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Qiu Y, Sun J, Wang Y, Jin C, Ju W, Yang G, Gu K, Liu H, Wang Z, Jiang X, Li M, Chen H, Chen M. Association between P-wave terminal force in lead V 1 and extent of left atrial low-voltage substrate in older patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:1153-1160. [PMID: 38030935 DOI: 10.1007/s10840-023-01710-w] [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: 09/08/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The P-wave terminal force in lead V1 (PTFV1) is a marker of cardiomyopathy and risk of atrial fibrillation (AF). Low-voltage area (LVA) in the left atrium (LA), which indicates underlying atrial fibrosis, could predict AF recurrence. This study aimed to investigate the correlation between PTFV1 and LVA in older patients with paroxysmal AF. METHODS From May 1, 2020, to October 31, 2021, a total of 162 patients aged 65-80 years with paroxysmal AF who underwent index ablation procedures were enrolled. PTFV1 was measured in sinus rhythm (SR) using 12-lead electrocardiograms prior to the ablation. Abnormal PTFV1 was defined as a ≥ 4 mVms depression. Additional LVA ablation beyond circumferential pulmonary vein isolation (CPVI) was performed if LVAs were found. RESULTS Among the 162 patients, 88 had a normal PTFV1 and 74 had an abnormal PTFV1 prior to ablation. There was a significant difference in LVA in patients with and without an abnormal PTFV1 (LVA, 11.0 vs. 5.1 cm2, P < 0.001; LVA burden, 8.9% vs. 4.5%, P < 0.001). PTFV1 and PTAV1 were highest in the upper tertile with extensive LVAs (P < 0.001). Multivariate analysis revealed that abnormal PTFV1 was an independent predictor of LVAs (β = 4.961; 95% CI, 2.135-7.788; P < 0.001). After a median follow-up of 23 months, the AF-free survival rate was similar between the normal PTFV1 group and the abnormal PTFV1 group (13/88 vs. 12/74, hazard ratio [HR], 0.933 [95% CI, 0.425-2.047]; P = 0.861). CONCLUSIONS Abnormal PTFV1 at baseline was independently associated with the extent of LVA in older patients with paroxysmal AF.
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Affiliation(s)
- Yue Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Jinyu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Yuxuan Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Caiyi Jin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Kai Gu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Hailei Liu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Zidun Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Xiaohong Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Mingfang Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Hongwu Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
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Kawatani S, Kotake Y, Takami A, Nakamura K, Tomomori T, Okamura A, Kato M, Yamamoto K. Predictor of A4 amplitude using preprocedural electrocardiography in patients with leadless pacemakers. Heart Rhythm 2024; 21:1064-1071. [PMID: 38382683 DOI: 10.1016/j.hrthm.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Based on historical studies of leadless pacemakers (LPs), high atrioventricular synchrony (AVS) with mechanical sensing-based VDD pacing is largely influenced by A4 amplitude. A limited study investigated the predictors of A4 amplitude using clinical and echocardiographic parameters. OBJECTIVE The purpose of this study was to investigate the predictors of A4 amplitude preoperatively to select patients who could benefit the most from AVS among patients with VDD LPs (Micra-AV, Medtronic). METHODS Data from patients who received Micra-AV implantations from November 2021 to August 2023 at Tottori University Hospital were analyzed. Twelve-lead electrocardiography and transthoracic echocardiography were performed before the Micra-AV implantations. To assess the electrical indices associated with the A4 signal, electrocardiographic morphologic P-wave parameters were analyzed, including P-wave duration, P-wave amplitude, maximum deflection index (MDI), and P-wave dispersion. RESULTS A total of 50 patients who underwent Micra-AV implantations (median age 84 years; 64% male) were included and divided into 2 groups based on the median value of A4 amplitude, the high-A4 group (A4 amplitude >2.5 m/s2; n = 26), and low-A4 group (A4 amplitude ≤2.5 m/s2; n = 24). There was a significant difference between the high-A4 and low-A4 groups with regard to left ventricular ejection fraction (P = .01), P-wave dispersion (P = .01), and MDI (P <.001). Multivariate logistic analysis revealed that lower MDI was an independent predictor of high A4-amplitude (odds ratio 0.78; 95% confidence interval 0.67-0.92; P = 0.003). CONCLUSION Preoperative electrocardiographic evaluations of P-wave morphology may be useful for predicting A4 amplitude. MDI was the only independent A4 amplitude predictor that seemed promising for selecting Micra-AV patients.
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Affiliation(s)
- Shunsuke Kawatani
- Department of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yasuhito Kotake
- Department of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Aiko Takami
- Department of Cardiology, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Kensuke Nakamura
- Department of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takuya Tomomori
- Department of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Akihiro Okamura
- Department of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masaru Kato
- Department of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
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Marano M, Senigalliesi L, Cocola R, Fontana M, Parente E, Russo V. Advanced Interatrial Block across the Spectrum of Renal Function. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1001. [PMID: 38929618 PMCID: PMC11205515 DOI: 10.3390/medicina60061001] [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: 05/21/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
Background and Objective: Interatrial block (IAB) is defined as a conduction delay between the right and left atria. No data are available about the prevalence of both partial IAB and advanced IAB among the different stages of chronic kidney disease. The aim of this study was to describe the prevalence and type of advanced IAB across the spectrum of renal function, including patients on dialysis and the clinical characteristics associated with advanced IAB. Materials and Methods: Retrospective, single-center study of 151 patients consecutively admitted to the Nephrology and Ophthalmology Unit for 3 months. The study population was divided into three groups according to stages of chronic kidney disease. We evaluated the prevalence and pattern of IAB among the groups and the clinical characteristics associated with advanced IAB. Results: The prevalence of partial IAB was significantly lower in end-stage kidney disease (ESKD) group compared to control group (36.7% vs. 59.6%; p = 0.02); in contrast the prevalence of advanced IAB was significantly higher in both chronic kidney disease (CKD) (17.8% vs. 5.3%, p = 0.04) and ESKD group (24.5% vs. 5.3%, p = 0.005) compared to control group. The atypical pattern of advanced IAB was more frequent in both the ESKD and CKD group than in the control group (100% and 75% vs. 33.3%; p = 0.02). Overall, among patients that showed advanced IAB, 17 (73.9%) showed an atypical pattern by morphology and 2 (8.7%) showed an atypical pattern by duration of advanced IAB. The ESKD group was younger than the control group (65.7 ± 12.3 years vs. 71.3 ± 9.9 years; p = 0.01) and showed a higher prevalence of beta blockers (42.9% vs. 19.3%; p = 0.009), as in the CKD group (37.8% vs. 19.3%; p= 0.04). Conclusions: The progressive worsening of renal function was associated with an increasing prevalence of advanced IAB. Advanced IAB may be a sign of uremic cardiomyopathy and may suggest further evaluation with long-term follow-up to investigate its prognostic significance in chronic kidney disease.
