6%, versus 3.6% (p < 0.01) in the Framingham and 3% (p < 0.01) in the ARIC populations. Left ventricular hypertrophy was present in 28.6%, versus 13.6% (p < 0.02) in the Framingham and 10.4% (p < 0.001) in the ARIC populations. Interpretation Given the increased prevalence of cardiovascular disease, patients with mitochondrial abnormalities on skeletal muscle biopsy should undergo routine cardiac screening with physical exam, electrocardiography, and cardiac imaging.
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Affiliation(s)
- M Scott Binder
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Ricardo H Roda
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea M Corse
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sunjeet Sidhu
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Stewart
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreas S Barth
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Søndergaard MM, Riis J, Bodker KW, Hansen SM, Nielsen J, Graff C, Pietersen AH, Nielsen JB, Tayal B, Polcwiartek C, Torp-Pedersen C, Soegaard P, Kragholm KH. Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting. Open Heart 2021; 8:e001425. [PMID: 33574021 PMCID: PMC7880100 DOI: 10.1136/openhrt-2020-001425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
AIM Left bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data. METHODS AND RESULTS Using ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment. CONCLUSION Prolonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.
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Affiliation(s)
| | - Johannes Riis
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Steen Møller Hansen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Nielsen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Graff
- Department of Health, Science and Technology, Aalborg University Faculty of Health Sciences, Aalborg, Denmark
| | - Adrian Holger Pietersen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerod, Denmark
| | - Jonas Bille Nielsen
- University of Copenhagen, Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark
- Department of Cardiology, Laboratory of Molecular Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Hospital Vendsyssel in Hjørring, Hjorring, Denmark
| | - Christoffer Polcwiartek
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | | | - Peter Soegaard
- Cardiology Clinic Heart-Lung, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Regional Hospital North Jutland, Hjorring, Denmark
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11
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Affiliation(s)
- Yochai Birnbaum
- The Section of CardiologyBaylor College of MedicineHoustonTX
| | - Kjell Nikus
- Faculty of Medicine and Health TechnologyTampere University and Heart CenterTampere University HospitalTampereFinland
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12
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Effect of antihypertensive therapy on development of incident conduction system disease in hypertensive patients. J Hypertens 2019; 37:629-635. [DOI: 10.1097/hjh.0000000000001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Mantovani A, Rigolon R, Pichiri I, Morani G, Bonapace S, Dugo C, Zoppini G, Bonora E, Targher G. Relation of elevated serum uric acid levels to first-degree heart block and other cardiac conduction defects in hospitalized patients with type 2 diabetes. J Diabetes Complications 2017; 31:1691-1697. [PMID: 29033310 DOI: 10.1016/j.jdiacomp.2017.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/21/2017] [Accepted: 09/17/2017] [Indexed: 11/29/2022]
Abstract
AIMS Several studies have reported that moderately elevated serum uric acid levels are associated with an increased risk of tachyarrhythmias (mainly atrial fibrillation) in patients with and without type 2 diabetes mellitus (T2DM). It is currently unknown whether an association also exists between elevated serum uric acid levels and cardiac conduction defects in patients with T2DM. METHODS We retrospectively analyzed a hospital-based sample of 967 patients with T2DM discharged from our Division of Endocrinology over the years 2007-2014. Standard electrocardiograms were performed on all patients and were interpreted by expert cardiologists. RESULTS Overall, 267 (27.6%) patients had some type of conduction defects on electrocardiograms (defined as at least one block among first-degree atrio-ventricular block, second-degree block, third-degree block, left bundle branch block, right bundle branch block, left anterior hemi-block or left posterior hemi-block). Patients in the 3rd serum uric acid tertile had a higher prevalence of any cardiac conduction defects than those belonging to 2nd or 1st tertile, respectively (35.8% vs. 25.0% vs. 22.6%; p<0.0001). Elevated serum uric acid levels were associated with a nearly twofold increased risk of cardiac conduction defects after adjustment for age, sex, hemoglobin A1c, diabetes duration, metabolic syndrome, chronic kidney disease, chronic obstructive pulmonary disease, ischemic heart disease, valvular heart disease and medication use (adjusted-odds ratio 1.84, 95% confidence intervals 1.2-2.9; p=0.009). CONCLUSIONS Moderately elevated serum uric acid levels are associated with an increased prevalence of any cardiac conduction defects in hospitalized patients with T2DM, independent of multiple risk factors and potential confounding variables.
