1
|
Piccirillo G, Moscucci F, Mezzadri M, Caltabiano C, Cisaria G, Vizza G, De Santis V, Giuffrè M, Stefano S, Scinicariello C, Carnovale M, Corrao A, Lospinuso I, Sciomer S, Rossi P. Artificial Intelligence Applied to Electrical and Non-Invasive Hemodynamic Markers in Elderly Decompensated Chronic Heart Failure Patients. Biomedicines 2024; 12:716. [PMID: 38672072 PMCID: PMC11048014 DOI: 10.3390/biomedicines12040716] [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: 02/04/2024] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES The first aim of this study was to assess the predictive power of Tend interval (Te) and non-invasive hemodynamic markers, based on bioimpedance in decompensated chronic heart failure (CHF). The second one was to verify the possible differences in repolarization and hemodynamic data between CHF patients grouped by level of left ventricular ejection fraction (LVEF). Finally, we wanted to check if repolarization and hemodynamic data changed with clinical improvement or worsening in CHF patients. METHODS Two hundred and forty-three decompensated CHF patients were studied by 5 min ECG recordings to determine the mean and standard deviation (TeSD) of Te (first study). In a subgroup of 129 patients (second study), non-invasive hemodynamic and repolarization data were recorded for further evaluation. RESULTS Total in-hospital and cardiovascular mortality rates were respectively 19 and 9%. Te was higher in the deceased than in surviving subjects (Te: 120 ± 28 vs. 100 ± 25 ms) and multivariable logistic regression analysis reported that Te was related to an increase of total (χ2: 35.45, odds ratio: 1.03, 95% confidence limit: 1.02-1.05, p < 0.001) and cardiovascular mortality (χ2: 32.58, odds ratio: 1.04, 95% confidence limit: 1.02-1.06, p < 0.001). Subjects with heart failure with reduced ejection fraction (HFrEF) reported higher levels of repolarization and lower non-invasive systolic hemodynamic data in comparison to those with preserved ejection fraction (HFpEF). In the subgroup, patients with the NT-proBNP reduction after therapy showed a lower rate of Te, heart rate, blood pressures, contractility index, and left ventricular ejection time in comparison with the patients without NT-proBNP reduction. CONCLUSION Electrical signals from ECG and bioimpedance were capable of monitoring the patients with advanced decompensated CHF. These simple, inexpensive, non-invasive, easily repeatable, and transmissible markers could represent a tool to remotely monitor and to intercept the possible worsening of these patients early by machine learning and artificial intelligence tools.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Martina Mezzadri
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Cristina Caltabiano
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Giovanni Cisaria
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Guendalina Vizza
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Valerio De Santis
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Marco Giuffrè
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Sara Stefano
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Claudia Scinicariello
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Myriam Carnovale
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Andrea Corrao
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Ilaria Lospinuso
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Susanna Sciomer
- Department of Internal and Clinical Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00185 Rome, Italy; (G.P.); (M.M.); (C.C.); (G.C.); (G.V.); (V.D.S.); (M.G.); (S.S.); (C.S.); (M.C.); (A.C.); (S.S.)
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Hospital, Isola Tiberina-Gemelli Isola, 00186 Rome, Italy;
| |
Collapse
|
2
|
Yılmaz M, Yılmaz S. Electrocardiographic frontal QRS-T angle is independently associated with panic disorder. Int J Psychiatry Med 2024; 59:167-181. [PMID: 37342881 DOI: 10.1177/00912174231184759] [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] [Indexed: 06/23/2023]
Abstract
OBJECTIVE Panic disorder (PD) may cause serious cardiac arrhythmias by causing electrical abnormalities. Abnormal P-wave axis (aPwa), presence of fragmented QRS (fQRS), wide frontal QRS-T angle (fQRSTa), QRS duration corrected (QRSdc) and log/ logQRS duration/RR interval (log/logQRS/RR) have been correlated with increased risk of serious supraventricular and ventricular cardiac arrhythmias in a general population. The purpose of this study was to compare these newly explored atrial and ventricular arrhythmia indicators in patients with PD and in healthy subjects. METHOD A total of 169 newly diagnosed PD patients and 128 healthy subjects were included in the study. The Panic and Agoraphobia Scale (PAS) was administered, and 12-lead electrocardiography (ECG) measurements were obtained. Electrocardiographic parameters including aPwa, fQRSTa, presence of fQRS, QRS duration corrected (QRSdc), and log/logQRS duration/RR distance (log/logQRS/RR) were compared between the two groups. RESULTS aPwa and fQRS, in addition to fQRSTa, QRSdc, and log/ logQRS/RR ratio values, were significantly increased in the PD group compared to healthy controls. Correlation analyses revealed that wider fQRSTa, number of fQRS derivation, number of total fQRS, wider QRSdc, and log/logQRS/RR ratio significantly correlated with PAS score. Logistic regression analysis demonstrated that fQRSTa and the number of total fQRS were independently associated with PD. CONCLUSION PD is associated with wider fQRSTa, QRSdc, and log/logQRS/RR in addition to the increased abnormal aPwa and presence of fQRS. These findings suggest that untreated PD patients may be susceptible to supraventricular and ventricular arrhythmia, indicating that ECG should be routinely obtained in the management of PD patients.
Collapse
Affiliation(s)
- Mücahid Yılmaz
- Department of Cardiology, Elazig Fethi Sekin Sehir Hastanesi, Elazig, Turkey
| | - Seda Yılmaz
- Department of Psychiatry, Elazig Fethi Sekin Sehir Hastanesi, Elazig, Turkey
| |
Collapse
|
3
|
Piccirillo G, Moscucci F, Di Diego I, Mezzadri M, Caltabiano C, Carnovale M, Corrao A, Lospinuso I, Stefano S, Scinicariello C, Giuffrè M, De Santis V, Sciomer S, Rossi P, Fiori E, Magrì D. Effect of Head-Up/-Down Tilt on ECG Segments and Myocardial Temporal Dispersion in Healthy Subjects. BIOLOGY 2023; 12:960. [PMID: 37508390 PMCID: PMC10376208 DOI: 10.3390/biology12070960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023]
Abstract
The head-up/-down tilt test acutely modifies the autonomic nervous system balance throughout a deactivation of the cardiopulmonary reflexes. The present study examines the influence of head-up/-down tilt on a number of ECG segments. A total of 20 healthy subjects underwent a 5 min ECG and noninvasive hemodynamic bio-impedance recording, during free and controlled breathing, lying at (a) 0°; (b) -45°, tilting up at 45°, and tilting up at 90°. Heart rate variability power spectral analysis was obtained throughout some ECG intervals: P-P (P), P-Q (PQ), PeQ (from the end of P to Q wave), Q-R peak (QR intervals), Q-R-S (QRS), Q-T peak (QTp), Q-T end (QTe), STp, STe, T peak-T end (Te), and, eventually, the TeP segments (from the end of T to the next P waves). Results: In all study conditions, the Low Frequency/High FrequencyPP and LFPP normalized units (nu) were significantly lower than the LF/HFRR and LFRRnu, respectively. Conversely, the HFPP and HFPPnu were significantly higher in all study conditions. STe, QTp, and QTe were significantly related to the PP and RR intervals, whereas the T wave amplitude was inversely related to the standard deviations of all the myocardial repolarization variables and to the left ventricular end-systolic volume (LVEDV). The T wave amplitude diminished during head-up tilt and significantly correlated with the LVEDV.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Ilaria Di Diego
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Martina Mezzadri
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Cristina Caltabiano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Myriam Carnovale
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Andrea Corrao
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Ilaria Lospinuso
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Sara Stefano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Claudia Scinicariello
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Marco Giuffrè
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Valerio De Santis
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Viale del Policlinico, 00161 Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Hospital Isola Tiberina-Gemelli Isola, 00186 Rome, Italy
| | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00198 Rome, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00198 Rome, Italy
| |
Collapse
|
4
|
Piccirillo G, Moscucci F, Sciomer S, Magrì D. Chronic Heart Failure Management: Monitoring Patients and Intercepting Exacerbations. Rev Cardiovasc Med 2023; 24:208. [PMID: 39077011 PMCID: PMC11266474 DOI: 10.31083/j.rcm2407208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/03/2023] [Accepted: 03/22/2023] [Indexed: 07/31/2024] Open
Abstract