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Affiliation(s)
- Marco Marano
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Luigi Senigalliesi
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Rossella Cocola
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Mariarosaria Fontana
- Unit of Nephrology and Dialysis, Maria Rosaria Clinic, Via Colle San Bartolomeo, 80045 Pompei, Italy; (M.M.); (L.S.); (R.C.); (M.F.)
| | - Erika Parente
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80126 Naples, Italy;
| | - Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80126 Naples, Italy;
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Li M, Ji Y, Shen Y, Wang W, Lakshminarayan K, Soliman EZ, Chen M, Chen LY. Deep terminal negative of the P wave in V1 and incidence of ischemic stroke: The atherosclerosis risk in communities (ARIC) study. J Electrocardiol 2024; 84:123-128. [PMID: 38636124 PMCID: PMC11470811 DOI: 10.1016/j.jelectrocard.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Deep terminal negative of the P wave in V1 (DTNPV1) is a marker of left atrial remodeling. We aimed to evaluate the association of DTNPV1 with incident ischemic stroke. METHODS The Atherosclerosis Risk in Communities study is a prospective community-based cohort study. All participants at visit 4 (1996-1998) except those with prevalent stroke, missing covariates, and missing or uninterpretable ECG were included. DTNPV1 was defined as the absolute value of the depth of the terminal negative phase >100 μV in the presence of biphasic P wave in V1. Association between DTNPV1 as a time-dependent exposure variable and incident ischemic stroke was evaluated. The accuracy of the prediction model consisting of DTNPV1 and CHA2DS2-VASc variables in predicting ischemic stroke was analyzed. RESULTS Among 10,605 participants (63 ± 6 years, 56% women, 20% Black), 803 cases of ischemic stroke occurred over a median follow-up of 20.19 years. After adjusting for demographics, DTNPV1 was associated with an increased risk of stroke (HR 1.96, [95% CI 1.39-2.77]). After further adjusting for stroke risk factors, use of aspirin and anticoagulants, and time-dependent atrial fibrillation, DTNPV1 was associated with a 1.50-fold (95% CI 1.06-2.13) increased risk of stroke. When added to the CHA2DS2-VASc variables, DTNPV1 did not significantly improve stroke prediction as assessed by C-statistic. However, there was improvement in risk classification for participants who did not develop stroke. CONCLUSION DTNPV1 is significantly associated with higher risk of ischemic stroke. Since DTNPV1 is a simplified electrocardiographic parameter, it may help stroke prediction, a subject for further research.
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Affiliation(s)
- Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuekai Ji
- Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Youmei Shen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Elsayed Z Soliman
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Yee Chen
- Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, USA.
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Lin H, Lin M, Lin T, Ye M. Prognostic Value of PtfV1 in Long-Term Outcomes of Patients with Unstable Angina. Int J Gen Med 2023; 16:6065-6072. [PMID: 38148885 PMCID: PMC10750485 DOI: 10.2147/ijgm.s439105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023] Open
Abstract
Background P-wave terminal force in lead V1 (PtfV1) irregularity has been associated with various cardiovascular conditions, including atrial fibrillation, left ventricular diastolic dysfunction, valvular heart disease, congestive heart failure, stroke, and mortality. However, its prognostic value for unstable angina (UA) has not been extensively studied. To address this knowledge gap, this study aimed to evaluate the long-term predictive significance of PtfV1 at discharge for UA patients. Methods A total of 707 patients with newly diagnosed UA were included in this study. PtfV1 measurements were recorded at admission and discharge. PtfV1(+) was defined as an absolute value above 0.04mm·s, while PtfV1(-) was defined as an absolute value below 0.04mm·s. Based on their PtfV1 values at discharge, patients were categorized into two groups: PtfV1(-) and PtfV1(+). Univariate and multivariate regression analyses were conducted to identify variables that could potentially contribute to the risk of UA. Results Univariate analysis revealed a higher incidence of total adverse outcomes and major adverse cardiovascular events (MACE) in the PtfV1(+) group compared to the PtfV1(-) group, with a risk ratio (RR) of 2.006 [95% confidence interval (95% CI): 1.389-2.896] for total outcomes and an RR of 2.759 (95% CI: 1.870-4.070) for MACE. After adjusting for confounding factors through multivariate analysis, participants with PtfV1(+) had a 46% increased risk [adjusted hazard ratio (HR): 1.458; 95% CI: 1.010-2.104]for total adverse outcomes and an 86% increased risk (adjusted HR: 1.863; 95% CI: 1.246-2.786) for MACE compared to those with PtfV1(-). Conclusion The presence of PtfV1(+) at discharge is an independent predictor of poor outcomes and provides extended prognostic information for UA patients.
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Affiliation(s)
- Huizhong Lin
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou City, People’s Republic of China
| | - Maosen Lin
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou City, People’s Republic of China
| | - Tao Lin
- Department of Epidemiology and Health Statistics, Fujian Medical University, Fuzhou City, People’s Republic of China
| | - Mingfang Ye
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou City, People’s Republic of China
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Xie W, Wu L, Yang M, Luo H, Li W, Li H. Association of preoperative electrocardiographic markers with sepsis in elderly patients after general surgery. BMC Cardiovasc Disord 2023; 23:485. [PMID: 37794366 PMCID: PMC10552407 DOI: 10.1186/s12872-023-03535-x] [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: 04/02/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Electrocardiographic markers, as surrogates for sympathetic excitotoxicity, are widely predictive of cardiovascular adverse events, but whether these markers can predict postsurgical sepsis (SS) is unclear. METHODS We retrospectively analyzed patients who underwent abdominal surgery from March 2013 to May 2023. We collected basic data, comorbidities, blood samples, echocardiology, electrocardiogram, and surgical data, as well as short-term outcome. The primary endpoints were postsurgical SS, in which logistic regression analyses can identify independent risk factors. The optimal cut-off value predictive postsurgical SS both P wave and PR interval were calculated in the receiver operating characteristic curve (ROC). RESULTS A total of 1988 subjects were analyzed, and the incidence of postsurgical SS was 3.8%. The mean age at enrollment was 68.6 ± 7.1 years, and 53.2% of the participants were men. In the ROC analysis, the areas under the curve (AUC) for P wave and PR interval predictive postsurgical SS were 0.615 (95%CI, 0.548-0.683; p = 0.001) and 0.618 (95%CI, 0.554-0.682; p = 0.001), respectively. The P wave and PR interval predicted postoperative sepsis with optimal discrimination of 103 and 157 ms, with a sensitivity of 0.744 and 0.419, and a specificity of 0.427 and 0.760. P-wave less than 103 ms or PR interval less than 157 ms associated with a 2.06 or 2.33 fold increase occurred risk postsurgical SS. CONCLUSIONS Shorter P-wave and PR intervals were both independently associated with postsurgical SS. These preoperative electrophysiological markers could have potential useful for early recognition of postoperative SS.
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Affiliation(s)
- WeiXian Xie
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China
| | - LiXia Wu
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China
| | - MeiXing Yang
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China
| | - HongLi Luo
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China
| | - Weichao Li
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China.
| | - Heng Li
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China.
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Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou VS, Pugh PJ. Electrocardiographic Predictors of Atrial Fibrillation. Med Sci (Basel) 2023; 11:medsci11020030. [PMID: 37092499 PMCID: PMC10123668 DOI: 10.3390/medsci11020030] [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: 03/09/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common pathological arrhythmia, and its complications lead to significant morbidity and mortality. However, patients with AF can often go undetected, especially if they are asymptomatic or have a low burden of paroxysms. Identification of those at high risk of AF development may help refine screening and management strategies. METHODS PubMed and Embase databases were systematically searched for studies looking at electrocardiographic predictors of AF from inception to August 2021. RESULTS A total of 115 studies were reported which examined a combination of atrial and ventricular parameters that could be electrocardiographic predictors of AF. Atrial predictors include conduction parameters, such as the PR interval, p-wave index and dispersion, and partial interatrial or advanced interatrial block, or morphological parameters, such as p-wave axis, amplitude and terminal force. Ventricular predictors include abnormalities in QRS amplitude, morphology or duration, QT interval duration, r-wave progression and ST segment, i.e., t-wave abnormalities. CONCLUSIONS There has been significant interest in electrocardiographic prediction of AF, especially in populations at high risk of atrial AF, such as those with an embolic stroke of undetermined source. This review highlights the breadth of possible predictive parameters, and possible pathological bases for the predictive role of each parameter are proposed.
