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Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki Y, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. J Arrhythm 2024; 40:655-752. [PMID: 39139890 PMCID: PMC11317726 DOI: 10.1002/joa3.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and GeneticsNational Cerebral and Cardiovascular Center
| | | | - Shinji Koba
- Division of Cardiology, Department of MedicineShowa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular MedicineKitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | | | - Kaoru Tanno
- Cardiovascular Center, Cardiology DivisionShowa University Koto‐Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal MedicineFujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of CardiologyTokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Toshio Kinoshita
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, Mita HospitalInternational University of Health and Welfare
| | - Nobuyuki Masaki
- Department of Intensive Care MedicineNational Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | - Hirotaka Yada
- Department of CardiologyInternational University of Health and Welfare Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular MedicineNippon Medical School
| | - Takeshi Kimura
- Cardiovascular MedicineKyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of MedicineUniversity of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric CardiologySaitama Medical University International Medical Center
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Jain H, Marsool Marsool MD, Verma A, Irfan H, Nadeem A, Jain J, Goyal A, Passey S, Gole S, Khatib MN, Zahiruddin QS, Gaidhane AM, Rustagi S, Satapathy P. A Comprehensive Review on the Electrocardiographic Manifestations of Cardiac Sarcoidosis: Patterns and Prognosis. Curr Cardiol Rep 2024:10.1007/s11886-024-02088-5. [PMID: 38954351 DOI: 10.1007/s11886-024-02088-5] [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: 06/25/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Cardiac sarcoidosis (CS) refers to cardiac involvement in sarcoidosis and is usually associated with worse outcomes. This comprehensive review aims to elucidate the electrocardiographic (ECG) signs and features associated with CS, as well as examine modern techniques and their importance in CS evaluation. RECENT FINDINGS The exact pathogenesis of CS is still unclear, but it stems from an abnormal immunological response triggered by environmental factors in individuals with genetic predisposition. CS presents with non-cardiac symptoms; however, conduction system abnormalities are common in patients with CS. The most common electrocardiographic (ECG) signs include atrioventricular blocks and ventricular tachyarrhythmia. Distinct patterns, such as fragmented QRS complexes, T-wave alternans, and bundle branch blocks, are critical indicators of myocardial involvement. The application of advanced ECG techniques such as signal-averaged ECG, Holter monitoring, wavelet-transformed ECG, microvolt T-wave alternans, and artificial intelligence-supported analysis holds promising outcomes for opportune detection and monitoring of CS. Timely utilisation of inexpensive and readily available ECG possesses the potential to allow early detection and intervention for CS. The integration of artificial intelligence models into ECG analysis is a promising approach for improving the ECG diagnostic accuracy and further risk stratification of patients with CS.
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Affiliation(s)
- Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | | | - Amogh Verma
- Department of Internal Medicine, Rama Medical College Hospital and Research Center, Hapur, India.
| | - Hamza Irfan
- Department of Internal Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan
| | - Abdullah Nadeem
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Jyoti Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College, KEM Hospital, Mumbai, India
| | - Siddhant Passey
- Department of Internal Medicine, University of Connecticut Health Center, Connecticut, USA
| | - Shrey Gole
- Department of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Abhay M Gaidhane
- Global Health Academy, School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Sarvesh Rustagi, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospital, Saveetha University, Chennai, 602117, India
- Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, 51001, Iraq
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3
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Kimata M, Hashimoto K, Harada N, Kawamura Y, Kimizuka Y, Fujikura Y, Kaneko M, Kiriu N, Sekine Y, Iwabuchi N, Kiyozumi T, Kawana A, Matsukuma S, Tanaka Y. Noninvasive Ambulatory Electrocardiographic Markers from Patients with COVID-19 Pneumonia: A Report of Three Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:655. [PMID: 38674301 PMCID: PMC11052239 DOI: 10.3390/medicina60040655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
Coronavirus disease 2019 (COVID-19) has affected medical practice. More than 7,000,000 patients died worldwide after being infected with COVID-19; however, no specific laboratory markers have yet been established to predict death related to this disease. In contrast, electrocardiographic changes due to COVID-19 include QT prolongation and ST-T changes; however, there have not been studies on the ambulatory electrocardiographic markers of COVID-19. We encountered three patients diagnosed as having COVID-19 who did not have a prior history of significant structural heart diseases. All patients had abnormalities in ambulatory echocardiogram parameters detected by high-resolution 24 h electrocardiogram monitoring: positive late potentials (LPs) and T-wave alternans (TWA), abnormal heart rate variability (HRV), and heart rate turbulence (HRT). Case 1 involved a 78-year-old woman with a history of chronic kidney disease, Case 2 involved a 76-year-old man with hypertension and diabetes, and Case 3 involved a 67-year-old man with renal cancer, lung cancer, and diabetes. None of them had a prior history of significant structural heart disease. Although no significant consistent increases in clinical markers were observed, all three patients died, mainly because of respiratory failure with mild heart failure. The LP, TWA, HRV, and HRT were positive in all three cases with no significant structural cardiac disease at the initial phase of admission. The further accumulation of data regarding ambulatory electrocardiographic markers in patients with COVID-19 is needed. Depending on the accumulation of data, the LP, TWA, HRV, and HRT could be identified as potential risk factors for COVID-19 pneumonia in the early phase of admission.