Despite significant progress in the field of therapy and management, chronic heart failure (CHF) still remains one of the most common causes of morbidity and mortality, especially among the elderly in Western countries. In particular, frequent episodes of decompensation and, consequently, repeated hospitalizations represent an unsustainable burden for national health systems and the cause of worsening quality of life. CHF is more prevalent in elderly women, who often have "peculiar" clinical characteristics and a more preserved ejection fraction caused by endothelial dysfunction and micro-vessel damage. At the moment, noninvasive technologies that are able to remotely monitor these patients are not widely available yet, and clinical trials are underway to evaluate invasive remote sensors. Unfortunately, implantable devices for identifying decompensation are not the most practical solution in the majority of of patients with chronic heart failure. In particular, they are hypothesized to have the possibility of monitoring patients by pro-B-type natriuretic peptide, ventricular repolarization variability, and bioimpedance cardiography at the first point of care, but new technology and clinical trials must be planned to address the development and spread of these emergent possibilities.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, “Sapienza'' University of Rome, 00161 Rome, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, “Sapienza'' University of Rome, 00161 Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, “Sapienza'' University of Rome, 00189 Rome, Italy
| |
Collapse
|
5
|
Piccirillo G, Moscucci F, Mezzadri M, Caltabiano C, Di Diego I, Carnovale M, Corrao A, Stefano S, Scinicariello C, Giuffrè M, De Santis V, Sciomer S, Rossi P, Magrì D. Electrocardiographic and other Noninvasive Hemodynamic Markers in Decompensated CHF Patients. J Cardiovasc Dev Dis 2023; 10:125. [PMID: 36975889 PMCID: PMC10058439 DOI: 10.3390/jcdd10030125] [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: 01/04/2023] [Revised: 02/14/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Acutely decompensated chronic heart failure (adCHF) is among the most important causes of in-hospital mortality. R-wave peak time (RpT) or delayed intrinsicoid deflection was proposed as a risk marker of sudden cardiac death and heart failure decompensation. Authors want to verify if QR interval or RpT, obtained from 12-lead standard ECG and during 5-min ECG recordings (II lead), could be useful to identify adCHF. At hospital admission, patients underwent 5-min ECG recordings, obtaining mean and standard deviation (SD) of the following ECG intervals: QR, QRS, QT, JT, and T peak-T end (Te). The RpT from a standard ECG was calculated. Patients were grouped by the age-stratified Januzzi NT-proBNP cut-off. A total of 140 patients with suspected adCHF were enrolled: 87 (mean age 83 ± 10, M/F 38/49) with and 53 (mean age: 83 ± 9, M/F: 23/30) without adCHF. V5-, V6- (p < 0.05) RpT, and QRSD, QRSSD, QTSD, JTSD, and TeSDp < 0.001 were significantly higher in the adCHF group. Multivariable logistic regression analysis demonstrated that the mean of QT (p < 0.05) and Te (p < 0.05) were the most reliable markers of in-hospital mortality. V6 RpT was directly related to NT-proBNP (r: 0.26, p < 0.001) and inversely related to a left ventricular ejection fraction (r: 0.38, p < 0.001). The intrinsicoid deflection time (obtained from V5-6 and QRSD) could be used as a possible marker of adCHF.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Federica Moscucci
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Martina Mezzadri
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Cristina Caltabiano
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Ilaria Di Diego
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Myriam Carnovale
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Andrea Corrao
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Sara Stefano
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Claudia Scinicariello
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Marco Giuffrè
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Valerio De Santis
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine and Anesthsiological and Cardiovascular Sciences, Policlinico Umberto I, "La Sapienza" University of Rome, 00185 Rome, Italy
| | - Pietro Rossi
- Cardiology Division, Arrhytmology Unit, S. Giovanni Calibita Hospital, 00186 Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, 00185 Rome, Italy
| |
Collapse
|
6
|
Piccirillo G, Moscucci F, Carnovale M, Bertani G, Lospinuso I, Di Diego I, Corrao A, Sabatino T, Zaccagnini G, Crapanzano D, Rossi P, Magrì D. QT and Tpeak-Tend interval variability: Predictive electrical markers of hospital stay length and mortality in acute decompensated heart failure. Preliminary data. Clin Cardiol 2022; 45:1192-1198. [PMID: 36082998 DOI: 10.1002/clc.23888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As previously reported, an increased repolarization temporal imbalance induces a higher risk of total/cardiovascular mortality. HYPOTHESIS The aim of this study was to assess if the electrocardiographic short period markers of repolarization temporal dispersion could be predictive of the hospital stay length and mortality in patients with acutely decompensated chronic heart failure (CHF). METHOD Mean, standard deviation (SD), and normalized variance (VN) of QT (QT) and Tpeak-Tend (Te) were obtained on 5-min ECG recording in 139 patients hospitalized for acutely decompensated CHF, subgrouping the patients for hospital length of stay (LoS): less or equal 1 week (≤1 W) and those with more than 1 week (>1 W). RESULTS We observed an increase of short-period repolarization variables (TeSD and TeVN, p < .05), a decrease of blood pressure (p < .05), lower ejection fraction (p < .05), and higher plasma level of biomarkers (NT-proBNP, p < .001; Troponin, p < .05) in >1 W LoS subjects. 30-day deceased subjects reported significantly higher levels of QTSD (p < .05), Te mean (p < .001), TeSD (p < .05), QTVN (p < .05) in comparison to the survivors. Multivariable Cox regression analysis reported that TeVN was a risk factor for longer hospital stay (hazard ratio: 1.04, 95% confidence limit: 1.01-1.08, p < .05); whereas, a longer Te mean was associated with higher mortality risk (hazard ratio: 1.02, 95% confidence limit: 1.01-1.03, p < .05). CONCLUSION A longer hospital stay is considered a clinical surrogate of CHF severity, we confirmed this finding. Therefore, these electrical and simple parameters could be used as noninvasive, transmissible, inexpensive markers of CHF severity and mortality.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Myriam Carnovale
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Gaetano Bertani
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Ilaria Lospinuso
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Ilaria Di Diego
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Corrao
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Teresa Sabatino
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Zaccagnini
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Davide Crapanzano
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita, Isola Tiberina, Rome, Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
7
|
Yu J, Zhang RF, Mao YL. Cerebellar fastigial nucleus electrostimulation attenuates inflammation in a Post-Infarction rat model by activating cholinergic anti-inflammatory pathways. Neurosci Lett 2022; 788:136860. [PMID: 36041546 DOI: 10.1016/j.neulet.2022.136860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
There are negative correlations between indices of heart rate variability (HRV) and markers of inflammation. The inflammation plays an important role in myocardial damages after myocardial infarction (MI). Our previous study found that fastigial nucleus electrostimulation (FNS) improved abnormal HRV in a rat model of MI. Whether and how it can reduce inflammation and improve cardiac function after MI and the underlying mechanisms remain unknown. 66 Sprague Dawley rats were randomly divided into 4 groups as follows: i) Sham operation group (Sham); ii) Myocardial infarction group (MI); iii) FNS+MI group (FNS plus MI): left fastigial nucleus electrostimulation; iv) FNL+FNS+MI group (left fastigial nucleus lesion plus FNS plus MI). The serum expressions of acetylcholine (ACh), pro-inflammatory cytokines tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), and anti-inflammatory cytokines IL-10 after FNS were measured using ELISA. Subsequently, the infarct size, the infiltration of inflammatory cells, the fibrotic area, and cardiac function were also evaluated. Additionally, the effects of FNS on the cholinergic anti-inflammatory pathway (CAP)-related proteins expression were determined by Western blot. We found that FNS significantly upregulated ACh and IL-10 expressions in serum, and decreased TNF-α and IL-6 levels. FNS significantly attenuated inflammatory cell infiltration and infarct size, decreased fibrosis, increased left ventricular ejection fraction (LVEF), and reduced mortality. Besides, the levels of p-STAT3/STAT3 and p-NF-κB/NF-κB significantly elevated after MI. FNS down-regulated the expression of p-STAT3/STAT3 and p-NF-κB/NF-κB. The protective effects of FNS were partially reversed by the fastigial nucleus lesion. Our data suggested that FNS can alleviate the inflammation after MI, and its cardiac neuroprotective mechanism may be achieved by increasing vagus tone, releasing ACh, and further activating the CAP via α7nAChR. The precise mechanism remains to be elucidated.
