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Lin SC, Chou HH, Lin TY, Huang HL. Corrected QT Interval and Outcomes of Dialysis Patients with Symptomatic Peripheral Artery Disease: A Prospective Cohort Study. J Clin Med 2024; 13:654. [PMID: 38337348 PMCID: PMC10856551 DOI: 10.3390/jcm13030654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) is common and associated with a higher risk of cardiovascular morbidity and mortality in dialysis patients. A longer corrected QT (QTc) interval has been associated with adverse cardiovascular events and mortality in the general population and patients with end-stage kidney disease. However, little evidence is available on the predictive value of QTc in dialysis patients with PAD. METHODS We conducted a prospective cohort study of 356 dialysis patients with symptomatic PAD undergoing endovascular therapy. We performed the resting 12-lead electrocardiogram (ECG) at baseline. Cox regression analyses were used to assess the association of QTc with all-cause mortality and major adverse cardiovascular events (MACEs), defined as non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death. RESULTS The mean age was 67.3 ± 11.5 years; 41.6% of participants were women. The median QTc was 471 (interquartile ranges 448-491) milliseconds (ms). During a median follow-up of 2.2 years, 188 (52.8%) patients died, and MACEs occurred in 119 (33.4%) patients. In multivariable-adjusted models, patients in tertile 3 of QTc levels had a significantly greater risk of all-cause mortality (hazard ratio [HR] 2.41, 95% confidence intervals [CI] 1.58-3.69) and MACEs (HR 1.90, 95% CI 1.15-3.13) than those in tertile 1. Similarly, each 10-ms increase in the baseline QTc predicted a higher risk of all-cause death (HR 1.15, 95% CI 1.09-1.21) and MACEs (HR 1.15, 95% CI 1.07-1.23). CONCLUSIONS QTc prolongation was independently associated with adverse outcomes among dialysis patients with symptomatic PAD.
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Affiliation(s)
- Shuang-Chin Lin
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian District, New Taipei City 231, Taiwan; (S.-C.L.); (H.-H.C.)
| | - Hsin-Hua Chou
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian District, New Taipei City 231, Taiwan; (S.-C.L.); (H.-H.C.)
- School of Medicine, Tzu Chi University, Hualien City 970, Taiwan
| | - Ting-Yun Lin
- School of Medicine, Tzu Chi University, Hualien City 970, Taiwan
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian District, New Taipei City 231, Taiwan
| | - Hsuan-Li Huang
- Division of Cardiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289, Jianguo Road, Xindian District, New Taipei City 231, Taiwan; (S.-C.L.); (H.-H.C.)
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien City 970, Taiwan
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Lu YY, Chen YC, Lin YK, Chen SA, Chen YJ. Electrical and Structural Insights into Right Ventricular Outflow Tract Arrhythmogenesis. Int J Mol Sci 2023; 24:11795. [PMID: 37511554 PMCID: PMC10380666 DOI: 10.3390/ijms241411795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/08/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
The right ventricular outflow tract (RVOT) is the major origin of ventricular arrhythmias, including premature ventricular contractions, idiopathic ventricular arrhythmias, Brugada syndrome, torsade de pointes, long QT syndrome, and arrhythmogenic right ventricular cardiomyopathy. The RVOT has distinct developmental origins and cellular characteristics and a complex myocardial architecture with high shear wall stress, which may lead to its high vulnerability to arrhythmogenesis. RVOT myocytes are vulnerable to intracellular sodium and calcium overload due to calcium handling protein modulation, enhanced CaMKII activity, ryanodine receptor phosphorylation, and a higher cAMP level activated by predisposing factors or pathological conditions. A reduction in Cx43 and Scn5a expression may lead to electrical uncoupling in RVOT. The purpose of this review is to update the current understanding of the cellular and molecular mechanisms of RVOT arrhythmogenesis.
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Affiliation(s)
- Yen-Yu Lu
- Division of Cardiology, Department of Internal Medicine, Sijhih Cathay General Hospital, New Taipei City 22174, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City 24257, Taiwan
| | - Yao-Chang Chen
- Department of Biomedical Engineering, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Cardiovacular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yi-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Cardiovacular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11696, Taiwan
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3
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Letz T, Hörandtner C, Braunisch MC, Gundel P, Matschkal J, Bachler M, Lorenz G, Körner A, Schaller C, Lattermann M, Holzinger A, Heemann U, Wassertheurer S, Schmaderer C, Mayer CC. Automatic ECG-based detection of left ventricular hypertrophy and its predictive value in haemodialysis patients. Physiol Meas 2023; 44:075002. [PMID: 37336235 DOI: 10.1088/1361-6579/acdfb3] [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: 01/13/2023] [Accepted: 06/19/2023] [Indexed: 06/21/2023]
Abstract
Objective.Left ventricular hypertrophy (LVH) is one of the most severe risk factors in patients with end-stage kidney disease (ESKD) regarding all-cause and cardiovascular mortality. It contributes to the risk of sudden cardiac death which accounts for approximately 25% of deaths in ESKD patients. Electrocardiography (ECG) is the least expensive way to assess whether a patient has LVH, but manual annotation is cumbersome. Thus, an automated approach has been developed to derive ECG-based LVH parameters. The aim of the current study is to compare automatic to manual measurements and to investigate their predictive value for cardiovascular and all-cause mortality.Approach.From the 12-lead 24 h ECG measurements of 301 ESKD patients undergoing haemodialysis, three different LVH parameters were calculated. Peguero-Lo Presti voltage, Cornell voltage, and Sokolow-Lyon voltage were automatically derived and compared to the manual annotations. To determine the agreement between manual and automatic measurements and their predictive value, Bland-Altman plots were created and Cox regression analysis for cardiovascular and all-cause mortality was performed.Main results.The median values for the automatic assessment were: Peguero-Lo Presti voltage 1.76 mV (IQR 1.29-2.55), Cornell voltage 1.14 mV (IQR 0.721-1.66), and Sokolow-Lyon voltage 1.66 mV (IQR 1.08-2.23). The mean differences when compared to the manual measurements were -0.027 mV (0.21 SD), 0.027 mV (0.13 SD) and -0.025 mV (0.24 SD) for Peguero-Lo Presti, Cornell, and Sokolow-Lyon voltage, respectively. The categorial LVH detection based on pre-defined thresholds differed in only 13 cases for all indices between manual and automatic assessment. Proportional hazard ratios only differed slightly in categorial LVH detection between manually and automatically determined LVH parameters; no differences could be found for continuous parameters.Significance.This study provides evidence that automatic algorithms can be as reliable in LVH parameter assessment and risk prediction as manual measurements in ESKD patients undergoing haemodialysis.
