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Ahmadzadeh M, Rahimi M, Toufan-Tabrizi* M, Mohammadi K. Determining whether LV filling time contributes to HF symptoms in different widths of QRS in LBBB patients: A clinical study. Glob Cardiol Sci Pract 2024; 2024:e202408. [PMID: 38404659 PMCID: PMC10886770 DOI: 10.21542/gcsp.2024.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/11/2023] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVES Accurate assessment of left ventricular (LV) function is essential for managing patients with left bundle branch block (LBBB). This study aimed to evaluate the relationship between LV systolic function, left ventricular diastolic filling time (LVFT), QRS duration, and heart failure symptoms in patients with LBBB. METHODS This study was conducted between June 2021 and June 2022. Patients with LBBB and sinus rhythm who were referred to the echocardiography department were included in the study. All the patients underwent electrocardiogram-gated echocardiography using the same machine. In this study, the LVFT value was measured in absolute terms and as a ratio to the R-R interval (LVFT/RR). RESULTS A total of sixty-five patients were included, forty-two (64.6%) were women, and the mean age was 60.71 ± 8.72. We performed three one-way ANOVA tests that showed that LV filling time/RR ratio, QRS duration, and ejection fraction were significantly different between heart failure classes (p = 0.008, p = 0.001, and p < 0.001, respectively). A weak correlation was observed between LVEF and LVFT/RR (r = 0.349, p = 0.004). Additionally, QRS duration was negatively correlated with LVEF (r = - 0.395, p = 0.004) and LVFT/RR (r = - 0.350, p = 0.004), although these correlations were weak. CONCLUSION We showed that LVFT/RR ratio differed significantly between HF functional classes and was lower in patients with more severe HF symptoms. Additionally, QRS duration was negatively correlated with LVEF and LVFT/RR, and patients with more severe HF symptoms had longer QRS durations.
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Affiliation(s)
| | | | | | - Kamran Mohammadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Bourazana A, Giamouzis G, Skoularigis J, Triposkiadis F, Xanthopoulos A. Glucose lowering does not necessarily reduce cardiovascular risk in type 2 diabetes. World J Cardiol 2022; 14:266-270. [PMID: 35582467 PMCID: PMC9048273 DOI: 10.4330/wjc.v14.i4.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/29/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) is a health condition characterized by glucose dysregulation and affects millions of people worldwide. The presentation of heart failure in diabetic cardiomyopathy extends over a wide phenotypic spectrum, commencing from asymptomatic, subclinical structural abnormalities to severely symptomatic biventricular dysfunction with increased mortality risk. Similarly, the spectrum of systolic dysfunction in diabetic-induced heart failure is diverse. DM leads also to cardiac electrical remodeling reacting on various targets. Dipeptidyl peptidase-4 (DPP-4) inhibitors reduce glucagon and blood glucose levels by raising levels of the endogenous hormones glucagon-like-peptide 1 and glucose-dependent insulinotropic peptide and constitute a safe and effective glucose lowering treatment option in patients with type 2 DM. Despite DPP-4 inhibitors’ efficacy regarding glycemic control, their effect on cardiovascular outcomes (myocardial infarction, stroke, hospitalization for heart failure, hospitalization for unstable angina, hospitalization for coronary revascularization, and cardiovascular death) in diabetic patients has been neutral. The potential correlation between atrial flutter and DPP-4 inhibitors administration needs further investigation.