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Affiliation(s)
- Panagiota Anna Chousou
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Rahul Chattopadhyay
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Vasiliki Tsampasian
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Peter John Pugh
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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Wali R, Wang X, Li C, Yang H, Liu F, Sama SD, Bai L, Lee S, Hidru TH, Yang X, Xia Y. Early atrial remodeling predicts the risk of cardiovascular events in patients with metabolic syndrome: a retrospective cohort study. Front Cardiovasc Med 2023; 10:1162886. [PMID: 37206097 PMCID: PMC10188925 DOI: 10.3389/fcvm.2023.1162886] [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: 02/10/2023] [Accepted: 03/21/2023] [Indexed: 05/21/2023] Open
Abstract
Background This study aims to assess the prevalence of atrial cardiomyopathy (ACM) in patients with new-onset metabolic syndrome (MetS) and investigate whether ACM could be a predictor of hospital admission for cardiovascular (CV) events. Methods Patients with MetS who were free of clinically proven atrial fibrillation and other CV diseases (CVDs) at baseline were included in the present study. The prevalence of ACM was compared between MetS patients with and without left ventricular hypertrophy (LVH). The time to first hospital admission for a CV event between subgroups was assessed using the Cox proportional hazard model. Results A total of 15,528 MetS patients were included in the final analysis. Overall, LVH patients accounted for 25.6% of all newly diagnosed MetS patients. ACM occurred in 52.9% of the cohort and involved 74.8% of LVH patients. Interestingly, a significant percentage of ACM patients (45.4%) experienced MetS without LVH. After 33.2 ± 20.6 months of follow-up, 7,468 (48.1%) patients had a history of readmission due to CV events. Multivariable Cox regression analysis revealed that ACM was associated with an increased risk of admission for CVDs in the MetS patients with LVH [hazard ratio (HR), 1.29; 95% confidence interval (CI), 1.142-1.458; P < 0.001]. Likewise, ACM was found to be independently associated with hospital readmission due to CVD-related events in MetS patients without LVH (HR, 1.175; 95% CI, 1.105-1.250; P < 0.001). Conclusion ACM is a marker of early myocardial remodeling and predicts hospitalization for CV events in patients with MetS.
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Affiliation(s)
- Rohbaiz Wali
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xinying Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chenglin Li
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Heng Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fei Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Salah D. Sama
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lan Bai
- Yidu Cloud Technology, Ltd., Beijing, China
| | - Sharen Lee
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tesfaldet H. Hidru
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaolei Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Correspondence: Yunlong Xia Xiaolei Yang
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Correspondence: Yunlong Xia Xiaolei Yang
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Gao X, Lai Y, Luo X, Peng D, Li Q, Zhou H, Xue Y, Guo H, Zhao J, Yang H, Kuang S, Wang Z, Zhang M, Deng C, Wu S, Rao F. Acetyltransferase p300 regulates atrial fibroblast senescence and age-related atrial fibrosis through p53/Smad3 axis. Aging Cell 2022; 22:e13743. [PMID: 36468256 PMCID: PMC9835568 DOI: 10.1111/acel.13743] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/30/2022] [Accepted: 11/06/2022] [Indexed: 12/09/2022] Open
Abstract
Atrial fibrosis induced by aging is one of the main causes of atrial fibrillation (AF), but the potential molecular mechanism is not clear. Acetyltransferase p300 participates in the cellular senescence and fibrosis, which might be involved in the age-related atrial fibrosis. Four microarray datasets generated from atrial tissue of AF patients and sinus rhythm (SR) controls were analyzed to find the possible relationship of p300 (EP300) with senescence and fibrosis. And then, biochemical assays and in vivo electrophysiological examination were performed on older AF patients, aging mice, and senescent atrial fibroblasts. The results showed that (1) the left atrial tissues of older AF patients, aging mouse, and senescence human atrial fibroblasts had more severe atrial fibrosis and higher protein expression levels of p300, p53/acetylated p53 (ac-p53)/p21, Smad3/p-Smads, and fibrosis-related factors. (2) p300 inhibitor curcumin and p300 knockdown treated aging mouse and senescence human atrial fibroblasts reduced the senescence ratio of atrial fibroblasts, ameliorated the atrial fibrosis, and decreased the AF inducibility. In contrast, over-expression of p300 can lead to the senescence of atrial fibroblasts and atrial fibrosis. (3) p53 knockdown decreased the expression of aging and fibrosis-related proteins. (4) Co-immunoprecipitation and immunofluorescence showed that p53 forms a complex with smad3 and directly regulates the expression of smad3 in atrial fibroblasts. Our findings suggest that the mechanism of atrial fibrosis induced by aging is, at least, partially dependent on the regulation of p300, which provides new sights into the AF treatment, especially for the elderly.
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Affiliation(s)
- Xiao‐Yan Gao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Ying‐Yu Lai
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Department of PharmacyThe People's Hospital of HezhouHezhouChina
| | - Xue‐Shan Luo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - De‐Wei Peng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Qiao‐Qiao Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Hui‐Shan Zhou
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Yu‐Mei Xue
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Hui‐Ming Guo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Jun‐Fei Zhao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Hui Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Su‐Juan Kuang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Zhao‐Yu Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Meng‐Zhen Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Chun‐Yu Deng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Shu‐Lin Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Fang Rao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina,Provincial Key Laboratory of Clinical Pharmacology, Research Center of Medical Sciences, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
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10
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Herrera C, Bruña V, María Barrio J, Cuerpo G, Fernández-Avilés F, Bayés de Luna A, Martínez-Sellés M. Atrial myxoma surgery and p-wave remodeling. Pacing Clin Electrophysiol 2022; 45:1160-1164. [PMID: 35898158 DOI: 10.1111/pace.14573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Data regarding atrial electrocardiographic parameters in patients with atrial myxomas are scarce. METHODS We aimed to study atrial electrocardiographic features in patients with atrial myxomas, before and after surgery. We also analyze the incidence of atrial fibrillation during follow-up and its correlation with different P-wave indexes. 32 patients in sinus rhythm that underwent atrial myxoma surgery were included. RESULTS Mean age was 55.0±12.6 years and 18 (56.3%) were women. Ten patients had left atrial enlargement (31.3%). Only one myxoma was located in the right atrium. At baseline 7 cases of partial interatrial block (IAB) were detected (21.9%), two in the absence of left atrial enlargement. There were significant differences in atrial electrocardiographic indexes before and after surgery, including P-wave duration (108.9±17.9 ms vs. 93.0±12.4 ms; p < 0.001), partial IAB (21.9% vs 3.1%; p = 0.012) and duration of P-wave terminal force in lead V1 negativity (-0.6±0.3 vs -0.5±0.3 mm; p = 0.034). At a mean follow up of 10.0±5.5 years, 10 patients (31.3%) had experienced at least one episode of atrial fibrillation. Post-operative P-wave duration was associated with atrial fibrillation occurrence during follow-up (Hazard ratio: 0.90, 95% confidence interval: 0.83-0.98; p = 0.020). CONCLUSIONS Abnormalities in atrial electrocardiographic indexes are common in atrial myxomas and frequently improve after surgery. Post-operative P-wave duration is associated with atrial fibrillation occurrence during follow-up. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cristian Herrera
- Department of Cardiology, Hospital General Universitario Gregorio Marañón. CIBER-CV, Madrid, Spain
| | - Vanesa Bruña
- Department of Cardiology, Hospital Universitario 12 de Octubre. CIBER-CV, Madrid, Spain
| | - Jose María Barrio
- Department of Anestesiology. Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gregorio Cuerpo
- Department of Cardiac Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón. CIBER-CV, Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | - Antonio Bayés de Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón. CIBER-CV, Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Universidad Europea, Madrid, Spain
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11
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Chen LY, Ribeiro ALP, Platonov PG, Cygankiewicz I, Soliman EZ, Gorenek B, Ikeda T, Vassilikos VP, Steinberg JS, Varma N, Bayés-de-Luna A, Baranchuk A. P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research-A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. CIRCULATION. ARRHYTHMIA AND ELECTROPHYSIOLOGY 2022; 15:e010435. [PMID: 35333097 PMCID: PMC9070127 DOI: 10.1161/circep.121.010435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Atrial cardiomyopathy, characterized by abnormalities in atrial structure and function, is associated with increased risk of adverse cardiovascular and neurocognitive outcomes, independent of atrial fibrillation. There exists a critical unmet need for a clinical tool that is cost-effective, easy to use, and that can diagnose atrial cardiomyopathy. P wave parameters (PWPs) reflect underlying atrial structure, size, and electrical activation; alterations in these factors manifest as abnormalities in PWPs that can be readily ascertained from a standard 12-lead ECG and potentially be used to aid clinical decision-making. PWPs include P wave duration, interatrial block, P wave terminal force in V1, P wave axis, P wave voltage, P wave area, and P wave dispersion. PWPs can be combined to yield an index (P wave index), such as the morphology-voltage-P-wave duration ECG risk score. Abnormal PWPs have been shown in population-based cohort studies to be independently associated with higher risks of atrial fibrillation, ischemic stroke, sudden cardiac death, and dementia. Additionally, PWPs, either individually or in combination (as a P wave index), have been reported to enhance prediction of atrial fibrillation or ischemic stroke. To facilitate translation of PWPs to routine clinical practice, additional work is needed to standardize measurement of PWPs (eg, via semiautomated or automated measurement), confirm their reliability and predictive value, leverage novel approaches (eg, wavelet analysis of P waves and machine learning algorithms), and finally, define the risk-benefit ratio of specific interventions in high-risk individuals. Our ultimate goal is to repurpose the ubiquitous 12-lead ECG to advance the study, diagnosis, and treatment of atrial cardiomyopathy, thus overcoming critical challenges in prevention of cardiovascular disease and dementia.
