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Wang X, Wei L, Wu Y, Yan J, Zhao L, Yue X, Gao C. ST-segment elevation predicts the occurrence of malignant ventricular arrhythmia events in patients with acute ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2023; 23:61. [PMID: 36732698 PMCID: PMC9896671 DOI: 10.1186/s12872-023-03099-w] [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: 10/05/2022] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND ST-segment elevation (STE) represents a repolarization dispersion marker underlying arrhythmogenesis in ST-segment elevation myocardial infarction (STEMI); however, its value for predicting malignant ventricular arrhythmia events (MVAEs) remains uncertain. METHODS In total, 285 patients with STEMI and those with or without MVAEs who presented within 6 h of symptom onset were enrolled. The relationships between STE and clinical characteristics of MVAEs (defined as ventricular tachycardia or ventricular fibrillation) were analyzed using t-test, chi-square test, binary multivariate logistic regression, and receiver operating characteristic curve analysis. RESULTS Patients with STEMI and MVAEs had a shorter time from symptom onset to balloon time (p = 0.0285) and greater STE (p < 0.01) than those without MVAEs. The symptom-to-balloon time, age, and STE were associated with MVAEs after stepwise regression analysis in all cases. Only STE was significantly associated with the occurrence of MVAEs (all, p < 0.01). The area under the curve (AUC) of STE for predicting MVAEs was 0.905, and the cut-off value was 4.5 mV. When only infarct-related arteries were included in the analysis, the AUC of the left anterior descending artery was 0.925 with a cut-off value of 4.5 mV, that of the right coronary artery was 0.915 with a cut-off value of 4.5 mV, and that of the left circumflex artery was 0.929 with a cut-off value of 4.0 mV. CONCLUSIONS In patients with STEMI presenting within 6 h of symptom onset, age, symptom-to-balloon time, and STE were the main predictors for MVAEs. However, among these, STE was the strongest predictor for MVAEs and was an index for repolarization dispersion of cardiomyocytes in infarcted and non-infarcted areas.
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Affiliation(s)
- Xianpei Wang
- Department of Cardiology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province, China.
| | - Lifang Wei
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China
| | - Ying Wu
- grid.414011.10000 0004 1808 090XHenan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan Province China
| | - Juanjuan Yan
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China
| | - Linwei Zhao
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China
| | - Xinjie Yue
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China
| | - Chuanyu Gao
- grid.414011.10000 0004 1808 090XDepartment of Cardiology, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou University Central China Fuwai Hospital, No. 1 Fuwai Avenue, Zhengdong New District, Zhengzhou, Henan Province China ,grid.414011.10000 0004 1808 090XHenan Provincial Key Lab for Control of Coronary Heart Disease, Zhengzhou University Central China Fuwai Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan Province China
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Erdoğan A, Akyol B, Özkan E, Sonsöz MR, Saltan Özateş Y. Tp-Te Interval and Tp-Te/QT Ratio Predict Coronary Artery Disease Severity in Non-ST Segment Elevation Acute Myocardial Infarction. JOURNAL OF ACADEMIC RESEARCH IN MEDICINE 2022. [DOI: 10.4274/jarem.galenos.2022.52244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Şaylık F, Çınar T, Selçuk M, Akbulut T. Association of Tp-e/QT ratio with SYNTAX score II in patients with coronary artery disease. Scand Cardiovasc J Suppl 2022; 56:325-330. [PMID: 35957499 DOI: 10.1080/14017431.2022.2107236] [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: 12/30/2022]
Abstract
Background. The SYNTAX score II (SS) is an angiographic tool, which grades the complexity of coronary artery lesions and predicts short- and long-term events. Tp-e/QT ratio is a novel electrocardiographic marker for the risk of ventricular arrhythmias. We aimed to investigate whether there was a correlation between SS and Tp-e/QT ratio.Methods. A total of 227 consecutive patients who underwent elective coronary angiography were enrolled in this study. Patients who had a lumen diameter >1.5 mm and at least % 50 diameter stenosis on coronary angiogram were determined as coronary artery disease (CAD) group, and others were identified as a control group. The SS was calculated for the CAD group, and SS ≥23 was defined as a high SS group, and SS < 23 was identified as a low SS group. Electrocardiographic indices, such as Tp-e and Tp-e/QT, were measured for all patients. A multivariable logistic regression analysis was performed with variables age, interventricular septum thickness (IVS), hypertension, and Tp-e/QT. Results. Tp-e interval and Tp-e/QT ratio were higher in the CAD group compared with the control group. Tp-e, corrected Tp-e (cTP-e) and Tp-e/QT were higher in the high SS group than in the low SS group. The cTp-e and Tp-e/QT were correlated with SS score. Age, IVS and Tp-e/QT ratio were independent predictors of high SS in the logistic regression analysis. Conclusions. Tp-e/QT ratio was an independent predictor of high SS and might be used for risk stratification in CAD patients.