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Affiliation(s)
- Motohiro Kimata
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
| | - Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
| | - Naomi Harada
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
| | - Yusuke Kawamura
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
| | - Yoshifumi Kimizuka
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (Y.K.); (Y.F.); (A.K.)
| | - Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (Y.K.); (Y.F.); (A.K.)
| | - Mayuko Kaneko
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
| | - Nobuaki Kiriu
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
| | - Yasumasa Sekine
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
| | - Natsumi Iwabuchi
- Department of Laboratory Medicine, National Defense Medical College Hospital, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (N.I.); (S.M.)
| | - Tetsuro Kiyozumi
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.K.); (Y.S.); (T.K.)
- Department of Defense Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (Y.K.); (Y.F.); (A.K.)
| | - Susumu Matsukuma
- Department of Laboratory Medicine, National Defense Medical College Hospital, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (N.I.); (S.M.)
- Department of Pathology and Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan
| | - Yuji Tanaka
- Department of General Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa 359-8513, Saitama, Japan; (M.K.); (N.H.); (Y.T.)
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Duca ȘT, Badescu MC, Costache AD, Chetran A, Miftode RȘ, Tudorancea I, Mitu O, Afrăsânie I, Ciorap RG, Șerban IL, Pavăl DR, Dmour B, Cepoi MR, Costache-Enache II. Harmony in Chaos: Deciphering the Influence of Ischemic Cardiomyopathy and Non-Cardiac Comorbidities on Holter ECG Parameters in Chronic Heart Failure Patients: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:342. [PMID: 38399629 PMCID: PMC10889994 DOI: 10.3390/medicina60020342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
Background and Objective: In the landscape of heart failure, non-cardiac comorbidities represent a formidable challenge, imparting adverse prognostic implications. Holter ECG monitoring assumes a supplementary role in delineating myocardial susceptibility and autonomic nervous system dynamics. This study aims to explore the potential correlation between Holter ECG parameters and comorbidities in individuals with ischemic cardiomyopathy experiencing heart failure (HF), with a particular focus on the primary utility of these parameters as prognostic indicators. Materials and Methods: In this prospective inquiry, a cohort of 60 individuals diagnosed with heart failure underwent stratification into subgroups based on the presence of comorbidities, including diabetes, chronic kidney disease, obesity, or hyperuricemia. Upon admission, a thorough evaluation of all participants encompassed echocardiography, laboratory panel analysis, and 24 h Holter monitoring. Results: Significant associations were uncovered between diabetes and unconventional physiological indicators, specifically the Triangular index (p = 0.035) and deceleration capacity (p = 0.002). Pertaining to creatinine clearance, notable correlations surfaced with RMSSD (p = 0.026), PNN50 (p = 0.013), and high-frequency power (p = 0.026). An examination of uric acid levels and distinctive Holter ECG patterns unveiled statistical significance, particularly regarding the deceleration capacity (p = 0.045). Nevertheless, in the evaluation of the Body Mass Index, no statistically significant findings emerged concerning Holter ECG parameters. Conclusions: The identified statistical correlations between non-cardiac comorbidities and patterns elucidated in Holter ECG recordings underscore the heightened diagnostic utility of this investigative modality in the comprehensive evaluation of individuals grappling with HF. Furthermore, we underscore the critical importance of the thorough analysis of Holter ECG recordings, particularly with regard to subtle and emerging parameters that may be overlooked or insufficiently acknowledged.
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Affiliation(s)
- Ștefania-Teodora Duca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Minerva Codruta Badescu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of III Internal Medicine Clinic, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Alexandru-Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Adriana Chetran
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Radu Ștefan Miftode
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Ionuț Tudorancea
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
- Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Irina Afrăsânie
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Radu-George Ciorap
- Department of Biomedical Science, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa”, 700145 Iasi, Romania;
| | - Ionela-Lăcrămioara Șerban
- Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - D. Robert Pavăl
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK;
| | - Bianca Dmour
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
| | - Maria-Ruxandra Cepoi
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
| | - Irina-Iuliana Costache-Enache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (Ș.-T.D.); (A.C.); (R.Ș.M.); (O.M.); (I.A.); (B.D.); (M.-R.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
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Hashimoto K, Harada N. Recent progress of Holter-based late potential for predicting serious cardiac events and its implications and future challenges. J Electrocardiol 2023; 81:136-141. [PMID: 37696173 DOI: 10.1016/j.jelectrocard.2023.08.018] [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: 07/27/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023]
Abstract
Late potential (LP) has recently been measured using Holter electrocardiogram (H-LP), and accumulating evidence suggests that it is a useful approach for detecting lethal arrhythmias and sudden cardiac death, especially in cases of ischemic heart disease. In this review, our primary objective was to advance the understanding and utilization of H-LP by elucidating the existing unresolved aspects, thereby serving as a guide for future research in this domain. Particularly, the combination of H-LP with non-sustained ventricular tachycardia, rather than LP alone, may improve the accuracy of the test. H-LP parameters show diurnal variations in both patients with cardiac disease and healthy individuals. Although H-LP shows promise as the future mainstream LP test, there are several problems; specifically, handling noise levels when H-LP is performed in unrestricted daily activities. Additionally, a reference value that considers diurnal variations has not yet been established. These challenges need to be addressed to improve the viability and clinical use of H-LP. By incorporating H-LP into routine assessments, healthcare practitioners can gain valuable insights into the cardiovascular health of their patients, facilitating timely interventions and better disease management.