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Affiliation(s)
- Lin Yee Chen
- Lillehei Heart Institute & Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis' MN (L.Y.C.)
| | - Antonio Luiz Pinho Ribeiro
- Centro de Telessaúde, Hospital das Clínicas, & Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.P.R.)
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund' Sweden (P.G.P.)
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Poland (I.C.)
| | - Elsayed Z Soliman
- Institute of Global Health & Human Ecology, American University in Cairo, Cairo, Egypt (E.Z.S.).,Epidemiological Cardiology Research Center (EPICARE), Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
| | - Bulent Gorenek
- Department of Cardiology, Eskişehir Osmangazi University, Eskisehir, Turkey (B.G.)
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo' Japan (T.I.)
| | - Vassilios P Vassilikos
- Third Cardiology Department, Hippokrateio General Hospital, Medical School, Aristotle University of Thessaloniki, Greece (V.P.V.)
| | - Jonathan S Steinberg
- Clinical Cardiovascular Research Center, Univ of Rochester School of Medicine & Dentistry, Rochester, NY (J.S.S.)
| | - Niraj Varma
- Cardiac Electrophysiology, Heart & Vascular Institute, Cleveland Clinic, Cleveland' OH (N.V.)
| | - Antoni Bayés-de-Luna
- Cardiovascular Research Foundation. Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (A.B.-d.-L.)
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science, Center, Queen's University, Kingston, Ontario, Canada (A.B.)
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12
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Herrera C, Bruña V, Comella A, de la Rosa A, Díaz-González L, Ruiz-Ortiz M, Lacalzada-Almeida J, Lucía A, Boraita A, Bayés-de-Luna A, Martínez-Sellés M. Left atrial enlargement in competitive athletes and atrial electrophysiology. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 75:421-428. [PMID: 34373222 DOI: 10.1016/j.rec.2021.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES There are scarce data on left atrial (LA) enlargement and electrophysiological features in athletes. METHODS Multicenter observational study in competitive athletes and controls. LA enlargement was defined as LA volume indexed to body surface area ≥ 34mL/m2. We analyzed its relationship with atrial electrocardiography parameters. RESULTS We included 356 participants, 308 athletes (mean age: 36.4±11.6 years) and 48 controls (mean age: 49.3±16.1 years). Compared with controls, athletes had a higher mean LA volume index (29.8±8.6 vs 25.6±8.0mL/m2, P=.006) and a higher prevalence of LA enlargement (113 [36.7%] vs 5 [10.4%], P <.001), but there were no relevant differences in P-wave duration (106.3±12.5ms vs 108.2±7.7ms; P=.31), the prevalence of interatrial block (40 [13.0%] vs 4 [8.3%]; P=.36), or morphology-voltage-P-wave duration score (1.8±0.84 vs 1.5±0.8; P=.71). Competitive training was independently associated with LA enlargement (OR, 14.7; 95%CI, 4.7-44.0; P <.001) but not with P-wave duration (OR, 1.02; 95%CI, 0.99-1.04), IAB (OR, 1.4; 95%CI, 0.7-3.1), or with morphology-voltage-P-wave duration score (OR, 1.4; 95%CI, 0.9-2.2). CONCLUSIONS LA enlargement is common in adult competitive athletes but is not accompanied by a significant modification in electrocardiographic parameters.
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Affiliation(s)
- Cristian Herrera
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Vanesa Bruña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Agustí Comella
- Laboratorio de Fisiología del Ejercicio de Bayés Esport, Grupo de Investigación en Metodología, Métodos, Modelos y Resultados (M3O) de la Universidad de Vic-Universidad Central de Catalunya, Vic, Barcelona, Spain
| | - Alejandro de la Rosa
- Servicio de Cardiología, Hospital Hospiten Rambla, Santa Cruz de Tenerife, Spain
| | | | - Martín Ruiz-Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan Lacalzada-Almeida
- Laboratorio de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Alejandro Lucía
- Facultad de Ciencias de la Actividad Física y el Deporte, Universidad Europea, Madrid, Spain; Laboratorio de Actividad Física y Salud, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Araceli Boraita
- Servicio de Cardiología, Centro de Medicina del Deporte, Madrid, Spain
| | - Antonio Bayés-de-Luna
- Fundación de Investigación Cardiovascular, ICCC-Instituto de Investigación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain.
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13
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Herrera C, Bruña V, Comella A, de la Rosa A, Díaz-González L, Ruiz-Ortiz M, Lacalzada-Almeida J, Lucía A, Boraita A, Bayés-de-Luna A, Martínez-Sellés M. Dilatación de la aurícula izquierda en deportistas de alta competición y electrofisiología auricular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Kreimer F, Aweimer A, Pflaumbaum A, Mügge A, Gotzmann M. Impact of P-wave indices in prediction of atrial fibrillation-Insight from loop recorder analysis. Ann Noninvasive Electrocardiol 2021; 26:e12854. [PMID: 33963655 PMCID: PMC8411742 DOI: 10.1111/anec.12854] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Several P-wave indices are associated with the development of atrial fibrillation (AF). However, previous studies have been limited in their ability to reliably diagnose episodes of AF. Implantable loop recorders allow long-term, continuous, and therefore more reliable detection of AF. HYPOTHESIS The aim of this study is to identify and evaluate ECG parameters for predicting AF by analyzing patients with loop recorders. METHODS This study included 366 patients (mean age 62 ± 16 years, mean LVEF 61 ± 6%, 175 women) without AF who underwent loop recorder implantation between 2010-2020. Patients were followed up on a 3 monthly outpatient interval. RESULTS During a follow-up of 627 ± 409 days, 75 patients (20%) reached the primary study end point (first detection of AF). Independent predictors of AF were as follows: age ≥68 years (hazard risk [HR], 2.66; 95% confidence interval [CI], 1.668-4.235; p < .001), P-wave amplitude in II <0.1 mV (HR, 2.11; 95% CI, 1.298-3.441; p = .003), P-wave terminal force in V1 ≤ -4000 µV × ms (HR, 5.3; 95% CI, 3.249-8.636; p < .001, and advanced interatrial block (HR, 5.01; 95% CI, 2.638-9.528; p < .001). Our risk stratification model based on these independent predictors separated patients into 4 groups with high (70%), intermediate high (41%), intermediate low (18%), and low (4%) rates of AF. CONCLUSIONS Our study indicated that P-wave indices are suitable for predicting AF episodes. Furthermore, it is possible to stratify patients into risk groups for AF using simple ECG parameters, which is particularly important for patients with cryptogenic stroke.
