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Latrofa S, Hartwig V, Bachi L, Notarstefano P, Garibaldi S, Panchetti L, Nesti M, Seghetti P, Startari U, Mirizzi G, Morelli MS, Modena M, Mazzanti A, Emdin M, Giannoni A, Rossi A. Endocardial repolarization dispersion in BrS: A novel automatic algorithm for mapping activation recovery interval. J Cardiovasc Electrophysiol 2024; 35:965-974. [PMID: 38477371 DOI: 10.1111/jce.16244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Repolarization dispersion in the right ventricular outflow tract (RVOT) contributes to the type-1 electrocardiographic (ECG) phenotype of Brugada syndrome (BrS), while data on the significance and feasibility of mapping repolarization dispersion in BrS patients are scarce. Moreover, the role of endocardial repolarization dispersion in BrS is poorly investigated. We aimed to assess endocardial repolarization patterns through an automated calculation of activation recovery interval (ARI) estimated on unipolar electrograms (UEGs) in spontaneous type-1 BrS patients and controls; we also investigated the relation between ARI and right ventricle activation time (RVAT), and T-wave peak-to-end interval (Tpe) in BrS patients. METHODS Patients underwent endocardial high-density electroanatomical mapping (HDEAM); BrS showing an overt type-1 ECG were defined as OType1, while those without (latent type-1 ECG and LType1) received ajmaline infusion. BrS patients only underwent programmed ventricular stimulation (PVS). Data were elaborated to obtain ARI corrected with the Bazett formula (ARIc), while RVAT was derived from activation maps. RESULTS 39 BrS subjects (24 OType1 and 15 LTtype1) and 4 controls were enrolled. OType1 and post-ajmaline LType1 showed longer mean ARIc than controls (306 ± 27.3 ms and 333.3 ± 16.3 ms vs. 281.7 ± 10.3 ms, p = .05 and p < .001, respectively). Ajmaline induced a significant prolongation of ARIc compared to pre-ajmaline LTtype1 (333.3 ± 16.3 vs. 303.4 ± 20.7 ms, p < .001) and OType1 (306 ± 27.3 ms, p < .001). In patients with type-1 ECG (OTtype1 and post-ajmaline LType1) ARIc correlated with RVAT (r = .34, p = .04) and Tpec (r = .60, p < .001), especially in OType1 subjects (r = .55, p = .008 and r = .65 p < .001, respectively). CONCLUSION ARIc mapping demonstrates increased endocardial repolarization dispersion in RVOT in BrS. Endocardial ARIc positively correlates with RVAT and Tpec, especially in OType1.
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Affiliation(s)
- Sara Latrofa
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Lorenzo Bachi
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | | | | | - Paolo Seghetti
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- Institute of Clinical Physiology, Pisa, Italy
| | | | | | | | - Martina Modena
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Michele Emdin
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alberto Giannoni
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Andrea Rossi
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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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.
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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;
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Baskan S, Karaca Ozer P, Orta H, Ozbingol D, Yavuz ML, Ayduk Govdeli E, Nisli K, Oztarhan K. Prognostic Value of Tpeak-Tend Interval in Early Diagnosis of Duchenne Muscular Dystrophy Cardiomyopathy. Diagnostics (Basel) 2023; 13:2381. [PMID: 37510124 PMCID: PMC10377932 DOI: 10.3390/diagnostics13142381] [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: 06/04/2023] [Revised: 07/02/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The most common cause of death in patients with Duchenne muscular dystrophy (DMD) is cardiomyopathy. Our aim was to investigate the relationship between the Tpeak-Tend (Tp-e) interval and the premature ventricular contraction (PVC) burden and therefore early arrhythmic risk and cardiac involvement in DMD patients. Twenty-five patients with DMD followed by pediatric cardiology were included in the study. Those with a frequency of <1% PVC in the 24 h Holter were assigned to Group 1 (n = 15), and those with >1% were assigned to Group 2 (n = 10). Comparisons were made with healthy controls (n = 27). Left ventricular ejection fraction (LVEF) was lowest in Group 2 and highest in the control group (p < 0.001). LV end-diastolic diameter was greater in Group 2 than in Group 1 and the control group (p = 0.005). Pro-BNP and troponin levels were higher in Group 1 and Group 2 than in the control group (p = 0.001 and p < 0.001, respectively). Tp-e interval was longer in Group 2 compared to Group 1 and the control group (p < 0.001). The LVEF (OR 0.879, 95% CI 0.812-0.953; p = 0.002) and Tp-e interval (OR 1.181, 95% CI 1.047-1.332; p = 0.007) were independent predictors of PVC/24 h frequency of >1%. A Tp-e interval > 71.65 ms predicts PVC > 1%, with a sensitivity of 80% and a specificity of 90% (AUC = 0.842, 95% CI (0.663-1.000), p = 0.001). Determination of Tp-e prolongation from ECG data may help in the determination of cardiac involvement and early diagnosis of arrhythmic risk in DMD.
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Affiliation(s)
- Serra Baskan
- Department of Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34134, Turkey
| | - Pelin Karaca Ozer
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34134, Turkey
| | - Huseyin Orta
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34134, Turkey
| | - Doruk Ozbingol
- Department of Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34134, Turkey
| | - Mustafa Lutfi Yavuz
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34134, Turkey
| | - Elif Ayduk Govdeli
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34134, Turkey
| | - Kemal Nisli
- Department of Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34134, Turkey
| | - Kazim Oztarhan
- Department of Pediatric Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34134, Turkey
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Viskin S. Long QT begets long QT. J Cardiovasc Electrophysiol 2023; 34:177-179. [PMID: 36335630 DOI: 10.1111/jce.15736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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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.