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Affiliation(s)
- Theresa Letz
- AIT Austrian Institute of Technology GmbH, Center for Health and Bioresources, Medical Signal Analysis, Giefinggasse 4, A-1210 Vienna, Austria
- TU Wien, Institute of Analysis and Scientific Computing, Wiedner Hauptstr. 8, A-1040 Vienna, Austria
| | - Carina Hörandtner
- AIT Austrian Institute of Technology GmbH, Center for Health and Bioresources, Medical Signal Analysis, Giefinggasse 4, A-1210 Vienna, Austria
- TU Wien, Institute of Analysis and Scientific Computing, Wiedner Hauptstr. 8, A-1040 Vienna, Austria
| | - Matthias C Braunisch
- Technical University of Munich, Klinikum rechts der Isar, Department of Nephrology, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Peter Gundel
- Technical University of Munich, Klinikum rechts der Isar, Department of Nephrology, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Julia Matschkal
- Technical University of Munich, Klinikum rechts der Isar, Department of Nephrology, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Martin Bachler
- AIT Austrian Institute of Technology GmbH, Center for Health and Bioresources, Medical Signal Analysis, Giefinggasse 4, A-1210 Vienna, Austria
| | - Georg Lorenz
- Technical University of Munich, Klinikum rechts der Isar, Department of Nephrology, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Andreas Körner
- TU Wien, Institute of Analysis and Scientific Computing, Wiedner Hauptstr. 8, A-1040 Vienna, Austria
| | - Carolin Schaller
- Technical University of Munich, Klinikum rechts der Isar, Department of Nephrology, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Moritz Lattermann
- Technical University of Munich, Klinikum rechts der Isar, Department of Nephrology, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Andreas Holzinger
- University of Natural Resources and Life Sciences Vienna; Peter-Jordan Straße 82, A-1190 Vienna, Austria
| | - Uwe Heemann
- Technical University of Munich, Klinikum rechts der Isar, Department of Nephrology, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Siegfried Wassertheurer
- AIT Austrian Institute of Technology GmbH, Center for Health and Bioresources, Medical Signal Analysis, Giefinggasse 4, A-1210 Vienna, Austria
| | - Christoph Schmaderer
- Technical University of Munich, Klinikum rechts der Isar, Department of Nephrology, Ismaninger Strasse 22, D-81675 Munich, Germany
| | - Christopher C Mayer
- AIT Austrian Institute of Technology GmbH, Center for Health and Bioresources, Medical Signal Analysis, Giefinggasse 4, A-1210 Vienna, Austria
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Hiraiwa H, Kasugai D, Okumura T, Murohara T. Implications of uremic cardiomyopathy for the practicing clinician: an educational review. Heart Fail Rev 2023:10.1007/s10741-023-10318-1. [PMID: 37173614 PMCID: PMC10403419 DOI: 10.1007/s10741-023-10318-1] [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] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Studies over recent years have redeveloped our understanding of uremic cardiomyopathy, defined as left ventricular hypertrophy, congestive heart failure, and associated cardiac hypertrophy plus other abnormalities that result from chronic kidney disease and are often the cause of death in affected patients. Definitions of uremic cardiomyopathy have conflicted and overlapped over the decades, complicating the body of published evidence, and making comparison difficult. New and continuing research into potential risk factors, including uremic toxins, anemia, hypervolemia, oxidative stress, inflammation, and insulin resistance, indicates the increasing interest in illuminating the pathways that lead to UC and thereby identifying potential targets for intervention. Indeed, our developing understanding of the mechanisms of UC has opened new frontiers in research, promising novel approaches to diagnosis, prognosis, treatment, and management. This educational review highlights advances in the field of uremic cardiomyopathy and how they may become applicable in practice by clinicians. Pathways to optimal treatment with current modalities (with hemodialysis and angiotensin-converting enzyme inhibitors) will be described, along with proposed steps to be taken in research to allow evidence-based integration of developing investigational therapies.
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Affiliation(s)
- Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Daisuke Kasugai
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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5
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Zhan X, Zeng C, He J, Wang M, Xiao J. Non-specific electrocardiographic ST-T abnormalities predict mortality in patients on peritoneal dialysis. Front Cardiovasc Med 2022; 9:930517. [PMID: 36588547 PMCID: PMC9798218 DOI: 10.3389/fcvm.2022.930517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to evaluate the predictive value of non-specific ST-segment and/or T-wave abnormalities in electrocardiography (ECG) for all-cause and cardiovascular mortality (CVM) in peritoneal dialysis (PD) patients. Methods All patients who started PD between November 1, 2005, and February 28, 2017, at the First Affiliated Hospital of Nanchang University were enrolled. The primary outcomes were all-cause mortality and CVM. The Kaplan-Meier method and a log-rank test were used for the survival analysis. Multivariate Cox proportional hazards models were used to investigate the risk factors for all-cause mortality and CVM. Results A total of 724 eligible PD patients were enrolled, including 401 (55.4%) men. In total, 153 (21.1%) patients died during a mean follow-up period of 27 (interquartile range, 13-41) months, and cardiovascular death was responsible for 84 of these deaths. The patients with non-specific ST-T abnormalities (NSSTTAs) had lower overall and cardiovascular survival rates compared to those free from any ECG abnormalities. According to the multivariate Cox proportional hazards models, (NSSTTAs) are independent risk factors for all-cause mortality and CVM, the hazard ratios are 1.81 (95% confidence interval, 1.11-2.95; p = 0.017) and 2.86 (95% confidence interval, 1.52-5.37; p = 0.001), respectively. Conclusion Non-specific ST-T abnormalities can serve as risk markers of all-cause and CVM in PD patients.
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Affiliation(s)
- Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chuanfei Zeng
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jiajing He
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Menghui Wang
- Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jun Xiao
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China,*Correspondence: Jun Xiao,
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Daralammouri Y, Qaddumi J, Ayoub K, Abu-Hantash D, Al-Sadi MA, Ayaseh RM, Azamtta M, Sawalmeh O, Hamdan Z. Pathological right ventricular changes in synthesized electrocardiogram in end-stage renal disease patients and their association with mortality and cardiac hospitalization: a cohort study. BMC Nephrol 2022; 23:79. [PMID: 35209873 PMCID: PMC8867672 DOI: 10.1186/s12882-022-02707-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Right ventricular (RV) function is an important prognostic predictor for end-stage renal disease (ESRD) patients. Non-invasive evaluation of RV function by simple electrocardiogram (ECG) is not yet evident. The purpose of this article was to investigate the presence and association of pathological right ventricular changes in synthesized ECG with cardiac hospitalization and mortality. Methods A prospective cohort study of 137 ESRD patients (mean age: 56 years) were recruited from the hemodialysis unit in An-Najah National University Hospital, Nablus, Palestine. Synthesized ECG was done right before the hemodialysis (HD) session. The pathological right ventricular changes were recorded for each patient. The relationship between pathological RV changes and mortality, cardiac and non-cardiac hospitalization was assessed through a 6-months follow-up period. Results Right ventricular Q wave was found in 2.2% of patients, while right ventricular ST elevation was found in 0.7% of patients, and right ventricular negative T wave was found in 0.7% of patients. During the 6-month period of follow-up, 36 (26.3%) patients were hospitalized, nine patients (6.6%) due to cardiac causes. A total of 8 (5.83%) patients died, out of those 4 patients (2.91%) due to cardiac causes. Using Fisher’s exact test, there was a significant association between pathological abnormalities in synthesized ECG and hospitalization among hemodialysis patients, (p = 0.047). Pathological changes in synthesized ECG were less prevalent in non-cardiac hospitalizations than in cardiac hospitalizations. Conclusions The presence of pathological RV synthesized ECG changes can predict cardiac hospitalization in ESRD patients. Synthesized ECG is a good available tool that can be easily performed in ESRD patients. To determine whether Synthesized ECG can be used as a screening tool for pathological RV changes in a dialysis patients, more research with a larger number of patients and a longer follow-up period is required.
