1
|
Soflaei Saffar S, Nazar E, Sahranavard T, Fayedeh F, Moodi Ghalibaf A, Ebrahimi M, Alimi H, Shahri B, Izadi-Moud A, Ferns GA, Ghodsi A, Mehrabi S, Tarhimi M, Esmaily H, Moohebati M, Ghayour-Mobarhan M. Association of T-wave electrocardiogram changes and type 2 diabetes: a cross-sectional sub-analysis of the MASHAD cohort population using the Minnesota coding system. BMC Cardiovasc Disord 2024; 24:48. [PMID: 38218755 PMCID: PMC10788011 DOI: 10.1186/s12872-023-03649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/30/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) has become a major health concern with an increasing prevalence and is now one of the leading attributable causes of death globally. T2DM and cardiovascular disease are strongly associated and T2DM is an important independent risk factor for ischemic heart disease. T-wave abnormalities (TWA) on electrocardiogram (ECG) can indicate several pathologies including ischemia. In this study, we aimed to investigate the association between T2DM and T-wave changes using the Minnesota coding system. METHODS A cross-sectional study was conducted on the MASHAD cohort study population. All participants of the cohort population were enrolled in the study. 12-lead ECG and Minnesota coding system (codes 5-1 to 5-4) were utilized for T-wave observation and interpretation. Regression models were used for the final evaluation with a level of significance being considered at p < 0.05. RESULTS A total of 9035 participants aged 35-65 years old were included in the study, of whom 1273 were diabetic. The prevalence of code 5-2, 5-3, major and minor TWA were significantly higher in diabetics (p < 0.05). However, following adjustment for age, gender, and hypertension, the presence of TWAs was not significantly associated with T2DM (p > 0.05). Hypertension, age, and body mass index were significantly associated with T2DM (p < 0.05). CONCLUSIONS Although some T-wave abnormalities were more frequent in diabetics, they were not statistically associated with the presence of T2DM in our study.
Collapse
Affiliation(s)
- Sara Soflaei Saffar
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eisa Nazar
- Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Toktam Sahranavard
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Fayedeh
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Mahmoud Ebrahimi
- Vascular and Endovascular Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Alimi
- Vascular and Endovascular Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahram Shahri
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azadeh Izadi-Moud
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton and Sussex Medical School, Division of Medical Education, Brighton, UK
| | - Alireza Ghodsi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Mehrabi
- Department of Cardiology, Faculty of Medicine, Gonabad University of Medical Sciences, Mashhad, Iran
| | - Milad Tarhimi
- Department of Cardiology, Faculty of Medicine, Gonabad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Moohebati
- Vascular and Endovascular Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Majid Ghayour-Mobarhan
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, 99199-91766, Iran.
| |
Collapse
|
2
|
ElRefai M, Abouelasaad M, Wiles BM, Dunn AJ, Coniglio S, Zemkoho AB, Morgan J, Roberts PR. Correlation analysis of deep learning methods in S-ICD screening. Ann Noninvasive Electrocardiol 2023:e13056. [PMID: 36920649 DOI: 10.1111/anec.13056] [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: 12/11/2022] [Revised: 01/12/2023] [Accepted: 02/26/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Machine learning methods are used in the classification of various cardiovascular diseases through ECG data analysis. The concept of varying subcutaneous implantable cardiac defibrillator (S-ICD) eligibility, owing to the dynamicity of ECG signals, has been introduced before. There are practical limitations to acquiring longer durations of ECG signals for S-ICD screening. This study explored the potential use of deep learning methods in S-ICD screening. METHODS This was a retrospective study. A deep learning tool was used to provide descriptive analysis of the T:R ratios over 24 h recordings of S-ICD vectors. Spearman's rank correlation test was used to compare the results statistically to those of a "gold standard" S-ICD simulator. RESULTS A total of 14 patients (mean age: 63.7 ± 5.2 years, 71.4% male) were recruited and 28 vectors were analyzed. Mean T:R, standard deviation of T:R, and favorable ratio time (FVR)-a new concept introduced in this study-for all vectors combined were 0.21 ± 0.11, 0.08 ± 0.04, and 79 ± 30%, respectively. There were statistically significant strong correlations between the outcomes of our novel tool and the S-ICD simulator (p < .001). CONCLUSION Deep learning methods could provide a practical software solution to analyze data acquired for longer durations than current S-ICD screening practices. This could help select patients better suited for S-ICD therapy as well as guide vector selection in S-ICD eligible patients. Further work is needed before this could be translated into clinical practice.