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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
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Tashiro N, Muneuchi J, Ezaki H, Kobayashi M, Yamada H, Sugitani Y, Watanabe M. Ventricular Repolarization Dispersion is a Potential Risk for the Development of Life-Threatening Arrhythmia in Children with Hypertrophic Cardiomyopathy. Pediatr Cardiol 2022; 43:1455-1461. [PMID: 35284943 DOI: 10.1007/s00246-022-02867-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
The risk stratification and early interventions are necessary in patients with hypertrophic cardiomyopathy (HCM), as life-threatening arrhythmia (LTA) is a leading cause of death. This study aimed to explore whether an interval between the peak of the T wave to the end terminal of the T wave (Tp-e), which represents ventricular repolarization dispersion, could predict the risk for LTA in children with HCM. We analyzed electrocardiography at the first and last visits in children (aged < 15 years) with HCM, and compared Tp-e interval and the ratio of Tp-e interval to QT interval (Tp-e/QT) between children with and without LTA. We studied 25 children with HCM. During the follow-up of 85 (38-146) months, there were 7 children with LTA. The 5-year sudden cardiac death (SCD) risk was 1.4 (1.1-2.5) %, which suggested that our cohort consisted of patients at a lower risk for SCD. Age was significantly older in children with LTA compared to those without it (12.5 vs.1.0 years, P = 0.037), although sex, the presence of family history and symptoms at diagnosis, the maximum left ventricular wall thickness Z-score did not differ between the groups. At the last electrocardiography before LTA, corrected Tp-e interval and Tp-e/QT ratio were significantly greater in patients with LTA compared to those in patients without LTA (corrected Tp-e: 103 vs. 78 ms, P = 0.020; Tp-e/QT: 0.28 vs. 0.22, P = 0.046). Corrected Tp-e and Tp-e/QT ratio cutoff values of 91 ms and 0.28 yielded as the predictors for LTA with sensitivity of 85% and 72%, specificity of 71% and 89%, respectively. Prolonged absolute and corrected Tp-e intervals and an increase in the Tp-e/QT ratio can be useful predictors for LTA in children with HCM. We offer temporal assessments of ventricular repolarization dispersion to stratify the risk for the development of LTA/SCD among children with HCM.
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Affiliation(s)
- Naoko Tashiro
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan.
| | - Hiroki Ezaki
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Masaru Kobayashi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Hiromu Yamada
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Yuichiro Sugitani
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
| | - Mamie Watanabe
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8501, Japan
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Gassanov N, Mutallimov M, Caglayan E, Erdmann E, Er F. ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator. J Cardiol 2022; 80:573-577. [PMID: 35985868 DOI: 10.1016/j.jjcc.2022.08.001] [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: 05/23/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) is increasingly used in patients at elevated risk for ventricular arrhythmias but not fulfilling the indications for an implantable cardioverter defibrillator (ICD). Currently, there is an insufficient risk prediction of fatal arrhythmias in patients at risk. In this study, we assessed the prognostic role of baseline electrocardiogram (ECG) in WCD patients. METHODS WCD patients from diverse clinical institutions in Germany (n = 227) were retrospectively enrolled and investigated for the incidences of death or ventricular arrhythmias during WCD wearing. In addition, the widely accepted ECG predictors of adverse outcome were analyzed in patients with arrhythmic events. RESULTS Life-threatening arrhythmias occurred in 22 (9.7 %) patients, mostly in subjects with ischemic heart disease (15 of 22). There was no difference in baseline left ventricular ejection fraction (LVEF) in subjects with and without arrhythmic events (31.3 ± 7.9 % vs. 32.6 ± 8.3 %; p = 0,24). Patients with arrhythmia exhibited significantly longer QRS duration (109.5 ± 23.1 ms vs. 100.6 ± 22.3 ms, p = 0,04), Tpeak-Tend (Tp-e) (103.1 ± 15.6 ms vs. 93.2 ± 19.2 ms, p = 0,01) and QTc (475.0 ± 60.0 ms vs. 429.6 ± 59.4 ms, p < 0,001) intervals. In contrast, no significant differences were found for incidences of fragmented QRS (27.3 % vs. 24 %, p = 0.79) and inverted/biphasic T-waves (16.6 % vs. 22.7 %, p = 0,55). In multivariate regression analysis both Tp-e (HR 1.03; 95 % CI 1.001-1.057; p = 0.02) and QTc (HR 1.02; 95 % CI 1.006-1.026; p < 0.001) were identified as independent predictors of ventricular arrhythmias. After WCD use, the prophylactic ICD was indicated in 76 patients (33 %) with uneventful clinical course but persistent LVEF ≤35 %. The ECG analysis in these subjects did not reveal any relevant changes in arrhythmogenesis markers. CONCLUSIONS ECG repolarization markers Tp-e and QTc are associated with malignant arrhythmias in WCD patients and may be used - in addition to other established risk markers - to identify appropriate patients for ICD implantation.