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Affiliation(s)
- Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Naomi Harada
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
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Hashimoto K, Harada N, Kimata M, Kawamura Y, Fujita N, Sekizawa A, Ono Y, Obuchi Y, Takayama T, Kasamaki Y, Tanaka Y. Increasing averaging beats improves the test accuracy on Holter-based late potentials in patients with myocardial infarction. Ann Noninvasive Electrocardiol 2023; 28:e13089. [PMID: 37724719 PMCID: PMC10646378 DOI: 10.1111/anec.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/18/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The prevalence of Holter-based late potentials (H-LPs) in cases of fatal cardiac events has increased. Although the noise level of H-LP is higher than that of conventional real-time late potential (LP) recording, a procedure to reduce the noise severity in H-LP by increasing the averaging beats has not been investigated. METHODS We enrolled 104 patients with post-myocardial infarction (MI) and 86 control participants. Among the patients, 30 reported sustained ventricular tachycardia (VT), and the remaining 74 had unrecorded VT. H-LPs were measured twice in all groups to evaluate the efficacy of increasing the averaging beats for H-LPs. Thereafter, the average of LP was calculated at 250 (default setting), 300, 400, 500, 600, 700, and 800 beats. RESULTS Across all three groups (MI-VT group, MI non-VT group, and control group), the noise levels significantly decreased in consonance with the increase in averaging beats. In the MI-VT group, the H-LP positive rate considerably increased with the increase in the averaging beats from 250 to 800 both at night and daytime. In the MI-VT group, the LP parameters significantly deteriorated, which led to a positive judgment corresponding to the increment of the averaged night and day beats. The H-LP positive rates were unchanged in the MI non-VT and control groups, while the LP parameters remained consistent, despite the increased averaging beats in the MI non-VT and control groups. CONCLUSION Increasing the calculated averaging beats in H-LPs can improve the sensitivity of predicting fatal cardiac events in patients with MI.
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Affiliation(s)
- Kenichi Hashimoto
- Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
| | - Naomi Harada
- Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
| | - Motohiro Kimata
- Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
| | - Yusuke Kawamura
- Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
- Department of Integrative Physiology and Bio‐Nano MedicineNational Defense Medical CollegeTokorozawaJapan
| | - Naoya Fujita
- Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
| | - Akinori Sekizawa
- Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
| | - Yosuke Ono
- Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
| | - Yasuhiro Obuchi
- Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
| | - Tadateru Takayama
- Department of General MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Kasamaki
- Department of General MedicineKanazawa Medical College Himi Municipal HospitalHimiJapan
| | - Yuji Tanaka
- Department of General MedicineNational Defense Medical CollegeTokorozawaJapan
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7
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Pingitore A, Peruzzi M, Clarich SC, Palamà Z, Sciarra L, Cavarretta E. An overview of the electrocardiographic monitoring devices in sports cardiology: Between present and future. Clin Cardiol 2023; 46:1028-1037. [PMID: 37349944 PMCID: PMC10540029 DOI: 10.1002/clc.24073] [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] [Received: 04/18/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Athletes represent a mainly healthy population, which however could be considered at risk of major arrhythmic events, especially in case of undiagnosed cardiomyopathies. For this reason, the periodical sports medicine examination and the electrocardiography are essential tools in the cardiovascular screening, even though they do not always succeed in identifying rhythm disturbances, particularly when asymptomatic or rarely symptomatic. HYPOTHESIS Prolonged cardiac monitoring often enables clinicians to stratify the arrhythmic risk and reach the diagnosis. The technological progress of the last decades has produced an always-increasing number of heart rhythm monitoring devices, starting from the 24-hour electrocardiogram Holter monitoring and ending with the wide world of wearable devices. METHODS In the literature, the extreme utility of this equipment in the patients affected by cardiovascular diseases and in the general population is well established. On the contrary, athletes-based randomized trials or large-scale epidemiological studies targeting the frequency of cardiac symptoms and the use of cardiac monitoring are missing, while an ever-growing number of case series and small observational studies are flourishing in recent years. RESULTS The present review showcases the available electrocardiographic monitoring options, principally in the medical setting, listing their characteristics, their indications, their supporting evidence, and their general pros and cons. CONCLUSIONS The ultimate goal of this review is guiding physicians through the wide variety of heart rhythm monitoring options in the specific subfield of sports cardiology, when an arrhythmia is suspected in an athlete, to tailor the diagnostic process and favor the best diagnostic accuracy.