Collapse
Affiliation(s)
- Jiang Yu
- Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China; Department of Cardiology, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang 621000, Sichuan, China
| | - Run-Feng Zhang
- Department of Cardiology, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang 621000, Sichuan, China.
| | - Yi-Li Mao
- Department of Cardiology, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang 621000, Sichuan, China
| |
Collapse
|
8
|
Glucose dysregulation and repolarization variability markers are short-term mortality predictors in decompensated heart failure. Cardiovasc Endocrinol Metab 2022; 11:e0264. [PMID: 35664451 PMCID: PMC9155175 DOI: 10.1097/xce.0000000000000264] [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: 02/03/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
Abstract
As recently reported, elevated fasting glucose plasma level constitutes a risk factor for 30-day total mortality in acutely decompensated chronic heart failure (CHF). Aim of this study was to evaluate the 30-day mortality risk in decompensated CHF patients by fasting glucose plasma level and some repolarization ECG markers.
Collapse
|
9
|
Kenig A, Kolben Y, Asleh R, Amir O, Ilan Y. Improving Diuretic Response in Heart Failure by Implementing a Patient-Tailored Variability and Chronotherapy-Guided Algorithm. Front Cardiovasc Med 2021; 8:695547. [PMID: 34458334 PMCID: PMC8385752 DOI: 10.3389/fcvm.2021.695547] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/21/2021] [Indexed: 01/12/2023] Open
Abstract
Heart failure is a major public health problem, which is associated with significant mortality, morbidity, and healthcare expenditures. A substantial amount of the morbidity is attributed to volume overload, for which loop diuretics are a mandatory treatment. However, the variability in response to diuretics and development of diuretic resistance adversely affect the clinical outcomes. Morevoer, there exists a marked intra- and inter-patient variability in response to diuretics that affects the clinical course and related adverse outcomes. In the present article, we review the mechanisms underlying the development of diuretic resistance. The role of the autonomic nervous system and chronobiology in the pathogenesis of congestive heart failure and response to therapy are also discussed. Establishing a novel model for overcoming diuretic resistance is presented based on a patient-tailored variability and chronotherapy-guided machine learning algorithm that comprises clinical, laboratory, and sensor-derived inputs, including inputs from pulmonary artery measurements. Inter- and intra-patient signatures of variabilities, alterations of biological clock, and autonomic nervous system responses are embedded into the algorithm; thus, it may enable a tailored dose regimen in a continuous manner that accommodates the highly dynamic complex system.
Collapse
Affiliation(s)
- Ariel Kenig
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yotam Kolben
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Rabea Asleh
- Department of Cardiology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Offer Amir
- Department of Cardiology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Yaron Ilan
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| |
Collapse
|
10
|
Vila BCP, Camacho AA, Sousa MG. T-wave peak-end interval and ratio of T-wave peak-end and QT intervals: novel arrhythmogenic and survival markers for dogs with myxomatous mitral valve disease. J Vet Cardiol 2021; 35:25-41. [PMID: 33812131 DOI: 10.1016/j.jvc.2021.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION/OBJECTIVES In the past few years, novel markers such as the interval between the peak and the end of T-wave (Tpte) and Tpte/QT ratio have been shown to have high sensitivity for ventricular arrhythmias and mortality. We analyzed these and other parameters of ventricular repolarization, such as QT interval, QT interval corrected for heart rate (QTc), and QT dispersion (QTd) in dogs with myxomatous mitral valve disease (MMVD). Additionally, we investigated their relationship with the progression of the disease, echocardiographic parameters, and ventricular arrhythmias and assessed their prognostic value with development of clinical signs or mortality as the final outcome. ANIMALS, MATERIALS AND METHODS Epidemiological, clinical, echocardiographic, and electrocardiographic data were obtained from 236 dogs with MMVD and 15 healthy dogs. Prognostic and survival information was also recorded for the MMVD group. All ventricular repolarization indices were measured in 10 lead electrocardiographic recordings. RESULTS With the exception of the QT interval, most repolarization markers increased along with the frequency of arrhythmias and with the progression of MMVD. The parameters that best identified ventricular arrhythmias (AUC > 0.7) were Tpte (aVR, rV2, average rV2-V10, average rV2-V4) and Tpte/QT (II, aVR, rV2). In survival analysis, statistically significant markers with the highest differences in median survival were Tpte (maximum of any lead, maximum rV2-V10), QTc aVR, and Tpte rV2. CONCLUSION Tpte and Tpte/QT are good non-invasive markers for clinical risk stratification in dogs with MMVD.
Collapse
Affiliation(s)
- B C P Vila
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, 80035-050, Brazil.
| | - A A Camacho
- Department of Veterinary Clinic and Surgery, São Paulo State University, Jaboticabal, SP, 14884-900, Brazil
| | - M G Sousa
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná, Curitiba, PR, 80035-050, Brazil
| |
Collapse
|
11
|
Piccirillo G, Moscucci F, Bertani G, Lospinuso I, Sabatino T, Zaccagnini G, Crapanzano D, Diego ID, Corrao A, Rossi P, Magrì D. Short-period temporal repolarization dispersion in subjects with atrial fibrillation and decompensated heart failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:327-333. [PMID: 33382121 DOI: 10.1111/pace.14158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/13/2020] [Accepted: 12/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES The association between chronic heart failure (CHF) and permanent atrial fibrillation is very frequent. The repolarization duration was already found predictive for atrial fibrillation. Aim of this study was to evaluate the influence of atrial fibrillation on short period repolarization variables in decompensated CHF patients. METHOD We used 5 min ECG recordings to assess the mean, standard deviation (SD), and normalized variance (NV) of the following variables: QT end (QTe), QT peak (QTp), and T peak to T end (Te) in 121 decompensated CHF, of whom 40 had permanent atrial fibrillation, too. We reported also the 30-day mortality. RESULTS QTpSD (p < .01), TeSD (p < .01), QTpVN (p < .01), and TeVN (p < .01) were higher in the atrial fibrillation than among sinus rhythm CHF subjects. Multivariable logistic analysis selected only TeSD (odd ratio, o.r.: 1.32, 95% confidence interval, c.i.: 1.06-1.65, p: .015) associated with atrial fibrillation. A total of 27 patients died during the 30-days follow-up (overall mortality rate 22%), 7 (18%), and 20 (25%) respectively in the atrial fibrillation and sinus rhythm patients. Furthermore, the following variables were associated to the morality risk: NT-pro Brain Natriuretic Peptide (o.r.: 1.00, 95% c.i.: 1.00-1.00, p: .041), left ventricular end diastolic diameter (o.r.: 0.81, 95% c.i.: 0.67-0.96, p: .010), and Te mean (o.r.: 1.04, 95% c.i.: 1.02-1.09, p: .012). CONCLUSION In decompensated CHF subjects, Te mean seems be associated to mortality and TeSD to the permanent atrial fibrillation. We could hypothesize that, during severe CHF, the multi-level ionic CHF channel derangement could be critical in influencing these non-invasive markers. (ClinicalTrials.gov number, NCT04127162).
