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Evaluating of Red Blood Cell Distribution Width, Comorbidities and Electrocardiographic Ratios as Predictors of Prognosis in Patients with Pulmonary Hypertension. Diagnostics (Basel) 2021; 11:diagnostics11071297. [PMID: 34359380 PMCID: PMC8305029 DOI: 10.3390/diagnostics11071297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Pulmonary hypertension is a rare condition that impairs patients' quality of life and life expectancy. The development of noninvasive instruments may help elucidate the prognosis of this cardiorespiratory disease. We aimed to evaluate the utility of routinely performed noninvasive test results as prognostic markers in patients with pulmonary hypertension. We enrolled 198 patients with mean pulmonary artery pressure >25 mmHg measured at cardiac catheterisation or echocardiographic pulmonary artery systolic pressure > 40 mmHg and tricuspid regurgitation Vmax >2.9 m/s, and clinical information regarding management and follow-up studies from the date of diagnosis. Multivariate analysis revealed that female sex [HR: 0.21, (95% CI: 0.07-0.64); p = 0.006], the presence of collagenopathies [HR: 8.63, (95% CI: 2.38-31.32); p = 0.001], an increased red blood cell distribution width [HR: 1.25, (95% CI: 1.04-1.49); p = 0.017] and an increased electrocardiographic P axis (P°)/T axis (T°) ratio [HR: 0.93, (95% CI: 0.88-0.98); p = 0.009] were severity-associated factors, while older age [HR: 1.57, (95% CI: 1.04-1.28); p = 0.006], an increased QRS axis (QRS°)/T° ratio [HR: 1.21, (95% CI: 1.09-1.34); p < 0.001], forced expiratory volume in 1 s [HR: 0.94, (95% CI: 0.91-0.98); p = 0.01] and haematocrit [HR: 0.93, (95% CI: 0.87-0.99); p = 0.04] were mortality-associated factors. Our results support the importance of red blood cell distribution width, electrocardiographic ratios and collagenopathies for assessing pulmonary hypertension prognosis.
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Pollard JD, Haq KT, Lutz KJ, Rogovoy NM, Paternostro KA, Soliman EZ, Maher J, Lima JA, Musani S, Tereshchenko LG. Sex differences in vectorcardiogram of African-Americans with and without cardiovascular disease: a cross-sectional study in the Jackson Heart Study cohort. BMJ Open 2021; 11:e042899. [PMID: 33518522 PMCID: PMC7852937 DOI: 10.1136/bmjopen-2020-042899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/19/2020] [Accepted: 01/11/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We hypothesised that (1) the prevalent cardiovascular disease (CVD) is associated with global electrical heterogeneity (GEH) after adjustment for demographic, anthropometric, socioeconomic and traditional cardiovascular risk factors, (2) there are sex differences in GEH and (3) sex modifies an association of prevalent CVD with GEH. DESIGN Cross-sectional, cohort study. SETTING Prospective African-American The Jackson Heart Study (JHS) with a nested family cohort in 2000-2004 enrolled residents of the Jackson, Mississippi metropolitan area. PARTICIPANTS Participants from the JHS with analysable ECGs recorded in 2009-2013 (n=3679; 62±12 y; 36% men; 863 family units). QRS, T and spatial ventricular gradient (SVG) vectors' magnitude and direction, spatial QRS-T angle and sum absolute QRST integral (SAI QRST) were measured. OUTCOME Prevalent CVD was defined as the history of (1) coronary heart disease defined as diagnosed/silent myocardial infarction, or (2) revascularisation procedure defined as prior coronary/peripheral arterial revascularisation, or (3) carotid angioplasty/carotid endarterectomy, or (4) stroke. RESULTS In adjusted mixed linear models, women had a smaller spatial QRS-T angle (-12.2 (95% CI -19.4 to -5.1)°; p=0.001) and SAI QRST (-29.8 (-39.3 to -20.3) mV*ms; p<0.0001) than men, but larger SVG azimuth (+16.2(10.5-21.9)°; p<0.0001), with a significant random effect between families (+20.8 (8.2-33.5)°; p=0.001). SAI QRST was larger in women with CVD as compared with CVD-free women or men (+15.1 (3.8-26.4) mV*ms; p=0.009). Men with CVD had a smaller T area (by 5.1 (95% CI 1.2 to 9.0) mV*ms) and T peak magnitude (by 44 (95%CI 16 to 71) µV) than CVD-free men. T vectors pointed more posteriorly in women as compared with men (peak T azimuth + 17.2(8.9-25.6)°; p<0.0001), with larger sex differences in T azimuth in some families by +26.3(7.4-45.3)°; p=0.006. CONCLUSIONS There are sex differences in the electrical signature of CVD in African-American men and women. There is a significant effect of unmeasured genetic and environmental factors on cardiac repolarisation.
