1
|
Association between ventricular repolarization parameters and cardiovascular death in patients of the SWISS-AF cohort. Int J Cardiol 2022; 356:53-59. [DOI: 10.1016/j.ijcard.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 11/18/2022]
|
2
|
Fang SC, Wu YL, Tsai PS. Heart Rate Variability and Risk of All-Cause Death and Cardiovascular Events in Patients With Cardiovascular Disease: A Meta-Analysis of Cohort Studies. Biol Res Nurs 2019; 22:45-56. [PMID: 31558032 DOI: 10.1177/1099800419877442] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Lower heart rate variability (HRV) is associated with a higher risk of cardiovascular events and mortality, although the extent of the association is uncertain. We performed a meta-analysis of cohort studies to elucidate the association between HRV and the risk of all-cause death or cardiovascular events in patients with cardiovascular disease (CVD) during a follow-up of at least 1 year. We searched four databases (PubMed, MEDLINE, Embase, and Cochrane Central Register of Controlled Trials) and extracted the adjusted hazard ratio (HR) from eligible studies. We included 28 cohort studies involving 3,094 participants in the meta-analysis. Results revealed that lower HRV was associated with a higher risk of all-cause death and cardiovascular events; the pooled HR was 2.27 (95% confidence interval [CI]: 1.72, 3.00) and 1.41 (95% CI: 1.16, 1.72), respectively. In subgroup analyses, the pooled HR of all-cause death was significant for patients with acute myocardial infarction (AMI) but not for those with heart failure. The pooled HR for cardiovascular events was significant for the subgroup of patients with AMI and acute coronary syndrome but not for those with coronary artery disease and heart failure. Additionally, both time and frequency domains of HRV were significantly associated with risk of all-cause death and cardiovascular events in patients with CVD.
Collapse
Affiliation(s)
- Su-Chen Fang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei
| | - Yu-Lin Wu
- Department of Nursing, St. Mary's Junior College of Medicine, Nursing and Management, Yilan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei.,Department of Nursing and Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei.,Sleep Research Center, Taipei Medical University Hospital, Taipei
| |
Collapse
|
3
|
Restitution and Stability of Human Ventricular Action Potential at High and Variable Pacing Rate. Biophys J 2019; 117:2382-2395. [PMID: 31514969 DOI: 10.1016/j.bpj.2019.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022] Open
Abstract
Despite the key role of beat-to-beat action potential (AP) variability in the onset of ventricular arrhythmias at high pacing rate, the knowledge of the involved dynamics and of effective prognostic parameters is largely incomplete. Electrical restitution (ER), the way AP duration (APD) senses changes in preceding cycle length (CL), has been used to monitor transition to arrhythmias. The use of standard ER (sER), though, is controversial, not always suitable for in vivo and only rarely for clinical applications. By means of simulations on a human ventricular AP model, I investigate the dynamics of APD at high pacing rate under sinusoidally, saw-tooth, and randomly variable pacing CLs. AP sequences were compared in terms of beat-to-beat restitution (btb-ER) and of the collections of sER curves generated from each beat. A definition of APD stability is also proposed, based on successive APD changes introduced in an AP sequence by a premature beat. The explored CL range includes values leading to APD alternans under constant pacing. Three different types of response to CL variability were found, corresponding to progressively higher rate of beat-to-beat CL changes. Low rates (∼1 ms/beat) generate a btb-ER dominated by steady-state rate dependence of APD (type 1), intermediate rates (∼5 ms/beat) lead to a btb-ER similar to a single sER (type 2), and high rates (∼20 ms/beat) to hysteretic btb-ER under periodic pacing and to a vertically spread btb-ER in the case of random pacing (type 3). Stability of AP repolarization always increases with the rate of CL changes. Thus, rather than looking at sER slope, which requires additional interventions during the recording of cardiac electrical activity, this study provides rationale for the use of btb-ER representations as predictors of repolarization stability under extreme pacing conditions, known to be critical for the arrhythmia development.