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Federica Moscucci
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Gaetano Bertani
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Ilaria Lospinuso
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Teresa Sabatino
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Giulia Zaccagnini
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Davide Crapanzano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Ilaria Di Diego
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Andrea Corrao
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "Sapienza", University of Rome, Rome, Italy
| | - Pietro Rossi
- Cardiology Division, Arrhytmology Unit, S. Giovanni Calibita, Isola Tiberina, Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
12
|
Piccirillo G, Moscucci F, Iorio CD, Fabietti M, Mastropietri F, Crapanzano D, Bertani G, Sabatino T, Zaccagnini G, Lospinuso I, Magrì D. Time- and frequency-domain analysis of repolarization phase during recovery from exercise in healthy subjects. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1096-1103. [PMID: 32789871 DOI: 10.1111/pace.14038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 08/09/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIM Recently, data from temporal dispersion of myocardial repolarization analysis have gained a capital role in the sudden cardiac death risk stratification. Aim of this study was to evaluate the influence of heart rate, autonomic nervous system, and controlled breathing on different myocardial repolarization markers in healthy subjects. METHOD Myocardial repolarization dispersion markers from short-period (5 minutes) electrocardiogram (ECG) analysis (time and frequency domain) have been obtained in 21 healthy volunteers during the following conditions: free breathing (rest); controlled breathing (resp); the first 5 minutes of postexercise recovery phases (exercisePeak ), maximum sympathetic activation; and during the second 5 minutes of postexercise recovery phases (exerciseRecovery ), intermediate sympathetic activation. Finally, we analyzed the whole repolarization (QTe), the QT peak (QTp), and T peak - T end intervals (Te). RESULTS During the exercisePeak , major part of repolarization variables changed in comparison to the rest and resp conditions. Particularly, QTe, QTp, and Te standard deviations (QTeSD , QTpSD , and TeSD ); variability indexes (QTeVI and QTpVI), normalized variances (QTeVN, QTpVN, and TeVN); and the ratio between short-term QTe, QTp, and Te variability RR (STVQTe/RR , STVQTp/RR, and STVTe/RR ) increased. During exerciseRecovery , QTpSD (P < .05), QTpVI (P < .05), QTeVN (P < .05), QTpVN (P < .001), TeVN (P < .05), STVQTe/RR (P < .05), STVQTp/RR (P < .001), and STVTe/RR (P < .001) were significantly higher in comparison to the rest. The slope between QTe (0.24 ± 0.06) or QTp (0.17 ± 0.06) and RR were significantly higher than Te (0.07 ± 0.06, P < .001). CONCLUSION Heart rate and sympathetic activity, obtained during exercise, seem able to influence the time domain markers of myocardial repolarization dispersion in healthy subjects, whereas they do not alter any spectral components.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federica Moscucci
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudia Di Iorio
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marcella Fabietti
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fabiola Mastropietri
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Davide Crapanzano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gaetano Bertani
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Teresa Sabatino
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giulia Zaccagnini
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ilaria Lospinuso
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
13
|
Piccirillo G, Moscucci F, Mariani MV, Di Iorio C, Fabietti M, Mastropietri F, Crapanzano D, Bertani G, Sabatino T, Zaccagnini G, Lospinuso I, Rossi P, Magrì D. Hospital mortality in decompensated heart failure. A pilot study. J Electrocardiol 2020; 61:147-152. [PMID: 32629315 DOI: 10.1016/j.jelectrocard.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/29/2020] [Accepted: 05/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIM Heart failure is a leading cause of morbidity and mortality worldwide and it is a major cause of emergency department access for cardiovascular disease patients. Aim of this study was to identify the electrocardiographic (ECG) markers, based on short-term temporal repolarization dispersion, capable to individuate decompensated chronic heart failure (CHF) patients at high mortality risk. METHODS We obtained the following variables from an ECG recording, monitored via mobile phone, during 5-minute recordings in decompensated CHF patients: RR, QT end (QTe), QT peak (QTp) and T peak to T end (Te) and we calculated mean, standard deviation (SD) and normalized index (N). RESULTS In-hospital mortality occurred for 25 subjects on 101 studied (25%). Deceased patients showed higher QTeSD (p < 0.01), Te mean (p < 0.01), TeSD (p < 0.05), QTeVN (p < 0.05) than the surviving group. Logistic multivariable analysis evidenced that Te mean was a significant predictor of in-hospital mortality (odd ratio: 0.09, 95% confidence limit: 0.02-0.35, p: 0.001). At multiple regression analysis, TeSD was significantly and positively related only to the NT-pro BNP levels (r: 0.540; p < 0.001). The Te mean (AUC: 0.677 p < 0.01) and TeSD (AUC: 0.647, p: 0.05) showed significant sensitivity/specificity for the event. CONCLUSIONS The Te mean and TeSD seem to be a promising noninvasive clinical marker able to identify patients with decompensated CHF at high risk of in-hospital mortality.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Federica Moscucci
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy.
| | - Marco Valerio Mariani
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Claudia Di Iorio
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Marcella Fabietti
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Fabiola Mastropietri
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Davide Crapanzano
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Gaetano Bertani
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Teresa Sabatino
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Giulia Zaccagnini
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Ilaria Lospinuso
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico N. 155, 00185 Roma, Italy
| | - Pietro Rossi
- Division of Cardiology, S. Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Piazza Ponte dei Quattro Capi, 39 186 Roma, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, k00189 Rome, Italy
| |
Collapse
|
14
|
Piccirillo G, Moscucci F, Bertani G, Lospinuso I, Mastropietri F, Fabietti M, Sabatino T, Zaccagnini G, Crapanzano D, Di Diego I, Corrao A, Rossi P, Magrì D. Short-Period Temporal Dispersion Repolarization Markers Predict 30-Days Mortality in Decompensated Heart Failure. J Clin Med 2020; 9:E1879. [PMID: 32560151 PMCID: PMC7356287 DOI: 10.3390/jcm9061879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Electrocardiographic (ECG) markers of the temporal dispersion of the myocardial repolarization phase have been shown able to identify chronic heart failure (CHF) patients at high mortality risk. The present prospective single-center study sought to investigate in a well-characterized cohort of decompensated heart failure (HF) patients the ability of short-term myocardial temporal dispersion ECG variables in predicting the 30-day mortality, as well as their relationship with N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) plasmatic values. METHOD One hundred and thirteen subjects (male: 59, 67.8%) with decompensated CHF underwent 5 min of ECG recording, via a mobile phone. We obtained QT end (QTe), QT peak (QTp) and T peak to T end (Te) and calculated the mean, standard deviation (SD), and normalized index (VN). RESULTS Death occurred for 27 subjects (24%) within 30 days after admission. Most of the repolarization indexes (QTe mean (p < 0.05), QTeSD (p < 0.01), QTpSD (p < 0.05), mean Te (p < 0.05), TeSD (p < 0.001) QTeVN (p < 0.05) and TeVN (p < 0.01)) were significantly higher in those CHF patients with the highest NT-proBNP (>75th percentile). In all the ECG data, only TeSD was significantly and positively related to the NT-proBNP levels (r: 0.471; p < 0.001). In the receiver operating characteristic (ROC) analysis, the highest accuracy for 30-day mortality was found for QTeSD (area under curve, AUC: 0.705, p < 0.01) and mean Te (AUC: 0.680, p < 0.01), whereas for the NT-proBNP values higher than the 75th percentile, the highest accuracy was found for TeSD (AUC: 0.736, p < 0.001) and QTeSD (AUC: 0.696, p < 0.01). CONCLUSION Both mean Te and TeSD could be considered as reliable markers of worsening HF and of 30-day mortality. Although larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162).
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Federica Moscucci
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Gaetano Bertani
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Ilaria Lospinuso
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Fabiola Mastropietri
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Marcella Fabietti
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Teresa Sabatino
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Giulia Zaccagnini
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Davide Crapanzano
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Ilaria Di Diego
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Andrea Corrao
- Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy; (G.P.); (G.B.); (I.L.); (F.M.); (M.F.); (T.S.); (G.Z.); (D.C.); (I.D.D.); (A.C.)
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita, Isola Tiberina, 00186 Rome, Italy;
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy;
| |
Collapse
|
15
|
Aydin MD, Acikel M, Aydin N, Aydin ME, Ahiskalioglu A, Atalay C, Ahiskalioglu EO, Erdogan F, Sipal S. Predestinating Role of Cardiac Ganglia on Heart Life Expectancy in Rabbits After Brain Death Following Subarachnoid Hemorrhage: An Experimental Study. Transplant Proc 2019; 52:61-66. [PMID: 31837820 DOI: 10.1016/j.transproceed.2019.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/11/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cardiac ganglia are rechargeable batteries of the heart. The essential role of cardiac ganglia on cardiac life expectancy has not been examined following brain death. The aim of this study was to determine cardiac ganglia numbers and neuron density following subarachnoid hemorrhage (SAH). METHODS Twenty-five hybrid rabbits were grouped as control (n = 5), sham (n = 5), and SAH (n = 15). The SAH groups' animals were subjected to injections of lethal dose of 2.00 cc autologous blood into their cisterna magna until linear EEG was obtained. The hearts of all animals were extracted following intracardiac formalin injection and examined. Cardiac ganglia and normal/degenerated neuron densities of cardiac neurons were recorded. RESULTS The mean volume of normal neuron density of ganglia was 6.980 ± 830/mm3, and the degenerated neuron density of ganglia was 3 ± 1/mm3 in the control group, 6134 ± 712/mm3; 23 ± 9/mm3 in the sham group, 3456 ± 589; 1161 ± 72/mm3 in the surviving group; and 1734 ± 341/mm3, 4259 ± 865/mm3 in the dead animals in the SAH group. The algebraic results of heart work capacity (Wh) were estimated as 1375 ± 210 Wh in the control group, 1036 ± 225 in the sham group, 800 ± 110 Wh in the surviving group, and < 100 ± 20 in the dead animals in the SAH group. Degenerated cardiac neuron density/Wh correlation is statistically meaningful between the dead in the SAH group versus the SAH-surviving, sham, and control groups (P < .0005). CONCLUSIONS Normal cardiac ganglia numbers and/or cardiac ganglia neuron density may be related to cardiac survival following brain death after subarachnoid hemorrhage.