Collapse
Affiliation(s)
- Mohamed ElRefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohamed Abouelasaad
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Anthony J Dunn
- School of Mathematical Sciences, University of Southampton, UK
| | | | - Alain B Zemkoho
- School of Mathematical Sciences, University of Southampton, UK
| | - John Morgan
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
ElRefai M, Abouelasaad M, Wiles BM, Dunn AJ, Coniglio S, Zemkoho AB, Morgan JM, Roberts PR. Role of deep learning methods in screening for subcutaneous implantable cardioverter defibrillator in heart failure. Ann Noninvasive Electrocardiol 2022; 28:e13028. [PMID: 36524869 PMCID: PMC9833355 DOI: 10.1111/anec.13028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION S-ICD eligibility is assessed at pre-implant screening where surface ECG traces are used as surrogates for S-ICD vectors. In heart failure (HF) patients undergoing diuresis, electrolytes and fluid shifts can cause changes in R and T waves. Subsequently, T:R ratio, a major predictor of S-ICD eligibility, can be dynamic. METHODS This is a prospective study of patients with structurally normal hearts and HF patients undergoing diuresis. All patients were fitted with Holters® to record their S-ICD vectors. Our deep learning model was used to analyze the T:R ratios across the recordings. Welch two sample t-test and Mann-Whitney U were used to compare the data between the two groups. RESULTS Twenty-one patients (age 58.43 ± 18.92, 62% male, 14 HF, 7 normal hearts) were enrolled. There was a significant difference in the T:R ratios between both groups. Mean T: R was higher in the HF group (0.18 ± 0.08 vs 0.10 ± 0.05, p < .001). Standard deviation of T: R was also higher in the HF group (0.09 ± 0.05 vs 0.07 ± 0.04, p = .024). There was no difference between leads within the same group. CONCLUSIONS T:R ratio, a main determinant for S-ICD eligibility, is higher and has more tendency to fluctuate in HF patients undergoing diuresis. We hypothesize that our novel neural network model could be used to select HF patients eligible for S-ICD by better characterization of T:R ratio reducing the risk of T-wave over-sensing (TWO) and inappropriate shocks. Further work is required to consolidate our findings before applying to clinical practice.
Collapse
Affiliation(s)
- Mohamed ElRefai
- Cardiac Rhythm Management Research DepartmentUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK,Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Mohamed Abouelasaad
- Cardiac Rhythm Management Research DepartmentUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | | | - Anthony J. Dunn
- School of Mathematical SciencesUniversity of SouthamptonSouthamptonUK
| | - Stefano Coniglio
- School of Mathematical SciencesUniversity of SouthamptonSouthamptonUK
| | - Alain B. Zemkoho
- School of Mathematical SciencesUniversity of SouthamptonSouthamptonUK
| | - John M. Morgan
- Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Paul R. Roberts
- Cardiac Rhythm Management Research DepartmentUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK,Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| |
Collapse
|
4
|
Dunn AJ, ElRefai MH, Roberts PR, Coniglio S, Wiles BM, Zemkoho AB. Deep learning methods for screening patients' S-ICD implantation eligibility. Artif Intell Med 2021; 119:102139. [PMID: 34531008 DOI: 10.1016/j.artmed.2021.102139] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/20/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
Subcutaneous Implantable Cardioverter-Defibrillators (S-ICDs) are used for prevention of sudden cardiac death triggered by ventricular arrhythmias. T Wave Over Sensing (TWOS) is an inherent risk with S-ICDs which can lead to inappropriate shocks. A major predictor of TWOS is a high T:R ratio (the ratio between the amplitudes of the T and R waves). Currently, patients' Electrocardiograms (ECGs) are screened over 10 s to measure the T:R ratio to determine the patients' eligibility for S-ICD implantation. Due to temporal variations in the T:R ratio, 10 s is not a long enough window to reliably determine the normal values of a patient's T:R ratio. In this paper, we develop a convolutional neural network (CNN) based model utilising phase space reconstruction matrices to predict T:R ratios from 10-second ECG segments without explicitly locating the R or T waves, thus avoiding the issue of TWOS. This tool can be used to automatically screen patients over a much longer period and provide an in-depth description of the behavior of the T:R ratio over that period. The tool can also enable much more reliable and descriptive screenings to better assess patients' eligibility for S-ICD implantation.