Collapse
|
4
|
Al-Zaiti SS, Pietrasik G, Carey MG, Alhamaydeh M, Canty JM, Fallavollita JA. The role of heart rate variability, heart rate turbulence, and deceleration capacity in predicting cause-specific mortality in chronic heart failure. J Electrocardiol 2018; 52:70-74. [PMID: 30476644 DOI: 10.1016/j.jelectrocard.2018.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The volume of regional denervated myocardium (D-M) on positron emission tomography has been recently suggested as a strong independent predictor of cause-specific mortality from sudden cardiac arrest (SCA) in chronic heart failure. We sought to evaluate whether ECG indices of global autonomic function predict risk of SCA to a similar degree as regional D-M. METHODS Subjects enrolled in the Prediction of Arrhythmic Events using Positron Emission Tomography (PAREPET) study were included in this study. Patients completed a 24-hour Holter ECG at enrollment and were followed up at 3-month intervals. SCA events were adjudicated by two board-certified cardiologists. Other cardiovascular death events were classified as nonsudden cardiac death (NSCD). Eight measures of heart rate variability were analyzed: SDNN, RMSSD, low-frequency (LF) and high-frequency (HF) power, heart rate turbulence onset and slope, and acceleration and deceleration capacity. We used competing risk regression to delineate cause-specific mortality from SCA versus NSCD. RESULTS Our sample included 127 patients (age 67 ± 12, 92% male). After a median follow-up of 4.1 years, there were 22 (17%) adjudicated SCA and 18 (14%) adjudicated NSCD events. In multivariate Cox-regression, LF power was the only HRV parameter to predict time-to-SCA. However, in competing risk analysis, reduced LF power was preferentially associated with NSCD rather than SCA (HR = 0.92 [0.85-0.98], p = 0.019). CONCLUSION Depressed LF power might indicate impaired vagal reflex, which suggests that increasing vagal tone in these patients would have a protective effect against NSCD beyond that achieved by the mere slowing of heart rate using β-blockers.
Collapse
Affiliation(s)
- Salah S Al-Zaiti
- University of Pittsburgh, Pittsburgh, PA, United States of America.
| | | | - Mary G Carey
- Strong Memorial Hospital at University of Rochester Medical Center, Rochester, NY, United States of America
| | | | - John M Canty
- State University of New York, Buffalo, NY, United States of America; VA Western NY Health Care System, Buffalo, NY, United States of America
| | - James A Fallavollita
- State University of New York, Buffalo, NY, United States of America; VA Western NY Health Care System, Buffalo, NY, United States of America
| |
Collapse
|
5
|
Atrial fibrillation is associated with sudden cardiac death: a systematic review and meta-analysis. J Interv Card Electrophysiol 2018; 51:91-104. [DOI: 10.1007/s10840-017-0308-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/19/2017] [Indexed: 01/11/2023]
|
6
|
Botsva N, Naishtetik I, Khimion L, Chernetchenko D. Predictors of aging based on the analysis of heart rate variability. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1269-1278. [PMID: 28983984 DOI: 10.1111/pace.13180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/31/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The current significant progress in the use of heart rate variability in the solution of many diagnostic and therapeutic problems is determined by the availability of standardized methods of measurement and physiological interpretation of heart rate variability indices on the one hand and the high technological level of state-of-the-art electronic measuring equipment that is used for automatic registration and computer processing of cardio-signals. METHODS A retrospective analysis of anonymized cardio screening results of 22,433 adult residents of 565 settlements (cities and villages) across all 20 administrative districts of the Khmelnytskyi Region (Ukraine) was conducted to find a statistically significant connection between individual heart rate variability parameters and the age of people. RESULTS Primary statistical analysis and visualization showed a correlation between the selected heart rate variability parameters and the age and sex of the examined persons. The study found values of the predicted age slightly over estimation versus the actual age for very young test subjects and below estimation for elderly subjects. CONCLUSION The use of neural network computations and the modification of the algorithm through the construction of individual training samples for different age intervals, and the creation of individual ensembles of classification neural networks, therefore achieved a prediction of the age of examined persons based on the values of their time and frequency domain heart rate variability indices, with 87% accuracy for women and 85% accuracy for men in the 66-85 years age interval and at least 85% for age groups across the entire sample.