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Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Riccardo Rigolon
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Isabella Pichiri
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Morani
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Clementina Dugo
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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14
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Patel N, O'Neal WT, Whalen SP, Soliman EZ. The association of QT interval components with atrial fibrillation. Ann Noninvasive Electrocardiol 2017; 23:e12467. [PMID: 28660734 DOI: 10.1111/anec.12467] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/22/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Although abnormalities of the QT interval are associated with atrial fibrillation (AF), it is unclear whether ventricular depolarization (QRS duration) or repolarization (JT interval) is a more important marker of AF risk. METHODS This analysis included 4,181 (95% white; 59% women) participants from the Cardiovascular Health Study (CHS) who were free of baseline AF and major intraventricular delay. A linear scale was used to compute heart rate adjusted QT (QTa), QRS (QRSa ), and JT (JTa ) intervals. Prolonged QTa , QRSa , and JTa were defined by values greater than the sex-specific 95th percentile for each measurement. AF events were ascertained during the annual study electrocardiograms and from hospitalization discharge data. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for the associations of prolonged QTa , QRSa , and JTa with AF, separately. RESULTS Over a mean follow-up of 12.1 years, a total of 1,236 (30%) AF events were detected. An increased risk of AF (HR = 1.50. 95% CI = 1.20, 1.88) was observed with prolonged QTa . When we examined the association between individual components of the QTa interval and AF, the risk of AF was limited to prolonged JTa (HR = 1.31, 95% CI = 1.04, 1.65) and not prolonged QRSa (HR = 1.00, 95% CI = 0.77, 1.30). Similar results were obtained per 1-SD increase in QTa (HR = 1.07, 95% CI = 1.01, 1.13), QRSa (HR = 0.99, 95% CI = 0.94, 1.06), and JTa (HR = 1.07, 95% CI = 1.01, 1.13). CONCLUSIONS The JT interval is a more important marker of AF risk in the QT interval among persons who do not have ventricular conduction delays.
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Affiliation(s)
- Nikhil Patel
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - S Patrick Whalen
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elsayed Z Soliman
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
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15
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Mantovani A. Nonalcoholic Fatty Liver Disease (NAFLD) and Risk of Cardiac Arrhythmias: A New Aspect of the Liver-heart Axis. J Clin Transl Hepatol 2017; 5:134-141. [PMID: 28660151 PMCID: PMC5472934 DOI: 10.14218/jcth.2017.00005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a pathologic condition frequently observed in clinical practice. To date, the prevalence of NAFLD is approximately 25-30% among adults of the general population in Western countries but increases to approximately 70-75% among patients with type 2 diabetes mellitus. In the last decade, accumulating evidence has clearly demonstrated that patients with NAFLD have not only an increased liver-related morbidity and mortality but also an increased risk of fatal and non-fatal cardiovascular events. In particular, several studies have documented the existence of an independent association among NAFLD and cardiac changes in structure and function in both non-diabetic and diabetic patients. In addition, mounting evidence also suggests that there is a strong relationship between NAFLD and cardiac arrhythmias, such as atrial fibrillation, QTc prolongation and ventricular arrhythmias. This is of clinical interest, as it could explain, at least in part, the increased risk of death for cardiovascular disease in patients with NAFLD. Therefore, seeing that cardiovascular disease complications are the leading cause of disability and death in NAFLD patients, the recent European clinical practice guidelines advised to check the cardiovascular system in all patients with NAFLD. This clinical mini review will briefly describe the increasing body of evidence regarding the association between NAFLD and cardiac arrhythmias, and discuss the potential biological mechanisms underlying this association.
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Affiliation(s)
- Alessandro Mantovani
- *Correspondence to: Alessandro Mantovani, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani, 1, 37126 Verona, Italy. Tel: +39-45-8123110, Fax: +39-45-8122841, E-mail:
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16
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O'Neal WT, Mazur M, Bertoni AG, Bluemke DA, Al-Mallah MH, Lima JAC, Kitzman D, Soliman EZ. Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2017; 6:JAHA.117.006023. [PMID: 28546456 PMCID: PMC5669197 DOI: 10.1161/jaha.117.006023] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Several markers detected on the routine 12‐lead ECG are associated with future heart failure events. We examined whether these markers are able to separate the risk of heart failure with reduced ejection fraction (HFrEF) from heart failure with preserved ejection fraction (HFpEF). Methods and Results We analyzed data of 6664 participants (53% female; mean age 62±10 years) from MESA (Multi‐Ethnic Study of Atherosclerosis) who were free of cardiovascular disease at baseline (2000–2002). A competing risks analysis was used to compare the association of several baseline ECG predictors with HFrEF and HFpEF detected during a median follow‐up of 12.1 years. A total of 127 HFrEF and 117 HFpEF events were detected during follow‐up. In a multivariable adjusted model, prolonged QRS duration, delayed intrinsicoid deflection, left‐axis deviation, right‐axis deviation, prolonged QT interval, abnormal QRS‐T axis, left ventricular hypertrophy, ST/T‐wave abnormalities, and left bundle‐branch block were associated with HFrEF. In contrast, higher resting heart rate, abnormal P‐wave axis, and abnormal QRS‐T axis were associated with HFpEF. The risk of HFrEF versus HFpEF was significantly differently for delayed intrinsicoid deflection (hazard ratio: 4.90 [95% confidence interval (CI), 2.77–8.68] versus 0.94 [95% CI, 0.29–2.97]; comparison P=0.013), prolonged QT interval (hazard ratio: 2.39 [95% CI, 1.55–3.68] versus 0.52 [95% CI, 0.23–1.19]; comparison P<0.001), and ST/T‐wave abnormalities (hazard ratio: 2.47 [95% CI, 1.69–3.62] versus 1.13 [95% CI, 0.72–1.77]; comparison P=0.0093). Conclusions Markers of ventricular repolarization and delayed ventricular activation are able to distinguish between the future risk of HFrEF and HFpEF. These findings suggest a role for ECG markers in the personalized risk assessment of heart failure subtypes.
