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Huang H, Chien K, Liu Y. Outcomes with T-wave discordance of left bundle branch block and preserved or mildly reduced ejection fraction. ESC Heart Fail 2024; 11:2148-2158. [PMID: 38607371 PMCID: PMC11287352 DOI: 10.1002/ehf2.14764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Left bundle branch block (LBBB) is associated with an increased risk of adverse outcomes for patients with heart failure. The prognosis of LBBB in patients with a preserved ejection fraction (EF) remains controversial. This study investigated the predictive value of T-wave discordance for the prognosis of patients with LBBB and preserved or mildly reduced EF. METHODS AND RESULTS We enrolled 707 patients with complete LBBB and left ventricular (LV) EF ≥ 40% observed using electrocardiograms (ECGs) and echocardiograms between January 2010 and December 2018. Their serial ECGs were reviewed during the follow-up period. The T-wave pattern was classified as discordant LBBB (dLBBB) or concordant LBBB (cLBBB) according to the 12-lead ECG T-wave morphology. The primary outcome was the composite of cardiovascular death or hospitalization for heart failure during a median follow-up period of 3.1 years. A multivariable Cox regression analysis was used to evaluate the independent predictors of the primary outcome. Patients with dLBBB had more comorbidities, a higher heart rate, a longer QRS and QTc duration, a larger LV end-systolic volume and left atrial dimension, a lower LVEF, and a higher mitral E/A ratio and E/e', compared with those with cLBBB. Older age [hazard ratio (HR) = 1.023, 95% confidence interval (CI) = 1.001-1.046, P = 0.023], history of heart failure (HR = 2.440, 95% CI = 1.524-3.905, P = 0.001), chronic kidney disease (HR = 1.917, 95% CI = 1.182-3.110, P = 0.008), larger LV end-systolic volume (HR = 1.046, 95% CI = 1.017-1.075, P = 0.002), lower LVEF (HR = 0.916, 95% CI = 0.885-0.948, P = 0.001), and presence of dLBBB (HR = 1.63, 95% CI = 1.011-2.628, P = 0.032) were independent predictors of the primary outcome in patients with LBBB and LVEF ≥ 40%. The discordant or concordant T-wave morphology of LBBB could transform from one subtype to the other in up to 23% of the study population during the follow-up period, and individuals with persistent or transformed dLBBB faced an increased risk of cardiovascular death or non-fatal heart failure hospitalization. CONCLUSIONS In patients with LBBB and EF ≥ 40%, dLBBB serves as an independent predictor of a higher risk of cardiovascular death or non-fatal heart failure hospitalization.
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Affiliation(s)
- Hui‐Chun Huang
- Department of Internal Medicine, Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of Medicine, National Taiwan UniversityNo. 7 Chung‐Shan South RdTaipei100Taiwan
| | - Kuo‐Liong Chien
- Department of Internal Medicine, Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of Medicine, National Taiwan UniversityNo. 7 Chung‐Shan South RdTaipei100Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
| | - Yen‐Bin Liu
- Department of Internal Medicine, Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of Medicine, National Taiwan UniversityNo. 7 Chung‐Shan South RdTaipei100Taiwan
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Riis J, Kragholm K, Torp-Pedersen C, Andersen S. Association between thyroid function, nursing home admission and mortality in community-dwelling adults over 80 years. Arch Gerontol Geriatr 2023; 104:104806. [PMID: 36099728 DOI: 10.1016/j.archger.2022.104806] [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: 06/21/2022] [Revised: 08/27/2022] [Accepted: 09/02/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Thyroid deficiency may reduce mortality in older adults, but older adults prioritize independence over merely staying alive. We investigated the association between thyroid dysfunction and nursing home admission and all-cause mortality in community-dwelling older adults over 80. METHODS We conducted a retrospective population-based open cohort study using data from laboratory registries covering 75% of Denmark supplemented by national registries. We included all community-dwelling older adults over 80 years with a first TSH measurement between 1996 and 2019. Participants with prior thyroid disorders or medication affecting the thyroid were excluded. Participants were followed from inclusion until nursing home admission, death or loss to follow-up due to emigration. RESULTS We included 272,495 participants at baseline. Median follow-time was 3.71 years in analyses of nursing home admissions and 4.00 years for all-cause mortality. Hypothyroidism was associated with lower nursing home admission (TSH 5-10 mIU/l: HR 0.85, 95% CI: 0.80-0.91, P < 0.001); TSH >10 mIU/l HR 0.68, 95% CI: 0.54-0.85, P = 0.001) and with reduced all-cause mortality (TSH >10 mIU/l: HR 0.81, 95% CI: 0.70-0.93, P = 0.002). The association between hyperthyroidism and nursing home admission was of little clinical significance while hyperthyroidism was associated with increased all-cause mortality hazard both for low (HR 1.16, 95% CI 1.13-1.19, P < 0.001) and suppressed (HR 95% CI: 1.14 1.07-1.21, P < 0.001) TSH. CONCLUSION Hypothyroidism is associated with a reduced nursing home admission hazard and to a lesser extent all-cause mortality in community-dwelling adults over 80 years, while hyperthyroidism is associated with increased all-cause mortality but not hazard of nursing home admission.