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Affiliation(s)
- Yunis Daralammouri
- Department of Cardiology, An-Najah National University Hospital, Nablus, Palestine. .,Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Jamal Qaddumi
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Khubaib Ayoub
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Doaa Abu-Hantash
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mai Arafat Al-Sadi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rofayda M Ayaseh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Murad Azamtta
- Department of Cardiology, An-Najah National University Hospital, Nablus, Palestine
| | - Osama Sawalmeh
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Zakaria Hamdan
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.,Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine.,Nephrology Unit, An-Najah National University Hospital, Nablus, Palestine
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Huang SY, Chen YC, Kao YH, Lu YY, Lin YK, Higa S, Chen SA, Chen YJ. Calcium dysregulation increases right ventricular outflow tract arrhythmogenesis in rabbit model of chronic kidney disease. J Cell Mol Med 2021; 25:11264-11277. [PMID: 34761510 PMCID: PMC8650029 DOI: 10.1111/jcmm.17052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/24/2021] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
Chronic kidney disease (CKD) increases the risk of arrhythmia. The right ventricular outflow tract (RVOT) is a crucial site of ventricular tachycardia (VT) origination. We hypothesize that CKD increases RVOT arrhythmogenesis through its effects on calcium dysregulation. We analysed measurements obtained using conventional microelectrodes, patch clamp, confocal microscopy, western blotting, immunohistochemical examination and lipid peroxidation for both control and CKD (induced by 150 mg/kg neomycin and 500 mg/kg cefazolin daily) rabbit RVOT tissues or cardiomyocytes. The RVOT of CKD rabbits exhibited a short action potential duration, high incidence of tachypacing (20 Hz)‐induced sustained VT, and long duration of isoproterenol and tachypacing‐induced sustained and non‐sustained VT. Tachypacing‐induced sustained and non‐sustained VT in isoproterenol‐treated CKD RVOT tissues were attenuated by KB‐R7943 and partially inhibited by KN93 and H89. The CKD RVOT myocytes had high levels of phosphorylated CaMKII and PKA, and an increased expression of tyrosine hydroxylase‐positive neural density. The CKD RVOT myocytes exhibited large levels of Ito, IKr, NCX and L‐type calcium currents, calcium leak and malondialdehyde but low sodium current, SERCA2a activity and SR calcium content. The RVOT in CKD with oxidative stress and autonomic neuron hyperactivity exhibited calcium handling abnormalities, which contributed to the induction of VT.
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Affiliation(s)
- Shih-Yu Huang
- Division of Cardiac Electrophysiology, Cardiovascular Center, Cathay General Hospital, Taipei City, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yao-Chang Chen
- Department of Biomedical Engineering, National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Hsun Kao
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei City, Taiwan.,Department of Medical Education and Research, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Yen-Yu Lu
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Urasoe, Japan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei City, Taiwan.,Cardiovascular Center, Taichung Veterans General Hospital, Taichung City, 40705, Taiwan
| | - Yi-Jen Chen
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei City, Taiwan.,Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Cardiovascular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
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Lee HJ, Choe AR, Lee H, Ryu DR, Kang EW, Park JT, Lee SH, Park J. Clinical Associations between Serial Electrocardiography Measurements and Sudden Cardiac Death in Patients with End-Stage Renal Disease Undergoing Hemodialysis. J Clin Med 2021; 10:jcm10091933. [PMID: 33947166 PMCID: PMC8124551 DOI: 10.3390/jcm10091933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Abstract
The rate of sudden cardiac death (SCD) for hemodialysis (HD) patients is significantly higher than that observed in the general population and have the highest risk for arrhythmogenic death. In this multi-center study, patients starting hemodialysis in each hospital were enrolled; they underwent regular check-ups in an open-patient clinic. We examined serial electrocardiography (ECG) data in patients undergoing HD and determined their associations with the occurrence of SCD. Of 678 enrolled subjects who underwent serial ECG before and after hemodialysis, 291 died and 39 developed SCD. In all subjects, the QT peak-to-end (QTpe) interval at all leads and QRS duration were shortened after hemodialysis. The SCD group showed a significant change in the QTpe interval of the inferior, anterior, and lateral leads before and after hemodialysis compared with the survivor group (p < 0.001). In the pre-hemodialysis ECG, SCD patients had significantly longer QTpe intervals in all leads (p < 0.001) and a longer QRS duration (92.6 ± 14.0 vs. 100.6 ± 14.9 ms, p = 0.015) than survivors. In conclusion, patients with a longer QTpe interval before hemodialysis and large changes in ECG parameters after hemodialysis might be at a higher risk of SCD. Therefore, changes in the ECG before and after hemodialysis could help to predict SCD.
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Affiliation(s)
- Hyun Jin Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - A Reum Choe
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea; (A.R.C.); (D.R.R.)
| | - HaeJu Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul 03080, Korea;
| | - Dong Ryeol Ryu
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea; (A.R.C.); (D.R.R.)
| | - Ea Wha Kang
- Division of Nephrology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea;
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul 03722, Korea;
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: (S.H.L.); (J.P.)
| | - Junbeom Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea
- Correspondence: (S.H.L.); (J.P.)
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Akcay M, Yıldırım U. Effect of dialysis and transplantation on myocardial repolarization parameters and P-wave dispersion in chronic kidney disease. J Arrhythm 2021; 37:348-355. [PMID: 33850576 PMCID: PMC8022004 DOI: 10.1002/joa3.12511] [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: 09/26/2020] [Revised: 12/11/2020] [Accepted: 01/10/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) patients are at higher risk for cardiac arrhythmias. The risk of arrhythmia may change with different treatment modalities. We proposed to compare the effects of varied therapy methods on myocardial repolarization parameters (Tp-e, QT, QTc intervals, Tp-e/QT, Tp-e/QTc ratios) and P-wave dispersion (PWD) in patients with CKD. METHODS Three groups were formed from the patients aged between 18 and 65 years, as Group 1 consisting of CKD patients receiving hemodialysis (HD) three times a week, Group 2 consisting of predialysis CKD patients and Group 3 consisting of CKD patients who underwent successful transplantation. All patients' basic demographic data, risk factors, and echocardiographic parameters were recorded, and electrocardiographic repolarization parameters and PWD were analyzed. RESULTS The PR, QT, and QTc intervals were significantly shorter in the transplantation group compared to the other groups (P = .020, P < .001, P = .035; respectively). Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly higher in the predialysis group compared to the other groups (P < .001, P < .001, P = .001; respectively), while there was no significant variation between the HD and transplantation groups (P > .05). PWD was significantly increased in the predialysis group compared to other two groups (P < .001), while no significant variation between the HD and transplantation groups was observed. CONCLUSION We found that the Tp-e interval, Tp-e/QT, Tp-e/QTc, and PWD were significantly higher in the predialysis CKD group, but the PR, QT, and QTc intervals were significantly shorter in the transplantation group compared to the other groups. The prognostic significance and prediction of these parameters in arrhythmic events in CKD patients requires further evaluation with long-time follow-up.