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Affiliation(s)
- Faysal Şaylık
- Department of Cardiology, Van Training and Research Hospital, Health Sciences University, Van, Turkey
| | - Tufan Çınar
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Murat Selçuk
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Training and Research Hospital, Health Sciences University, Van, Turkey
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Terminal T-wave inversion predicts reperfusion tachyarrhythmias in STEMI. J Electrocardiol 2022; 71:28-31. [PMID: 35026678 DOI: 10.1016/j.jelectrocard.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/15/2021] [Accepted: 12/23/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A reliable electrocardiographic predictor of ventricular fibrillation (VF) in patients with ST elevation myocardial infarction (STEMI) is lacking so far. Previous experimental/simulation study suggested a terminal T-wave inversion (TTWI) in ischemia-related ECG leads corresponding to anterior infarct localization as an independent predictor of reperfusion VF (rVF). This T-wave characteristic has never been tested as a rVF predictor in clinical settings. The aim of this study was to test if terminal T-wave inversion (TTWI) at admission ECG (before reperfusion) can serve as a predictor of ventricular fibrillation during reperfusion (rVF) in patients with anterior STEMI undergoing primary PCI. METHODS AND RESULTS Study population included consecutive patients with anterior infarct localization admitted for primary PCI (n = 181, age 65 [57; 76] years, 66% male). Of those, 14 patients had rVF (rVF group, age 59 [47; 76] years, 64% male) and patients without rVF comprised the No-rVF group (n = 167, age 65 [57; 76] years, 66% male). Association of TTWI with rVF was analyzed using logistic regression analysis adjusted for relevant clinical and electrocardiographic covariates. The prevalence of TTWI in rVF group was 62% comparing to 23% in the No-rVF group, p = 0.005. TTWI was associated with increased risk of rVF (OR 5.51; 95% CI 1.70-17.89; p = 0.004) and remained a significant predictor after adjustment for age, gender, history of MI prior to index admission, VF before reperfusion, Tpeak-Tend, maximal ST elevation, and QRS duration (OR 23.49; 95% CI 3.14-175.91; p = 0.002). CONCLUSIONS The terminal T-wave inversion in anterior leads before PCI independently predicted rVF in patients with anterior MI thus confirming the previous experimental/simulation findings.
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Liu X, Huang F, Lu X, Wang Y, Cai T, Peng A, Zhu W. Study on the Effects of Kuanxiong Aerosol on the Isolated Artery and Rabbits Acute Myocardial Ischemia Model. Comb Chem High Throughput Screen 2021; 25:1534-1544. [PMID: 34382509 DOI: 10.2174/1386207324666210811142312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Kuan xiong aerosol (KXA) is a kind of Chinese herbal compound used to regulating qi-flowing for relieving pain and improving angina. However, little pharmacological study of this traditional Chinese medicine preparation has been reported to confirm these activities. OBJECTIVE This article aims to observe the effect of resisting acute myocardial ischemia (AMI) in vivo and dilating vessel in vitro of KXA. MATERIALS The AMI model involves intravenously injecting pituitary (2 U.kg-1) into the ear of rabbits. Electrocardiograph (ECG) T waves were then recorded after administration and the falling range was calculated. Following this, the level of serum Cardiac troponin T (cTn-T) and the histopathology of the cardiac muscle tissue was evaluated. In vitro, the effect of KXA on vasodilation of isolated aortic rings that had been pre-contracted with KCl (30 mM) was observed. RESULTS It was found KXA reduced ECG ST-T waves and serum cTn-T in the rabbit AMI model, protected myocardial tissue from fracturing and loss of myocardial fibers, and inhibited inflammatory cell infiltration, cavitation degeneration and karyopyknosis of the myocardial matrix. Furthermore, the administration of 0.215, 1.075 and 2.150 mg.mL-1 KXA resulted in significant relaxation of the aortic rings at a rate of 69.63 %, 90.14 % and 118.72 % (p < 0.01) of the untreated ones, and a second shrinkage ratio of 20.17 %, 4.29 %, and 4.54 % (p < 0.01) of the untreated ones, respectively. CONCLUSIONS these results suggest KXA protects against AMI, contributes to dilation of blood vessels and has long-acting effectiveness.