Collapse
Affiliation(s)
- Mehmet Dumlu Aydin
- Ataturk University, Medical Faculty, Department of Neurosurgery, Erzurum, Turkey.
| | - Mahmut Acikel
- Ankara Higher Education and Research Hospital, Department of Cardiology, Ankara, Turkey
| | - Nazan Aydin
- Uskudar University, Medical Faculty, Department of Psychiatri, Erzurum, Turkey
| | - Muhammed Enes Aydin
- Ataturk University, Medical Faculty, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Ataturk University, Medical Faculty, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - Canan Atalay
- Ataturk University, Medical Faculty, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - Elif Oral Ahiskalioglu
- Ataturk University, Medical Faculty, Department of Anesthesiology and Reanimation, Erzurum, Turkey
| | - Fazlı Erdogan
- Ataturk Training and Research Hospital, Department of Pathology Ankara, Turkey
| | - Sare Sipal
- Ataturk University, Medical Faculty, Department of Pathology, Erzurum, Turkey
| |
Collapse
|
16
|
Liu Y, Fu X, Gao H, Ren Y, Li H, He Y, Wang G. Effects of different concentrations of desflurane on the index of cardiac electrophysiological balance in gynecologic surgery patients. Can J Physiol Pharmacol 2019; 98:332-335. [PMID: 31770012 DOI: 10.1139/cjpp-2019-0290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objectives were to observe the effects of different concentrations of desflurane on QT, QTc, Tp-e, Tp-e/QT, and the index of cardiac electrophysiological balance (iCEB). Sixty patients were randomly divided into group D1, group D2, and group D3 by using a random number table, 20 in each group. After entering the operating room, patients received 10 mL/kg hydroxyethyl starch, 0.1 mg/kg midazolam, 0.1 mg/kg vecuronium, 3 μg/kg fentanyl, and 0.3 mg/kg etomidate intravenously and then accepted intubation and mechanical ventilation. The desflurane evaporator was opened. The concentrations of desflurane in the D1, D2, and D3 groups were maintained at 0.6, 1.3, and 2.0 minimum alveolar concentration (MAC), respectively. Twelve-lead ECGs were recorded at time before induction (T1) and at 20 min after desflurane reached the required concentration (T2). HR and MAP were recorded measure and the QT interval, QTc interval, Tp-e interval, Tp-e/QT ratio, and iCEB were calculated. Compared with before inhalation (T1), the QTc interval was prolonged in the D1, D2, and D3 groups after inhalation of different concentrations of desflurane for 20 min (T2) (P < 0.05) and the Tp-e/QT ratio decreased in the D1 and D2 groups at T2 (P < 0.05). Compared with the D1 and D2 groups, the Tp-e/QT ratio of the D3 group increased at T2 (P < 0.05). There was no significant difference in Tp-e interval and iCEB at any time (P > 0.05). The study suggested that inhalation of desflurane at a normal concentration cannot cause arrhythmogenic characteristics and affect the cardiac electrophysiological stability.
Collapse
Affiliation(s)
- Yanqiu Liu
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, P.R. China
| | - Xiaokui Fu
- Department of Anesthesiology, Guizhou Medical University, Guiyang, Guizhou, P.R. China
| | - Hong Gao
- The Third Affiliated Hospital of Guizhou Medical University, Duyun, Guizhou, P.R. China
| | - Yimin Ren
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, P.R. China
| | - Huayu Li
- Department of Anesthesiology, Guizhou Medical University, Guiyang, Guizhou, P.R. China
| | - Youqin He
- Department of Anesthesiology, Guizhou Medical University, Guiyang, Guizhou, P.R. China
| | - Guilong Wang
- Department of Anesthesiology, Guizhou Medical University, Guiyang, Guizhou, P.R. China
| |
Collapse
|
17
|
Lu J, Liu K, Qi M, Geng H, Hao J, Wang R, Zhao X, Liu Y, Liu J. Effects of Cr(VI) exposure on electrocardiogram, myocardial enzyme parameters, inflammatory factors, oxidative kinase, and ATPase of the heart in Chinese rural dogs. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:30444-30451. [PMID: 31440970 DOI: 10.1007/s11356-019-06253-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
Heavily chromium-polluted areas, where people are prohibited from entering, are paradises for stray dogs. In this study, stray dogs were used to study the effects of chromium exposure on the heart of dogs in severely Cr(VI)-contaminated rural areas of China. The dogs were given water (control), low dose (L, 0.92 mg/kg), medium dose (M, 1.15 mg/kg), and high dose (H, 1.38 mg/kg) of Cr(VI). The changes of electrocardiogram (ECG), myocardial enzyme parameters, inflammatory factors, oxidative kinase, and ATPase were measured to determine the toxicity of chromium on the heart of dogs. Results showed that the ST segment of ECG increased significantly, and the amplitude of T wave increased in the experimental group. The myocardial enzyme (CK-MB, AST, CK, and LDH) content in groups M and H increased significantly over time. The values of CAT, T-SOD, IL-10, and ATPase (K+-Na+-ATPase and Ca2+-Mg2+-ATPase) decreased with the increase of Cr(VI) dose, and the content of MDA, IL-1β, IL-8, and TNF-α increased with the increase of Cr(VI) dose. Our study suggested that the heart of Chinese rural dog was damaged by Cr(VI), and Cr(VI) could cause oxidative damage and alteration of ATPase content in dogs.
Collapse
Affiliation(s)
- Jianwei Lu
- College of Veterinary Medicine, Shandong Agricultural University, Tai'an, 271018, China
| | - Kangping Liu
- Research Center for Animal Disease Control Engineering, Shandong Agricultural University, Tai'an, 271018, China
| | - Mengzhu Qi
- College of Veterinary Medicine, Shandong Agricultural University, Tai'an, 271018, China
| | - Hao Geng
- Research Center for Animal Disease Control Engineering, Shandong Agricultural University, Tai'an, 271018, China
| | - JiaJia Hao
- College of Veterinary Medicine, Shandong Agricultural University, Tai'an, 271018, China
| | - Run Wang
- College of Veterinary Medicine, Shandong Agricultural University, Tai'an, 271018, China
| | - Xiaona Zhao
- College of Veterinary Medicine, Shandong Agricultural University, Tai'an, 271018, China
| | - Yongxia Liu
- Research Center for Animal Disease Control Engineering, Shandong Agricultural University, Tai'an, 271018, China
| | - Jianzhu Liu
- College of Veterinary Medicine, Shandong Agricultural University, Tai'an, 271018, China.
| |
Collapse
|
18
|
Piccirillo G, Moscucci F, Pofi R, D'Alessandro G, Minnetti M, Isidori AM, Francomano D, Lenzi A, Puddu PE, Alexandre J, Magrì D, Aversa A. Changes in left ventricular repolarization after short-term testosterone replacement therapy in hypogonadal males. J Endocrinol Invest 2019; 42:1051-1065. [PMID: 30838540 PMCID: PMC6692303 DOI: 10.1007/s40618-019-01026-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/14/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Evidences suggest that androgen deficiency is associated with sudden cardiac death (SCD). Our purpose was to analyse some electrocardiographic (ECG) markers of repolarization phase in hypogonadal patients either at baseline or after testosterone replacement therapy (TRT). PATIENTS AND METHODS Baseline and after 6 months of testosterone replacement therapy, 14 hypogonadal patients and 10 age-matched controls underwent a short-term ECG recordings at rest and immediately after a maximal exercise test. The following ECG parameters have been collected: QTe (the interval between the q wave the end of T wave), QTp (the interval between the q wave and the peak of T wave), and Te (the interval between the peak and the end of T wave). RESULTS At baseline, in the hypogonadal patients, corrected QTe and QTp values were longer at rest than in the controls at rest (p < 0.05), whereas, during the recovery phase, only the QTp remained significantly longer (p < 0.05). After TRT, hypogonadal patients showed an improvement only in Te (p < 0.05). Conversely, any difference between hypogonadal patients and control subjects was found with respect to the markers of temporal dispersion of repolarization phases, except for a worse QTp → Te coherence (p = 0.001) obtained during the recovery phase. CONCLUSIONS In conclusion, at rest, hypogonadal patients suffer from a stable increase in the myocardial repolarization phase without an increase in its temporal dispersion and, hence, the SCD risk seems to be low.