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Affiliation(s)
- Annachiara Pingitore
- Department of General and Specialistic Surgery “Paride Stefanini”Sapienza University of RomeRomeItaly
| | - Mariangela Peruzzi
- Department of Clinical Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeRomeItaly
- Mediterranea CardiocentroNaplesItaly
| | | | - Zefferino Palamà
- Electrophysiology Service, Division of CardiologyCasa di Cura Villa VerdeTarantoItaly
- Department of Clinical Medicine, Public Health, Life and Environmental SciencesUniversity of L'AquilaCoppitoItaly
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental SciencesUniversity of L'AquilaCoppitoItaly
| | - Elena Cavarretta
- Mediterranea CardiocentroNaplesItaly
- Department of Medical‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
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8
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Hashimoto K, Harada N, Kimata M, Kawamura Y, Fujita N, Sekizawa A, Ono Y, Obuchi Y, Takayama T, Kasamaki Y, Tanaka Y. Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1460. [PMID: 37629750 PMCID: PMC10456944 DOI: 10.3390/medicina59081460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Holter-based late potentials (LPs) are useful for predicting lethal arrhythmias in organic cardiac diseases. Although Holter-based LPs exhibit diurnal variation, no studies have evaluated the optimal timing of LP measurement over 24 h for predicting lethal arrhythmia that leads to sudden cardiac death. Thus, this study aimed to validate the most effective timing for Holter-based LP testing and to explore factors influencing the diurnal variability in LP parameters. Materials and Methods: We retrospectively analyzed 126 patients with post-myocardial infarction (MI) status and 60 control participants who underwent high-resolution Holter electrocardiography. Among the 126 post-MI patients, 23 developed sustained ventricular tachycardia (VT) (the MI-VT group), while 103 did not (the MI-non-VT group) during the observation period. Holter-based LPs were measured at 0:00, 4:00, 8:00, 12:00, 16:00, and 20:00, and heart rate variability analysis was simultaneously performed to investigate factors influencing the diurnal variability in LP parameters. Results: Holter-based LP parameters showed diurnal variation with significant deterioration at night and improvement during the day. Assessment at the time with the longest duration of low-amplitude signals < 40 μV in the filtered QRS complex terminus (LAS40) gave the highest receiver operating characteristics curve (area under the curve, 0.659) and the highest odds ratio (3.75; 95% confidence interval, 1.45-9.71; p = 0.006) for predicting VT. In the multiple regression analysis, heart rate and noise were significant factors affecting the LP parameters in the MI-VT and control groups. In the non-VT group, the LP parameters were significantly influenced by noise and parasympathetic heart rate variability parameters, such as logpNN50. Conclusions: For Holter-based LP measurements, the test accuracy was higher when the LP was measured at the time of the highest or worst value of LAS40. Changes in autonomic nervous system activity, including heart rate, were factors influencing diurnal variability. Increased parasympathetic activity or bradycardia may exacerbate Holter-based LP parameters.
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Affiliation(s)
- Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (N.H.); (M.K.); (Y.K.); (N.F.); (A.S.); (Y.O.); (Y.O.); (Y.T.)
| | - Naomi Harada
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (N.H.); (M.K.); (Y.K.); (N.F.); (A.S.); (Y.O.); (Y.O.); (Y.T.)
| | - Motohiro Kimata
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (N.H.); (M.K.); (Y.K.); (N.F.); (A.S.); (Y.O.); (Y.O.); (Y.T.)
| | - Yusuke Kawamura
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (N.H.); (M.K.); (Y.K.); (N.F.); (A.S.); (Y.O.); (Y.O.); (Y.T.)
| | - Naoya Fujita
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (N.H.); (M.K.); (Y.K.); (N.F.); (A.S.); (Y.O.); (Y.O.); (Y.T.)
| | - Akinori Sekizawa
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (N.H.); (M.K.); (Y.K.); (N.F.); (A.S.); (Y.O.); (Y.O.); (Y.T.)
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (N.H.); (M.K.); (Y.K.); (N.F.); (A.S.); (Y.O.); (Y.O.); (Y.T.)
| | - Yasuhiro Obuchi
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (N.H.); (M.K.); (Y.K.); (N.F.); (A.S.); (Y.O.); (Y.O.); (Y.T.)
| | - Tadateru Takayama
- Department of General Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan;
| | - Yuji Kasamaki
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama 953-8531, Japan;
| | - Yuji Tanaka
- Department of General Medicine, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan; (N.H.); (M.K.); (Y.K.); (N.F.); (A.S.); (Y.O.); (Y.O.); (Y.T.)
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9
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Duca ȘT, Roca M, Costache AD, Chetran A, Afrăsânie I, Miftode RȘ, Tudorancea I, Matei I, Ciorap RG, Mitu O, Bădescu MC, Iliescu-Halitchi D, Halițchi-Iliescu CO, Mitu F, Lionte C, Costache II. T-Wave Analysis on the 24 h Holter ECG Monitoring as a Predictive Assessment of Major Adverse Cardiovascular Events in Patients with Myocardial Infarction: A Literature Review and Future Perspectives. Life (Basel) 2023; 13:life13051155. [PMID: 37240799 DOI: 10.3390/life13051155] [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: 03/05/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Myocardial ischemia is a pathophysiological state characterized by inadequate perfusion of the myocardium, resulting in an imbalance between myocardial oxygen demand and supply. It is most commonly caused by coronary artery disease, in which atherosclerotic plaques lead to luminal narrowing and reduced blood flow to the heart. Myocardial ischemia can manifest as angina pectoris or silent myocardial ischemia and can progress to myocardial infarction or heart failure if left untreated. Diagnosis of myocardial ischemia typically involves a combination of clinical evaluation, electrocardiography and imaging studies. Electrocardiographic parameters, as assessed by 24 h Holter ECG monitoring, can predict the occurrence of major adverse cardiovascular events in patients with myocardial ischemia, independent of other risk factors. The T-waves in patients with myocardial ischemia have prognostic value for predicting major adverse cardiovascular events, and their electrophysiological heterogeneity can be visualized using various techniques. Combining the electrocardiographic findings with the assessment of myocardial substrate may offer a better picture of the factors that can contribute to cardiovascular death.