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Affiliation(s)
- Xia Liu
- Institute of Basic Medicine, Zhejiang Academy of Traditional Chinese Medicine, Zhejiang 310007. China
| | - Feihua Huang
- Institute of Basic Medicine, Zhejiang Academy of Traditional Chinese Medicine, Zhejiang 310007. China
| | - Xiao Lu
- Zhejiang Supor Nanyang pharmaceutical Company Limited, Zhejiang 310017. China
| | - Yuji Wang
- Institute of Basic Medicine, Zhejiang Academy of Traditional Chinese Medicine, Zhejiang 310007. China
| | - Tingting Cai
- Institute of Basic Medicine, Zhejiang Academy of Traditional Chinese Medicine, Zhejiang 310007. China
| | - Aiping Peng
- Institute of Basic Medicine, Zhejiang Academy of Traditional Chinese Medicine, Zhejiang 310007. China
| | - Wanping Zhu
- Institute of Basic Medicine, Zhejiang Academy of Traditional Chinese Medicine, Zhejiang 310007. China
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Akcay M, Coksevim M, Yenercag M. Effect of ranolazine on Tp-e interval, Tp-e/QTc, and P-wave dispersion in patients with stable coronary artery disease. J Arrhythm 2021; 37:1015-1022. [PMID: 34386127 PMCID: PMC8339098 DOI: 10.1002/joa3.12549] [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: 01/08/2021] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Ranolazine is an antianginal drug and also exhibits antiarrhythmic effect by affecting action potential time, refractory period, and repolarization reserve. We evaluated the effect of ranolazine therapy on myocardial repolarization parameters (Tp-e, QT, QTc intervals, Tp-e/QT, and Tp-e/QTc ratios), index of cardiac electrophysiological balance (iCEB) (QT/QRS, QTc/QRS) and P-wave dispersion (PWD) in patients with stable coronary artery disease (CAD). METHODS This study included 175 patients, aged between 35 and 90 years who were followed with stable CAD for at least 3 months. Ninety patients had been receiving ranolazine for at least 1 month, and 85 patients had never received ranolazine. All patients' basic demographic data, risk factors, medications, and echocardiographic parameters recorded. Myocardial repolarization parameters, P-wave times, and PWD were analyzed from 12 lead electrodes. RESULTS There was no variation between the groups in terms of basic demographic parameters and CAD risk factors. Tp-e interval (87.3 ± 14.4 vs. 90.8 ± 12.4 msn, P < .001), Tp-e/QT (0.22 ± 0.04 vs. 0.23 ± 0.03; P = .03), Tp-e/QTc (0.21 ± 0.04 vs. 0.22 ± 0.04 P = .001), and PWD (39.2 ± 13.7 vs. 43.5 ± 12.9 P = .028) were significantly lower in the ranolazine group. But iCEB was similar in both groups. In multivariate analysis after adjusted confounding factors such as age and BMI, Tp-e/QTc ratio, QTc, Pmax, and PWD were found significantly in ranolazine group again. CONCLUSION Tp-e/QTc ratio, QTc, Pmax, and PWD were significantly lower in stable CAD patients under ranolazine therapy. In stable CAD patients, the prognostic significance of ranolazine for arrhythmic events requires further evaluation of these parameters through long-term follow-up and large-scale prospective studies.