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Affiliation(s)
- Wesley T O'Neal
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Matylda Mazur
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alain G Bertoni
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Mouaz H Al-Mallah
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI.,King Abdullah International Medical Research Center, King Abdul Aziz Cardiac Center, King Saud bin Abdul Aziz University for Health Sciences Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD.,Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - Dalane Kitzman
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Elsayed Z Soliman
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC .,Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC
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17
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Pantazopoulos JS, David A, Kostis WJ, Cosgrove NM, Kostis JB. Cardiovascular outcomes in patients with intraventricular conduction blocks: A sixteen-year follow-up in a state-wide database. Hellenic J Cardiol 2016; 58:194-201. [PMID: 27965025 DOI: 10.1016/j.hjc.2016.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND To assess the adverse clinical effects of left anterior hemiblock alone or in combination with right bundle branch block and of complete left bundle branch block in comparison with isolated right bundle branch block and the relationship of these effects with altered mechanoelectric factors resulting in left ventricular dysfunction. METHODS In a 16-year follow-up study using a statewide database, we studied the occurrence of mortal and morbid cardiovascular (CV) events among patients without apparent ischemic heart disease who had left anterior hemiblock (LAHB, n=4273, right bundle branch block (RBBB) with LAHB (BFBB, n=1857) and left bundle branch block (LBBB, n=9484 compared to isolated RBBB (n=25288). RESULTS After adjustment for demographics, co-morbidities and insurance, LAHB was associated with a significant excess risk of all-cause death (HR 1.134, 95% CI 1.061-1.213, p=0.0002) and CV death (HR 1.329, 95% CI 1.174-1.501, p<0.0001). BFBB was associated with excess HF (HR 1.190, 95% CI 1.048-1.351, p<0.0071), all-cause death (HR 1.440, 95% CI 1.045-1.252, p=0.0036) and CV death (HR 1.210, 95% CI 1.020-1.436, p<0.0001). LBBB was associated with an excess risk of MR (HR 1.307, 95% CI 1.116-1.530, p<0.0009), HF 1.177, 95% CI1.097-1.263, p<0.0001) and CV death (HR 1.220, 95% CI 1.106-1.345, p<0.0001). CONCLUSIONS In patients without apparent ischemic heart disease, the presence of LAHB alone or in combination with RBBB imparts increased risk of CV and all-cause death compared to isolated RBBB. BFBB is also associated with an increased risk of HF.
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Affiliation(s)
- John S Pantazopoulos
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Alice David
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William J Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nora M Cosgrove
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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18
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O'Neal WT, Qureshi WT, Nazarian S, Kawel-Boehm N, Bluemke DA, Lima JAC, Soliman EZ. Electrocardiographic Time to Intrinsicoid Deflection and Heart Failure: The Multi-Ethnic Study of Atherosclerosis. Clin Cardiol 2016; 39:531-6. [PMID: 27552258 DOI: 10.1002/clc.22561] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/01/2016] [Accepted: 05/06/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Time to intrinsicoid deflection (ID), the time from onset of the QRS complex to the peak of the R wave on the electrocardiogram, represents delayed ventricular activation and suggests that impaired myocardial function is present. It is unknown whether delayed time to ID is predictive of future heart failure (HF) events. HYPOTHESIS Delayed time to ID is predictive of future HF events. METHODS A total of 6394 participants (mean age, 62 ± 10 years; 54% women; 38% whites, 28% blacks, 22% Hispanics, 12% Chinese Americans) without clinically apparent cardiovascular disease or major ventricular conduction delay (QRS ≥120 ms) from the Multi-Ethnic Study of Atherosclerosis were included. Time to ID was automatically measured from baseline electrocardiograms (2000-2002) as the maximum value in leads V5 and V6 . Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time to ID and HF. RESULTS Over a median follow-up of 11.2 years, a total of 217 (3.4%) participants developed HF (incidence rate per 1000 person-years: 3.33, 95% CI: 2.91-3.80). In a multivariable Cox regression analysis adjusted for demographics, cardiovascular risk factors, and potential confounders, each 10-ms increase in maximum time to ID was associated with an increased risk for HF (HR: 1.42, 95% CI: 1.15-1.74). The results remained similar when stratified by age, sex, and race/ethnicity. CONCLUSIONS Delayed time to ID is able to identify individuals at risk for developing HF before major ventricular conduction delays (eg, bundle branch block) are evident.