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Affiliation(s)
- Natig Gassanov
- Department of Internal Medicine II, Klinikum Idar-Oberstein, Idar-Oberstein, Germany.
| | - Mirza Mutallimov
- Department of Internal Medicine II, Klinikum Idar-Oberstein, Idar-Oberstein, Germany
| | - Evren Caglayan
- Department of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Erland Erdmann
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Fikret Er
- Department of Internal Medicine I, Klinikum Gütersloh, Gütersloh, Germany
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Klein MG, Krantz MJ, Fatima N, Watters A, Colon-Sanchez D, Geiger RM, Goldstein RE, Solhjoo S, Mehler PS, Flagg TP, Haigney MC. Methadone Blockade of Cardiac Inward Rectifier K + Current Augments Membrane Instability and Amplifies U Waves on Surface ECGs: A Translational Study. J Am Heart Assoc 2022; 11:e023482. [PMID: 35658478 PMCID: PMC9238736 DOI: 10.1161/jaha.121.023482] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Methadone is associated with a disproportionate risk of sudden death and ventricular tachyarrhythmia despite only modest inhibition of delayed rectifier K+ current (IKr), the principal mechanism of drug-associated arrhythmia. Congenital defects of inward rectifier K+ current (IK1) have been linked to increased U-wave amplitude on ECG and fatal arrhythmia. We hypothesized that methadone may also be a potent inhibitor of IK1, contributing to delayed repolarization and manifesting on surface ECGs as augmented U-wave integrals. Methods and Results Using a whole-cell voltage clamp, methadone inhibited both recombinant and native IK1 with a half-maximal inhibitory concentration IC50) of 1.5 μmol/L, similar to that observed for IKr block (half-maximal inhibitory concentration of 2.9 μmol/L). Methadone modestly increased the action potential duration at 90% repolarization and slowed terminal repolarization at low concentrations. At higher concentrations, action potential duration at 90% repolarization lengthening was abolished, but its effect on terminal repolarization rose steadily and correlated with increased fluctuations of diastolic membrane potential. In parallel, patient ECGs were analyzed before and after methadone initiation, with 68% of patients having a markedly increased U-wave integral compared with premethadone (lead V3; mean +38%±15%, P=0.016), along with increased QT and TPeak to TEnd intervals, likely reflective of IKr block. Conclusions Methadone is a potent IK1 inhibitor that causes augmentation of U waves on surface ECG. We propose that increased membrane instability resulting from IK1 block may better explain methadone's arrhythmia risk beyond IKr inhibition alone. Drug-induced augmentation of U waves may represent evidence of blockade of multiple repolarizing ion channels, and evaluation of the effect of that agent on IK1 may be warranted.
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Affiliation(s)
- Michael G Klein
- Cardiology Division Department of Medicine Uniformed Services University Bethesda MD
| | - Mori J Krantz
- Denver Health Medical Center Cardiology Division Denver CO.,Department of Medicine University of Colorado School of Medicine Aurora CO.,Chief Science Advisor Cardiac Safety and Cardiovascular Imaging, Clario Inc. Philadelphia PA
| | - Naheed Fatima
- Department of Anatomy, Physiology & Genetics Uniformed Services University Bethesda MD
| | - Ashlie Watters
- ACUTE at Denver Health Denver CO.,Department of Medicine University of Colorado School of Medicine Aurora CO
| | - Dayan Colon-Sanchez
- Psychiatry Division Outpatient Behavioral Health Services, Denver Health, & University of Colorado School of Medicine Denver CO
| | - Robert M Geiger
- Department of Anatomy, Physiology & Genetics Uniformed Services University Bethesda MD
| | - Robert E Goldstein
- Cardiology Division Department of Medicine Uniformed Services University Bethesda MD
| | - Soroosh Solhjoo
- Cardiology Division Department of Medicine Uniformed Services University Bethesda MD.,Military Cardiovascular Outcomes Research (MiCOR) Bethesda MD
| | - Philip S Mehler
- ACUTE at Denver Health Denver CO.,Department of Medicine University of Colorado School of Medicine Aurora CO
| | - Thomas P Flagg
- Department of Anatomy, Physiology & Genetics Uniformed Services University Bethesda MD
| | - Mark C Haigney
- Cardiology Division Department of Medicine Uniformed Services University Bethesda MD.,Military Cardiovascular Outcomes Research (MiCOR) Bethesda MD
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9
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Velocity tracking of cardiac vector loops to identify signs of stress-induced ischaemia. Med Biol Eng Comput 2022; 60:1313-1321. [DOI: 10.1007/s11517-022-02503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/10/2022] [Indexed: 10/18/2022]
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10
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Song L, Zhao X, Lv W, Zeng J, Wang Y, Gong B, Kalogeropoulos AP, Pu H, Bai Y, Peng S. Preliminary study on the diagnostic value of cardiac magnetic resonance feature tracking for malignant ventricular arrhythmias in non-ischemic dilated cardiomyopathy. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:215. [PMID: 35280384 PMCID: PMC8908127 DOI: 10.21037/atm-22-660] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/22/2022] [Indexed: 11/08/2022]
Abstract
Background Patients with nonischemic dilated cardiomyopathy (NIDCM) and malignant ventricular arrhythmia (MVA) often have a poor prognosis and a high risk of sudden cardiac death. Although the diagnosis of MVA is straightforward by electrocardiogram (ECG), the underlying abnormalities of ventricular mechanics in these patients are unknown. This study aims to preliminarily explore the value of cardiac magnetic resonance feature tracking (CMR-FT) for MVA in dilated cardiomyopathy. Methods In this retrospective study, patients with NIDCM who met inclusion criteria were divided into an MVA group and a non-MVA group (included from January 2018 to September 2021). The interobserver agreement of myocardial strain parameters, including global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS), were tested. The GLS, GCS, GRS, left ventricular ejection fraction (LVEF), Tpeak-Tend interval on ECG and brain natriuretic peptide (BNP) were compared between groups. Single-factor and multifactor receiver operating characteristic (ROC) curve analyses were conducted to calculate the area under the ROC curve (AUC), cut-off point, sensitivity, and specificity of these parameters in predicting MVA in NIDCM. Results A total of 161 NIDCM patients were included (54 in the MVA group). GLS, GCS, and GRS had good interobserver agreement (all intraclass correlation coefficients >0.80). The absolute GLS and GCS, GRS and LVEF were lower in the MVA group than the non-MVA group (P<0.001), Tpeak-Tend and BNP were higher (P<0.001). Single-factor ROC curve analysis showed that GLS, GCS and GRS had certain diagnostic value for MVA (AUC =0.795, 0.802, and 0.754, respectively). Among them, GCS had higher sensitivity and specificity (GCS 0.796/0.776, GLS 0.778/0.757, GRS 0.741/0.692). Multifactor ROC curve analysis showed the combination of GLS and GCS (AUC =0.810), the combination of GCS and GRS (AUC =0.802), the combination of GLS and GRS (AUC =0.787), the combination of GLS, GCS, and GRS (AUC =0.810). Conclusions The three-dimensional myocardial strain parameters (especially GLS and GCS) measured by CMR-FT had certain diagnostic value and could reflect the underlying abnormality of ventricular mechanics of NIDCM with MVA.