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Affiliation(s)
- Ștefania-Teodora Duca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Cardiology, "St. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Mihai Roca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Alexandru-Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Adriana Chetran
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Cardiology, "St. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Irina Afrăsânie
- Department of Cardiology, "St. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Radu-Ștefan Miftode
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Cardiology, "St. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Ionuț Tudorancea
- Department of Cardiology, "St. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
- Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Iulian Matei
- Department of Cardiology, "St. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Radu-George Ciorap
- Department of Biomedical Science, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa", 700145 Iasi, Romania
| | - Ovidiu Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Cardiology, "St. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Minerva Codruța Bădescu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of III Internal Medicine Clinic, "St. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Dan Iliescu-Halitchi
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Cardiology, Arcadia Hospital, 700620 Iasi, Romania
| | - Codruța-Olimpiada Halițchi-Iliescu
- Department of Mother and Child Medicine-Pediatrics, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Pedriatics, Arcadia Hospital, 700620 Iasi, Romania
| | - Florin Mitu
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Cătălina Lionte
- Department of Internal Medicine III, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700145 Iasi, Romania
- Department of Cardiology, Helicomed Hospital, 700115 Iasi, Romania
| | - Irina-Iuliana Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
- Department of Cardiology, "St. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
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10
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Ramírez J, Kiviniemi A, van Duijvenboden S, Tinker A, Lambiase PD, Junttila J, Perkiömäki JS, Huikuri HV, Orini M, Munroe PB. ECG T-Wave Morphologic Variations Predict Ventricular Arrhythmic Risk in Low- and Moderate-Risk Populations. J Am Heart Assoc 2022; 11:e025897. [PMID: 36036209 PMCID: PMC9496440 DOI: 10.1161/jaha.121.025897] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early identification of individuals at risk of sudden cardiac death (SCD) remains a major challenge. The ECG is a simple, common test, with potential for large-scale application. We developed and tested the predictive value of a novel index quantifying T-wave morphologic variations with respect to a normal reference (TMV), which only requires one beat and a single-lead ECG. Methods and Results We obtained reference T-wave morphologies from 23 962 participants in the UK Biobank study. With Cox models, we determined the association between TMV and life-threatening ventricular arrhythmia in an independent data set from UK Biobank study without a history of cardiovascular events (N=51 794; median follow-up of 122 months) and SCD in patients with coronary artery disease from ARTEMIS (N=1872; median follow-up of 60 months). In UK Biobank study, 220 (0.4%) individuals developed life-threatening ventricular arrhythmias. TMV was significantly associated with life-threatening ventricular arrhythmias (hazard ratio [HR] of 1.13 per SD increase [95% CI, 1.03-1.24]; P=0.009). In ARTEMIS, 34 (1.8%) individuals reached the primary end point. Patients with TMV ≥5 had an HR for SCD of 2.86 (95% CI, 1.40-5.84; P=0.004) with respect to those with TMV <5, independently from QRS duration, corrected QT interval, and left ventricular ejection fraction. TMV was not significantly associated with death from a cause other than SCD. Conclusions TMV identifies individuals at life-threatening ventricular arrhythmia and SCD risk using a single-beat single-lead ECG, enabling inexpensive, quick, and safe risk assessment in large populations.
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Affiliation(s)
- Julia Ramírez
- Clinical Pharmacology and Precision Medicine William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London London United Kingdom.,Aragon Institute of Engineering Research University of Zaragoza Zaragoza Spain.,Centro de Investigación Biomédica en Red - Bioingeniería, Biomateriales y Nanomedicina Zaragoza Spain
| | - Antti Kiviniemi
- Research Unit of Internal Medicine Medical Research Center Oulu, University of Oulu and Oulu University Hospital Oulu Finland
| | - Stefan van Duijvenboden
- Clinical Pharmacology and Precision Medicine William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London London United Kingdom.,Institute of Cardiovascular Science University College London London United Kingdom
| | - Andrew Tinker
- Clinical Pharmacology and Precision Medicine William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London London United Kingdom.,National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre Barts and The London School of Medicine and Dentistry, Queen Mary University of London London United Kingdom
| | - Pier D Lambiase
- Institute of Cardiovascular Science University College London London United Kingdom.,Barts Heart Centre St Bartholomew's Hospital London United Kingdom
| | - Juhani Junttila
- Research Unit of Internal Medicine Medical Research Center Oulu, University of Oulu and Oulu University Hospital Oulu Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine Medical Research Center Oulu, University of Oulu and Oulu University Hospital Oulu Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine Medical Research Center Oulu, University of Oulu and Oulu University Hospital Oulu Finland
| | - Michele Orini
- Institute of Cardiovascular Science University College London London United Kingdom.,Barts Heart Centre St Bartholomew's Hospital London United Kingdom
| | - Patricia B Munroe
- Clinical Pharmacology and Precision Medicine William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London London United Kingdom.,National Institute for Health and Care Research Barts Cardiovascular Biomedical Research Centre Barts and The London School of Medicine and Dentistry, Queen Mary University of London London United Kingdom
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11
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Hashimoto K, Kinoshita T, Miwa Y, Amino M, Yoshioka K, Yodogawa K, Nakagawa M, Nakamura K, Watanabe E, Nakamura K, Watanabe T, Kasamaki Y, Ikeda T. Ambulatory electrocardiographic markers predict serious cardiac events in patients with chronic kidney disease: The Japanese Noninvasive Electrocardiographic Risk Stratification of Sudden Cardiac Death in Chronic Kidney Disease (JANIES-CKD) study. Ann Noninvasive Electrocardiol 2021; 27:e12923. [PMID: 34873791 PMCID: PMC8916573 DOI: 10.1111/anec.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Noninvasive electrocardiographic markers (NIEMs) are promising arrhythmic risk stratification tools for assessing the risk of sudden cardiac death. However, little is known about their utility in patients with chronic kidney disease (CKD) and organic heart disease. This study aimed to determine whether NIEMs can predict cardiac events in patients with CKD and structural heart disease (CKD‐SHD). Methods We prospectively analyzed 183 CKD‐SHD patients (median age, 69 years [interquartile range, 61−77 years]) who underwent 24‐h ambulatory electrocardiographic monitoring and assessed the worst values for ambulatory‐based late potentials (w‐LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT). The primary endpoint was the occurrence of documented lethal ventricular tachyarrhythmias (ventricular fibrillation or sustained ventricular tachycardia) or cardiac death. The secondary endpoint was admission for cardiovascular causes. Results Thirteen patients reached the primary endpoint during a follow‐up period of 24 ± 11 months. Cox univariate regression analysis showed that existence of w‐LPs (hazard ratio [HR] = 6.04, 95% confidence interval [CI]: 1.4−22.3, p = .007) and NSVT [HR = 8.72, 95% CI: 2.8−26.5: p < .001] was significantly associated with the primary endpoint. Kaplan–Meier analysis demonstrated that the combination of w‐LPs and NSVT resulted in a lower event‐free survival rate than did other NIEMs (p < .0001). No NIEM was useful in predicting the secondary endpoint, although the left ventricular mass index was correlated with the secondary endpoint. Conclusion The combination of w‐LPs and NSVT was a significant risk factor for lethal ventricular tachyarrhythmias and cardiac death in CKD‐SHD patients.