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Affiliation(s)
- Fabienne Kreimer
- University Hospital St Josef Hospital, Cardiology and Rhythmology, Ruhr University, Bochum, Germany
| | - Assem Aweimer
- University Hospital Bergmannsheil, Cardiology and Angiology, Ruhr University, Bochum, Germany
| | - Andreas Pflaumbaum
- University Hospital St Josef Hospital, Cardiology and Rhythmology, Ruhr University, Bochum, Germany
| | - Andreas Mügge
- University Hospital St Josef Hospital, Cardiology and Rhythmology, Ruhr University, Bochum, Germany.,University Hospital Bergmannsheil, Cardiology and Angiology, Ruhr University, Bochum, Germany
| | - Michael Gotzmann
- University Hospital St Josef Hospital, Cardiology and Rhythmology, Ruhr University, Bochum, Germany
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15
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Roy D, Mazumder O, Sinha A, Khandelwal S. Multimodal cardiovascular model for hemodynamic analysis: Simulation study on mitral valve disorders. PLoS One 2021; 16:e0247921. [PMID: 33662019 PMCID: PMC7932118 DOI: 10.1371/journal.pone.0247921] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/16/2021] [Indexed: 12/31/2022] Open
Abstract
Valvular heart diseases are a prevalent cause of cardiovascular morbidity and mortality worldwide, affecting a wide spectrum of the population. In-silico modeling of the cardiovascular system has recently gained recognition as a useful tool in cardiovascular research and clinical applications. Here, we present an in-silico cardiac computational model to analyze the effect and severity of valvular disease on general hemodynamic parameters. We propose a multimodal and multiscale cardiovascular model to simulate and understand the progression of valvular disease associated with the mitral valve. The developed model integrates cardiac electrophysiology with hemodynamic modeling, thus giving a broader and holistic understanding of the effect of disease progression on various parameters like ejection fraction, cardiac output, blood pressure, etc., to assess the severity of mitral valve disorders, naming Mitral Stenosis and Mitral Regurgitation. The model mimics an adult cardiovascular system, comprising a four-chambered heart with systemic, pulmonic circulation. The simulation of the model output comprises regulated pressure, volume, and flow for each heart chamber, valve dynamics, and Photoplethysmogram signal for normal physiological as well as pathological conditions due to mitral valve disorders. The generated physiological parameters are in agreement with published data. Additionally, we have related the simulated left atrium and ventricle dimensions, with the enlargement and hypertrophy in the cardiac chambers of patients with mitral valve disorders, using their Electrocardiogram available in Physionet PTBI dataset. The model also helps to create 'what if' scenarios and relevant analysis to study the effect in different hemodynamic parameters for stress or exercise like conditions.
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Affiliation(s)
- Dibyendu Roy
- TCS Research, Tata Consultancy Services Limited, Kolkata, India
- * E-mail:
| | - Oishee Mazumder
- TCS Research, Tata Consultancy Services Limited, Kolkata, India
| | - Aniruddha Sinha
- TCS Research, Tata Consultancy Services Limited, Kolkata, India
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16
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P-wave indices in Japanese patients with ischemic stroke: Implication of atrial myopathy in subtype of ischemic stroke. J Electrocardiol 2021; 66:18-22. [PMID: 33706220 DOI: 10.1016/j.jelectrocard.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND P-wave indices have been not fully studied in subtypes of ischemic stroke. We compared P-wave indices among embolic stroke, lacunar stroke and the control. METHODS P-wave duration, advanced interatrial block (aIAB) defined as P-wave duration ≥120 ms and biphasic (positive negative) morphology in inferior leads, and P-terminal force in lead V1 (PTFV1) were measured at the time of the first episode of cardioembolic stroke in 81 patients with paroxysmal atrial fibrillation (PAF), and in 64 patients with lacunar stroke, and compared with 100 control subjects. The latter two groups had no episode of PAF. RESULTS The age of participants was 76 ± 11 years. Age, sex distribution, body mass index and CHADS2 score were comparable among three groups. Maximum P-wave duration, the longest across 12 leads, was significantly prolonged in cardioembolic and lacuna stroke compared to the control; 118 ± 12 ms and 118 ± 11 ms vs. 110 ± 11 ms, respectively (P < 0.0001). P-wave duration ≥120 ms and aIAB were more prevalent in ischemic stroke groups than the control, and associated with a higher Odds ratio for stroke, more so in cardioembolic stroke. However, PTFV1 value and the prevalence of PTFV1 ≥ 4.0 ms·mV were significantly not different among the three groups. Abnormal P-wave duration and aIAB indicating the presence of atrial myopathy were present in cardioembolic and lacuna stroke. CONCLUSION Atrial myopathy was present in cardioembolic and lacunar stroke, but it can't be the direct cause of small vessel occlusion in lacunar stroke. Roles of atrial myopathy in each subtype of ischemic stroke should be studied.
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17
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Gulsen K, Ince O, Akgun T, Demir S, Uslu A, Kup A, Ocal L, Emiroglu MY, Kargin R, Sahin I, Kepez A, Okuyan E, Ozdemir N, Kaymaz C. The effect of P wave indices on new onset atrial fibrillation after trans-catheter aortic valve replacement. J Electrocardiol 2020; 61:71-76. [PMID: 32554159 DOI: 10.1016/j.jelectrocard.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Data is scarce regarding the relation between P wave indices and new onset atrial fibrillation (NOAF) after trans-catheter aortic valve replacement (TAVR). AIMS The present study aimed to find out certain characteristics of P wave that may predict NOAF after TAVR procedure. METHOD Patients with severe calcific aortic stenosis who had undergone TAVR procedure between 2013 and 2019 in two centers were investigated. P wave abnormalities that have been resumed to reflect impaired atrial conduction; partial and advanced inter atrial block (IAB), P-wave terminal force in lead V1, P wave dispersion, reduced amplitude of P- wave in lead I, P wave peak time in D2 and V1 were evaluated on pre- procedural 12 derivation surface electrocardiography (ECG). The relationship between these parameters and incidence of NOAF during index hospitalization was evaluated. RESULTS A total of 227 consecutive patients (median age 79 [74-83]; 134 [59%] female) were included in the study. NOAF occurred in 46 (20.3%) patients. P wave duration, P wave dispersion, number of patients with partial and advanced IAB, left atrium diameter, STS score were higher in NOAF patients. Use of general anesthesia and history of prior open heart surgery were also more frequent in NOAF group. In multivariable logistic regression analysis; advanced IAB (OR 6.413 [2.555-16.095] p < 0.01), P wave dispersion (OR 3.544 [1.431-8.780] p = 0.006) and use of general anesthesia (OR 2.736 [1.225-6.109] p = 0.014) were independent predictors of NOAF. CONCLUSION Among P wave abnormalities evaluated on pre-procedural 12-derivation surface ECG, advanced IAB and P wave dispersion may predict NOAF after TAVR procedure.