Collapse
Affiliation(s)
- Nataliia Botsva
- Oles Honchar Dnipropetrovsk National University, 20 Kazakova Str., Dnipro, 49010, Ukraine
| | - Iryna Naishtetik
- Academy of the Postgraduate Education named after P.L. Schupik, Dorogozhytska Str., Kyiv, 04112, Ukraine
| | - Ludmyla Khimion
- Academy of the Postgraduate Education named after P.L. Schupik, Dorogozhytska Str., Kyiv, 04112, Ukraine
| | - Dmitriy Chernetchenko
- Oles Honchar Dnipropetrovsk National University, 20 Kazakova Str., Dnipro, 49010, Ukraine
| |
Collapse
|
7
|
Indik JH, Nair V, Rafikov R, Nyotowidjojo IS, Bisla J, Kansal M, Parikh DS, Robinson M, Desai A, Oberoi M, Gupta A, Abbasi T, Khalpey Z, Patel AR, Lang RM, Dudley SC, Choi BR, Garcia JGN, Machado RF, Desai AA. Associations of Prolonged QTc in Sickle Cell Disease. PLoS One 2016; 11:e0164526. [PMID: 27736922 PMCID: PMC5063274 DOI: 10.1371/journal.pone.0164526] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/27/2016] [Indexed: 12/23/2022] Open
Abstract
Sudden death is a leading cause of mortality in sickle cell disease, implicating ventricular tachyarrhythmias. Prolonged QTc on an electrocardiogram (ECG), commonly seen with myocardial ischemia, is a known risk for polymorphic ventricular tachycardia (VT). We hypothesized that prolonged QTc is associated with mortality in sickle cell disease. ECG were analyzed from a cohort of 224 sickle patients (University of Illinois at Chicago, UIC) along with available laboratory, and echocardiographic findings, and from another cohort of 38 patients (University of Chicago, UC) for which cardiac MRI and free heme values were also measured. In the UIC cohort, QTc was potentially related to mortality with a hazard ratio (HR) of 1.22 per 10ms, (P = 0.015), and a HR = 3.19 (P = 0.045) for a QTc>480ms. In multivariate analyses, QTc remained significantly associated with survival after adjusting for inpatient ECG status (HR 1.26 per 10ms interval, P = 0.010) and genotype status [HR 1.21 per 10ms interval, P = 0.037). QTc trended toward association with mortality after adjusting for both LDH and hydroxyurea use (HR 1.21 per 10ms interval, P = 0.062) but was not significant after adjusting for TRV. In univariate analyses, QTc was related to markers of hemolysis including AST (P = 0.031), hemoglobin (P = 0.014), TR velocity (P = 0.036), higher in inpatients (P<0.001) and those with an SS compared to SC genotype (P<0.001) in the UIC cohort as well as to free heme in the UC cohort (P = 0.002). These findings support a relationship of prolonged QTc with hemolysis and potentially mortality in sickle cell disease.