Collapse
Affiliation(s)
- Anthony J Dunn
- University of Southampton, School of Mathematical Sciences, United Kingdom
| | | | | | - Stefano Coniglio
- University of Southampton, School of Mathematical Sciences, United Kingdom
| | - Benedict M Wiles
- St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Alain B Zemkoho
- University of Southampton, School of Mathematical Sciences, United Kingdom.
| |
Collapse
|
5
|
Lee S, Zhou J, Jeevaratnam K, Wong WT, Wong ICK, Mak C, Mok NS, Liu T, Zhang Q, Tse G. Paediatric/young versus adult patients with long QT syndrome. Open Heart 2021; 8:openhrt-2021-001671. [PMID: 34518285 PMCID: PMC8438947 DOI: 10.1136/openhrt-2021-001671] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Long QT syndrome (LQTS) is a less prevalent cardiac ion channelopathy than Brugada syndrome in Asia. The present study compared the outcomes between paediatric/young and adult LQTS patients. Methods This was a population-based retrospective cohort study of consecutive patients diagnosed with LQTS attending public hospitals in Hong Kong. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF). Results A total of 142 LQTS (mean onset age=27±23 years old) were included. Arrhythmias other than VT/VF (HR 4.67, 95% CI (1.53 to 14.3), p=0.007), initial VT/VF (HR=3.25 (95% CI 1.29 to 8.16), p=0.012) and Schwartz score (HR=1.90 (95% CI 1.11 to 3.26), p=0.020) were predictive of the primary outcome for the overall cohort, while arrhythmias other than VT/VF (HR=5.41 (95% CI 1.36 to 21.4), p=0.016) and Schwartz score (HR=4.67 (95% CI 1.48 to 14.7), p=0.009) were predictive for the adult subgroup (>25 years old; n=58). A random survival forest model identified initial VT/VF, Schwartz score, initial QTc interval, family history of LQTS, initially asymptomatic and arrhythmias other than VT/VF as the most important variables for risk prediction. Conclusion Clinical and ECG presentation varies between the paediatric/young and adult LQTS population. Machine learning models achieved more accurate VT/VF prediction.