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Affiliation(s)
- Linsheng Song
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xinyi Zhao
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenlong Lv
- Department of Radiotherapy, Cancer Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jie Zeng
- Department of Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Gong
- Human Disease Genes Key Laboratory of Sichuan Province and Institute of Laboratory Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Andreas P Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, NY, USA
| | - Hong Pu
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yifeng Bai
- Department of Oncology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Shengkun Peng
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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11
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Jaromin J, Markiewicz-Łoskot G, Szydłowski L, Kulawik A. Diagnostic Value of the TpTe Interval in Children with Ventricular Arrhythmias. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12194. [PMID: 34831949 PMCID: PMC8623175 DOI: 10.3390/ijerph182212194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/06/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The changes in the period of ventricular repolarization, i.e., QT interval, QTp (Q-Tpeak) and TpTe interval (Tpeak-Tend), make it possible to assess the electrical instability of the heart muscle, which may lead to the development of life-threatening ventricular arrhythmia. The aim of the study was to determine and evaluate the use of differences in T-wave morphology and durations of repolarization period parameters (QT, TpTe) in resting ECGs for children with ventricular arrhythmias. METHODS The retrospective analysis was made of the disease histories of 80 examined children with resting ECGs, which were admitted to the Children's Cardiology Department. The study group consisted of 46 children aged 4 to 18 with ventricular arrhythmias and the control group consisted of 34 healthy children between 4 and 18 years of age, with no arrhythmias. RESULTS The duration of the TpTe interval was significantly (p < 0.001) longer in the group of children with ventricular arrhythmia with abnormal T-wave (bactrian/bifid, humid/biphasic) compared to the TpTe interval in children with ventricular arrhythmia with the normal repolarization period. The duration of the TpTe (p < 0.001), QTcB (p < 0.001) and QTcF (p < 0.001) intervals were significantly longer in the group of children with ventricular arrhythmias and with abnormal T-wave compared to the values of the TpTe, QTcB, and QTcF intervals of the control group with normal morphology of the repolarization period. Only the duration of the TpTe interval was significantly (p = 0.020) longer in the group of children with ventricular arrhythmia without clinical symptoms. CONCLUSIONS Children with benign ventricular arrhythmias recorded on a standard ECG with prolonged TpTe and QT intervals and abnormal T-wave morphology require systematic and frequent cardiac check up with long term ECG recordings due to the possibility of future more severe ventricular arrhythmias. Further follow-up studies in even larger groups of patients are necessary to confirm the values of these repolarization parameters in clinical practice.
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Affiliation(s)
- Joanna Jaromin
- Department of Nursing and Social Medical Problems, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Grażyna Markiewicz-Łoskot
- Department of Nursing and Social Medical Problems, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Faculty of Medical Sciences in Katowice, Medical University in Silesia, 40-752 Katowice, Poland;
| | - Agnieszka Kulawik
- Faculty of Science and Technology, University of Silesia in Katowice, Bankowa 14, 40-007 Katowice, Poland;
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12
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Lucci VEM, Harrison EL, DeVeau KM, Harman KA, Squair JW, Krassioukov A, Magnuson DSK, West CR, Claydon VE. Markers of susceptibility to cardiac arrhythmia in experimental spinal cord injury and the impact of sympathetic stimulation and exercise training. Auton Neurosci 2021; 235:102867. [PMID: 34399294 DOI: 10.1016/j.autneu.2021.102867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 01/01/2023]
Abstract
Injury to descending autonomic (sympathetic) pathways is common after high-level spinal cord injury (SCI) and associated with abnormal blood pressure and heart rate regulation. In individuals with high-level SCI, abnormal sympathovagal balance (such as during autonomic dysreflexia; paroxysmal hypertension provoked by sensory stimuli below the injury) is proarrhythmogenic. Exercise training is a key component of SCI rehabilitation and management of cardiovascular disease risk, but it is unclear whether exercise training influences susceptibility to cardiac arrhythmia. We aimed to evaluate: (i) whether susceptibility to arrhythmia increases in a rodent-model of SCI; (ii) the impact of the sympathomimetic drug dobutamine (DOB) on arrhythmia risk; (iii) whether exercise training ameliorates arrhythmia risk. Twenty-one Wistar rats were divided into 3 subgroups: T2-contusive SCI (T2, n = 7), T2-contusive SCI completing passive hindlimb cycling training (PHLC, n = 7), and T10-contusive SCI (T10, n = 7). Known electrocardiographic arrhythmia markers and heart rate variability parameters were evaluated before (PRE), 1-week (POST) and 5-weeks post-SCI (TERM) at baseline and during DOB infusion (30 μg/kg/min). Baseline markers of arrhythmia risk were increased in both T2 and T10 animals. DOB decreased R-R interval (p < 0.001), and increased markers of risk for ventricular arrhythmia, particularly in high-level (T2) animals (p < 0.05). Exercise training blunted the exacerbation of markers of arrhythmia risk in the presence of DOB. Markers of risk for cardiac arrhythmia are increased in experimental SCI, and DOB further increases arrhythmia risk in high-level SCI. Exercise training did not improve markers of arrhythmia risk at rest, but did ameliorate markers of arrhythmia risk during sympathetic stimulation.