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Affiliation(s)
- James D Pollard
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kazi T Haq
- Department of Medicine, Cardiovascular Division, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Katherine J Lutz
- Department of Medicine, Cardiovascular Division, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Nichole M Rogovoy
- Department of Medicine, Cardiovascular Division, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Kevin A Paternostro
- Department of Medicine, Cardiovascular Division, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joseph Maher
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Joao Ac Lima
- Department of Medicine, Cardiovascular Division, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Solomon Musani
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Larisa G Tereshchenko
- Department of Medicine, Cardiovascular Division, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
- Department of Medicine, Cardiovascular Division, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kurisu S, Nitta K, Watanabe N, Ikenaga H, Ishibashi K, Fukuda Y, Nakano Y. Effects of Newly Developed Right Versus Left Bundle Branch Block on the QRS Axis, T-wave Axis and Frontal QRS-T Angle in Patients with a Narrow QRS. Intern Med 2021; 60:25-30. [PMID: 32788526 PMCID: PMC7835454 DOI: 10.2169/internalmedicine.5442-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective The QRS-T angle has been established as a repolarization marker. In the present study, we determined whether or not newly developed bundle branch block (BBB) affected the QRS-T angle in patients with a narrow QRS. Methods Twenty-four patients with newly developed BBB and no adverse cardiac events were retrospectively included. The frontal QRS-T angle was defined as the absolute value of the difference between the frontal plane QRS axis and the T-wave axis. These electrocardiogram parameters were serially measured in the settings of narrow QRS and BBB. Results Twelve patients had newly developed right BBB (RBBB), and 12 had newly developed left BBB (LBBB). The development of RBBB did not affect the QRS axis, T-wave axis of QRS-T angle (41° ±42° to 53° ±65°, p = 0.63). In contrast, the development of LBBB shifted the QRS axis to the left (25° ±29° to -18° ±31°, p = 0.003), resulting in an increased QRS-T angle (72° ±50° to 123° ±39°, p = 0.001). Regarding RBBB, an excellent correlation and agreement were found between the QRS-T angles in the setting of narrow QRS and RBBB (r = 0.88; p <0.001; bias, 2.9° ±20.9°). However, there was a significant bias between the QRS-T angles in the setting of narrow QRS and LBBB (51.9° ±40.4°; p = 0.001). Conclusion Our data suggested that the QRS-T angle in the setting of RBBB reflected the original QRS-T angle in the setting of narrow QRS well, whereas the QRS-T angle in the setting of LBBB did not.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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Blinova EV, Sakhnova TA, Yurasova ES. [Diagnostic and prognostic significance of QRS-T angle]. TERAPEVT ARKH 2020; 92:85-93. [PMID: 33346436 DOI: 10.26442/00403660.2020.09.000752] [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: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/28/2022]
Abstract
The angle between theQRSandTvectors reflects the consistency or inconsistency of the processes of de- and repolarization of the ventricles of the heart and is considered one of the indicators of global electrical heterogeneity of myocardium. In recent years, the prognostic value of theQRS-Tangle has been demonstrated in relation to total and cardiovascular mortality, both in the population and in various groups of patients. The mechanisms of this phenomenon are not completely clear. The review analyses studies published over the past five years on the relationship between theQRS-Tangle and mortality, as well as coronary heart disease and heart failure. Possible mechanisms for increasing theQRS-Tangle are discussed. Data are given on the use of theQRS-Tangle in diagnostic and prognostic scales, including in combination with other indicators of global electrical heterogeneity of myocardium.