Collapse
Affiliation(s)
- Julia H Indik
- Department of Medicine and Arizona Health Sciences Center, University of Arizona, Tucson, AZ, United States of America
| | - Vineet Nair
- Department of Medicine and Arizona Health Sciences Center, University of Arizona, Tucson, AZ, United States of America
| | - Ruslan Rafikov
- Department of Medicine and Arizona Health Sciences Center, University of Arizona, Tucson, AZ, United States of America
| | - Iwan S Nyotowidjojo
- Department of Medicine and Arizona Health Sciences Center, University of Arizona, Tucson, AZ, United States of America
| | - Jaskanwal Bisla
- Department of Medicine and Arizona Health Sciences Center, University of Arizona, Tucson, AZ, United States of America
| | - Mayank Kansal
- Department of Medicine, University of Illinois Hospitals and Health Sciences System, Chicago, IL, United States of America
| | - Devang S Parikh
- Department of Medicine, University of Illinois Hospitals and Health Sciences System, Chicago, IL, United States of America
| | - Melissa Robinson
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Anand Desai
- Department of Family Medicine, Creighton University Medical Center, Omaha, NE, United States of America
| | - Megha Oberoi
- Department of Medicine, Oakhill Hospital, Brooksville, FL, United States of America
| | - Akash Gupta
- Department of Medicine and Arizona Health Sciences Center, University of Arizona, Tucson, AZ, United States of America
| | - Taimur Abbasi
- Department of Medicine, Mercy Hospital and Health Center, Chicago, IL, United States of America
| | - Zain Khalpey
- Department of Surgery and Arizona Health Sciences Center, University of Arizona, Tucson, AZ, United States of America
| | - Amit R Patel
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Roberto M Lang
- Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Samuel C Dudley
- Lifespan Cardiovascular Institute and Brown University, Providence, RI, United States of America
| | - Bum-Rak Choi
- Lifespan Cardiovascular Institute and Brown University, Providence, RI, United States of America
| | - Joe G N Garcia
- Department of Medicine and Arizona Health Sciences Center, University of Arizona, Tucson, AZ, United States of America
| | - Roberto F Machado
- Department of Medicine, University of Illinois Hospitals and Health Sciences System, Chicago, IL, United States of America
| | - Ankit A Desai
- Department of Medicine and Arizona Health Sciences Center, University of Arizona, Tucson, AZ, United States of America
| |
Collapse
|
8
|
Eranti A, Aro AL, Kenttä T, Holkeri A, Tikkanen JT, Junttila MJ, Huikuri HV. 12-Lead electrocardiogram as a predictor of sudden cardiac death: from epidemiology to clinical practice. SCAND CARDIOVASC J 2016; 50:253-259. [PMID: 27454252 DOI: 10.1080/14017431.2016.1215520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sudden cardiac death (SCD) causes a high burden of premature deaths in the population affecting subjects of all ages. The identification of subjects at high risk for SCD is of great importance as the prevention of many of these events would be possible with the treatment of underlying cardiac diseases and the use of implantable cardioverter-defibrillators (ICD). However, the current selection of patients for ICD therapy is based solely on left ventricular ejection fraction, and thus a substantial portion of patients at high risk does not qualify for the therapy. Role of the standard electrocardiogram (ECG) in SCD risk stratification has been under active research during the last decade and multiple abnormalities of depolarization and repolarization on the ECG associated with an increased risk of SCD have been identified. In this review, we describe the basic pathophysiological principles behind these changes. We also review the current knowledge of the prognostic significance of ECG predictors of SCD in the general population, and in patients with coronary heart disease (CHD), heart failure, cardiomyopathies, and in inheritable arrhythmia syndromes. Also, insights into the novel digital ECG signal processing techniques are provided.