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Affiliation(s)
- Vera-Ellen M Lucci
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, British Columbia, Canada; International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, British Columbia, Canada
| | - Emma L Harrison
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, British Columbia, Canada
| | - Kathryn M DeVeau
- Kentucky Spinal Cord Injury Research Center, University of Louisville, KY, United States of America
| | - Kathryn A Harman
- Kentucky Spinal Cord Injury Research Center, University of Louisville, KY, United States of America
| | - Jordan W Squair
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, British Columbia, Canada
| | - Andrei Krassioukov
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, British Columbia, Canada
| | - David S K Magnuson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, KY, United States of America
| | - Christopher R West
- International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, British Columbia, Canada; Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia (UBC), British Columbia, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, British Columbia, Canada; International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, British Columbia, Canada.
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13
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Andršová I, Hnatkova K, Šišáková M, Toman O, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Heart Rate Dependency and Inter-Lead Variability of the T Peak - T End Intervals. Front Physiol 2021; 11:595815. [PMID: 33384609 PMCID: PMC7769826 DOI: 10.3389/fphys.2020.595815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
The electrocardiographic (ECG) assessment of the T peak–T end (Tpe) intervals has been used in many clinical studies, but several related physiological aspects have not been reported. Specifically, the sources of the Tpe differences between different ECG leads have not been systematically researched, the relationship of Tpe duration to underlying heart rate has not been firmly established, and little is known about the mutual correspondence of Tpe intervals measured in different ECG leads. This study evaluated 796,620 10-s 12-lead ECGs obtained from long-term Holters recorded in 639 healthy subjects (311 female) aged 33.8 ± 9.4 years. For each ECG, transformation to orthogonal XYZ lead was used to measure Tpe in the orthogonal vector magnitude (used as a reference for lead-to-lead comparisons) and to construct a three-dimensional T wave loop. The loop roundness was expressed by a ratio between its circumference and length. These ratios were significantly related to the standard deviation of Tpe durations in different ECG leads. At the underlying heart rate of 60 beats per minute, Tpe intervals were shorter in female than in male individuals (82.5 ± 5.6 vs 90.0 ± 6.5 ms, p < 0.0001). When studying linear slopes between Tpe intervals measured in different leads and the underlying heart rate, we found only minimal heart rate dependency, which was not systematic across the ECG leads and/or across the population. For any ECG lead, positive Tpe/RR slope was found in some subjects (e.g., 79 and 25% of subjects for V2 and V4 measurements, respectively) and a negative Tpe/RR slope in other subjects (e.g., 40 and 65% for V6 and V5, respectively). The steepest positive and negative Tpe/RR slopes were found for measurements in lead V2 and V4, respectively. In all leads, the Tpe/RR slope values were close to zero, indicating, on average, Tpe changes well below 2 ms for RR interval changes of 100 ms. On average, longest Tpe intervals were measured in lead V2, the shortest in lead III. The study concludes that the Tpe intervals measured in different leads cannot be combined. Irrespective of the measured ECG lead, the Tpe interval is not systematically heart rate dependent, and no heart rate correction should be used in clinical Tpe investigations.
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Affiliation(s)
- Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Martina Šišáková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Ondřej Toman
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Katharina M Huster
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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14
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Zhang D, Tu H, Wang C, Cao L, Hu W, Hackfort BT, Muelleman RL, Wadman MC, Li YL. Inhibition of N-type calcium channels in cardiac sympathetic neurons attenuates ventricular arrhythmogenesis in heart failure. Cardiovasc Res 2021; 117:137-148. [PMID: 31995173 PMCID: PMC7797209 DOI: 10.1093/cvr/cvaa018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/13/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023] Open
Abstract
AIMS Cardiac sympathetic overactivation is an important trigger of ventricular arrhythmias in patients with chronic heart failure (CHF). Our previous study demonstrated that N-type calcium (Cav2.2) currents in cardiac sympathetic post-ganglionic (CSP) neurons were increased in CHF. This study investigated the contribution of Cav2.2 channels in cardiac sympathetic overactivation and ventricular arrhythmogenesis in CHF. METHODS AND RESULTS Rat CHF was induced by surgical ligation of the left coronary artery. Lentiviral Cav2.2-α shRNA or scrambled shRNA was transfected in vivo into stellate ganglia (SG) in CHF rats. Final experiments were performed at 14 weeks after coronary artery ligation. Real-time polymerase chain reaction and western blot data showed that in vivo transfection of Cav2.2-α shRNA reduced the expression of Cav2.2-α mRNA and protein in the SG in CHF rats. Cav2.2-α shRNA also reduced Cav2.2 currents and cell excitability of CSP neurons and attenuated cardiac sympathetic nerve activities (CSNA) in CHF rats. The power spectral analysis of heart rate variability (HRV) further revealed that transfection of Cav2.2-α shRNA in the SG normalized CHF-caused cardiac sympathetic overactivation in conscious rats. Twenty-four-hour continuous telemetry electrocardiogram recording revealed that this Cav2.2-α shRNA not only decreased incidence and duration of ventricular tachycardia/ventricular fibrillation but also improved CHF-induced heterogeneity of ventricular electrical activity in conscious CHF rats. Cav2.2-α shRNA also decreased susceptibility to ventricular arrhythmias in anaesthetized CHF rats. However, Cav2.2-α shRNA failed to improve CHF-induced cardiac contractile dysfunction. Scrambled shRNA did not affect Cav2.2 currents and cell excitability of CSP neurons, CSNA, HRV, and ventricular arrhythmogenesis in CHF rats. CONCLUSIONS Overactivation of Cav2.2 channels in CSP neurons contributes to cardiac sympathetic hyperactivation and ventricular arrhythmogenesis in CHF. This suggests that discovering purely selective and potent small-molecule Cav2.2 channel blockers could be a potential therapeutic strategy to decrease fatal ventricular arrhythmias in CHF.