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Affiliation(s)
- Kamil Gulsen
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Orhan Ince
- Bagcilar Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Taylan Akgun
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Serdar Demir
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Abdulkadir Uslu
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ayhan Kup
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Lutfi Ocal
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Y Emiroglu
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ramazan Kargin
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Irfan Sahin
- Bagcilar Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Alper Kepez
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Ertugrul Okuyan
- Bagcilar Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Nihal Ozdemir
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Cihangir Kaymaz
- Kartal Kosuyolu Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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18
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Lacalzada-Almeida J, Izquierdo-Gómez MM, Laynez-Cerdeña I, García-Niebla J, Bruña V, Bayés de Luna A, Martínez-Sellés M. Electrocardiogram and left atrial abnormality: Design of an observational study to clarify diagnostic criteria. Ann Noninvasive Electrocardiol 2020; 25:e12770. [PMID: 32468671 PMCID: PMC7679830 DOI: 10.1111/anec.12770] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 01/06/2023] Open
Abstract
Background The criteria applied for diagnosis of left atrial (LA) abnormality using electrocardiogram (ECG) have high specificity but low sensitivity. In fact, some authors have suggested classifying P‐wave anomalies associated with LA abnormality and interatrial block as “atrial abnormalities.” The most widely known ECG criteria for LA abnormality include P‐wave duration, morphology and voltage of P wave in inferior leads, presence of P‐wave terminal force in V1 (PtfV1), and P‐wave axis and area. PtfV1 has also been reported to vary according to misplacement of the V1 and V2 electrodes. Methods The objective of this observational cohort study is to determine the degree of correlation between ECG criteria for LA abnormality and left atrium volume and functionality, as determined by speckle tracking echocardiography. The study also aims to investigate the correlation between these echocardiographic parameters and PtfV1 value by placing the V1 and V2 electrodes in the second, third, and fourth intercostal spaces. Results and Conclusions Our results could help to clarify whether the decrease in left atrial deformity, which is currently considered a surrogate target of fibrosis, correlates better with ECG criteria for LA abnormality than atrial volumes.
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Affiliation(s)
| | | | | | | | - Vanesa Bruña
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | | | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain.,Universidad Europea, Universidad Complutense Madrid, Madrid, Spain
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19
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Huang Z, Zheng Z, Wu B, Tang L, Xie X, Dong R, Luo Y, Li S, Zhu J, Liu J. Predictive value of P wave terminal force in lead V1 for atrial fibrillation: A meta-analysis. Ann Noninvasive Electrocardiol 2020; 25:e12739. [PMID: 32022368 PMCID: PMC7358887 DOI: 10.1111/anec.12739] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background Several studies have explored the association between P wave terminal force in lead V1 (PTFV1) and risk of atrial fibrillation (AF) occurrence, but the results were controversial. This meta‐analysis aimed to examine whether abnormal PTFV1 could predict AF occurrence. Methods We searched PubMed, Embase, and Cochrane Library databases for articles published before August 25, 2018. Pooled odds ratios (ORs) of AF occurrence were calculated using random‐effects models to explore the significance of PTFV1. Results A total of 12 studies examining 51,372 participants were included, with 9 studies analyzing PTFV1 as a categorical variable and 4 studies analyzing PTFV1 as a continuous variable. As a categorical variable, abnormal PTFV1 (>0.04 mm s) was significantly associated with AF occurrence with a pooled OR of 1.39 (95% confidence interval [CI] 1.08–1.79, p = .01). Subgroup analysis found that ORs of studies in hemodialysis patients (OR = 4.89, 95% CI 2.54–9.90, p < .001) and acute ischemic stroke patients (OR = 1.60, 95% CI 1.14–2.25, p = .007) were higher than general population (OR = 1.15, 95% CI 1.03–1.29, p = .01). Studies from Europe (OR = 1.05, 95% CI 0.91–1.20, p = .51) yielded lower OR of endpoints compared with Asia (OR = 1.89, 95% CI 1.38–2.60, p < .001) and United States (OR = 1.43, 95% CI 1.19–1.72, p < .001). As a continuous variable, PTFV1 was also significantly associated with AF occurrence with a polled OR per 1 standard deviation (SD) change of 1.27 (95% CI 1.02–1.59, p = .03). Conclusions PTFV1 was significantly associated with the risk of AF and was considered to be a good predictor of AF occurrence in population with or without cardiovascular diseases.
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Affiliation(s)
- Zhuoshan Huang
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenda Zheng
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bingyuan Wu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Leile Tang
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xujing Xie
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruimin Dong
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanting Luo
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Suhua Li
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jieming Zhu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinlai Liu
- Department of Cardiovascular Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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20
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Salih AF, Brazinji AFA. Value of P wave dispersion in pediatric patients with secundum atrial septal defect. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/115849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Ahmad MI, Singleton MJ, Bhave PD, Kamel H, Soliman EZ. Atrial cardiopathy and stroke mortality in the general population. Int J Stroke 2019; 15:650-656. [PMID: 31530133 DOI: 10.1177/1747493019876543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prior studies examining the link between atrial cardiopathy and stroke risk have focused mainly on non-fatal stroke. AIMS To examine the association between atrial cardiopathy and stroke mortality. METHODS This analysis included 8028 participants (60.0 ± 13.4 years, 51.9% women, 49.8% white) from the Third National Health and Nutrition Examination (NHANES III) Survey. Atrial cardiopathy was defined as abnormal deep terminal negativity of the P wave in V1 (DTNPV1 = negative p-wave in V1<-100 µv), an electrocardiographic marker of atrial cardiopathy. Stroke mortality was ascertained using the National Death Index over a median follow-up of 14 years. RESULTS 2.95% (n = 237) of the participants had atrial cardiopathy, and the prevalence was slightly higher in blacks (4%) versus whites (3%). During follow-up, stroke mortality was more common in those with (5.9%) than those without (2.7%) atrial cardiopathy; p = .004. In a multivariable adjusted model, atrial cardiopathy was associated with a 76% increased risk of stroke mortality (HR (95% CI): 1.76 (1.02-3.04)]. This association was stronger in non-whites than whites (HR (95% CI): 3.50 (1.74-7.03) vs. 0.98 (0.40-2.42), respectively; interaction p = 0.03). Among those with baseline atrial cardiopathy, the annualized stroke mortality rates/1000 participants across CHA2DS2-VASc scores of 0, 1, and ≥2 were 0.0, 2.2, and 7.8, respectively. CONCLUSIONS Atrial cardiopathy is associated with an increased risk of stroke mortality, especially among non-whites. Among those with atrial cardiopathy, the risk of stroke mortality exponentially increases as the CHA2DS2-VASc score becomes 2 or above. Randomized controlled trials are needed to assess the efficacy of anticoagulation in the prevention of ischemic stroke and thus, stroke mortality in the presence of atrial cardiopathy.
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Affiliation(s)
- Muhammad I Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Matthew J Singleton
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Prashant D Bhave
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hooman Kamel
- Department of Neurology and Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Elsayed Z Soliman
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
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22
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Ahmad MI, Mujtaba M, Anees MA, Li Y, Soliman EZ. Interrelation Between Electrocardiographic Left Atrial Abnormality, Left Ventricular Hypertrophy, and Mortality in Participants With Hypertension. Am J Cardiol 2019; 124:886-891. [PMID: 31324356 DOI: 10.1016/j.amjcard.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 11/20/2022]
Abstract
Left ventricular hypertrophy (LVH) and left atrial abnormality (LAA) are common correlated complications of hypertension. It is unclear how common for electrocardiographic markers of LAA (ECG-LAA) to coexist with ECG-LVH and how their coexistence impacts their prognostic significance. This analysis included 4,077 participants (61.2 ± 13.0 years, 51.2% women, 48.6% whites) with hypertension from the Third National Health and Nutrition Examination Survey. ECG-LVH was defined by Cornell voltage criteria. ECG-LAA was defined as deep terminal negativity of P wave in V1 >100 µV. Cox proportional hazard analysis was used to examine the associations between various combinations of ECG-LAA and ECG-LVH with all-cause mortality over a median follow-up of 14 years. The baseline prevalence of ECG-LVH, ECG-LAA, and the concomitant presence of both was 3.6%, 2.7%, and 0.34%, respectively. In a multivariable-adjusted model, mortality risk was highest in the group with concomitant ECG-LAA and ECG-LVH (hazard ratio [HR; 95% confidence interval {CI}] 2.69 [1.51, 4.80]), followed by isolated ECG-LAA (HR [95% CI] 1.63 [1.26, 2.12]), and then isolated ECG-LVH (HR [95% CI] 1.40 [1.08, 1.81]), compared with the group without ECG-LAA or ECG-LVH. Effect modification of these results by age and diabetes but not by gender or race was observed. In models with similar adjustment where ECG-LVH and ECG-LAA were entered as 2 separate variables and subsequently additionally adjusted for each other, the mortality risk was essentially unchanged for both variables. In conclusion, in participants with hypertension, ECG-LAA and ECG-LVH are independent markers of poor outcomes, and their concomitant presence carries a higher risk than either marker alone.