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Affiliation(s)
- Murat Akcay
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
| | - Metin Coksevim
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
| | - Mustafa Yenercag
- Department of CardiologyFaculty of MedicineOrdu UniversityOrduTurkey
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Kup A, Uslu A, Demir S, Gulsen K, Celik M, Bayam E, Kanar BG, Kepez A, Akgun T. Tp-Te interval and Tp-Te/QT ratio may be predictive of idiopathic ventricular tachycardia in patients with frequent outflow tract premature ventricular complexes. Acta Cardiol 2021; 76:605-610. [PMID: 32284019 DOI: 10.1080/00015385.2020.1751958] [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: 10/24/2022]
Abstract
BACKGROUND The aim of present study is to evaluate the predictive value of QTc dispersion, Tp-Te interval and Tp-Te/QT ratio for idiopathic monomorphic outflow tract ventricular tachycardia (VT) occurrence in patients with frequent idiopathic outflow tract premature ventricular complexes (PVCs). METHODS A total of 180 patients (49.2 ± 13.6 years, 74 male) who had undergone outflow tract PVC ablation between 01 January 2015 and 01 November 2018 constituted our study population. Patients with isolated outflow tract PVC without any VT recording on Holter recordings and without any inducible VT at EPS were classified as isolated PVC group. Patients with any episode of VT that has the same morphology with outflow tract PVC were classified as nonsustained or sustained VT groups based on the duration of VT episode. QTc dispersion, Tp-Te and Tp-Te/QT ratio values were calculated and compared between groups. RESULTS There were 116 patients with isolated PVC, 35 patients with nonsustained VT and 29 patients with sustained VT. QTc dispersion, Tp-Te and Tp-Te/QT ratio values were significantly lower in patients with isolated PVC compared to patients with nonsustained or sustained VT episodes. Tpeak to Tend interval greater than 110.5 msec on derivation V6 predicted VT occurrence with 93.8% sensitivity and 82.8% specificity. Tpeak to Tend/QT interval greater than 0.27 on derivation V6 predicted VT occurrence with 93.8% sensitivity and 0.81% specificity. CONCLUSION Tp-Te interval and Tp-Te/QT ratio on derivation V6 may aid in prediction of presence of outflow tract VT in clinical practice.
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Affiliation(s)
- Ayhan Kup
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Abdulkadir Uslu
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Serdar Demir
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Kamil Gulsen
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Mehmet Celik
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Emrah Bayam
- Umraniye Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Alper Kepez
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Taylan Akgun
- Kartal Kosuyolu Training and Research Hospital, Cardiology Clinic, Istanbul, Turkey
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Dong Y, Shi Y, Wang J, Dan Q, Gao L, Zhao C, Mu Y, Liu M, Yin C, Wu R, Liu Y, Li Y, Wang X. Development and Validation of a Risk Prediction Model for Ventricular Arrhythmia in Elderly Patients with Coronary Heart Disease. Cardiol Res Pract 2021; 2021:2283018. [PMID: 34285814 PMCID: PMC8275423 DOI: 10.1155/2021/2283018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sudden cardiac death is a leading cause of death from coronary heart disease (CHD). The risk of sudden cardiac death (SCD) increases with age, and sudden arrhythmic death remains a major cause of mortality in elderly individuals, especially ventricular arrhythmias (VA). We developed a risk prediction model by combining ECG and other clinical noninvasive indexes including biomarkers and echocardiology for VA in elderly patients with CHD. METHOD In the retrospective study, a total of 2231 consecutive elderly patients (≥60 years old) with CHD hospitalized were investigated, and finally 1983 patients were enrolled as the model group. The occurrence of VA within 12 months was mainly collected. Study parameters included clinical characteristics (age, gender, height, weight, BMI, and past medical history), ECG indexes (QTcd, Tp-e/QT, and HRV indexes), biomarker indexes (NT-proBNP, Myo, cTnT, CK-MB, CRP, K+, and Ca2+), and echocardiology indexes. In the respective study, 406 elderly patients (≥60 years old) with CHD were included as the verification group to verify the model in terms of differentiation and calibration. RESULTS In the multiparameter model, seven independent predictors were selected: LVEF, LAV, HLP, QTcd, sex, Tp-e/QT, and age. Increased HLP, Tp-e/QT, QTcd, age, and LAV were risk factors (RR > 1), while female and increased LVEF were protective factors (RR < 1). This model can well predict the occurrence of VA in elderly patients with CHD (for model group, AUC: 0.721, 95% CI: 0.669∼0.772; for verification group, AUC: 0.73, 95% CI: 0.648∼0.818; Hosmer-Lemeshow χ 2 = 13.541, P=0.095). After adjusting the predictors, it was found that the combination of clinical indexes and ECG indexes could predict VA more efficiently than using clinical indexes alone. CONCLUSIONS LVEF, LAV, QTcd, Tp-e/QT, gender, age, and HLP were independent predictors of VA risk in elderly patients with CHD. Among these factors, the echocardiology indexes LVEF and LAV had the greatest influence on the predictive efficiency of the model, followed by ECG indexes, QTcd and Tp-e/QT. After verification, the model had a good degree of differentiation and calibration, which can provide a certain reference for clinical prediction of the VA occurrence in elderly patients with CHD.