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MESH Headings
- Action Potentials
- Animals
- Calcium/metabolism
- Calcium Channels, N-Type/genetics
- Calcium Channels, N-Type/metabolism
- Calcium Signaling
- Cells, Cultured
- Disease Models, Animal
- Heart/innervation
- Heart Failure/genetics
- Heart Failure/metabolism
- Heart Failure/physiopathology
- Heart Rate
- Male
- RNA Interference
- RNA, Small Interfering/genetics
- RNA, Small Interfering/metabolism
- Rats, Sprague-Dawley
- Stellate Ganglion/metabolism
- Stellate Ganglion/physiopathology
- Sympathetic Fibers, Postganglionic/metabolism
- Sympathetic Fibers, Postganglionic/physiopathology
- Tachycardia, Ventricular/genetics
- Tachycardia, Ventricular/metabolism
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/prevention & control
- Ventricular Fibrillation/genetics
- Ventricular Fibrillation/metabolism
- Ventricular Fibrillation/physiopathology
- Ventricular Fibrillation/prevention & control
- Rats
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Affiliation(s)
- Dongze Zhang
- Department of Emergency Medicine, University of Nebraska Medical Center, 985850 Nebraska Medical Center, Omaha, NE 68198-5850, USA
| | - Huiyin Tu
- Department of Emergency Medicine, University of Nebraska Medical Center, 985850 Nebraska Medical Center, Omaha, NE 68198-5850, USA
| | - Chaojun Wang
- Department of Emergency Medicine, University of Nebraska Medical Center, 985850 Nebraska Medical Center, Omaha, NE 68198-5850, USA
- Department of Cardiovascular Disease, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, 710061, China
| | - Liang Cao
- Department of Emergency Medicine, University of Nebraska Medical Center, 985850 Nebraska Medical Center, Omaha, NE 68198-5850, USA
- Department of Cardiac Surgery, Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Wenfeng Hu
- Department of Emergency Medicine, University of Nebraska Medical Center, 985850 Nebraska Medical Center, Omaha, NE 68198-5850, USA
| | - Bryan T Hackfort
- Department of Cellular & Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Robert L Muelleman
- Department of Emergency Medicine, University of Nebraska Medical Center, 985850 Nebraska Medical Center, Omaha, NE 68198-5850, USA
| | - Michael C Wadman
- Department of Emergency Medicine, University of Nebraska Medical Center, 985850 Nebraska Medical Center, Omaha, NE 68198-5850, USA
| | - Yu-Long Li
- Department of Emergency Medicine, University of Nebraska Medical Center, 985850 Nebraska Medical Center, Omaha, NE 68198-5850, USA
- Department of Cellular & Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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15
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Tomaselli Muensterman E, Jaynes HA, Sowinski KM, Overholser BR, Shen C, Kovacs RJ, Tisdale JE. Transdermal Testosterone Attenuates Drug-Induced Lengthening of Both Early and Late Ventricular Repolarization in Older Men. Clin Pharmacol Ther 2020; 109:1499-1504. [PMID: 33020898 PMCID: PMC10150401 DOI: 10.1002/cpt.2072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/27/2020] [Indexed: 01/16/2023]
Abstract
We have previously reported that transdermal testosterone attenuates drug-induced QT interval lengthening in older men. However, it is unknown whether this is due to modulation of early ventricular repolarization, late repolarization, or both. In a secondary analysis of a prospective, randomized, double-blind, placebo-controlled three-way crossover study, we determined if transdermal testosterone and oral progesterone attenuate drug-induced lengthening of early and late ventricular repolarization, represented by the electrocardiographic measurements J-Tpeak c and Tpeak -Tend , respectively, as well as Tpeak -Tend /QT, a measure of transmural dispersion of repolarization. Male volunteers ≥ 65 years of age (n = 14) were randomized to receive transdermal testosterone 100 mg, oral progesterone 400 mg, or matching transdermal/oral placebo daily for 7 days. On the morning following the seventh day, subjects received intravenous ibutilide 0.003 mg/kg, after which electrocardiograms were performed serially. One subject was excluded due to difficulty in T-wave interpretation. Pre-ibutilide J-Tpeak c was lower during the testosterone phase than during progesterone and placebo (216 ± 23 vs. 227 ± 28 vs. 227 ± 21 ms, P = 0.002). Maximum post-ibutilide J-Tpeak c was also lower during the testosterone phase (233 ± 22 vs. 246 ± 29 vs. 248 ± 23 ms, P < 0.0001). Pre-ibutilide Tpeak -Tend was not significantly different during the three phases, but maximum post-ibutilide Tpeak -Tend was lower during the testosterone phase (80 ± 12 vs. 89 ± 18 vs. 86 ± 15 ms, P = 0.002). Maximum Tpeak -Tend /QT was also lower during the testosterone phase (0.199 ± 0.023 vs. 0.216 ± 0.035 vs. 0.209 ± 0.031, P = 0.005). Progesterone exerted minimal effect on drug-induced lengthening of J-Tpeak c, and no effect on Tpeak -Tend or Tpeak -Tend /QT. Transdermal testosterone attenuates drug-induced lengthening of both early and late ventricular repolarization in older men.