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Affiliation(s)
- Murat Akcay
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
| | - Ufuk Yıldırım
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
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10
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Lai AC, Bienstock SW, Sharma R, Skorecki K, Beerkens F, Samtani R, Coyle A, Kim T, Baber U, Camaj A, Power D, Fuster V, Goldman ME. A Personalized Approach to Chronic Kidney Disease and Cardiovascular Disease: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 77:1470-1479. [PMID: 33736830 DOI: 10.1016/j.jacc.2021.01.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/11/2023]
Abstract
Cardiovascular disease is the most common cause of death in patients with end-stage renal disease (ESRD). The initiation of dialysis for treatment of ESRD exacerbates chronic electrolyte and hemodynamic perturbations. Rapid large shifts in effective intravascular volume and electrolyte concentrations ultimately lead to subendocardial ischemia, increased left ventricular wall mass, and diastolic dysfunction, and can precipitate serious arrhythmias through a complex pathophysiological process. These factors, unique to advanced kidney disease and its treatment, increase the overall incidence of acute coronary syndrome and sudden cardiac death. To date, risk prediction models largely fail to incorporate the observed cardiovascular mortality in the CKD population; however, multimodality imaging may provide an additional prognostication and risk stratification. This comprehensive review discusses the cardiovascular risks associated with hemodialysis, and explores the pathophysiology and the novel utilization of multimodality imaging in CKD to promote a personalized approach for these patients with implications for future research.
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Affiliation(s)
- Ashton C Lai
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | | | - Raman Sharma
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Karl Skorecki
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Frans Beerkens
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Rajeev Samtani
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Andrew Coyle
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Tonia Kim
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Anton Camaj
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - David Power
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Martin E Goldman
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA.
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11
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Garikapati K, Goh D, Khanna S, Echampati K. Uraemic Cardiomyopathy: A Review of Current Literature. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2021; 15:1179546821998347. [PMID: 33707979 PMCID: PMC7907931 DOI: 10.1177/1179546821998347] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/03/2021] [Indexed: 12/18/2022]
Abstract
Uraemic Cardiomyopathy (UC) is recognised as an intricate and multifactorial disease which portends a significant burden in patients with End-Stage Renal Disease (ESRD). The cardiovascular morbidity and mortality associated with UC is significant and can be associated with the development of arrythmias, cardiac failure and sudden cardiac death (SCD). The pathophysiology of UC involves a complex interplay of traditional implicative factors such as haemodynamic overload and circulating uraemic toxins as well as our evolving understanding of the Chronic Kidney Disease-Mineral Bone Disease pathway. There is an instrumental role for multi-modality imaging in the diagnostic process; including transthoracic echocardiography and cardiac magnetic resonance imaging in identifying the hallmarks of left ventricular hypertrophy and myocardial fibrosis that characterise UC. The appropriate utilisation of the aforementioned diagnostics in the ESRD population may help guide therapeutic approaches, such as pharmacotherapy including beta-blockers and aldosterone-antagonists as well as haemodialysis and renal transplantation. Despite this, there remains limitations in effective therapeutic interventions for UC and ongoing research on a cellular level is vital in establishing further therapies.
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Affiliation(s)
- Kartheek Garikapati
- Department of Internal Medicine,
Toowoomba Hospital, Toowoomba, QLD, Australia
| | - Daniel Goh
- Department of Internal Medicine,
Toowoomba Hospital, Toowoomba, QLD, Australia
- University of New South Wales, Sydney,
NSW, Australia
| | - Shaun Khanna
- Department of Internal Medicine,
Toowoomba Hospital, Toowoomba, QLD, Australia
- University of New South Wales, Sydney,
NSW, Australia
| | - Krishna Echampati
- Department of Internal Medicine,
Toowoomba Hospital, Toowoomba, QLD, Australia
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12
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Vareesangthip K, Yincharoen P, Winijkul A, Chanchairujira T. Cardiac arrhythmia during early-week and mid-week dialysis in hemodialysis patients. Ther Apher Dial 2021; 25:890-898. [PMID: 33470546 DOI: 10.1111/1744-9987.13622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
Data on cardiac arrhythmia and electrolyte changes during the dialysis cycle have been limited. Fifty-two hemodialysis (HD) patients underwent 48-h Holter monitoring during early-week and mid-week HD sessions. Pre-HD and post-HD blood samples were collected in both HD sessions. The 48-h Holter data were divided into five phases: (1) 4-h during the early-week HD (HD1), (2) 12-h post-HD1, (3) 16-h period between Phases 2 and 4 (used as the patient's baseline electrocardiography [ECG]), (4) 12-h pre-HD2 phase, and (5) 4-h during the mid-week HD (HD2). The patients' mean age was 68.54 ± 13.37 years. We found that the dialysate-to-serum[K] gradient and changes of S[K] were significantly higher in HD1 than in HD2, as well as changes of S[Mg]. There were no significant ECG changes during the 4-h HD1 and HD2 when compared with the baseline ECG. Phase 2 of Holter ECG was the most common phase that showed significant changes (increased QT interval dispersion (QTD), increased ventricular events, increased number of premature ventricular contractions, ST elevation and ST depression), which was contributed from the dialysate[K] 2 mmol/L subgroup, but not the dialysate[K] 3 mmol/L subgroup. In the subgroup of patients with a high ultrafiltration rate (UFR; mean UFR ≥10 mL/kg/h), there were significantly increased ventricular events and ST-segment changes in Phase 2. In conclusion, ECG changes were associated with the dialysis cycle, significantly in the 12-h after early-week HD sessions. These may be associated with low dialysate[K] or high dialysate-to-S[K] gradient, high ultrafiltration rate and duration of the interdialytic interval.
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Affiliation(s)
- Kornchanok Vareesangthip
- Renal Division, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Picha Yincharoen
- Renal Division, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arjbordin Winijkul
- Cardiology Division, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thawee Chanchairujira
- Renal Division, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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13
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Fang J, Su H, Song A, Tong Y, Huang Z, Ding F, Liu Y. Evaluation of inflammatory and cardiac-electrophysiological markers in patients undergoing peritoneal dialysis. Biomark Med 2020; 14:1641-1649. [PMID: 33336590 DOI: 10.2217/bmm-2020-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The Tp-e/QT (peak to end of T-wave duration/QT interval) ratio is a promising marker of myocardial repolarization and ventricular arrhythmogenesis. Its elevation is associated with sudden cardiac death in different clinical conditions. This study was designed to assess the possible association between increased Tp-e/QT ratio and clinical factors in peritoneal dialysis patients. Materials & methods: We devised a prospective cross-sectional study, which included 107 patients who were divided into groups according to their Tp-e/QT ratio. The association of an increased Tp-e/QT ratio with related factors was analyzed with multivariate logistic regression. Results: Thirty-one patients, who had an elevated Tp-e/QT ratio, showed higher values of IL-6, left ventricular end-systolic diameter, Tp-e, percentage of diabetes mellitus, coronary artery calcification, and left ventricular ejection fraction. Multivariate analysis revealed that IL-6 was an independent risk factor for a higher Tp-e/QT ratio after adjustments. Conclusion: Our study revealed that a high serum IL-6 level in peritoneal dialysis patients increased the risk of a higher Tp-e/QT ratio, which indicated a potentially hazardous interplay between inflammation and arrhythmogenesis.