Collapse
Affiliation(s)
- Antti Eranti
- a Department of Internal Medicine , Päijät-Häme Central Hospital , Lahti , Finland
| | - Aapo L Aro
- b Division of Cardiology , Heart and Lung Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Tuomas Kenttä
- c Medical Research Center Oulu, Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Arttu Holkeri
- b Division of Cardiology , Heart and Lung Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Jani T Tikkanen
- c Medical Research Center Oulu, Oulu University Hospital and University of Oulu , Oulu , Finland
| | - M Juhani Junttila
- c Medical Research Center Oulu, Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Heikki V Huikuri
- c Medical Research Center Oulu, Oulu University Hospital and University of Oulu , Oulu , Finland
| |
Collapse
|
9
|
Electrocardiographic Predictors of Cardiovascular Mortality. DISEASE MARKERS 2015; 2015:727401. [PMID: 26257460 PMCID: PMC4519551 DOI: 10.1155/2015/727401] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 06/20/2015] [Accepted: 07/02/2015] [Indexed: 01/26/2023]
Abstract
Cardiovascular diseases are the main causes of mortality. Sudden cardiac death may also appear in athletes, due to underlying congenital or inherited cardiac abnormalities. The electrocardiogram is used in clinical practice and clinical trials, as a valid, reliable, accessible, inexpensive method. The aim of the present paper was to review electrocardiographic (ECG) signs associated with cardiovascular mortality and the mechanisms underlying those associations, providing a brief description of the main studies in this area, and consider their implication for clinical practice in the general population and athletes. The main ECG parameters associated with cardiovascular mortality in the present paper are the P wave (duration, interatrial block, and deep terminal negativity of the P wave in V1), prolonged QT and Tpeak-Tend intervals, QRS duration and fragmentation, bundle branch block, ST segment depression and elevation, T waves (inverted, T wave axes), spatial angles between QRS and T vectors, premature ventricular contractions, and ECG hypertrophy criteria.
Collapse
|
10
|
Al-Zaiti SS, Fallavollita JA, Canty JM, Carey MG. The prognostic value of discordant T waves in lead aVR: A simple risk marker of sudden cardiac arrest in ischemic cardiomyopathy. J Electrocardiol 2015; 48:887-92. [PMID: 26233648 DOI: 10.1016/j.jelectrocard.2015.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Simple and reliable ECG marker(s) for sudden cardiac arrest (SCA) could be very useful in assessing high-risk populations. Since ischemic repolarization abnormalities in the left ventricular (LV) apex are strongly correlated with discordant T waves in lead aVR, we sought to evaluate the clinical and prognostic significance of this feature in ischemic cardiomyopathy. METHODS The PAREPET trial enrolled patients with ischemic cardiomyopathy eligible for a primary prevention implantable cardiac defibrillator (ICD). Those with persistent pacing or left bundle branch block were excluded. Amplitudes of T/aVR were automatically computed from median ECG beats at enrollment and endpoints were blindly adjudicated. RESULTS The sample was mainly composed of older men (n=138, age 65±12, 91% male, EF 29±9%). At enrollment, amplitude of T/aVR significantly correlated with EF, indexed LV end-diastolic volume, B-type natriuretic peptide (BNP), regional scar volume, and PET-quantified denervated myocardium. After a median follow up of 4.2years, there were 23 (17%) adjudicated SCA. In multivariate analysis, the presence of discordant T/aVR (>0mm, n=42, 30%) was a significant and independent predictor of SCA (hazard ratio 2.0 [95% CI 1.0-4.9]) and cardiac death (hazard ratio 1.9 [95% CI 1.0-3.7]). CONCLUSIONS In subjects with ischemic cardiomyopathy, discordant T waves in lead aVR are associated with high-risk clinical parameters including lower ejection fraction, greater ventricular volume, higher BNP, and more denervated myocardium. Furthermore, discordant T/aVR remained an independent predictor of SCA and cardiovascular mortality even after accounting for these prognostic factors.
Collapse
Affiliation(s)
| | - James A Fallavollita
- VA WNY Health Care System at Buffalo, Buffalo, NY, USA; Clinical Translational Research Center, Buffalo, NY, USA; Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | - John M Canty
- VA WNY Health Care System at Buffalo, Buffalo, NY, USA; Clinical Translational Research Center, Buffalo, NY, USA; Department of Medicine, University at Buffalo, Buffalo, NY, USA; Department of Physiology & Biophysics, University at Buffalo, Buffalo, NY, USA; Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Mary G Carey
- University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|