Collapse
Affiliation(s)
- Sharen Lee
- Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Ian Chi Kei Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Chloe Mak
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | - Ngai Shing Mok
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, People's Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Gary Tse
- Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration .,Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| |
Collapse
|
6
|
Bird K, Chan G, Lu H, Greeff H, Allen J, Abbott D, Menon C, Lovell NH, Howard N, Chan WS, Fletcher RR, Alian A, Ward R, Elgendi M. Assessment of Hypertension Using Clinical Electrocardiogram Features: A First-Ever Review. Front Med (Lausanne) 2020; 7:583331. [PMID: 33344473 PMCID: PMC7746856 DOI: 10.3389/fmed.2020.583331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/16/2020] [Indexed: 12/31/2022] Open
Abstract
Hypertension affects an estimated 1.4 billion people and is a major cause of morbidity and mortality worldwide. Early diagnosis and intervention can potentially decrease cardiovascular events later in life. However, blood pressure (BP) measurements take time and require training for health care professionals. The measurements are also inconvenient for patients to access, numerous daily variables affect BP values, and only a few BP readings can be collected per session. This leads to an unmet need for an accurate, 24-h continuous, and portable BP measurement system. Electrocardiograms (ECGs) have been considered as an alternative way to measure BP and may meet this need. This review summarizes the literature published from January 1, 2010, to January 1, 2020, on the use of only ECG wave morphology to monitor BP or identify hypertension. From 35 articles analyzed (9 of those with no listed comorbidities and confounders), the P wave, QTc intervals and TpTe intervals may be promising for this purpose. Unfortunately, with the limited number of articles and the variety of participant populations, we are unable to make conclusions about the effectiveness of ECG-only BP monitoring. We provide 13 recommendations for future ECG-only BP monitoring studies and highlight the limited findings in pregnant and pediatric populations. With the advent of convenient and portable ECG signal recording in smart devices and wearables such as watches, understanding how to apply ECG-only findings to identify hypertension early is crucial to improving health outcomes worldwide.
Collapse
Affiliation(s)
- Kathleen Bird
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gabriel Chan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Huiqi Lu
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Heloise Greeff
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - John Allen
- Research Center for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Derek Abbott
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia.,Center for Biomedical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Carlo Menon
- School of Mechatronic Systems Engineering, Simon Fraser University, Burnaby, BC, Canada
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Newton Howard
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Wee-Shian Chan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Ribon Fletcher
- D-Lab, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States
| | - Aymen Alian
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Rabab Ward
- School of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Mohamed Elgendi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,School of Mechatronic Systems Engineering, Simon Fraser University, Burnaby, BC, Canada.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.,School of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada.,BC Children's & Women's Hospital, Vancouver, BC, Canada
| |
Collapse
|
7
|
Wang Q, Ma W, Xia J. Nonalcoholic Fatty Liver Is Associated With Further Left Ventricular Abnormalities in Patients With Type 2 Diabetes Mellitus: A 3-Dimensional Speckle-Tracking Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1899-1911. [PMID: 29363154 DOI: 10.1002/jum.14536] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to detect left ventricular (LV) structure and function abnormalities in patients with type 2 diabetes mellitus with or without nonalcoholic fatty liver (NAFL) using 3-dimensional speckle-tracking echocardiography. METHODS Eighty patients with type 2 diabetes and a normal LV ejection fraction (≥55%), including 40 with coexistent NAFL, and 40 age- and sex-matched control participants were recruited. Conventional echocardiography and 3-dimensional speckle-tracking echocardiography were performed, and global longitudinal strain, global circumferential strain, global area strain, and global radial strain values were measured. RESULTS Significant differences in 2-dimensional LV functional patterns were found among the 3 groups (P = .031), and LV hypertrophy was the most prevalent in patients with diabetes and NAFL. The patients with diabetes only had significantly lower global longitudinal strain, global circumferential strain, and global radial strain than the controls (all P < .05). The patients with diabetes and NAFL had severely lower global longitudinal strain, global circumferential strain, global area strain, and global radial strain than the controls (all P < .001), and they also had severely lower global longitudinal strain, global area strain, and global radial strain than the patients with diabetes only (all P < 0.001). The hemoglobin A1c level and NAFL were independently associated with strain values in all patients with diabetes. The strain values in multiple directions (≥2 of global longitudinal, global circumferential, global area, and global radial strain) decreased significantly in the patients with diabetes and moderate and severe NAFL compared to those with mild NAFL (all P < .05). CONCLUSIONS Nonalcoholic fatty liver could aggravate LV hypertrophy and dysfunction in patients with type 2 diabetes. The combined application of conventional and 3-dimensional speckle-tracking echocardiography could detect these asymptomatic preclinical abnormalities.