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Affiliation(s)
- Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Mohammadtokir Mujtaba
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Yabing Li
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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23
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Prevalence, significance and reversal of abnormal P-wave indices in hypertension: A review and meta-analysis. J Electrocardiol 2019; 53:13-17. [DOI: 10.1016/j.jelectrocard.2018.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/23/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
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24
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Poor reliability of P-wave terminal force V1 in ischemic stroke. J Electrocardiol 2019; 52:47-52. [DOI: 10.1016/j.jelectrocard.2018.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/27/2018] [Accepted: 11/05/2018] [Indexed: 01/03/2023]
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25
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Jalini S, Rajalingam R, Nisenbaum R, Javier AD, Woo A, Pikula A. Atrial cardiopathy in patients with embolic strokes of unknown source and other stroke etiologies. Neurology 2018; 92:e288-e294. [DOI: 10.1212/wnl.0000000000006748] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/10/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo investigate the prevalence and clinical determinants of atrial cardiopathy in patients with embolic stroke of unknown source (ESUS) and compare with other established stroke etiologies.MethodsIn a cross-sectional study of 846 consecutive patients with ischemic stroke, we compared the prevalence of atrial cardiopathy (defined by p-wave terminal force in V1 >5,000 µV·ms or severe left atrial enlargement) between ESUS patients and patients with large artery atherosclerosis (LAA) and small vessel disease (SVD) strokes. Baseline characteristics were also compared between ESUS and cardioembolic (CE) patients.ResultsOf all, 158 (19%) patients met ESUS diagnostic criteria, while others were classified into LAA (n = 224, 26%), SVD (n = 154, 18%), and CE (n = 310, 37%). The prevalence of atrial cardiopathy was higher in ESUS patients compared to noncardioembolic stroke patients (26.6% vs 12.1% in LAA vs 16.9% in SVD; p = 0.001). ESUS patients were younger, were less hypertensive, and had higher cholesterol and low-density lipoprotein levels, but also had less left ventricular or atrial abnormalities when compared to CE patients.ConclusionThe prevalence of atrial cardiopathy was high in ESUS patients compared with patients with nonembolic strokes. Interestingly, ESUS patients were also clinically different from CE patients. While the presence of atrial cardiopathy may reflect a unique mechanism of thromboembolism in ESUS patients, it is still unclear if they may benefit from anticoagulation, or if the presence of atrial cardiopathy in this population could serve as a risk-stratifying marker for stroke recurrence. Further efforts are necessary to provide better characterization of the ESUS population in order to develop better stroke preventive strategies.
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26
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Pourafkari L, Baghbani-Oskouei A, Aslanabadi N, Tajlil A, Ghaffari S, Sadigh AM, Savadi-Oskouei S, Enamzadeh E, Parizad R, Nader ND. Fine versus coarse atrial fibrillation in rheumatic mitral stenosis: The impact of aging and the clinical significance. Ann Noninvasive Electrocardiol 2018; 23:e12540. [PMID: 29504703 DOI: 10.1111/anec.12540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/11/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) as the most rhythm disturbance in patients with rheumatic mitral stenosis (MS), is classified in to coarse and fine subtypes according to the height of fibrillatory wave amplitude. The aim of this study is to identify the factors associated with the presence of fine versus coarse morphology in patients with rheumatic MS. METHODS In this cross-sectional study, patients with confirmed diagnosis of severe rheumatic MS admitted between March 2013 and March 2017 were screened. Patients were categorized to sinus rhythm (SR) and AF rhythm (coarse and fine subtypes) groups according to the admission electrocardiogram. The association between various clinical and echocardiographic factors and the development of fine versus coarse AF were examined. RESULTS Among 754 patients with the diagnosis of rheumatic MS, 288 (198 female) were found to have AF (38%). Among them 206 (71.5%), and 82 (28.5%) patients had fine and coarse morphology respectively. Patient in these two groups were quite similar in terms of echocardiographic parameters and comorbidities. However, patients with fine morphology AF were significantly older. (p-Value=.007). CONCLUSION Coarse morphology of AF is common in patients with rheumatic MS. While echocardiographic or most clinical parameters do not seem to associate with the occurrence of coarse or fine morphology, age seems to be the only independent factor correlated with the presence of fine subtype of AF in this population.
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Affiliation(s)
- Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
| | | | - Naser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezou Tajlil
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Mosavi Sadigh
- Faculty of Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Safa Savadi-Oskouei
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elgar Enamzadeh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Raziyeh Parizad
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
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27
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Aizawa Y, Watanabe H, Okumura K. Electrocardiogram (ECG) for the Prediction of Incident Atrial Fibrillation: An Overview. J Atr Fibrillation 2017; 10:1724. [PMID: 29487684 DOI: 10.4022/jafib.1724] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/19/2017] [Accepted: 12/14/2017] [Indexed: 12/13/2022]
Abstract
Electrocardiograms (ECGs) have been employed to medically evaluate participants in population-based studies, and ECG-derived predictors have been reported for incident atrial fibrillation (AF). Here, we reviewed the status of ECG in predicting new-onset AF. We surveyed population-based studies and revealed ECG variables to be risk factors for incident AF. When available, the predictive values of each ECG risk marker were calculated. Both the atrium-related and ventricle-related ECG variables were risk factors for incident AF, with significant hazard risks (HRs) even after multivariate adjustments. The risk factors included P-wave indices (maximum P-wave duration, its dispersion or variation and P-wave morphology) and premature atrial contractions (PACs) or runs. In addition, left ventricular hypertrophy (LVH), ST-T abnormalities, intraventricular conduction delay, QTc interval and premature ventricular contractions (PVCs) or runs were a risk of incident AF. An HR of greater than 2.0 was observed in the upper 5th percentile of the P-wave durations, P-wave durations greater than 130 ms, P-wave morpholyg, PACs (PVCs) or runs, LVH, QTc and left anterior fascicular blocks. The sensitivity , specificity and the positive and negative predictive values were 3.6-53.8%, 61.7-97.9%, 2.9-61.7% and 77.4-97.7%, respectively. ECG variables are risk factors for incident AF. The correlation between the ECG-derived AF predictors, especially P-wave indices, and underlying diseases and the effects of the reversal of the ECG-derived predictors on incident AF by treatment of comorbidities require further study.