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Affiliation(s)
- Junyan Fang
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Haixia Su
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Ahui Song
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yan Tong
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Zehui Huang
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Feng Ding
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yingli Liu
- Division of Nephrology & Unit of Critical Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
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14
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Kurisu S, Nitta K, Watanabe N, Ikenaga H, Ishibashi K, Fukuda Y, Nakano Y. Effects of upright T-wave in lead aVR on left ventricular volume and function derived from ECG-gated SPECT in patients with advanced chronic kidney disease. Ann Nucl Med 2020; 35:1-7. [PMID: 32984938 DOI: 10.1007/s12149-020-01528-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Numerous studies have shown the association between chronic kidney disease (CKD) and adverse cardiac events. We investigated whether or not the upright T-wave in lead aVR (TaVR) could predict left ventricular (LV) volume and function derived from ECG-gated SPECT in patients with advanced CKD. METHODS Two hundred and sixty-one patients with advanced CKD [estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m2] were enrolled. Upright TaVR was defined as a wave with a positive deflection of > 0 mV. Enlarged LV end-diastolic volume (LVEDV) was defined as LVEDV index of > 76 ml/m2 in men and > 57 ml/m2 in women. Reduced LV ejection fraction (LVEF) was defined as LVEF of < 40%. RESULTS Forty-six patients (18%) had upright TaVR, and 215 patients (82%) had negative TaVR. Summed redistribution score (SRS) [ 6 (1-12) vs. 2 (0-5), p < 0.001] and summed difference score (SDS) [4 (1-6) vs. 2 (0-4), p = 0.004] were significantly larger in patients with upright TaVR than those with negative TaVR. Patients with upright TaVR had larger LVEDV index (75 ± 33 ml/m2 vs. 50 ± 18 ml/m2, p < 0.001) and lower LVEF (43 ± 14% vs. 58 ± 11%, p < 0.001) compared to those with negative TaVR. After adjusted for other variables including SRS and SDS, upright TaVR remained a significant predictor of enlarged LVEDV (odds ratio 5.45; 95% CI 2.16-14.22; p < 0.001) and reduced LVEF (odds ratio 4.54; 95% CI 1.70-12.23; p = 0.003). CONCLUSIONS Our data suggested that upright TaVR could predict LV volume and function derived from ECG-gated SPECT in patients with advanced CKD.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
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15
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Gul S, Yontar OC, Yenercag M, Seker OO, Erdogan G, Arslan U. Effect of angiotensin/neprilysin inhibition on ventricular repolarization and clinical arrhythmogenesis. CARDIO-IT 2020. [DOI: 10.15275/cardioit.2020.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The most common reason for sudden cardiac death in heart failure is malign ventricular arrhythmias. LCZ 696 improves hospitalization and sudden cardiac death outcomes in heart failure, however mechanisms in preventing sudden cardiac death are still unknown. There is little information available assessing effect of LCZ 696 on Tp-e interval and related calculations. In this study, we aimed to investigate the impact of Sacubitril/valsartan therapy on Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in heart failure patients and its reflections on clinical arrhythmogenesis. Methods: The study was designed as a prospective observational fashion. 265 patients with implantable cardioverter-defibrillator (ICD), who were on regular follow up at Samsun Training and Research Hospital Outpatient Heart Failure Clinic, were validated for the study. Clinical, echocardiographic, electrocardiogram and device data before initiation and six months after dose optimizing were obtained. Results: Stroke volume, cardiac output and ejection fraction significantly improved after LCZ 696 treatment. T wave related parameters, QT and QTC intervals significantly diminished. Furthermore, there was a negative correlation between baseline Tp-e interval duration and the absolute percentile increase of stroke volume(r:-0.234, p: 0.042) and cardiac output (r: -0.240, p: 0.037). Conclusion: In our study, switching Renin-Angiotensin-Aldosterone-System inhibitor with Angiotensin receptor/neprilysin inhibitor was associated with increase in left ventricle performance and decrease of sustained ventricular arrhythmias that required ICD shocks. These positive findings were accompanied by improvements in surface electrocaridogram changes such as Tp-e and related indices.
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Affiliation(s)
- Sefa Gul
- Samsun training and Research Hospital
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16
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Rogovoy NM, Howell SJ, Lee TL, Hamilton C, Perez‐Alday EA, Kabir MM, Zhang Y, Kim ED, Fitzpatrick J, Monroy‐Trujillo JM, Estrella MM, Sozio SM, Jaar BG, Parekh RS, Tereshchenko LG. Hemodialysis Procedure-Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14-Day ECG Monitoring. J Am Heart Assoc 2019; 8:e013748. [PMID: 31564195 PMCID: PMC6806026 DOI: 10.1161/jaha.119.013748] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background In patients with end‐stage kidney disease, sudden cardiac death is more frequent after a long interdialytic interval, within 6 hours after the end of a hemodialysis session. We hypothesized that the occurrence of paroxysmal arrhythmias is associated with changes in heart rate and heart rate variability in different phases of hemodialysis. Methods and Results We conducted a prospective ancillary study of the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease cohort. Continuous ECG monitoring was performed using an ECG patch, and short‐term heart rate variability was measured for 3 minutes every hour (by root mean square of the successive normal‐to‐normal intervals, spectral analysis, Poincaré plot, and entropy), up to 300 hours. Out of enrolled participants (n=28; age 54±13 years; 57% men; 96% black; 33% with a history of cardiovascular disease; left ventricular ejection fraction 70±9%), arrhythmias were detected in 13 (46%). Nonsustained ventricular tachycardia occurred more frequently during/posthemodialysis than pre‐/between hemodialysis (63% versus 37%, P=0.015). In adjusted for cardiovascular disease time‐series analysis, nonsustained ventricular tachycardia was preceded by a sudden heart rate increase (by 11.2 [95% CI 10.1–12.3] beats per minute; P<0.0001). During every‐other‐day dialysis, root mean square of the successive normal‐to‐normal intervals had a significant circadian pattern (Mesor 10.6 [ 95% CI 0.9–11.2] ms; amplitude 1.5 [95% CI 1.0–3.1] ms; peak at 02:01 [95% CI 20:22–03:16] am; P<0.0001), which was replaced by a steady worsening on the second day without dialysis (root mean square of the successive normal‐to‐normal intervals −1.41 [95% CI −1.67 to −1.15] ms/24 h; P<0.0001). Conclusions Sudden increase in heart rate during/posthemodialysis is associated with nonsustained ventricular tachycardia. Every‐other‐day hemodialysis preserves circadian rhythm, but a second day without dialysis is characterized by parasympathetic withdrawal.