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Affiliation(s)
- Ying Dong
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yajun Shi
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jinli Wang
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qing Dan
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ling Gao
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chenghui Zhao
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Mu
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Miao Liu
- Graduate School of Chinese PLA General Hospital, Beijing, China
| | - Chengliang Yin
- National Engineering Laboratory for Medical Big Data Application Technology, Chinese PLA General Hospital, Beijing, China
- Medical Big Data Research Center, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | - Rilige Wu
- Medical Big Data Research Center, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Yuqi Liu
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang Li
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xueping Wang
- Department of Cardiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
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Uslu A, Kup A, Gulsen K, Demir S, Kanar BG, Taylan G, Sari M, Akgun T, Kepez A. Acute effect of outflow tract premature ventricular complex ablation on QT dispersion, Tp-e interval and Tp-e/QT ratio. Acta Cardiol 2021; 76:127-131. [PMID: 32406298 DOI: 10.1080/00015385.2020.1761595] [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: 10/24/2022]
Abstract
BACKGROUND There is limited data regarding the effect of idiopathic premature ventricular complexes (PVC) on myocardial repolarisation. Most of PVC's originate from right and left ventricular outflow tracts (RVOT and LVOT). AIM The aim of this study is to evaluate the acute effect of outflow tract PVC ablation on electrocardiographic repolarisation markers. METHODS A total of 180 patients (49.2 ± 13.6 years, 74 male) without any exclusion criteria who had undergone outflow tract PVC ablation between 1 January 2015 and 1 November 2018 constituted our study population. Electrocardiographic recordings that had been obtained before and after ablation procedure on the same day were retrospectively evaluated for the QTc dispersion, Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio. Significance of difference between pre- and postablation values was tested. RESULTS There was no significant difference regarding QTc dispersion between pre- and post-ablation state (36.5 ± 20.9 vs. 35.3 ± 16.4 ms, p: NS). However, Tp-e and Tp-e/QT values in all lateral precordial derivations were observed to decrease significantly after PVC ablation (in the respective order on derivation V5: 104.0 ± 21.6 ms vs. 91.1 ± 14.8 ms, p<.001 and 0.26 ± 0.05 vs. 0.23 ± 0.04, p<.001). CONCLUSIONS Based on these observations, it may be suggested that frequent outflow tract PVC's increase transmural dispersion of repolarisation and this effect is attenuated by catheter ablation in the acute phase. Results of further prospective studies are required for evaluation of the long term effects of PVC ablation on myocardial repolarisation.