Collapse
Affiliation(s)
- G Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico, 00185, Rome, Italy
| | - F Moscucci
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico, 00185, Rome, Italy.
| | - R Pofi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G D'Alessandro
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico, 00185, Rome, Italy
| | - M Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Francomano
- Division of Internal Medicine and Endocrinology, Madonna delle Grazie Hospital, Velletri, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - P E Puddu
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, "La Sapienza" University of Rome, Viale del Policlinico, 00185, Rome, Italy
- EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, Université de Caen, Normandie, France
| | - J Alexandre
- EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, Université de Caen, Normandie, France
- Department of Pharmacology, CHU Caen, Caen, France
| | - D Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, University of Catanzaro « Magna Grecia », Catanzaro, Italy
| |
Collapse
|
19
|
Piccirillo G, Moscucci F, Fabietti M, Parrotta I, Mastropietri F, Di Iorio C, Sabatino T, Crapanzano D, Vespignani G, Mariani MV, Salvi N, Magrì D. Arrhythmic Risk in Elderly Patients Candidates to Transcatheter Aortic Valve Replacement: Predictive Role of Repolarization Temporal Dispersion. Front Physiol 2019; 10:991. [PMID: 31447689 PMCID: PMC6691061 DOI: 10.3389/fphys.2019.00991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/18/2019] [Indexed: 12/30/2022] Open
Abstract
Background/Aim Degenerative aortic valve stenosis (AS) is associated to ventricular arrhythmias and sudden cardiac death, as well as mental stress in specific patients. In such a context, substrate, autonomic imbalance as well as repolarization dispersion abnormalities play an undoubted role. Aim of the study was to evaluate the increase of premature ventricular contractions (PVC) and complex ventricular arrhythmias during mental stress in elderly patients candidate to the transcatheter aortic valve replacement (TAVR). Methods In eighty-one elderly patients with AS we calculated several short-period RR- and QT-derived variables at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE). Results All the myocardial repolarization dispersion markers worsened during mental stress (p < 0.05). Furthermore, during MMSE, low frequency component of the RR variability increased significantly both as absolute power (LFRR) and normalized units (LFRRN U) (p < 0.05) as well as the low-high frequency ratio (LFRR/HFRR) (p < 0.05). Eventually, twenty-four (30%) and twelve (15%) patients increased significantly PVC and, respectively, complex ventricular arrhythmias during the MMSE administration. At multivariate logistic regression analysis, the standard deviation of QTend (QTesd), obtained at rest, was predictive of increased PVC (odd ratio: 1.54, 95% CI 1.14-2.08; p = 0.005) and complex ventricular arrhythmias (odd ratio: 2.31, 95% CI 1.40-3.83; p = 0.001) during MMSE. The QTesd showed the widest sensitive-specificity area under the curve for the increase of PVC (AUC: 0.699, 95% CI: 0.576-0.822, p < 0.05) and complex ventricular arrhythmias (AUC: 0.801, 95% CI: 0.648-0.954, p < 0.05). Conclusion In elderly with AS ventricular arrhythmias worsened during a simple cognitive assessment, this events being a possible further burden on the outcome of TAVR. QTesd might be useful to identify those patients with the highest risk of ventricular arrhythmias. Whether the TAVR could led to a QTesd reduction and, hence, to a reduction of the arrhythmic burden in this setting of patients is worthy to be investigated.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Federica Moscucci
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Marcella Fabietti
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Ilaria Parrotta
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Fabiola Mastropietri
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Claudia Di Iorio
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Teresa Sabatino
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Davide Crapanzano
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Giulia Vespignani
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Marco Valerio Mariani
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Nicolò Salvi
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Geriatriche, Anestesiologiche e Nefrologiche, Policlinico Umberto I, "La Sapienza" University of Rome, Rome, Italy
| | - Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
20
|
Zhai Z, Zhao S, Tang M, Jia L, Zhang S. Chronic median nerve modulation reduces ventricular arrhythmia and improves ventricular function in a postmyocardial infarction rabbit model. Cardiovasc Ther 2018; 36:e12437. [PMID: 29797657 DOI: 10.1111/1755-5922.12437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/30/2018] [Accepted: 05/20/2018] [Indexed: 01/30/2023] Open
Abstract
AIM Median nerve stimulation (MNS) is a novel neuromodulation approach for treatment of ventricular arrhythmia, but little is known about its chronic effects. The aim of this study was to investigate the effects of chronic MNS on ventricular arrhythmia and ventricular dysfunction postmyocardial infarction (MI). METHOD Two weeks after MI, 12 rabbits were randomly divided into control and MNS groups, and chronic MNS was performed in MNS group for 2 weeks. Ventricular function and arrhythmias; sympathetic innervation and activity; and interleukin-1 β (IL-1 β) and norepinephrine (NE) levels were analyzed. RESULTS Both the total number of premature ventricular complex and episodes of ventricular tachycardia were lower in MNS group than in control group (20 560 ± 10 314 beats vs 70 079 ± 37 184 beats, P = .021, and 115 ± 63 episodes vs 307 ± 164 episodes, P = .034, respectively). Compared with control group, MNS decreased the cardiac sympathetic nerve density and level of circulating NE in MNS group (1798.42 ± 644.07 μm2 /mm2 vs 1003.79 ± 453.00 μm2 /mm2, P = .041, and 20.86 ± 4.54 pg/mL vs 11.07 ± 1.43 pg/mL, P = .002, respectively). MNS also improved the left ventricular ejection fraction (59.07 ± 1.91% vs 49.77 ± 3.47%, P = .003) and inhibited the level of IL-1 β in serum (69.19 ± 4.71 pg/mL vs 85.93 ± 12.80 pg/mL, P = .013). CONCLUSION Chronic MNS appears to protect against ventricular arrhythmia and improves ventricular function post-MI, which may be mediated by suppressing cardiac sympathetic activity and anti-inflammatory effects.
Collapse
Affiliation(s)
- Zhengqin Zhai
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Zhao
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Tang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liujun Jia
- Center for Cardiovascular Experimental Study and Evaluation, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
21
|
Hasan MA, Abbott D, Baumert M, Krishnan S. Increased beat-to-beat T-wave variability in myocardial infarction patients. ACTA ACUST UNITED AC 2018; 63:123-130. [PMID: 28002025 DOI: 10.1515/bmt-2015-0186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/15/2016] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to investigate the beat-to-beat variability of T-waves (TWV) and to assess the diagnostic capabilities of T-wave-based features for myocardial infarction (MI). A total of 148 recordings of standard 12-lead electrocardiograms (ECGs) from 79 MI patients (22 females, mean age 63±12 years; 57 males, mean age 57±10 years) and 69 recordings from healthy subjects (HS) (17 females, 42±18 years; 52 males, 40±13 years) were studied. For the quantification of beat-to-beat QT intervals in ECG signal, a template-matching algorithm was applied. To study the T-waves beat-to-beat, we measured the angle between T-wave max and T-wave end with respect to Q-wave (∠α) and T-wave amplitudes. We computed the standard deviation (SD) of beat-to-beat T-wave features and QT intervals as markers of variability in T-waves and QT intervals, respectively, for both patients and HS. Moreover, we investigated the differences in the studied features based on gender and age for both groups. Significantly increased TWV and QT interval variability (QTV) were found in MI patients compared to HS (p<0.05). No significant differences were observed based on gender or age. TWV may have some diagnostic attributes that may facilitate identifying patients with MI. In addition, the proposed beat-to-beat angle variability was found to be independent of heart rate variations. Moreover, the proposed feature seems to have higher sensitivity than previously reported feature (QT interval and T-wave amplitude) variability for identifying patients with MI.