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Affiliation(s)
| | - Heather A Jaynes
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA
| | - Kevin M Sowinski
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Brian R Overholser
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Changyu Shen
- The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard J Kovacs
- Krannert Institute of Cardiology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - James E Tisdale
- College of Pharmacy, Purdue University, Indianapolis, Indiana, USA.,Division of Clinical Pharmacology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
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16
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Markiewicz-Łoskot G, Kolarczyk E, Mazurek B, Łoskot M, Szydłowski L. Prolongation of Electrocardiographic T Wave Parameters Recorded during the Head-Up Tilt Table Test as Independent Markers of Syncope Severity in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6441. [PMID: 32899625 PMCID: PMC7558512 DOI: 10.3390/ijerph17186441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022]
Abstract
The head-up tilt table test (HUTT) with the upright phase is used to help determine an imbalance of the sympathetic nervous system that is related to abnormal electrocardiographic repolarization in children with vasovagal syncope (VVS) and also in patients with the long QT syndrome (LQTS). The study attempted to evaluate T wave morphology and QT and TpTe (Tpeak-Tend) intervals recorded in ECG during the HUTT for a more accurate diagnosis of children with VVS. The group investigated 70 children with a negative HUTT result: 40 patients with VVS and 30 healthy volunteers without syncope. The RR interval as well as TpTe, and QTc intervals were measured in lead V5 of electrocardiogram (ECG) on admission to the hospital and during three phases of the HUTT. In syncopal children, which included 23 children with bifid or flat T waves and 17 patients with normal T waves in the upright phase, the QTc and TpTe were longer (p < 0.001) compared to the other test phases and longer (p < 0.001) than in the control group, respectively, with the risk of arrhythmias. Only in the control group, the TpTe was shorter (p < 0.001) in the upright phase than in the other tilt phases. The TpTe in the upright phase (>70 ms) was a good discriminator, and was better than the QTc (>427 ms). Prolongation of electrocardiographic TpTe and QT intervals, in addition to the (abnormal T wave morphology recorded during the HUTT, are helpful for identifying VVS children more predisposed to ventricular arrhythmias with a latent risk of LQTS. Further studies are required to assess the value of these repolarization parameters in clinical practice.
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Affiliation(s)
- Grażyna Markiewicz-Łoskot
- Department of Nursing and Social Medical Problems, Faculty of Health Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Ewelina Kolarczyk
- Department of Propaedeutics of Nursing, Faculty of Health Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Bogusław Mazurek
- Department of Pediatric Cardiology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Marianna Łoskot
- Students' Research Group, Department of Nursing and Social Medical Problems, Faculty of Health Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
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Dynamic features of cardiac vector as alternative markers of drug-induced spatial dispersion. J Pharmacol Toxicol Methods 2020; 104:106894. [PMID: 32645483 DOI: 10.1016/j.vascn.2020.106894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/24/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The abnormal amplification of ventricular repolarization dispersion (VRD) has long been linked to proarrhythmia risk. Recently, the measure of VRD through electrocardiogram intervals has been strongly questioned. The search for an efficient and non-invasive surrogate marker of drug-induced dispersion effects constitute an urgent research challenge. METHODS Herein, drug-induced ventricular dispersion is generated by d-Sotalol supply in an In-vitro rabbit heart model. A cilindrical chamber simulates the thorax and a multi-electrode net is used to obtain spatial electrocardiographic signals. Cardiac vector dynamics is captured by novel velocity cardiomarkers obtained by quaternion methods. Through statistical analysis and machine learning technics, we compute potential dispersion markers that could define proarrhythmic risk. RESULTS The cardiomarkers with the greatest statistical significance, both obtained from the electrical cardiac vector, were: the QTω, which is the difference between first and last maxima of angular velocity and λ21vT, the roundness of linear velocity. When comparing with the performance of the current standards (89%), this pair was able to correctly separate 21 out of 22 experiments achieving a performance of 95%. Moreover, the QTω computes in a much more robust basis the QT interval, the current index for drug regulation. DISCUSSION These velocity markers circumvent the problems of accuratelly finding the fiducial points such as the always tricky T-wave end. Given the high performance they achieved, it is provided a promising outcome for future applications to the detection of anomalous changes of heterogeneity that may be useful for the purposes of torsadogenic toxicity studies.