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Affiliation(s)
- Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University, Tokyo, Japan
| | - Yosuke Miwa
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University, Kanagawa, Japan
| | - Koichiro Yoshioka
- Department of Cardiovascular Medicine, Tokai University, Kanagawa, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Kentaro Nakamura
- Division of Cardiovascular Medicine, Shin-Yamanote Hospital, Tokyo, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yuji Kasamaki
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University, Tokyo, Japan
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12
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Maru Y, Yodogawa K, Tanaka T, Kashiwada T, Iwasaki Y, Azuma A, Shimizu W. Detection of cardiac involvement in pulmonary sarcoidosis using high-resolution Holter electrocardiogram. J Arrhythm 2021; 37:438-444. [PMID: 33850586 PMCID: PMC8022007 DOI: 10.1002/joa3.12501] [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: 10/27/2020] [Revised: 12/03/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Early detection of cardiac involvement in patients with sarcoidosis is important but currently unresolved. The aim of this study was to elucidate the utility of frequency domain microvolt T-wave alternans (TWA), signal-averaged ECG (SAECG), and heart rate turbulence (HRT) using 24-hour Holter ECG for detecting cardiac involvement in patients with pulmonary sarcoidosis. METHODS This study consisted of consecutive 40 pulmonary sarcoidosis patients (11 males, 62 ± 13 years) who underwent 24-hour Holter monitoring with and without cardiac involvement. All patients underwent frequency domain TWA, SAECG, and HRT using 24-hour Holter monitoring. Patients with atrial fibrillation pacing or wide QRS electrocardiogram were excluded. RESULTS After 14 patients were excluded, a total of 26 patients (six males, 59 ± 14 years) were evaluated. Seven patients had cardiac involvement (cardiac sarcoidosis [CS] group). On the Holter SAECG, duration of low-amplitude signals <40 μV in the terminal filtered QRS complex (LAS40) was significantly higher, and root mean square voltage of the terminal 40 ms of the filtered QRS complex (RMS40) was significantly lower in the CS group compared with the non-CS group (LAS40: 61.4 ± 35.9 vs 37.6 ± 9.2 ms; P = .018, RMS40: 11.4 ± 10.3 vs 23.6 ± 13.2 ms; P = .023). Prevalence of positive late potential (LP) was also significantly higher in the CS group than that in the non-CS group (85.7% vs 31.5%; P = .026). The sensitivity, specificity, positive, and negative predictive values of LP for identifying patients with cardiac involvement were 85.7%, 68.4%, 50.0%, and 92.8%, respectively. CONCLUSION Holter SAECG may be useful for detecting cardiac involvement in patients with pulmonary sarcoidosis.
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Affiliation(s)
- Yujin Maru
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Kenji Yodogawa
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Toru Tanaka
- Department of Pulmonary Medicine and OncologyNippon Medical SchoolTokyoJapan
| | - Takeru Kashiwada
- Department of Pulmonary Medicine and OncologyNippon Medical SchoolTokyoJapan
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Arata Azuma
- Department of Pulmonary Medicine and OncologyNippon Medical SchoolTokyoJapan
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
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13
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Gao L, Gaba A, Cui L, Yang HW, Saxena R, Scheer FAJL, Akeju O, Rutter MK, Lo MT, Hu K, Li P. Resting Heartbeat Complexity Predicts All-Cause and Cardiorespiratory Mortality in Middle- to Older-Aged Adults From the UK Biobank. J Am Heart Assoc 2021; 10:e018483. [PMID: 33461311 PMCID: PMC7955428 DOI: 10.1161/jaha.120.018483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Spontaneous heart rate fluctuations contain rich information related to health and illness in terms of physiological complexity, an accepted indicator of plasticity and adaptability. However, it is challenging to make inferences on complexity from shorter, more practical epochs of data. Distribution entropy (DistEn) is a recently introduced complexity measure that is designed specifically for shorter duration heartbeat recordings. We hypothesized that reduced DistEn predicted increased mortality in a large population cohort. Method and Results The prognostic value of DistEn was examined in 7631 middle‐older–aged UK Biobank participants who had 2‐minute resting ECGs conducted (mean age, 59.5 years; 60.4% women). During a median follow‐up period of 7.8 years, 451 (5.9%) participants died. In Cox proportional hazards models with adjustment for demographics, lifestyle factors, physical activity, cardiovascular risks, and comorbidities, for each 1‐SD decrease in DistEn, the risk increased by 36%, 56%, and 73% for all‐cause, cardiovascular, and respiratory disease–related mortality, respectively. These effect sizes were equivalent to the risk of death from being >5 years older, having been a former smoker, or having diabetes mellitus. Lower DistEn was most predictive of death in those <55 years with a prior myocardial infarction, representing an additional 56% risk for mortality compared with older participants without prior myocardial infarction. These observations remained after controlling for traditional mortality predictors, resting heart rate, and heart rate variability. Conclusions Resting heartbeat complexity from short, resting ECGs was independently associated with mortality in middle‐ to older‐aged adults. These risks appear most pronounced in middle‐aged participants with prior MI, and may uniquely contribute to mortality risk screening.