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Affiliation(s)
- Angeliki Bourazana
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - Grigorios Giamouzis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | - John Skoularigis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
| | | | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece
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Rao ACA, Ng ACC, Sy RW, Chia KKM, Hansen PS, Chiha J, Kilian J, Kanagaratnam LB. Electrocardiographic QRS duration is influenced by body mass index and sex. IJC HEART & VASCULATURE 2021; 37:100884. [PMID: 34660881 PMCID: PMC8503593 DOI: 10.1016/j.ijcha.2021.100884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/05/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022]
Abstract
In a large group of subjects without overt conduction system disease, there was a positive association between increasing BMI and electrocardiographic QRS duration that was independent of other covariates such as sex and age. Females had narrower QRS complex than the males at similar age and in the similar BMI category. Findings of this research should prompt further studies to explore the underlying mechanisms for these observations and potential reversibility of the conduction abnormality with weight loss
Background Electrocardiogram (ECG) measured QRS duration has been shown to influence cardiovascular outcomes. However, there is paucity of data on whether ECG QRS duration is influenced by obesity and sex in large populations. Methods All ECGs performed by a pathology provider over a 2-year period were included. ECGs with confounding factors and those not in sinus rhythm were excluded from the primary analysis. Results Of the 76,220 who met the inclusion criteria, 41,685 (55%) were females. The median age of the study cohort was 61 years (interquartile [IQR] range 48–71 years). The median QRS duration was 86 ms (IQR 80–94 ms). The median BMI was 27.6 kg/m2 (IQR 24.2–31.8 kg/m2). When stratified according to the World Health Organization classification of BMI < 18.50 kg/m2, 18.50–24.99 kg/m2, 25.00–29.99 kg/m2, and ≥ 30.00 kg/m2, the median QRS durations were 82 ms (IQR 76–88 ms), 86 ms (IQR 80–92 ms), 88 ms (IQR 80–94 ms) and 88 ms (IQR 82–94 ms), respectively (p < 0.001 for linear trend). Median QRS duration for females was 84 ms (IQR 78–88 ms); for males, it was 92 ms (IQR 86–98 ms), p < 0.001. Compared to males, females had narrower QRS complexes at similar age and similar BMI. In multiple linear regression analysis, BMI correlated positively with QRS duration (standardized beta 0.095, p < 0.001) independent of age, sex, and heart rate. Conclusions In this large cohort there was a positive association between increasing BMI and QRS duration. Females had narrower QRS duration than males at similar age and similar BMI.
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Key Words
- Age
- BMI
- BMI, Body Mass Index
- CRP, C Reactive Protein
- CRT, Cardiac Resynchronisation therapy
- Cx 43, Connexin 43
- ECG QRS duration
- ECG, Electrocardiogram
- EDV, End Diastolic Volume
- ESV, End Systolic Volume
- IQR, Interquartile range
- Population health
- QTc, Corrected QT interval
- Sex
- WHO, World Health Organisation
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Affiliation(s)
- Anupam C A Rao
- Department of Cardiology, Ryde Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia
| | - Austin C C Ng
- Department of Cardiology, Concord Repatriation General Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia
| | - Raymond W Sy
- Department of Cardiology, Concord Repatriation General Hospital, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia
| | - Karin K M Chia
- Department of Cardiology, Royal North Shore Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Douglas Hanly Moir Pathology, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Douglas Hanly Moir Pathology, Australia
| | - Joseph Chiha
- Department of Cardiology, Bankstown Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Douglas Hanly Moir Pathology, Australia
| | - Jens Kilian
- Department of Cardiology, Bankstown Hospital, Australia.,University of New South Wales, Australia.,Douglas Hanly Moir Pathology, Australia
| | - Logan B Kanagaratnam
- Department of Cardiology, Ryde Hospital, Australia.,Department of Cardiology, Royal North Shore Hospital, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Douglas Hanly Moir Pathology, Australia
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Gallego M, Zayas-Arrabal J, Alquiza A, Apellaniz B, Casis O. Electrical Features of the Diabetic Myocardium. Arrhythmic and Cardiovascular Safety Considerations in Diabetes. Front Pharmacol 2021; 12:687256. [PMID: 34305599 PMCID: PMC8295895 DOI: 10.3389/fphar.2021.687256] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/15/2021] [Indexed: 12/20/2022] Open
Abstract