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Affiliation(s)
- Johannes Riis
- Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; Department of Cardiology and Clinical Investigation, Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Andersen DC, Kragholm K, Petersen LT, Graff C, Sørensen PL, Nielsen JB, Pietersen A, Søgaard P, Atwater BD, Friedman DJ, Torp-Pedersen C, Polcwiartek C. Association between vectorcardiographic QRS area and incident heart failure diagnosis and mortality among patients with left bundle branch block: A register-based cohort study. J Electrocardiol 2021; 69:30-35. [PMID: 34547542 DOI: 10.1016/j.jelectrocard.2021.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND QRS duration and morphology including left bundle branch block (LBBB) are the most widely used electrocardiogram (ECG) markers for assessing ventricular dyssynchrony and predicting heart failure (HF). However, the vectorcardiographic QRS area may more accurately identify delayed left ventricular activation and HF development. OBJECTIVE We investigated the association between QRS area and incident HF risk in patients with LBBB. METHODS By crosslinking data from Danish nationwide registries, we identified patients with a first-time digital LBBB ECG between 2001 and 2015. The vectorcardiographic QRS area was derived from a 12‑lead ECG using the Kors transformation method and grouped into quartiles. The endpoint was a composite of HF diagnosis, filled prescriptions for loop diuretics, or death from HF. Cause-specific multivariable Cox regression was used to compute hazard ratios(HR) with 95% confidence intervals(CI). RESULTS We included 3316 patients with LBBB free from prior HF-related events (median age, 72 years; male, 40%). QRS area quartiles comprised Q1, 36-98 μVs; Q2, 99-119 μVs; Q3, 120-145 μVs; and Q4, 146-295 μVs. During a 5-year follow-up, 31% of patients reached the composite endpoint, with a rate of 39% in the highest quartile Q4. A QRS area in quartile Q4 was associated with increased hazard of the composite endpoint (HR:1.48, 95%CI:1.22-1.80) compared with Q1. CONCLUSIONS Among primary care patients with newly discovered LBBB, a large vectorcardiographic QRS area (146-295 μVs) was associated with an increased risk of incident HF diagnosis, filling prescriptions for loop diuretics, or dying from HF within 5-years.