Collapse
Affiliation(s)
- Muhammad A Hasan
- Department of Electrical and Computer Engineering, Ryerson University, Toronto, Canada
- Department of Electrical and Electronics Engineering, The University of Adelaide, Adelaide, Australia
| | - Derek Abbott
- Department of Electrical and Electronics Engineering, The University of Adelaide, Adelaide, Australia
| | - Mathias Baumert
- Department of Electrical and Electronics Engineering, The University of Adelaide, Adelaide, Australia
| | - Sridhar Krishnan
- Department of Electrical and Computer Engineering, Ryerson University, Toronto, Canada
| |
Collapse
|
22
|
Orini M, Pueyo E, Laguna P, Bailon R. A Time-Varying Nonparametric Methodology for Assessing Changes in QT Variability Unrelated to Heart Rate Variability. IEEE Trans Biomed Eng 2017; 65:1443-1451. [PMID: 28991727 DOI: 10.1109/tbme.2017.2758925] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To propose and test a novel methodology to measure changes in QT interval variability (QTV) unrelated to RR interval variability (RRV) in nonstationary conditions. METHODS Time-frequency coherent and residual spectra representing QTV related (QTVrRRV) and unrelated (QTVuRRV) to RRV, respectively, are estimated using time-frequency Cohen's class distributions. The proposed approach decomposes the nonstationary output spectrum of any two-input one-output model with uncorrelated inputs into two spectra representing the information related and unrelated to one of the two inputs, respectively. An algorithm to correct for the bias of the time-frequency coherence function between QTV and RRV is proposed to provide accurate estimates of both QTVuRRV and QTVrRRV. Two simulation studies were conducted to assess the methodology in challenging nonstationary conditions and data recorded during head-up tilt in 16 healthy volunteers were analyzed. RESULTS In the simulation studies, QTVuRRV changes were tracked with only a minor delay due to the filtering necessary to estimate the nonstationary spectra. The correlation coefficient between theoretical and estimated patterns was even for extremely noisy recordings (signal to noise ratio (SNR) in QTV dB). During head-up tilt, QTVrRRV explained the largest proportion of QTV, whereas QTVuRRV showed higher relative increase than QTV or QTVrRRV in all spectral bands ( for most pairwise comparisons). CONCLUSION The proposed approach accurately tracks changes in QTVuRRV. Head-up tilt induced a slightly greater increase in QTVuRRV than in QTVrRRV. SIGNIFICANCE The proposed index QTVuRRV may represent an indirect measure of intrinsic ventricular repolarization variability, a marker of cardiac instability associated with sympathetic ventricular modulation and sudden cardiac death.
Collapse
|
23
|
Circadian pattern of short-term variability of the QT-interval in primary prevention ICD patients - EU-CERT-ICD methodological pilot study. PLoS One 2017; 12:e0183199. [PMID: 28827816 PMCID: PMC5565185 DOI: 10.1371/journal.pone.0183199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/31/2017] [Indexed: 01/26/2023] Open
Abstract
Objective Short-term variability of the QT-interval (STV-QT) was shown to be associated with an increased risk of ventricular arrhythmias. We aimed at investigating (a) whether STV-QT exhibits circadian pattern, and (b) whether such pattern differs between patients with high and low arrhythmia risk. Methods As part of the ongoing EU-CERT-ICD study, 24h high resolution digital ambulatory 12-lead Holter recordings are collected prior to ICD implantation for primary prophylactic indication. Presently available patients were categorized based on their arrhythmia score (AS), a custom-made weighted score of the number of arrhythmic events on the recording. STV-QT was calculated every hour in 30 patients of which 15 and 15 patients had a high and a low AS, respectively. Results The overall dynamicity of STV-QT showed high intra- and inter-individual variability with different circadian patterns associated with low and high AS. High AS patients showed a prominent peak both at 08:00 and 18:00. At these times, STV-QT was significantly higher in the high AS patients compared to the low AS patients (1.22ms±0.55ms vs 0.60ms±0.24ms at 08:00 and 1.12ms±0.39ms vs 0.64ms±0.29ms at 18:00, both p < 0.01). Conclusion In patients with high AS, STV-QT peaks in the early morning and late afternoon. This potentially reflects increased arrhythmia risk at these times. Prospective STV-QT determination at these times might thus be more sensitive to identify patients at high risk of ventricular arrhythmias.
Collapse
|
24
|
Bienias P, Łusakowska A, Ciurzyński M, Rymarczyk Z, Irzyk K, Konwerski M, Ciąpała K, Kowalski P, Kamińska A, Pruszczyk P. Cardiac autonomic function in type 1 and type 2 myotonic dystrophy. Clin Auton Res 2017; 27:193-202. [DOI: 10.1007/s10286-017-0413-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
|
25
|
Piccirillo G, Ottaviani C, Fiorucci C, Petrocchi N, Moscucci F, Di Iorio C, Mastropietri F, Parrotta I, Pascucci M, Magrì D. Transcranial direct current stimulation improves the QT variability index and autonomic cardiac control in healthy subjects older than 60 years. Clin Interv Aging 2016; 11:1687-1695. [PMID: 27895475 PMCID: PMC5117948 DOI: 10.2147/cia.s116194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Noninvasive brain stimulation technique is an interesting tool to investigate the causal relation between cortical functioning and autonomic nervous system (ANS) responses. Objective The objective of this report is to evaluate whether anodal transcranial direct current stimulation (tDCS) over the temporal cortex influences short-period temporal ventricular repolarization dispersion and cardiovascular ANS control in elderly subjects. Subjects and methods In 50 healthy subjects (29 subjects younger than 60 years and 21 subjects older than 60 years) matched for gender, short-period RR and systolic blood pressure spectral variability, QT variability index (QTVI), and noninvasive hemodynamic data were obtained during anodal tDCS or sham stimulation. Results In the older group, the QTVI, low-frequency (LF) power expressed in normalized units, the ratio between LF and high-frequency (HF) power, and systemic peripheral resistances decreased, whereas HF power expressed in normalized units and α HF power increased during the active compared to the sham condition (P<0.05). Conclusion In healthy subjects older than 60 years, tDCS elicits cardiovascular and autonomic changes. Particularly, it improves temporal ventricular repolarization dispersion, reduces sinus sympathetic activity and systemic peripheral resistance, and increases vagal sinus activity and baroreflex sensitivity.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | | | - Claudia Fiorucci
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | | | - Federica Moscucci
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Claudia Di Iorio
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Fabiola Mastropietri
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Ilaria Parrotta
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Matteo Pascucci
- Department of Cardiovascular, Respiratory, Nephrological, Anestesiological and Geriatric Sciences, "Sapienza" University
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, University of Rome "Sapienza", Rome, Italy
| |
Collapse
|
26
|
Piccirillo G, Moscucci F, Fiorucci C, Di Iorio C, Mastropietri F, Magrì D. Time- and frequency-domain analysis of beat to beat P-wave duration, PR interval and RR interval can predict asystole as form of syncope during head-up tilt. Physiol Meas 2016; 37:1910-1924. [PMID: 27681167 DOI: 10.1088/0967-3334/37/11/1910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To seek possible differences in short-period temporal RR interval, P-wave and PR interval dispersion and spectral coherence in patients with a head-up tilt test positive for vasovagal syncope with or without prolonged asystole, severe symptoms and at high risk of trauma. We retrospectively reviewed 5 min ECG and blood pressure recordings obtained at baseline, at rest and during head-up tilt in 40 patients diagnosed as having recurrent vasovagal syncope confirmed at a head-up tilt test. We analysed autoregressive spectral power for all the ECG-derived variables, focusing on temporal P-wave and PR interval dispersion indexes as well as their spectral coherence calculated on the same 5 min recordings at rest and during tilt. ECG recordings obtained during tilt before syncope showed significantly lower P → PR spectral coherence and higher RR standard deviations in patients with tilt-induced asystole than in those without (0.567 ± 0.097 versus 0.670 ± 0.127, p: 0.010 and 84 ± 36 versus 46 ± 22 ms2, p < 0.0001). Differences in the RR standard deviations persisted also on the last hundred beats (-100) (113 ± 54 versus 34 ± 17 ms2, p < 0.0001). Multiple regression analysis identified a significantly negative association between the maximum RR intervals and P → PR coherence at rest (β: -0.3, p < 0.05) and positive association with RR-100 standard deviation during tilt-induced syncope (β: 0.621, p < 0.001). P → PR spectral coherence could be used to assess the risk of prolonged asystole in patients with tilt-induced vasovagal syncope as well as as a possible surrogate for tilt-testing during these patients' follow-up.