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Affiliation(s)
| | | | | | | | | | - Muammar M. Kabir
- Oregon Health & Science UniversityPortlandOR
- The Hospital for Sick ChildrenThe University of TorontoOntarioCanada
| | | | - Esther D. Kim
- The Hospital for Sick ChildrenThe University of TorontoOntarioCanada
- Johns Hopkins UniversityBaltimoreMD
| | | | | | - Michelle M. Estrella
- Johns Hopkins UniversityBaltimoreMD
- Kidney Health Research CollaborativeUniversity of CaliforniaSan FranciscoCA
- San Francisco VA Health Care SystemSan FranciscoCA
| | | | | | - Rulan S. Parekh
- The Hospital for Sick ChildrenThe University of TorontoOntarioCanada
- Johns Hopkins UniversityBaltimoreMD
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17
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Tang JKK, Bennett MT, Rabkin SW. Assessment of QT interval in ventricular paced rhythm: Derivation of a novel formula. J Electrocardiol 2019; 57:55-62. [PMID: 31499424 DOI: 10.1016/j.jelectrocard.2019.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/26/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of the study was to determine the optimal formula to estimate QT interval adjusting for QRS prolongation during right ventricular (RV) pacing. METHODS This observational study included individuals (n = 43) with a newly implanted permanent ventricular pacemaker, who had a narrow QRS complex before pacemaker insertion. QT interval with RV pacing was related to QT interval before pacemaker implantation. The validation cohort (n = 442) had permanent RV pacing in DDD mode. RESULTS A new QTc formula was derived utilizing the constants from the relationship between the spline heart rate QT correction (QTcRBK) before and after pacing; specifically, QTcRBKPACED = QTcRBK × 0.86. The JT interval from paced complexes was highly heart rate (HR) dependent and was not accurate for QT assessment. Previous, QTc formula for paced complexes were not highly correlated with QT before pacing unless a robust HR correction is added. Formulae subtracting a fixed amount from QTcPACED markedly overestimated QTc before pacing. CONCLUSION We proposed a new, simple formula for QT estimation in RV pacing. JT interval in paced complexes is highly HR dependent and is not accurate for QT assessment. The new spline approach for HR correction for the QT, once incorporated into some previously proposed formulae, blunts HR dependency and improves prediction of QT before pacing. QTcRBKPACED*0.86 and QTcRBKPACED - (QRS*0.5) demonstrated the best balance of relatively strong correlation to QTc before pacing and accurate QTc prolongation identification. Abnormal QT for QTcRBKPACED*0.86 as defined by the 97.5th and 99th percentile are 469 and 479 ms respectively.
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Affiliation(s)
- Jacky K K Tang
- University of British Columbia, Division of Cardiology, Vancouver, B.C., Canada
| | - Matthew T Bennett
- University of British Columbia, Division of Cardiology, Vancouver, B.C., Canada
| | - Simon W Rabkin
- University of British Columbia, Division of Cardiology, Vancouver, B.C., Canada.
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18
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Buerschaper L, Floege J, Mühlfeld A, Schlieper G. Evaluation of Electrocardiographic Parameters Predicting Cardiovascular Events in Patients with End-Stage Renal Disease before and after Transplantation. Kidney Blood Press Res 2019; 44:615-627. [PMID: 31242495 DOI: 10.1159/000500917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular (CV) mortality represents the leading cause of death in patients with end-stage renal disease (ESRD). Efficient screening is required to detect CV disease at an early stage, but the best diagnostic work-up is uncertain. The aim of this study was to identify electrocardiographic parameters in dialysis patients associated with an increased frequency of CV events. METHODS A 12-lead electrocardiogram was performed in 139 patients who were on the renal transplant waiting list and who subsequently received a kidney transplant. CV events were analyzed from the day of listing for kidney transplantation until 1 year after renal transplantation. RESULTS Multivariate Cox regression analysis showed that an elevated T:R ratio in anterior and inferior leads was independently associated with CV events (T:R ratio of anterior leads hazard ratio [HR] 1.32 [95% CI 1.09-1.59; p = 0.004] and inferior leads HR 2.15 [95% CI 1.23-3.77; p = 0.008]). In particular, a T:R ratio in inferior leads exceeding 0.6 was associated with CV events in a Kaplan-Meier analysis. CONCLUSIONS Taken together, we found an increased T:R ratio in ESRD patients to be a predictive marker for CV events.
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Affiliation(s)
- Laura Buerschaper
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany,
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Anja Mühlfeld
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Georg Schlieper
- Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany.,Zentrum für Nieren-, Hochdruck- und Stoffwechselerkrankungen, Hannover, Germany
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19
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Sivri S, Çelik M. Evaluation of index of cardiac-electrophysiological balance before and after hemodialysis in patients with end-stage renal disease. J Electrocardiol 2019; 54:72-75. [PMID: 30928820 DOI: 10.1016/j.jelectrocard.2019.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ventricular arrhythmias and sudden cardiac deaths are the most common cause of mortality in patients with end-stage renal disease (ESRD). Index of cardiac-electrophysiological balance (iCEB) (QT/QRS) may predict malignant ventricular arrhythmias. In this study, we investigated whether iCEB value is increased in ESRD patients and whether it changes before and after hemodialysis. METHODS The study included 52 ESRD patients and 53 control subjects matched for age and comorbidities. Biochemical, electrocardiographic and echocardiographic values of all participants were recorded. QRS, QT, Tp-e were measured manually. QTC was calculated using Bazett's formula. Then, Tp-e/QT, Tp-e/QTc, QT/QRS, and QTc/QRS ratios were calculated. The changes in ECG parameters of the ESRD patients before and after HD were compared using paired t-test. RESULTS Mean age and male sex ratio was comparable in both groups (p = 0.448 and p = 0.777, respectively). Comorbidity incidences, and biochemical parameters except eGFR (p < 0.001), albumin (p < 0.001), HDL cholesterol (p = 0.03) and platelet counts (p < 0.001) were comparable in both groups. Compared to the control group, QT, QTc, Tp-e, Tp-e/QT, Tp-e/QTc, QT/QRS, and QTc/QRS ratios were higher in the ESRD group (p < 0.05 for each). While QT and QTc intervals did not change after HD in ESRD patients, Tp-e, Tp-e/QT, Tp-e/QTc, QT/QRS, and QTc/QRS parameters increased significantly. CONCLUSION In addition to ventricular repolarization dispersion indices in ESRD patients, iCEB elevation and increasing values after HD session indicate the increased risk of TdP-mediated ventricular arrhythmia after HD. Larger studies are needed to confirm our results.