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Affiliation(s)
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter L Sørensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas Bille Nielsen
- Laboratory for Molecular Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Adrian Pietersen
- Copenhagen General Practitioners' Laboratory, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Brett D Atwater
- Inova Heart and Vascular Institute, Fairfax, VA, United States
| | - Daniel J Friedman
- Section of Cardiac Electrophysiology, Yale School of Medicine, New Haven, CT, United States
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Inova Heart and Vascular Institute, Fairfax, VA, United States
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Mould SJ, Soliman EZ, Bertoni AG, Bhave PD, Yeboah J, Singleton MJ. Association of T-wave abnormalities with major cardiovascular events in diabetes: the ACCORD trial. Diabetologia 2021; 64:504-511. [PMID: 33420509 DOI: 10.1007/s00125-020-05337-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/15/2020] [Indexed: 12/07/2022]
Abstract
AIMS/HYPOTHESIS T-wave abnormalities (TWA) are often found on ECG and signify abnormal ventricular repolarisation. While TWA have been shown to be associated with subclinical atherosclerosis, the relationship between TWA and hard cardiovascular endpoints is less clear and may differ in the presence of diabetes, so we sought to explore these associations in participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. METHODS TWA were operationally defined as the presence of any Minnesota Codes 5-1 through 5-4 in any lead distribution. Multivariable Cox proportional hazards models were constructed to examine relationships between TWA and clinical cardiovascular events. Secondary analyses explored the risks conferred by major vs minor TWA, differential effects of TWA by anatomic localisation (anterolateral, inferior or anterior lead distributions), and differing associations in those with or without prevalent CVD. RESULTS Among 8176 eligible participants (mean 62.1 ± 6.3 SD years, 61.4% male), there were 3759 cardiovascular events, including 1430 deaths (473 of a cardiovascular aetiology), 474 heart failure events, 1452 major CHD events and 403 strokes. Participants with TWA had increased risks of all-cause mortality (HR 1.45 [95% CI 1.30, 1.62], p < 0.0001), cardiovascular mortality (HR 1.93 [1.59, 2.34], p = 0.0001), congestive heart failure (HR 2.04 [1.69, 2.48], p < 0.0001) and major CHD (HR 1.40 [1.26, 1.57], p < 0.0001), but no increased risk of stroke (HR 0.99 [0.80, 1.23], p = 0.95). Major TWA conferred a higher risk than minor TWA. When TWA were added to the UK Prospective Diabetes Study risk engine, there was improved discrimination for incident CHD events, but only for those with prevalent CVD (area under the receiver operating characteristic curve 0.5744 and 0.6030 with p = 0.0067). Adding TWA to the risk engine yielded improvements in reclassification that were of greater magnitude in those with prevalent CVD (net reclassification improvement [NRI] 0.24 [95% CI 0.16, 0.32] in those with prevalent CVD, NRI 0.14 [95% CI 0.07, 0.22] in those without prevalent CVD). CONCLUSIONS/INTERPRETATION The presence and magnitude of TWA are associated with increased risk of clinical cardiovascular events and mortality in individuals with diabetes and may have value in refining risk, particularly in those with prevalent CVD. Graphical abstract.
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Affiliation(s)
- Steven J Mould
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elsayed Z Soliman
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Prashant D Bhave
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph Yeboah
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Matthew J Singleton
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Søndergaard MM, Riis J, Bodker KW, Hansen SM, Nielsen J, Graff C, Pietersen AH, Nielsen JB, Tayal B, Polcwiartek C, Torp-Pedersen C, Soegaard P, Kragholm KH. Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting. Open Heart 2021; 8:e001425. [PMID: 33574021 PMCID: PMC7880100 DOI: 10.1136/openhrt-2020-001425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
AIM Left bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data. METHODS AND RESULTS Using ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment. CONCLUSION Prolonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.
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Affiliation(s)
| | - Johannes Riis
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Steen Møller Hansen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Nielsen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Graff
- Department of Health, Science and Technology, Aalborg University Faculty of Health Sciences, Aalborg, Denmark
| | - Adrian Holger Pietersen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerod, Denmark
| | - Jonas Bille Nielsen
- University of Copenhagen, Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark
- Department of Cardiology, Laboratory of Molecular Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Hospital Vendsyssel in Hjørring, Hjorring, Denmark
| | - Christoffer Polcwiartek
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | | | - Peter Soegaard
- Cardiology Clinic Heart-Lung, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Regional Hospital North Jutland, Hjorring, Denmark
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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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Boriani G, Vitolo M. The 12-lead ECG: a continuous reference for the cardiologist. J Cardiovasc Med (Hagerstown) 2019; 20:459-463. [PMID: 31045692 DOI: 10.2459/jcm.0000000000000803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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