Collapse
Affiliation(s)
- Qingqing Wang
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenyan Ma
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jizhu Xia
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
| |
Collapse
|
8
|
Iacoviello L, Bonaccio M, Di Castelnuovo A, Costanzo S, Rago L, De Curtis A, Assanelli D, Badilini F, Vaglio M, Persichillo M, Macfarlane PW, Cerletti C, Donati MB, de Gaetano G. Frontal plane T-wave axis orientation predicts coronary events: Findings from the Moli-sani study. Atherosclerosis 2017; 264:51-57. [PMID: 28772106 DOI: 10.1016/j.atherosclerosis.2017.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS The orientation of the frontal plane T-wave axis (T axis) is a reliable measure of ventricular repolarisation. We investigated the association between T-axis and the risk of coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), stroke and cardiovascular (CVD) mortality. METHODS A sample of 21,287 Moli-sani participants randomly recruited from the general adult (≥35 y) Italian population, free of CVD disease, were followed for a median of 4.4 years. T-axis was measured from a standard 12-lead resting ECG. RESULTS After adjusting for CVD risk factors, subjects with abnormal T-axis showed an increase in the risk of both CHD (Hazard Ratio (HR) = 2.65; 95% CI = 1.67-4.21), HF (HR = 2.56; 1.80-3.63), AF (HR = 2.48; 1.56-3.94) and CVD mortality (HR = 2.83; 1.50-5.32). The association with CHD and HF, but not with AF or CVD death, remained significant after further adjustment for ECG abnormalities. Subjects with abnormal T-axis showed higher levels of subclinical inflammation, hs-troponin I and hs-NT-proBNP (p < 0.001 for all). However, further adjustment for troponin I and/or NT-proBNP determined a reduction of HRs ranging from 12.1 to 24.0% for CHD, while additional adjustment for inflammation markers did not change any association. CONCLUSIONS An abnormal T-axis orientation is associated with an increased risk of both CHD and HF, independently of common CVD risk factors and other ECG abnormalities. This association was partially explained by increased hs-troponin I and hs-NT-proBNP levels.
Collapse
Affiliation(s)
- Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Augusto Di Castelnuovo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Livia Rago
- EPICOMED Research, SRL, Campobasso, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | | | | | | | - Mariarosaria Persichillo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | | | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | | |
Collapse
|
9
|
ECG-ViEW II, a freely accessible electrocardiogram database. PLoS One 2017; 12:e0176222. [PMID: 28437484 PMCID: PMC5402933 DOI: 10.1371/journal.pone.0176222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/17/2017] [Indexed: 11/19/2022] Open
Abstract
The Electrocardiogram Vigilance with Electronic data Warehouse II (ECG-ViEW II) is a large, single-center database comprising numeric parameter data of the surface electrocardiograms of all patients who underwent testing from 1 June 1994 to 31 July 2013. The electrocardiographic data include the test date, clinical department, RR interval, PR interval, QRS duration, QT interval, QTc interval, P axis, QRS axis, and T axis. These data are connected with patient age, sex, ethnicity, comorbidities, age-adjusted Charlson comorbidity index, prescribed drugs, and electrolyte levels. This longitudinal observational database contains 979,273 electrocardiograms from 461,178 patients over a 19-year study period. This database can provide an opportunity to study electrocardiographic changes caused by medications, disease, or other demographic variables. ECG-ViEW II is freely available at http://www.ecgview.org.
Collapse
|
10
|
Dilaveris P, Antoniou CK, Gatzoulis K, Tousoulis D. T wave axis deviation and QRS-T angle - Controversial indicators of incident coronary heart events. J Electrocardiol 2017; 50:466-475. [PMID: 28262257 DOI: 10.1016/j.jelectrocard.2017.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Indexed: 11/29/2022]
Abstract
Abnormal orientation of the T-wave axis and increased angle between the QRS complex (depolarization) and the T-wave (repolarization) have long been assumed to provide a global measure of repolarization abnormality, and have been used to assess ventricular repolarization. The ability of the T wave axis deviation and the QRS-T angle to predict incident coronary heart events was examined in several studies. However, conflicting results have led to significant controversy in the literature concerning their purported ability. Potential explanations involve true variation between study populations, non-standardized cut-off values, different baseline cardiovascular risk levels or different patterns of confounding by other concomitant cardiovascular risk factors. In the present article we will attempt to briefly present the rationale and pathophysiology behind these indices, summarize existing knowledge regarding their prognostic significance and their correlation with established cardiovascular disease risk factors. Further prospective studies are necessary to confirm or refute whether T-wave axis deviation, QRS-T angle and ventricular gradient may in the future serve as indicators of incident coronary heart events and mortality, both in populations with higher prevalence of subclinical advanced atherosclerotic heart disease and in apparently healthy subjects.