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Affiliation(s)
- Wesley T O'Neal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Waqas T Qureshi
- Department of Internal Medicine, Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Saman Nazarian
- Section for Cardiac Electrophysiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - David A Bluemke
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
| | - Joao A C Lima
- Department of Medicine, Division of Cardiology, and Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Elsayed Z Soliman
- Department of Internal Medicine, Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
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19
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Tolppanen H, Siirila-Waris K, Harjola VP, Marono D, Parenica J, Kreutzinger P, Nieminen T, Pavlusova M, Tarvasmaki T, Twerenbold R, Tolonen J, Miklik R, Nieminen MS, Spinar J, Mueller C, Lassus J. Ventricular conduction abnormalities as predictors of long-term survival in acute de novo and decompensated chronic heart failure. ESC Heart Fail 2015; 3:35-43. [PMID: 27774265 PMCID: PMC5061091 DOI: 10.1002/ehf2.12068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 08/08/2015] [Accepted: 09/07/2015] [Indexed: 11/30/2022] Open
Abstract
Aims Data on the prognostic role of left and right bundle branch blocks (LBBB and RBBB), and nonspecific intraventricular conduction delay (IVCD; QRS ≥ 110 ms, no BBB) in acute heart failure (AHF) are controversial. Our aim was to investigate electrocardiographic predictors of long‐term survival in patients with de novo AHF and acutely decompensated chronic heart failure (ADCHF). Methods and Results We analysed the admission electrocardiogram of 982 patients from a multicenter European cohort of AHF with 3.9 years' mean follow‐up. Half (51.5%, n = 506) of the patients had de novo AHF. LBBB, and IVCD were more common in ADCHF than in de novo AHF: 17.2% vs. 8.7% (P < 0.001) and 20.6% vs. 13.2% (P = 0.001), respectively, and RBBB was almost equally common (6.9% and 8.1%; P = 0.5), respectively. Mortality during the follow‐up was higher in patients with RBBB (85.4%) and IVCD (73.7%) compared with patients with normal ventricular conduction (57.0%); P < 0.001 for both. The impact of RBBB on prognosis was prominent in de novo AHF (adjusted HR 1.93, 1.03–3.60; P = 0.04), and IVCD independently predicted death in ADCHF (adjusted HR 1.79, 1.28–2.52; P = 0.001). Both findings were pronounced in patients with reduced ejection fraction. LBBB showed no association with increased mortality in either of the subgroups. The main results were confirmed in a validation cohort of 1511 AHF patients with 5.9 years' mean follow‐up. Conclusions Conduction abnormalities predict long‐term survival differently in de novo AHF and ADCHF. RBBB predicts mortality in de novo AHF, and IVCD in ADCHF. LBBB has no additive predictive value in AHF requiring hospitalization.
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Affiliation(s)
- Heli Tolppanen
- Heart and Lung Center, Cardiology Helsinki University Hospital Finland
| | | | - Veli-Pekka Harjola
- Division of Emergency Care, Department of Medicine Helsinki University Hospital Finland
| | - David Marono
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland
| | - Jiri Parenica
- Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center, Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic
| | - Philipp Kreutzinger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland
| | - Tuomo Nieminen
- Heart and Lung Center, Cardiology Helsinki University Hospital Finland
| | | | | | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland
| | - Jukka Tolonen
- Department of Medicine Helsinki University Hospital Finland
| | - Roman Miklik
- Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center, Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic
| | - Markku S Nieminen
- Heart and Lung Center, Cardiology Helsinki University Hospital Finland
| | - Jindrich Spinar
- Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center, Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland
| | - Johan Lassus
- Heart and Lung Center, Cardiology Helsinki University Hospital Finland
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