Collapse
Affiliation(s)
- Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | | | | | | | | | | |
Collapse
|
27
|
Baumert M, Porta A, Vos MA, Malik M, Couderc JP, Laguna P, Piccirillo G, Smith GL, Tereshchenko LG, Volders PGA. QT interval variability in body surface ECG: measurement, physiological basis, and clinical value: position statement and consensus guidance endorsed by the European Heart Rhythm Association jointly with the ESC Working Group on Cardiac Cellular Electrophysiology. Europace 2016; 18:925-44. [PMID: 26823389 PMCID: PMC4905605 DOI: 10.1093/europace/euv405] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 12/20/2022] Open
Abstract
This consensus guideline discusses the electrocardiographic phenomenon of beat-to-beat QT interval variability (QTV) on surface electrocardiograms. The text covers measurement principles, physiological basis, and clinical value of QTV. Technical considerations include QT interval measurement and the relation between QTV and heart rate variability. Research frontiers of QTV include understanding of QTV physiology, systematic evaluation of the link between QTV and direct measures of neural activity, modelling of the QTV dependence on the variability of other physiological variables, distinction between QTV and general T wave shape variability, and assessing of the QTV utility for guiding therapy. Increased QTV appears to be a risk marker of arrhythmic and cardiovascular death. It remains to be established whether it can guide therapy alone or in combination with other risk factors. QT interval variability has a possible role in non-invasive assessment of tonic sympathetic activity.
Collapse
Affiliation(s)
- Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Marc A Vos
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marek Malik
- St Paul's Cardiac Electrophysiology, University of London, and National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK
| | - Jean-Philippe Couderc
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Pablo Laguna
- Zaragoza University and CIBER-BBN, Zaragoza, Spain
| | - Gianfranco Piccirillo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Università 'La Sapienza' Rome, Rome, Italy
| | - Godfrey L Smith
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Larisa G Tereshchenko
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR, USA
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
28
|
Heart rate variability in shift workers: responses to orthostatism and relationships with anthropometry, body composition, and blood pressure. BIOMED RESEARCH INTERNATIONAL 2015; 2015:329057. [PMID: 26495293 PMCID: PMC4606218 DOI: 10.1155/2015/329057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 11/17/2022]
Abstract
In order to investigate the response of heart rate variability (HRV) components to postural change and their association with cardiovascular risk factors in shift workers, a cross-sectional study with 438 Brazilian males rotating shift workers was done. Anthropometric, body composition, and clinical measures were collected. Electrocardiogram was recorded for 3 minutes, in the supine and orthostatic position, and HRV components were extracted. Descriptive analyses showed that mean values of body mass index, waist circumference (WC), waist-to-height ratio, visceral fat area (VFA), and blood pressure (BP) were higher than the reference values. In the regression model, age, WC, VFA, and systolic BP showed negative association with HRV components. These findings suggest the need for determining effective strategies for the evaluation and promotion of health among shift workers focused on the altered variables.
Collapse
|
29
|
Li Y, Xiao Q, Zeng W, Guo H, Jiang K, Zhong M, Zhong J. Red Blood Cell Distribution Width is Independently Correlated With Diurnal QTc Variation in Patients With Coronary Heart Disease. Medicine (Baltimore) 2015; 94:e822. [PMID: 26061304 PMCID: PMC4616478 DOI: 10.1097/md.0000000000000822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the relationship between red blood cell distribution width (RDW) and diurnal corrected QT (QTc) variation in patients with coronary heart disease. This retrospective study included 203 patients who underwent coronary angiography between February 2013 and June 2014. RDW values and dynamic electrocardiography (Holter) results were collected to investigate the relationship between RDW and diurnal QTc variation. Patients were separated into three groups (A, B, and C) by binning their RDW values in an ascending order. RDW values, coronary artery scores and diurnal QTc variations were significantly different among these groups (P < 0.05). While coronary artery scores gradually rose with increased RDW, diurnal QTc variation decreased. Pearson's correlation analysis was applied to control for confounding factors, and multiple correlation analysis showed that coronary artery score was positively correlated with RDW (r = 0.130, P = 0.020), while it was not correlated with the diurnal QTc variation (r = -0.226, P = 0.681). RDW was negatively correlated with diurnal QTc variation (r = -0.197, P = 0.035). RDW is independently associated with diurnal QTc variation in patients with coronary heart disease.
Collapse
Affiliation(s)
- Yuanmin Li
- From the Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong (YL, MZ, JZ); and Department of Cardiology, Affiliated Hospital of Taishan Medical College, Taian, China (YL, QX, WZ, HG, KJ)
| | | | | | | | | | | | | |
Collapse
|
30
|
Li L, Guo Y, Zhai H, Yin Y, Zhang J, Chen H, Wang L, Li N, Liu R, Xia Y. Aging increases the susceptivity of MSCs to reactive oxygen species and impairs their therapeutic potency for myocardial infarction. PLoS One 2014; 9:e111850. [PMID: 25393016 PMCID: PMC4230939 DOI: 10.1371/journal.pone.0111850] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/08/2014] [Indexed: 11/24/2022] Open
Abstract
Myocardial infarction (MI) is one of the leading causes of death worldwide and Mesenchymal Stem Cells (MSCs) transplantation has been considered a promising therapy. Recently, it was reported that the therapeutic effectiveness of MSCs is dependent on the age of the donor, yet the underlying mechanism has not been thoroughly investigated. This study was designed to investigate whether this impaired therapeutic potency is caused by an increased susceptivity of MSCs from old donors to reactive oxygen species (ROS). The MSCs were isolated from the subcutaneous inguinal region of young (8–10 weeks) and old (18 months) Sprague–Dawley (SD) rats. By exposing these MSCs to H2O2, we found that the adhesion of MSCs from old donors was damaged more severely. Specifically, decreased expression of integrin and reduced phosphorylation of focal adhesion kinase Src and FAK were observed. Furthemore, H2O2 triggered an increased apoptosis of MSCs from old donors. To study the viability and therapeutic potency of MSCs from young and old donors in vivo, these MSCs were transplanted into acute MI model rats. We observed a more rapidly decreased survival rate of the old MSCs in the infarct region, which may be caused by their increased susceptivity to the micro-environmental ROS, as transplantation of the old MSCs with N-acetyl-L-cysteine (NAC), a ROS scavenger, protected them. The low viability of engrafted old MSCs consequently impaired their therapeutic effectiveness, judging by the histology and function of heart. Our study may help to understand the mechanism of MSCs-host interaction during MI, as well as shed light on the design of therapeutic strategy in clinic.
Collapse
Affiliation(s)
- Liang Li
- First Department of Cadres, First Hospital Affiliated to General Hospital of People's Liberation Army, Beijing, China
| | - Yingfei Guo
- Department of Emergency, First hospital affiliated to general hospital of People's Liberation Army, Beijing, China
| | - Hongxia Zhai
- First Department of Cadres, First Hospital Affiliated to General Hospital of People's Liberation Army, Beijing, China
| | - Yaxin Yin
- First Department of Cadres, First Hospital Affiliated to General Hospital of People's Liberation Army, Beijing, China
| | - Jinjin Zhang
- First Department of Cadres, First Hospital Affiliated to General Hospital of People's Liberation Army, Beijing, China
| | - Haiwei Chen
- First Department of Cadres, First Hospital Affiliated to General Hospital of People's Liberation Army, Beijing, China
| | - Lei Wang
- First Department of Cadres, First Hospital Affiliated to General Hospital of People's Liberation Army, Beijing, China
| | - Na Li
- First Department of Cadres, First Hospital Affiliated to General Hospital of People's Liberation Army, Beijing, China
| | - Runmei Liu
- First Department of Cadres, First Hospital Affiliated to General Hospital of People's Liberation Army, Beijing, China
| | - Yunfeng Xia
- First Department of Cadres, First Hospital Affiliated to General Hospital of People's Liberation Army, Beijing, China
- * E-mail:
| |
Collapse
|