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Affiliation(s)
- E V Blinova
- National Medical Research Center for Cardiology
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Prognostic value and prevalence of complete right bundle branch block in an elderly population: a community-based 10-year prospective study. Aging (Albany NY) 2020; 12:19073-19082. [PMID: 33021491 PMCID: PMC7732323 DOI: 10.18632/aging.103702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/06/2020] [Indexed: 01/24/2023]
Abstract
Complete right bundle branch block (CRBBB) occurs in 0.2% to 1.3% of the general population, but its prognostic significance in the geriatric population is unknown. We prospectively investigated the prevalence and prognostic value of CRBBB in individuals aged ≥65 years in a community-based population in Taiwan. A total of 5,830 community-dwelling individuals were prospectively recruited from 7 regions across Taiwan starting in December 2008 through March 2013. Those aged ≥65 years were included in the analysis (N=3,383). All subjects underwent a home visit and standardized medical exams and were followed up annually until the end of April 2019; cause of death was documented by citizen death records. The mean age of the study cohort was 73.5±5.9 years (65-104), and 47.21% were men. Among these individuals, 171 (5.05%) had CRBBB; the prevalence was higher in men (7.08%) than in women (3.25%). Subjects with CRBBB were older than those without CRBBB (75.4±6.5 vs. 73.4±5.9), and the frequency of CRBBB increased with age. Survival analysis revealed that all-cause mortality and cardiac mortality were similar in individuals with and without CRBBB during a mean follow-up of 92.6±23.6 months. CRBBB is not associated with increased risk of mortality in the geriatric population.
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Widened QRS-T Angle May Be a Measure of Poor Ventricular Stretch During Exercise Among On-duty Firefighters. J Cardiovasc Nurs 2020; 34:201-207. [PMID: 30520777 DOI: 10.1097/jcn.0000000000000554] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The spatial QRS-T angle is a measure of repolarization heterogeneity and may be a predictor of poor ventricular health. It is unknown whether a relationship exists between QRS-T angle and blood pressure (BP) during exercise. OBJECTIVE The purpose of this study was to evaluate the potential relationship between QRS-T angle and BP during exercise, which may be indicative of ventricular stretch. METHODS Ambulatory 12-lead 24-hour Holter electrocardiographic monitoring for QRS-T angle measurement was followed by exercise testing with BP (mm Hg) recordings taken preexercise, maximum achieved BP during exercise, and 2 minutes postexercise. Blood pressure recovery was calculated by subtracting the maximal and 2-minute postexercise BPs. Means (± standard deviation) and percentages are presented. Pearson correlations (r) among all QRS-T angles and all BP measures were performed. One-way analysis of variance was conducted on classification of QRS-T angle and all BP measures. RESULTS One hundred eleven firefighters (95.5% male; mean age, 44 years) were included in this analysis. Twenty-seven percent of the firefighters had either a borderline (100°-139°) or widened (≥140°) QRS-T angle. Although the analysis of variance was not statistically significant, a near-statistically significant negative correlation existed between QRS-T angle and maximum diastolic BP (r = -0.190, P = .05), and a statistically significant relationship existed between QRS-T angle and postexercise diastolic BP (r = -0.261, P = .008). CONCLUSIONS A negative correlation existed between QRS-T angle and maximal diastolic BP and postexercise diastolic BP. Lower maximum diastolic BP during and after exercise may be a sign of poor ventricular stretch. A widened spatial QRS-T angle may represent poor ventricular stretch.
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Sillanmäki S, Lipponen JA, Tarvainen MP, Laitinen T, Hedman M, Hedman A, Kivelä A, Hämäläinen H, Laitinen T. Relationships between electrical and mechanical dyssynchrony in patients with left bundle branch block and healthy controls. J Nucl Cardiol 2019; 26:1228-1239. [PMID: 29423906 DOI: 10.1007/s12350-018-1204-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Abnormal electrical activation may cause dyssynchronous left ventricular (LV) contraction. In this study, we characterized and analyzed electrical and mechanical dyssynchrony in patient with left bundle branch block (LBBB) and healthy controls. METHODS Myocardial perfusion imaging (MPI) data from 994 patients were analyzed. Forty-three patient fulfilled criteria for LBBB and 24 for controls. Electrical activation was characterized with vector electrocardiography (VECG) and LV function including mechanical dyssynchrony with ECG-gated MPI phase analysis. RESULTS QRS duration (QRSd; r = 0.69, P < .001) and a few other VECG parameters correlated significantly with phase bandwidth (phaseBW) representing mechanical dyssynchrony. End-diastolic volume (EDV; r = 0.59, P < .001), ejection fraction and end-systolic volume correlated also with phaseBW. QRSd (β = 0.47, P < .001) and EDV (β = 0.36, P = .001) were independently associated with phaseBW explaining 55% of its variation. Sixty percent of patients with LBBB had significant mechanical dyssynchrony. Those patients had wider QRSd (159 vs 147 ms, P = .013) and larger EDV (144 vs 94 mL, P = .008) than those with synchronous LV contraction. Cut-off values for mechanical dyssynchrony seen in patients with LBBB were QRSd ≥ 165 ms and EDV ≥ 109 mL. CONCLUSIONS Despite obvious conduction abnormality, LBBB is not always accompanied by mechanical dyssynchrony. QRSd and EDV explained 55% of variation seen in phaseBW. These two parameters were statistically different between LBBB cases with and without mechanical dyssynchrony.