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Affiliation(s)
- Lei Gao
- Department of Anesthesia Critical Care and Pain Medicine Massachusetts General HospitalHarvard Medical School Boston MA.,Medical Biodynamics Program Brigham and Women's Hospital Boston MA
| | - Arlen Gaba
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA
| | - Longchang Cui
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA
| | - Hui-Wen Yang
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA
| | - Richa Saxena
- Department of Anesthesia Critical Care and Pain Medicine Massachusetts General HospitalHarvard Medical School Boston MA.,Broad Institute of MIT and Harvard Cambridge MA.,Center for Genomic Medicine Massachusetts General Hospital Boston MA
| | - Frank A J L Scheer
- Broad Institute of MIT and Harvard Cambridge MA.,Division of Sleep Medicine Harvard Medical School Boston MA
| | - Oluwaseun Akeju
- Department of Anesthesia Critical Care and Pain Medicine Massachusetts General HospitalHarvard Medical School Boston MA
| | - Martin K Rutter
- Division of Diabetes Endocrinology & Gastroenterology The University of Manchester Manchester UK
| | - Men-Tzung Lo
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering National Central University Taoyuan Taiwan
| | - Kun Hu
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA.,Division of Sleep Medicine Harvard Medical School Boston MA
| | - Peng Li
- Medical Biodynamics Program Brigham and Women's Hospital Boston MA.,Division of Sleep Medicine Harvard Medical School Boston MA
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14
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Arsenos P, Gatzoulis KA, Doundoulakis I, Dilaveris P, Antoniou C, Stergios S, Sideris S, Ilias S, Tousoulis D. Arrhythmic risk stratification in heart failure mid-range ejection fraction patients with a non-invasive guiding to programmed ventricular stimulation two-step approach. J Arrhythm 2020; 36:890-898. [PMID: 33024466 PMCID: PMC7532265 DOI: 10.1002/joa3.12416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although some post myocardial infarction (post-MI) and dilated cardiomyopathy (DCM) patients with mid-range ejection fraction heart failure (HFmrEF/40%-49%) face an increased risk for arrhythmic sudden cardiac death (SCD), current guidelines do not recommend an implantable cardiac defibrilator (ICD). We risk stratified hospitalized HFmrEF patients for SCD with a combined non-invasive risk factors (NIRFs) guiding to programmed ventricular stimulation (PVS) two-step approach. METHODS Forty-eight patients (male = 83%, age = 64 ± 14 years, LVEF = 45 ± 5%, CAD = 69%, DCM = 31%) underwent a NIRFs screening first-step with electrocardiogram (ECG), SAECG, Echocardiography and 24-hour ambulatory ECG (AECG). Thirty-two patients with presence of one of three NIRFs (SAECG ≥ 2 positive criteria for late potentials, ventricular premature beats ≥ 240/24 hours, and non-sustained ventricular tachycardia [VT] episode ≥ 1/24 hours) were further investigated with PVS. Patients were classified as either low risk (Group 1, n = 16, NIRFs-), moderate risk (Group 2, n = 18, NIRFs+/PVS-), and high risk (Group 3, n = 14, NIRFs+/PVS+). All in Group 3 received an ICD. RESULTS After 41 ± 18 months, 9 of 48 patients, experienced the major arrhythmic event (MAE) endpoint (clinical VT/fibrillation = 3, appropriate ICD activation = 6). The endpoint occurred more frequently in Group 3 (7/14, 50%) than in Groups 1 and 2 (2/34, 5.8%). Logistic regression model adjusted for PVS, age, and LVEF revealed that PVS was an independent MAE predictor (OR: 21.152, 95% CI: 2.618-170.887, P = .004). Kaplan-Meier curves diverged significantly (log rank, P < .001) while PVS negative predictive value was 94%. CONCLUSIONS In hospitalized HFmrEF post-MI and DCM patients, a NIRFs guiding to PVS two-step approach efficiently detected the subgroup at increased risk for MAE.