Diabetes is a chronic metabolic disease characterized by hyperglycemia in the absence of treatment. Among the diabetes-associated complications, cardiovascular disease is the major cause of mortality and morbidity in diabetic patients. Diabetes causes a complex myocardial dysfunction, referred as diabetic cardiomyopathy, which even in the absence of other cardiac risk factors results in abnormal diastolic and systolic function. Besides mechanical abnormalities, altered electrical function is another major feature of the diabetic myocardium. Both type 1 and type 2 diabetic patients often show cardiac electrical remodeling, mainly a prolonged ventricular repolarization visible in the electrocardiogram as a lengthening of the QT interval duration. The underlying mechanisms at the cellular level involve alterations on the expression and activity of several cardiac ion channels and their associated regulatory proteins. Consequent changes in sodium, calcium and potassium currents collectively lead to a delay in repolarization that can increase the risk of developing life-threatening ventricular arrhythmias and sudden death. QT duration correlates strongly with the risk of developing torsade de pointes, a form of ventricular tachycardia that can degenerate into ventricular fibrillation. Therefore, QT prolongation is a qualitative marker of proarrhythmic risk, and analysis of ventricular repolarization is therefore required for the approval of new drugs. To that end, the Thorough QT/QTc analysis evaluates QT interval prolongation to assess potential proarrhythmic effects. In addition, since diabetic patients have a higher risk to die from cardiovascular causes than individuals without diabetes, cardiovascular safety of the new antidiabetic drugs must be carefully evaluated in type 2 diabetic patients. These cardiovascular outcome trials reveal that some glucose-lowering drugs actually reduce cardiovascular risk. The mechanism of cardioprotection might involve a reduction of the risk of developing arrhythmia.
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Affiliation(s)
- Mónica Gallego
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Julián Zayas-Arrabal
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Amaia Alquiza
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Beatriz Apellaniz
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Oscar Casis
- Department of Physiology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
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Harms PP, van der Heijden AA, Rutters F, Tan HL, Beulens JWJ, Nijpels G, Elders P. Prevalence of ECG abnormalities in people with type 2 diabetes: The Hoorn Diabetes Care System cohort. J Diabetes Complications 2021; 35:107810. [PMID: 33280986 DOI: 10.1016/j.jdiacomp.2020.107810] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
AIMS The American Diabetes Association, and the joint European Society of Cardiology and European Association for the Study of Diabetes guidelines recommend a resting ECG in people with type 2 diabetes with hypertension or suspected cardiovascular disease (CVD). However, knowledge on the prevalence of ECG abnormalities is incomplete. We aimed to analyse the prevalence of ECG abnormalities and their cross-sectional associations with cardiovascular risk factors in people with type 2 diabetes. METHODS We used data of the Diabetes Care System cohort obtained in 2018. ECG abnormalities were defined using the Minnesota Classification and categorised into types of abnormalities. The prevalence was calculated for the total population (n = 8068) and the subgroup of people without a history of CVD (n = 6494). Logistic regression models were used to asses cross-sectional associations. RESULTS Approximately one-third of the total population had minor (16.0%) or major (13.1%) ECG abnormalities. Of the participants without a CVD history, approximately one-quarter had minor (14.9%) or major (9.1%) ECG abnormalities, and for those with hypertension or very high CVD risk, the prevalence was 27.5% and 39.6%, respectively. ECG abnormalities were significantly and consistently associated with established CVD risk factors. CONCLUSIONS Resting ECG abnormalities are common in all people with type 2 diabetes (29.1%), including those without a history of CVD (24.0%), and their prevalence is related to traditional cardiovascular risk factors such as older age, male sex, hypertension, lower HDL cholesterol, higher BMI, and smoking behaviour.
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Affiliation(s)
- Peter P Harms
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice Medicine, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Amber A van der Heijden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice Medicine, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Femke Rutters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Hanno L Tan
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Experimental and Clinical Cardiology, Amsterdam Cardiovascular Sciences Research Institute, Meibergdreef 9, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Joline W J Beulens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Giel Nijpels
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice Medicine, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Petra Elders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice Medicine, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, the Netherlands
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