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Affiliation(s)
- Saara Sillanmäki
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Jukka A Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mika P Tarvainen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Tiina Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Antti Hedman
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Kivelä
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Hämäläinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Jensen JR, Kragholm K, Bødker KW, Mortensen R, Graff C, Pietersen A, Nielsen JB, Polcwiartek C, Tayal B, Torp-Pedersen C, Søgaard P, Hansen SM. Association between T-wave discordance and the development of heart failure in left bundle branch block patients: Results from the Copenhagen ECG study. J Electrocardiol 2018; 52:39-45. [PMID: 30476637 DOI: 10.1016/j.jelectrocard.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. METHODS Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. RESULTS In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71-3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19-1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26-4.02) within 30 days and a HR of 1.67 (95%CI 1.25-2.23) after 30 days. CONCLUSION T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.
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Affiliation(s)
- Johannes Riis Jensen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
| | - Kristian Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Rikke Mortensen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Adrian Pietersen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | | | - Christoffer Polcwiartek
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Changes in spatial QRS-T angle and QTc interval in patients with traumatic brain injury with or without intra-abdominal hypertension. J Electrocardiol 2018; 51:499-507. [PMID: 29310923 DOI: 10.1016/j.jelectrocard.2017.12.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Indexed: 02/02/2023]
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Kiciński P, Schlegel T, Dybała A, Zakrzewski M, Przybylska-Kuć S, Myśliński W, Mosiewicz J, Głuszek S, Jaroszyński A. Spatial QRS-T angle in patients with newly diagnosed obstructive sleep apnea syndrome. Adv Med Sci 2017; 62:240-245. [PMID: 28501722 DOI: 10.1016/j.advms.2016.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 09/21/2016] [Accepted: 11/29/2016] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of the study was to assess the spatial QRS-T angle (QRS-TA) in a group of newly diagnosed and untreated adult patients with obstructive sleep apnea syndrome (OSAS) and to identify potential factors affecting this parameter. PATIENTS AND METHODS The study group (PSG-confirmed OSAS) included 62 individuals, aged 51.7±10.3 years. The control group consisted of 25 individuals, aged 46.6±16.6 years with no sleep-disordered breathing. The diagnosis of OSAS and assessment of its severity was based on unattended all-night screening polysomnography. The spatial QRS-TA was reconstructed from 12-lead ECG using Kors' regression method. RESULTS Significant differences of spatial QRS-TA values were found between patients with severe OSAS (36.9±18.9°) and the controls (20.3±13.4°; p<0.01) and between patients with mild or moderate OSAS (32.3±20.1°) and the controls (p=0.01). Statistically significant correlations were found between spatial QRS-TA and polysomnographic indices (i.e. AHI, AI, RDT and RDTI). CONLUSIONS Spatial QRS-TA values are significantly higher in patients with OSAS than in controls, thus indicating increased heterogeneity of myocardial action potential. Further long-term prospective studies evaluating the prognostic value of spatial QRS-TA in OSAS patients are needed.
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Affiliation(s)
- Paweł Kiciński
- Department of Family Medicine, Medical University of Lublin, Lublin, Poland.
| | - Todd Schlegel
- Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden; Nicollier-Schlegel SARL, Trélex, Switzerland
| | - Andrzej Dybała
- Department of Internal Diseases, 1st Military Hospital, Lublin, Poland
| | - Maciej Zakrzewski
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
| | | | - Wojciech Myśliński
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
| | - Jerzy Mosiewicz
- Department of Internal Diseases, Medical University of Lublin, Lublin, Poland
| | - Stanisław Głuszek
- Faculty of Medicine and Health Science, The Jan Kochanowski University, Kielce, Poland
| | - Andrzej Jaroszyński
- Department of Family Medicine, Medical University of Lublin, Lublin, Poland; Faculty of Medicine and Health Science, The Jan Kochanowski University, Kielce, Poland
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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.
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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
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