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Affiliation(s)
- Petros Arsenos
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
- Arsenos Heart and Biosignals LabAvlonasGreece
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Ioannis Doundoulakis
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Polychronis Dilaveris
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Christos‐Konstantinos Antoniou
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Soulaidopoulos Stergios
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
| | - Skevos Sideris
- State Department of CardiologyHippokration General HospitalAthensGreece
| | | | - Dimitrios Tousoulis
- First Department of Cardiology and Electrophysiology LaboratoryHippokration General HospitalNational and Kapodistrian University of Athens School of MedicineAthensGreece
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15
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Hashimoto K, Amino M, Yoshioka K, Kasamaki Y, Kinoshita T, Ikeda T. Combined evaluation of ambulatory-based late potentials and nonsustained ventricular tachycardia to predict arrhythmic events in patients with previous myocardial infarction: A Japanese noninvasive electrocardiographic risk stratification of sudden cardiac death (JANIES) substudy. Ann Noninvasive Electrocardiol 2020; 26:e12803. [PMID: 32969113 PMCID: PMC7816808 DOI: 10.1111/anec.12803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 12/26/2022] Open
Abstract
Background Noninvasive electrocardiographic (ECG) markers are promising arrhythmic risk stratification tools for identifying sudden cardiac death. However, little is known about the usefulness of noninvasive ECG markers derived from ambulatory ECGs (AECG) in patients with previous myocardial infarction (pMI). We aimed to determine whether the ECG markers derived from AECG can predict serious cardiac events in patients with pMI. Methods We prospectively analyzed 104 patients with pMI (88 males, age 66 ± 11 years), evaluating late potentials (LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT) derived from AECG. The primary endpoint was the documentation of ventricular fibrillation or sustained ventricular tachycardia. Results Eleven patients reached the primary endpoint during a follow‐up period of 25 ± 9.5 months. Of the 104 patients enrolled in this study, LP positive in worst values (w‐LPs) and NSVT were observed in 25 patients, respectively. In the arrhythmic event group, the worst LP values and/or NSVT were found in eight patients (7.6%). The positive predictive and negative predictive values of the combined assessment with w‐LPs and NSVT were 56% and 94%, respectively, for predicting ventricular lethal arrhythmia. Kaplan–Meier analysis demonstrated that the combination of w‐LPs and NSVT had a poorer event‐free period than negative LPs (p < .0001). In the multivariate analysis, the combined assessment of w‐LPs and NSVT was a significant predictor of arrhythmic events (hazard ratio = 14.1, 95% confidence intervals: 3.4–58.9, p < .0001). Conclusion Combined evaluation of w‐LPs and NSVT was a powerful risk stratification strategy for predicting arrhythmia that can lead to sudden cardiac death in patients with pMI.
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Affiliation(s)
- Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University, Isehara, Japan
| | - Koichiro Yoshioka
- Department of Cardiovascular Medicine, Tokai University, Isehara, Japan
| | - Yuji Kasamaki
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
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16
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Braunisch MC, Mayer CC, Bauer A, Lorenz G, Haller B, Rizas KD, Hagmair S, von Stülpnagel L, Hamm W, Günthner R, Angermann S, Matschkal J, Kemmner S, Hasenau AL, Zöllinger I, Steubl D, Mann JF, Lehnert T, Scherf J, Braun JR, Moog P, Küchle C, Renders L, Malik M, Schmidt G, Wassertheurer S, Heemann U, Schmaderer C. Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients. Front Physiol 2020; 11:77. [PMID: 32116784 PMCID: PMC7027389 DOI: 10.3389/fphys.2020.00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background Excess mortality in hemodialysis patients is mostly of cardiovascular origin. We examined the association of heart rate turbulence (HRT), a marker of baroreflex sensitivity, with cardiovascular mortality in hemodialysis patients. Methods A population of 290 prevalent hemodialysis patients was followed up for a median of 3 years. HRT categories 0 (both turbulence onset [TO] and slope [TS] normal), 1 (TO or TS abnormal), and 2 (both TO and TS abnormal) were obtained from 24 h Holter recordings. The primary end-point was cardiovascular mortality. Associations of HRT categories with the endpoints were analyzed by multivariable Cox regression models including HRT, age, albumin, and the improved Charlson Comorbidity Index for hemodialysis patients. Multivariable linear regression analysis identified factors associated with TO and TS. Results During the follow-up period, 20 patients died from cardiovascular causes. In patients with HRT categories 0, 1 and 2, cardiovascular mortality was 1, 10, and 22%, respectively. HRT category 2 showed the strongest independent association with cardiovascular mortality with a hazard ratio of 19.3 (95% confidence interval: 3.69-92.03; P < 0.001). Age, calcium phosphate product, and smoking status were associated with TO and TS. Diabetes mellitus and diastolic blood pressure were only associated with TS. Conclusion Independent of known risk factors, HRT assessment allows identification of hemodialysis patients with low, intermediate, and high risk of cardiovascular mortality. Future prospective studies are needed to translate risk prediction into risk reduction in hemodialysis patients.
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Affiliation(s)
- Matthias C Braunisch
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Christopher C Mayer
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Axel Bauer
- Department of Cardiology, Munich University Clinic, German Centre for Cardiovascular Research, Ludwig Maximilian University of Munich, Munich, Germany.,University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Lorenz
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Konstantinos D Rizas
- Department of Cardiology, Munich University Clinic, German Centre for Cardiovascular Research, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefan Hagmair
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Lukas von Stülpnagel
- Department of Cardiology, Munich University Clinic, German Centre for Cardiovascular Research, Ludwig Maximilian University of Munich, Munich, Germany.,University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Hamm
- Department of Cardiology, Munich University Clinic, German Centre for Cardiovascular Research, Ludwig Maximilian University of Munich, Munich, Germany
| | - Roman Günthner
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Susanne Angermann
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Julia Matschkal
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Stephan Kemmner
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Anna-Lena Hasenau
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Isabel Zöllinger
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Dominik Steubl
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Johannes F Mann
- Department of Nephrology, University of Erlangen-Nuremberg, Erlangen, Germany.,KfH Kidney Center, Munich, Germany
| | | | | | | | - Philipp Moog
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Claudius Küchle
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Lutz Renders
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Georg Schmidt
- Klinik für Innere Medizin I, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Siegfried Wassertheurer
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Uwe Heemann
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Christoph Schmaderer
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
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