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Affiliation(s)
- Abdulkadir Uslu
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Kup
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Kamil Gulsen
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Serdar Demir
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Batur Gonenc Kanar
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Gokay Taylan
- Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey
| | - Münevver Sari
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Cardiology Clinic, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Alper Kepez
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
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Cosgun A, Oren H. Variation of Tpeak-end, corrected Tpeak-end, QT, and corrected QT intervals, Tpeak-end/QT, Tpeak-end/corrected QT ratios and heart rate variability according to decades in the healthy male subjects aged between 30 and 79 years. J Arrhythm 2020; 36:508-517. [PMID: 32528579 PMCID: PMC7279968 DOI: 10.1002/joa3.12339] [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: 02/09/2020] [Revised: 03/15/2020] [Accepted: 03/23/2020] [Indexed: 11/05/2022] Open
Abstract
Background Heart rate variability (HRV) is a predictor of cardiac autonomic functions. Ventricular repolarization markers can indicate ventricular arrhythmias. We aimed to evaluate variations of HRV and these repolarization markers in five healthy male groups between age 30 and 79 years according to decades. Materials and Methods The study group consisted of 500 healthy male subjects between October 2018 and May 2019. The male subjects were divided into five categories according to their ages. Then, electrocardiograms (ECG), transthoracic echocardiograms (TTE), and treadmill exercise test (TET) were performed. T-wave peak-end (Tp-e) interval was defined as the time between the peak point and end of T-wave. Tp-e, corrected Tp-e (cTp-e), QT, and corrected QT (QTc) were measured from the resting ECGs and HRV temporal parameters (SDNN, SDNN Index, SDANN Index, RMSSD, sNN50, and pNN50), and HRV frequency parameters (VLF, LF, HF, and LF/HF) were obtained from 24-hour Holter monitorization recordings. One-way ANOVA test was used for the differences between the groups. Pearson correlation test was used to determine the correlations between the values of all groups. Results Considering the repolarization parameters, there are significant differences in five groups in terms of Tp-e interval, but not Tp-e/QT and Tp-e/QTc ratios. Considering the HRV parameters, there were statistically significant differences between the five male healthy groups in terms of HRV temporal parameters and there are no significant differences in terms of HRV frequency parameters. Conclusion As the age increases, basal Tp-e interval increases and HRV temporal parameters decrease significantly in the male subjects aged between 30 and 79 years, but HRV frequency parameters do not change.
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Affiliation(s)
- Ayhan Cosgun
- Cardiology Department Sincan State Hospital Ankara Turkey
| | - Huseyin Oren
- Cardiology Department Ankara City Hospital Ankara Turkey
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11
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Cosgun A, Oren H. Variation of the T-wave peak-end interval and heart rate variability values in healthy males and females at various hours of the same day, and relationship of them. J Arrhythm 2020; 36:118-126. [PMID: 32071630 PMCID: PMC7011832 DOI: 10.1002/joa3.12296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The prolongation of repolarization time between the myocardial epicardium and endocardial cells is closely related to malignant ventricular arrhythmias. The purpose of our study was to compare repolarization markers, namely, T-wave peak-end interval (Tp-e), QT, corrected QT (QTc), Tp-e/QT, Tp-e/corrected QT (QTc), and Heart Rate Variability (HRV) values in healthy men and women and to investigate their daily variations. METHODS A total of 74 male and 78 female participants, being a government employee, and having no health problems, were included in the two study groups (males and females). A 24-hour, 12-lead Holter monitoring was performed on the volunteers. Then, the Tp-e interval and QT interval were measured on recordings. cTp-e and QTc were calculated by the use of Bazzet's formula. RESULTS There was no statistically significant difference between the groups in the cTp-e interval at 07.00 pm; however, it was significantly lower in the female group as compared with the male group at 07.00 am and 01.00 pm. It was significantly higher in the female group at 01.00 am compared with the male group. There were statistically significant moderate negative correlations between Tp-e intervals and a standard deviation of between two normal beats interval (SDNN) values at various hours of the same day. CONCLUSION There were statistically significant differences in terms of Tp-e and cTp-e intervals at various hours of the same day in both groups. In addition, there were statistically significant moderate negative correlations between Tp-e intervals and SDNN at various hours of the same day.
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Affiliation(s)
- Ayhan Cosgun
- Department of CardiologySincan State HospitalAnkaraTurkey
| | - Huseyin Oren
- Department of CardiologyAnkara City HospitalAnkaraTurkey
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Szabó Z, Ujvárosy D, Ötvös T, Sebestyén V, Nánási PP. Handling of Ventricular Fibrillation in the Emergency Setting. Front Pharmacol 2020; 10:1640. [PMID: 32140103 PMCID: PMC7043313 DOI: 10.3389/fphar.2019.01640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
Ventricular fibrillation (VF) and sudden cardiac death (SCD) are predominantly caused by channelopathies and cardiomyopathies in youngsters and coronary heart disease in the elderly. Temporary factors, e.g., electrolyte imbalance, drug interactions, and substance abuses may play an additive role in arrhythmogenesis. Ectopic automaticity, triggered activity, and reentry mechanisms are known as important electrophysiological substrates for VF determining the antiarrhythmic therapies at the same time. Emergency need for electrical cardioversion is supported by the fact that every minute without defibrillation decreases survival rates by approximately 7%–10%. Thus, early defibrillation is an essential part of antiarrhythmic emergency management. Drug therapy has its relevance rather in the prevention of sudden cardiac death, where early recognition and treatment of the underlying disease has significant importance. Cardioprotective and antiarrhythmic effects of beta blockers in patients predisposed to sudden cardiac death were highlighted in numerous studies, hence nowadays these drugs are considered to be the cornerstones of the prevention and treatment of life-threatening ventricular arrhythmias. Nevertheless, other medical therapies have not been proven to be useful in the prevention of VF. Although amiodarone has shown positive results occasionally, this was not demonstrated to be consistent. Furthermore, the potential proarrhythmic effects of drugs may also limit their applicability. Based on these unfavorable observations we highlight the importance of arrhythmia prevention, where echocardiography, electrocardiography and laboratory testing play a significant role even in the emergency setting. In the following we provide a summary on the latest developments on cardiopulmonary resuscitation, and the evaluation and preventive treatment possibilities of patients with increased susceptibility to VF and SCD.