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Affiliation(s)
- Serkan Sivri
- Department of Cardiology, Ahi Evran University Training and Research Hospital, Kırşehir, Turkey.
| | - Mustafa Çelik
- Department of Cardiology, Ahi Evran University Training and Research Hospital, Kırşehir, Turkey
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20
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Kooman JP, Usvyat LA, Dekker MJE, Maddux DW, Raimann JG, van der Sande FM, Ye X, Wang Y, Kotanko P. Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine? Blood Purif 2018; 47:171-184. [PMID: 30448825 DOI: 10.1159/000494827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD). Seasonal variations in BP and interdialytic-weight gain have been observed in ESRD patients in addition to a profound relative increase in mortality during the winter period. Moreover, nonphysiological treatment patters are imposed in HD patients, leading to an excess mortality at the end of the long interdialytic interval. Recently, new evidence has emerged on the prognostic impact of trajectories of common clinical and laboratory parameters such as BP, body temperature, and serum albumin, in addition to single point in time measurements. Backward analysis of changes in cardiovascular, nutritional, and inflammatory parameters before the occurrence as hospitalization or death has shown that changes may already occur within months to even 1-2 years before the event, possibly providing a window of opportunity for earlier interventions. Disturbances in physiological variability, such as in heart rate, characterized by a loss of fractal patterns, are associated with increased mortality. In addition, an increase in random variability in different parameters such as BP and sodium is also associated with adverse outcomes. Novel techniques, based on time-dependent analysis of variability and trends and interactions of multiple physiological and laboratory parameters, for which machine-learning -approaches may be necessary, are likely of help to the clinician in the future. However, upcoming research should also evaluate whether dynamic patterns observed in large epidemiological studies have relevance for the individual risk profile of the patient.
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Affiliation(s)
- Jeroen P Kooman
- Maastricht University Medical Center, Maastricht, The Netherlands,
| | - Len A Usvyat
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | | | - Dugan W Maddux
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | | | | | - Xiaoling Ye
- Renal Research Institute, New York, New York, USA
| | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California-Santa Barbara, Santa Barbara, California, USA
| | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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21
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Fitzpatrick J, Sozio SM, Jaar BG, McAdams-DeMarco MA, Estrella MM, Tereshchenko LG, Monroy-Trujillo JM, Parekh RS. Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis. Am J Nephrol 2018; 48:406-414. [PMID: 30428465 DOI: 10.1159/000494281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/27/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The risk of cardiovascular mortality is high among adults with end-stage renal disease (ESRD) undergoing hemodialysis. Waist-to-hip ratio (WHR), a metric of abdominal adiposity, is a predictor of cardiovascular disease (CVD) and mortality in the general population; however, no studies have examined the association with CVD mortality, particularly sudden cardiac death (SCD), in incident hemodialysis. METHODS Among 379 participants incident (< 6 months) to hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD study, we evaluated associations between WHR and risk of CVD mortality, SCD, and non-CVD mortality in Cox proportional hazards regression models. RESULTS At study enrollment, mean age was 55 years with 41% females, 73% African Americans, and 57% diabetics. Mean body mass index was 29.3 kg/m2, and mean WHR was 0.95. During a median follow-up time of 2.5 years, there were 35 CVD deaths, 15 SCDs, and 48 non-CVD deaths. Every 0.1 increase in WHR was associated with higher risk (hazard ratio [95% CI]) of CVD mortality (1.75 [1.06-2.86]) and SCD (2.45 [1.20-5.02]), but not non-CVD mortality (0.93 [0.59-1.45]), independently of demographics, body mass index, comorbidities, inflammation, and traditional CVD risk factors. CONCLUSIONS WHR is significantly associated with CVD mortality including SCD, independently of other CVD risk factors in incident hemodialysis. This simple, easily obtained bedside metric may be useful in dialysis patients for CVD risk stratification.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Nephrology Center of Maryland, Baltimore, Maryland, USA
| | - Mara A McAdams-DeMarco
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Ontario, USA
- Division of Cardiology, Department of Medicine, Oregon Health and Science University, Portland, Ontario, USA
| | - Jose M Monroy-Trujillo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA,
- Division of Nephrology, Department of Pediatrics and Medicine, The Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Ontario, Canada,
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22
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Effects of Marine n-3 Polyunsaturated Fatty Acids on Heart Rate Variability and Heart Rate in Patients on Chronic Dialysis: A Randomized Controlled Trial. Nutrients 2018; 10:nu10091313. [PMID: 30227610 PMCID: PMC6163625 DOI: 10.3390/nu10091313] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/08/2018] [Accepted: 09/12/2018] [Indexed: 12/28/2022] Open
Abstract
Marine n-3 polyunsaturated fatty acids (PUFA) may improve autonomic dysfunction, as indicated by an increase in heart rate variability (HRV) and reduce the risk of sudden cardiac death. Hence, the aim of this study was to investigate the effects of marine n-3 PUFA on 24-h HRV in patients on chronic dialysis, who have a high risk of sudden cardiac death. Between June 2014 and March 2016, 112 patients on chronic dialysis from Denmark were allocated to a daily supplement of 2 g marine n-3 PUFA or control for three months in a randomized, double-blinded, controlled trial. A 48-h Holter monitoring was performed and mean 24-h HRV indices for the two days were available in 85 patients. The mean age was 62.3 years (SD: 14.3) and median dialysis vintage was 1.7 years (IQR: 0.5, 6.4). Within-group and between-group changes in outcome were evaluated by a paired and two sample t-test, respectively. Marine n-3 PUFA did not change the primary endpoint SDNN (SD of all RR-intervals) reflecting overall HRV, but other HRV indices increased and the mean RR-interval increased significantly, corresponding to a decrease in heart rate by 2.5 beats per minute (p = 0.04). In conclusion, marine n-3 PUFA did not change SDNN, but the mean heart rate was significantly reduced and changes in other HRV-indices were also observed, indicating an increase in vagal modulation that might be protective against malignant ventricular arrhythmias.
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23
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Tereshchenko LG, Posnack NG. Does plastic chemical exposure contribute to sudden death of patients on dialysis? Heart Rhythm 2018; 16:312-317. [PMID: 30144582 DOI: 10.1016/j.hrthm.2018.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Larisa G Tereshchenko
- Oregon Health and Science University, Knight Cardiovascular Institute, Portland, Oregon.
| | - Nikki G Posnack
- Children's National Health System, Sheikh Zayed Institute, Heart Institute, Washington, District of Columbia
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24
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Saour BM, Wang JH, Lavelle MP, Mathew RO, Sidhu MS, Boden WE, Sacco JD, Costanzo EJ, Hossain MA, Vachharanji T, Alrefaee A, Asif A. TpTe and TpTe/QT: novel markers to predict sudden cardiac death in ESRD? ACTA ACUST UNITED AC 2018; 41:38-47. [PMID: 30118535 PMCID: PMC6534015 DOI: 10.1590/2175-8239-jbn-2017-0021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 05/28/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Reliable markers to predict sudden cardiac death (SCD) in patients with end stage renal disease (ESRD) remain elusive, but electrocardiogram (ECG) parameters may help stratify patients. Given their roles as markers for myocardial dispersion especially in high risk populations such as those with Brugada syndrome, we hypothesized that the Tpeak to Tend (TpTe) interval and TpTe/QT are independent risk factors for SCD in ESRD. METHODS Retrospective chart review was conducted on a cohort of patients with ESRD starting hemodialysis. Patients were US veterans who utilized the Veterans Affairs medical centers for health care. Average age of all participants was 66 years and the majority were males, consistent with a US veteran population. ECGs that were performed within 18 months of dialysis initiation were manually evaluated for TpTe and TpTe/QT. The primary outcomes were SCD and all-cause mortality, and these were assessed up to 5 years following dialysis initiation. RESULTS After exclusion criteria, 205 patients were identified, of whom 94 had a prolonged TpTe, and 61 had a prolonged TpTe/QT interval (not mutually exclusive). Overall mortality was 70.2% at 5 years and SCD was 15.2%. No significant difference was observed in the primary outcomes when examining TpTe (SCD: prolonged 16.0% vs. normal 14.4%, p=0.73; all-cause mortality: prolonged 55.3% vs. normal 47.7%, p=0.43). Likewise, no significant difference was found for TpTe/QT (SCD: prolonged 15.4% vs. normal 15.0%, p=0.51; all-cause mortality: prolonged 80.7% vs. normal 66.7%, p=0.39). CONCLUSIONS In ESRD patients on hemodialysis, prolonged TpTe or TpTe/QT was not associated with a significant increase in SCD or all-cause mortality.