Collapse
Affiliation(s)
- Polychronis Dilaveris
- First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
| | | | - Konstantinos Gatzoulis
- First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece
| |
Collapse
|
11
|
ECG predictors of T wave oversensing in subcutaneous implantable cardioverter defibrillators. Int J Cardiol 2016; 220:27-31. [DOI: 10.1016/j.ijcard.2016.06.128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 05/17/2016] [Accepted: 06/22/2016] [Indexed: 11/18/2022]
|
12
|
Bonaccio M, Di Castelnuovo A, Rago L, de Curtis A, Assanelli D, Badilini F, Vaglio M, Costanzo S, Persichillo M, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. T-wave axis deviation is associated with biomarkers of low-grade inflammation. Findings from the MOLI-SANI study. Thromb Haemost 2015; 114:1199-206. [PMID: 26155907 DOI: 10.1160/th15-02-0177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/26/2015] [Indexed: 11/05/2022]
Abstract
T-wave axis deviation (TDev) may help identifying subjects at risk for major cardiac events and mortality, but the pathogenesis of TDev is not well established; in particular, the possible association between TDev and inflammation is unexplored and unknown. We aimed at investigating the association between low-grade inflammation and TDev abnormalities by conducting a cross-sectional analysis on 17,507 subjects apparently free from coronary heart and haematological diseases enrolled in the MOLI-SANI study. TDev was measured from a standard 12-lead resting electrocardiogram. High sensitivity (Hs) C-reactive protein (CRP), leukocyte (WBC) and platelet counts, neutrophil or granulocyte to lymphocyte ratios were used as markers of inflammation. In multivariable model subjects reporting high CRP levels had higher odds of having borderline and abnormal TDev (OR=1.70; 95 %CI: 1.53-1.90 and OR=1.72; 95 %CI: 1.23-2.41, respectively); the association was still significant, although reduced, after controlling for body mass index (OR=1.17; 95 %CI: 1.05-1.32, for borderline and OR=1.46; 95 %CI: 1.03-2.08, for abnormal). Similarly, higher neutrophil or granulocyte to lymphocyte ratios were associated with increased odds of having abnormal TDev. Neither platelet nor leukocyte counts were associated with abnormal TDev. The relationship between CRP with TDev abnormalities was significantly stronger in men, in non- obese or normotensive individuals, and in those without metabolic syndrome. In conclusion, C-reactive protein and some cellular biomarkers of inflammation such as granulocyte or neutrophil to lymphocyte ratios were independently associated with abnormal TDev, especially in subjects at low CVD risk. These results suggest that a low-grade inflammation likely contributes to the pathogenesis of T- wave axis deviation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Licia Iacoviello
- Licia Iacoviello, Laboratory of Molecular and Nutritional Epidemiology, Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy, Tel.: +39 0865929664, Fax:+39 0865927575, E-mail:
| | | |
Collapse
|
13
|
Bianco HT, Izar MC, Póvoa RM, Bombig MT, Fonseca HA, Helfenstein T, Ferreira CE, Nicolau JC, Neto AA, Feio CM, Cerci MS, Fonseca FA. Left ventricular hypertrophy and QTc dispersion are predictors of long-term mortality in subjects with type 2 diabetes. Int J Cardiol 2014; 176:1170-2. [DOI: 10.1016/j.ijcard.2014.07.251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
|