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Cruces PD, Torkar D, Arini PD. Biomarkers of pre-existing risk of Torsade de Pointes under Sotalol treatment. J Electrocardiol 2020; 60:177-183. [PMID: 32464371 DOI: 10.1016/j.jelectrocard.2020.04.011] [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: 02/27/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Antiarrhythmic drugs therapies are currently going through a turning point. The high risk that exists during the treatments has led to an ongoing search for new non-invasive toxicity risk biomarkers. METHODS We propose the use of spatial biomarkers obtained through the quaternion algebra, evaluating the dynamics of the cardiac electrical vector in a non-invasive way in order to detect abnormal changes in ventricular heterogeneity. In groups of patients with and without history of Torsade de Pointes undergoing a Sotalol challenge, we compute the radius and the linear and angular velocities of QRS complex and T-wave loops. From these signals we extract significant features in order to compute a risk patient classifier. RESULTS Using machine learning techniques and statistical analysis, the combinations of few indices reach a pair of sensitivity/specificity of 100%/100% when separating patients with arrhythmogenic substrate. Several biomarkers not only measure drug-induced changes significantly but also observe differences in at-risk patients outperforming current standards. DISCUSSION Alternative biomarkers were able to describe pre-existing risk of patients. Given the high levels of significance and performance, these results could contribute to a better understanding of the torsadogenic substrate and to the safe development of drug therapies.
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Affiliation(s)
- Pablo Daniel Cruces
- Instituto de Ingeniería Biomédica, UBA, Paseo Colón 850 (C1063ACV), Buenos Aires, Argentina; Instituto Argentino de Matemática 'Alberto P. Calderón', CONICET, Saavedra 15 (C1083ACA), Buenos Aires, Argentina.
| | - Drago Torkar
- Institut 'Jožef Stefan', Department of Computer Systems, Jamova cesta 39 (SI-1000), Ljubljana, Slovenia
| | - Pedro David Arini
- Instituto de Ingeniería Biomédica, UBA, Paseo Colón 850 (C1063ACV), Buenos Aires, Argentina; Instituto Argentino de Matemática 'Alberto P. Calderón', CONICET, Saavedra 15 (C1083ACA), Buenos Aires, Argentina
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The Repolarization Period during the Head-Up Tilt Test in Children with Vasovagal Syncope. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061908. [PMID: 32183460 PMCID: PMC7143898 DOI: 10.3390/ijerph17061908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Electrocardiography (ECG) and the head-up tilt test (HUTT) are vital in clinical work-up in children with vasovagal syncope (VVS). Ventricular repolarization parameters (QT) measured during the HUTT can be indicative of electrical instability; however, these parameters are not frequently assessed. This study aimed to investigate if ventricular repolarization parameters measured during the HUTT could be indicative of future ventricular arrhythmias in children with syncope. METHODS The shape and amplitude of the T-wave and parameters of the repolarization period (QT, QTpeak, Tpeak-Tend) were evaluated in a resting ECG performed on the first day of hospitalization and in ECGs performed during three phases of the HUTT. RESULTS In the after-tilt phase of the HUTT, 19/30 children displayed a change in T-wave morphology. QTc was significantly longer in VVS I compared to that in VVS II patients, but not in the controls (p = 0.092). CONCLUSIONS We need further follow-up studies to establish the clinical importance of abnormal dynamics of the repolarization period in children with VVS and negative HUTT. Therefore, children with abnormal T-wave refraction and prolonged duration of the TpTe should remain under the care of a cardiological outpatient.
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Yoon N, Hong SN, Cho JG, Jeong HK, Lee KH, Park HW. Experimental verification of the value of the T peak -T end interval in ventricular arrhythmia inducibility in an early repolarization syndrome model. J Cardiovasc Electrophysiol 2019; 30:2098-2105. [PMID: 31424133 DOI: 10.1111/jce.14123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/21/2019] [Accepted: 08/03/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In patients with early repolarization patterns on ECG, many researchers have studied to find predictors of fatal arrhythmia. However, there are no satisfying clinical predictors. We evaluated the value of the Tpeak -Tend interval on pseudo-ECG in canine myocardial wedge preparation models of early repolarization syndrome. METHODS AND RESULTS Transmural pseudo-ECG and endocardial/epicardial action potentials were recorded from coronary-perfused canine left ventricular wedge preparations (n = 34). The Ito agonist NS5806 (8-10 µM), the calcium channel blocker verapamil (3 µM) and acetylcholine (2-3 µM) were used to mimic the disease model. A ventricular arrhythmia induction test was performed. QTpeak , QTend , Tpeak -Tend , and Tpeak -Tend /QTend were measured at 15 to 20 minutes after the provocative agent infusion. Polymorphic ventricular tachycardias (pVT) developed in 23 of the 34 preparations (67%). The maximal values of Tpeak -Tend and Tpeak -Tend /QTend were recorded just before pVT induction. At baseline, without the provocative agents, Tpeak -Tend and Tpeak -Tend /QTend were not different between pVT-induced and pVT-noninduced preparations. The Tpeak -Tend of the pVT-induced preparations was longer than that of non-induced preparations (58 ± 26.8 msec vs 33 ± 6.8 msec, P < .001). The Tpeak -Tend /QTend of pVT- induced preparations was larger than that of noninduced preparations (0.220 ± 0.1017 vs 0.128 ± 0.0312, P < .001). The transmural and epicardial dispersion of repolarization of pVT-induced preparations were larger than those of pVT-noninduced preparations. The transmural dispersion of repolarization showed a positive correlation with Tpeak -Tend . CONCLUSION Tpeak -Tend predicted malignant ventricular arrhythmias in early repolarization syndrome models. Tpeak -Tend reflects the repolarization heterogeneity of ventricular myocardium.
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Affiliation(s)
- Namsik Yoon
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seo Na Hong
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jeong Gwan Cho
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyung Ki Jeong
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ki Hong Lee
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyung Wook Park
- Heart Center of Chonnam National University Hospital, Gwangju, Republic of Korea
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