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Affiliation(s)
- Basil M Saour
- Albany Medical College, Albany, NY, USA.,Stratton VA Medical Center, Department of Medicine, Division of Cardiology, Albany, NY, USA.,Albany Medical College, Department of Medicine, Division of Cardiology, Albany, NY, USA
| | - Jeffrey H Wang
- Hennepin County Medical Center, Department of Medicine, Division of Nephrology, Minneapolis, MN, USA
| | | | - Roy O Mathew
- WJB Dorn VA Medical Center, Department of Medicine, Division of Nephrology, Columbia, SC, USA
| | - Mandeep S Sidhu
- Stratton VA Medical Center, Department of Medicine, Division of Cardiology, Albany, NY, USA.,Albany Medical College, Department of Medicine, Division of Cardiology, Albany, NY, USA
| | - William E Boden
- Stratton VA Medical Center, Department of Medicine, Division of Cardiology, Albany, NY, USA.,Albany Medical College, Department of Medicine, Division of Cardiology, Albany, NY, USA
| | - Joseph D Sacco
- Stratton VA Medical Center, Department of Medicine, Division of Cardiology, Albany, NY, USA.,Albany Medical College, Department of Medicine, Division of Cardiology, Albany, NY, USA
| | - Eric J Costanzo
- Jersey Shore University Medical College, Seton Hall Hackensack-Meridian School of Medicine, Department of Medicine, Neptune, New Jersey, USA
| | - Mohammad A Hossain
- Jersey Shore University Medical College, Seton Hall Hackensack-Meridian School of Medicine, Department of Medicine, Neptune, New Jersey, USA
| | - Tuhsar Vachharanji
- Salisbury VA Health Care System, Department of Nephrology, North Carolina, USA
| | - Anas Alrefaee
- Jersey Shore University Medical College, Seton Hall Hackensack-Meridian School of Medicine, Department of Medicine, Neptune, New Jersey, USA
| | - Arif Asif
- Jersey Shore University Medical College, Seton Hall Hackensack-Meridian School of Medicine, Department of Medicine, Neptune, New Jersey, USA
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25
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Malik M, Buxton AE, Huikuri H, Lombardi F, Schmidt G, Zabel M. Noninvasive electrophysiology in risk assessment and screening. Heart Rhythm 2018; 15:803-804. [DOI: 10.1016/j.hrthm.2018.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Indexed: 10/16/2022]
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26
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Marine n-3 PUFA, heart rate variability and ventricular arrhythmias in patients on chronic dialysis: a cross-sectional study. Br J Nutr 2018; 120:317-325. [PMID: 29779501 DOI: 10.1017/s0007114518001010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Marine n-3 PUFA may improve autonomic dysfunction by an increase in heart rate variability (HRV) and may reduce the risk of malignant ventricular arrhythmias. Only a few smaller studies have examined such effects in patients on chronic dialysis, who often have autonomic dysfunction and a high risk of sudden cardiac death, which accounts for almost 30 % of all deaths. This cross-sectional study investigated the association between the plasma phospholipid content of n-3 PUFA and 24-h HRV or ventricular arrhythmias in patients on chronic dialysis. A 48-h Holter monitoring was performed on 169 patients on in-centre dialysis (83 %), home haemodialysis (10 %) or peritoneal dialysis (7 %) obtaining data on arrhythmias (n 152) and 24-h HRV (n 135). The mean overall HRV (standard deviation of normal intervals (SDNN)) was low and 71 % had a reduced overall HRV (SDNN<100 ms) indicating autonomic dysfunction. No significant associations between plasma phospholipid content of total marine n-3 PUFA, EPA (22 : 5n-3) or DHA (22 : 6n-3) and time-domain or frequency-domain HRV were detected in crude or adjusted linear regression analysis. However, a higher plasma phospholipid content of DHA was associated with a significantly lower proportion of patients with ventricular tachycardia (higher DHA-tertile: 9 % v. lower DHA-tertile: 28 %, P=0·02). In conclusion, the content of marine n-3 PUFA in plasma phospholipids was not associated with 24-h HRV, but a higher plasma phospholipid content of DHA was associated with a lower occurrence of ventricular tachycardia suggesting an antiarrhythmic effect of marine n-3 PUFA in patients on chronic dialysis.
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27
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Cohen DJ, Schulman S, Masarsky CS, Todres-Masarsky M. The Kaleidoscope Model of Integrative Healthcare as a collaborative paradigm for cardiology and chiropractic: a call to action. Integr Med Res 2018; 7:1-8. [PMID: 29629286 PMCID: PMC5884005 DOI: 10.1016/j.imr.2018.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/17/2018] [Accepted: 01/24/2018] [Indexed: 11/28/2022] Open
Abstract
This review article proposes a model of integrative care for cardiovascular patients in institutional settings. We review relevant historic and contemporary examples of medical-chiropractic cooperation and a brief review of the literature illustrating the clinical benefits of chiropractic care for patients with cardiovascular disease. The groundwork proposes a distinct research and clinical practice model incorporating the doctor of chiropractic (D.C.) as a synergistic partner with the medical cardiologist coined the Kaleidoscope Model of Integrative Care (KM). While a traditional kaleidoscope does not alter the nature of light itself, the observer does see the 'raw data' of colors and shapes, wavelengths, etc. contained within the "potential" of the light itself; left unrecognized, even subtle re-orientations of the instrument changes the perspective. Similarly, the KM is intended as a conduit for slight reorientations to traditional medical-chiropractic-patient hierarchies, thus creating new treatment options and generating robust changes in inter-professional perception of the patient's condition(s) and treatment options. It is hoped that this model will not only serve future patients within hospitals, but that institutions will serve as incubators for better collaboration and research among the majority of free-standing medical and chiropractic practices ultimately benefitting the patient with cardiovascular disease.
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Affiliation(s)
| | - Steven Schulman
- Coronary Care Unit, Johns Hopkins, Baltimore, MD, United States
| | - Charles S. Masarsky
- Biology Department, Northern Virginia Community College, Springfield, VA, United States
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