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Affiliation(s)
- Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Ujvárosy
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tamás Ötvös
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Veronika Sebestyén
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Péter P Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dental Physiology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
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Cosgun A, Oren H, Turkkani MH. The relationship between systolic pulmonary arterial pressure and Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios in patients with newly diagnosed chronic obstructive pulmonary disease. Ann Noninvasive Electrocardiol 2019; 25:e12691. [PMID: 31508867 DOI: 10.1111/anec.12691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The risk of sudden cardiac death (SCD) and arrhythmias has been shown to be common in chronic obstructive pulmonary disease (COPD) subjects. We aimed to evaluate the markers of arrhythmia such as QT, QTc (corrected QT), Tp-e, and cTp-e (corrected Tp-e) intervals, Tp-e/QT ratio, and Tp-e/QTc ratio in newly diagnosed COPD subjects in both right and left precordial leads. MATERIALS AND METHODS The study group consisted of 74 subjects with obstructive respiratory function tests (RFTs). The control group consisted of 78 subjects who had nonobstructive RFTs. RFTs, electrocardiograms (ECG), and transthoracic echocardiograms (TTE) were performed, and QTR (QT interval in right precordial leads), QTL (QT interval in left precordial leads), Tp-eR (Tp-e interval in right precordial leads), and Tp-eL (Tp-e interval in left precordial leads) intervals; systolic pulmonary arterial pressure (sPAP); forced expiratory volume in one second (FEV1 )/forced vital capacity (FVC); and peripheral oxygen saturation(POS) values were measured. RESULTS Tp-eR interval 85.82 ± 5.34 millisecond (ms) versus 62.87 ± 3.55 ms (t = 31.29/p < .00001), cTp-eR interval 97.51 ± 7.18 ms versus 71.07 ± 4.58 ms (t = 27.20/p < .00001), Tp-eR/QTR ratio 0.234 ± 0.02 versus 0.164 ± 0.01 (t = 2.2/p = .014), and Tp-eR/QTcR ratio 0.201 ± 0.01 versus 0.141 ± 0.01 (t = 1.92/p = .028) were statistically significantly higher in COPD subjects. There was a strong negative correlation between RFT and sPAP (sPAP, 29.93 ± 5.1 mm Hg; and FEV1 /FVC, 63.78 ± 3.33%, r = -.85/p < .00001). There was a moderate positive correlation between sPAP and Tp-eR. CONCLUSION We found Tp-e and cTp-e intervals, Tp-e/QT ratio, and Tp-e/QTc ratio were significantly higher in the COPD patients than in the control group. In addition, in the COPD group, heart rate variability (HRV) parameters were significantly lower on ECG.
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Affiliation(s)
- Ayhan Cosgun
- Department of Cardiology, Sincan State Hospital, Ankara, Turkey
| | - Huseyin Oren
- Department of Cardiology, Ankara City Hospital, Ankara, Turkey
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Özbek SC, Sökmen E. Usefulness of Tp-Te interval and Tp-Te/QT ratio in the prediction of ventricular arrhythmias and mortality in acute STEMI patients undergoing fibrinolytic therapy. J Electrocardiol 2019; 56:100-105. [DOI: 10.1016/j.jelectrocard.2019.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/22/2019] [Accepted: 07/07/2019] [Indexed: 12/20/2022]
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