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Affiliation(s)
- Yoshifusa Aizawa
- Research and Development, Tachikawa Medical Center and Niigata University,Nagaoka and Niigata,Japan
| | - Hiroshi Watanabe
- Department of Cardiology, Graduate School of Medical and Dental Science,Niigata University, Niigata, Japan
| | - Ken Okumura
- Arrhythmia Center,Saiseikai Hospital Kumamoto, Kumamoto, Japan
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Emektar E, Çorbacıoğlu ŞK, Korucu O, Ramadan S, Uzunosmanoğlu H, Kan E, Çevik Y. The evaluation of a new marker of transmyocardial repolarization parameters in ischemic stroke patients; T peak-T end (T p-e), T p-e/QT c. Acta Neurol Belg 2017; 117:461-467. [PMID: 28110482 DOI: 10.1007/s13760-017-0744-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/04/2017] [Indexed: 11/26/2022]
Abstract
The cardiovascular manifestations of acute ischemic stroke have been well known. Several electrocardiography (ECG) abnormalities have been reported in patients following acute stroke, including QT interval prolongation, ST segment deviation and T-wave changes. This study aimed to investigate the changes in transmyocardial repolarization parameters, in ischemic stroke patients. The study is a prospective, blind, and controlled clinical study. The patients without cardiac disease who received ischemic stroke diagnoses were included in the study. ECG was received from the patients in the first hour and 72 h. The P, QT, T p-e, T p-e dispersion, and the T p-e/QT ratio were calculated. Moreover, fifty-five stroke patients and 35 control subjects were included to the study. All dispersion values and T p-e/QTc ratio in patients group were higher than those of control group (p < 0.05 for all values). When evaluated between ECGs' on first and third days, it was found that decreasing on all dispersion values and T p-e/QTc ratio in ECGs on third day than ECGs on first day (p < 0.05 for all values). QT, QTc, and T p-e dispersions values in patients who have insular lobe involvement were higher than those of patients who do not have insular lobe involvement (p < 0.001 for all values). In this study, we showed that acute stroke increases that P d, QTd, QTcd and new repolarization markers T p-e and T p-e/QTc, during first 24 and 72 h in acute stroke patients without cardiovascular disease compared with the control group. The physicians should be aware about ventricular dysrhythmias in patients with ischemic stroke and these patients closely observed with cardiac monitoring, especially within first 24 h, and especially patients with insular lobe involvement.
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Affiliation(s)
- Emine Emektar
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey.
| | - Şeref Kerem Çorbacıoğlu
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
| | - Osman Korucu
- Department of Neurology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Selma Ramadan
- Department of Radiology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Hüseyin Uzunosmanoğlu
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
| | - Eda Kan
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
| | - Yunsur Çevik
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Pınarbaşı, Sanatoryum Caddesi, Ardahan Sokak, No: 25, 06280, Keçiören, Ankara, Turkey
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29
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Miller JM. Mark E Josephson: Clinical Investigator. Arrhythm Electrophysiol Rev 2017; 6:9-12. [PMID: 28507738 DOI: 10.15420/aer.2017.6.1:ed3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mark E Josephson entered the world of clinical cardiac electrophysiology (EP) almost at its inception (1972); with so much to learn and so many directions one could take, he dived into the field with unbridled enthusiasm and an uncommon - perhaps almost unique - aptitude for asking questions and finding ways to answer them. Few aspects of EP escaped his indelible influence. In this short paper, I will attempt to touch on some of the high points of his astounding career as a clinical investigator.
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Affiliation(s)
- John M Miller
- Indiana University School of Medicine; Indiana University Health, Indianapolis, USA
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30
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Left atrial electromechanical conduction time predicts atrial fibrillation in patients with mitral stenosis: a 5-year follow-up speckle-tracking echocardiography study. Int J Cardiovasc Imaging 2017; 33:1491-1501. [DOI: 10.1007/s10554-017-1140-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
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MacAlpin RN. Significance of a negative sinus P wave in lead V 2 of the clinical electrocardiogram. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28213958 DOI: 10.1111/anec.12432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 12/30/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A negative sinus P wave in lead V2 (NPV2 ) of the electrocardiogram (ECG) is rare when leads are positioned correctly. This study was undertaken to clarify the significance of an unusually high incidence of this anomaly found in ECGs at my institution. METHODS One thousand four hundred thirty-five ECGs were randomly selected to determine the incidence and gender frequency in tracings showing positive (PPV2 ), and biphasic (BPV2 ) P waves in V2 , as well as NPV2 . To those cases with NPV2 , 84 cases with that anomaly from earlier archived ECGs were added to give a larger group for analysis. Medical records were reviewed for clinical details and other archived ECGs. RESULTS PPV2 , BPV2 , and NPV2 were found in 1,216 (84.5%), 150 (10.5%), and 69 cases (4.8%), respectively. Cases with NPV2 were more likely to be female (46 of 69 or 67.7%) than were those with either PPV2 (500 of 1,216 or 41.1%; p < .001), or BPV2 (71 of 150 or 47.3%; p < .01). NPV2 was commonly associated with ECG findings of left atrial abnormality (LAA), septal myocardial infarction, or a ventricular repolarization abnormality, but when multiple ECGs were available in these cases, such abnormalities were usually absent when there was either PPV2 or BPV2 . CONCLUSIONS With correct precordial lead placement, NPV2 is rare and BPV2 is also uncommon, and their presence should alert one to the probability of high placement of V1 and V2 , which can produce ECGs that mimic LAA, septal infarction, and ventricular repolarization abnormality.
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Affiliation(s)
- Rex N MacAlpin
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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32
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Rodrigues JCL, Erdei T, Dastidar AG, McIntyre B, Burchell AE, Ratcliffe LEK, Hart EC, Hamilton MCK, Paton JFR, Nightingale AK, Manghat NE. Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance. J Hum Hypertens 2016; 31:212-219. [PMID: 27604657 DOI: 10.1038/jhh.2016.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/07/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022]
Abstract
Left atrial enlargement (LAE) has adverse prognostic implications in hypertension. We sought to determine the accuracy of five electrocardiogram (ECG) criteria for LAE in hypertension relative to cardiac magnetic resonance (CMR) gold standard and investigate the effect of concomitant obesity. One hundred and thirty consecutive patients (age: 51.4±15.1 years, 47% male, 51% obese, systolic blood pressure (BP): 171±29 mm Hg, diastolic BP: 97±15 mm Hg) referred for CMR (1.5 T) from a tertiary hypertension clinic were included. Patients with concomitant cardiac pathology were excluded. ECGs were assessed blindly for the following: (1) P-wave >110 ms, (2) P-mitrale, (3) P-wave axis <30°, (4) area of negative P-terminal force in V1 >40 ms.mm and (5) positive P-terminal force in augmented vector left (aVL) >0.5 mm. Left atrial volume ≥55 ml m-2, measured blindly by CMR, was defined as LAE. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under the receiver operator curve were calculated. The prevalence of LAE by CMR was 26%. All the individual ECG LAE criteria were more specific than sensitive, with specificities ranging from 70% (P-axis <30o) to 99% (P-mitrale). Obesity attenuated the specificity of most of the individual ECG LAE criteria. Obesity correlated with significant lower specificity (48% vs 65%, P<0.05) and a trend towards lower sensitivity (59 vs 43%, P=0.119) when ≥1 ECG LAE criteria were present. Individual ECG criteria of LAE in hypertension are specific, but not sensitive, at identifying LAE. The ECG should not be used to excluded LAE in hypertension, particularly in obese subjects.
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Affiliation(s)
- J C L Rodrigues
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Faculty of Biomedical Sciences, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - T Erdei
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A G Dastidar
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - B McIntyre
- Severn Postgraduate Medical Education Foundation School, NHS Health Education South West, Bristol, UK
| | - A E Burchell
- CardioNomics Research Group, Clinical Imaging and Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - L E K Ratcliffe
- CardioNomics Research Group, Clinical Imaging and Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - E C Hart
- Faculty of Biomedical Sciences, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.,CardioNomics Research Group, Clinical Imaging and Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - M C K Hamilton
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J F R Paton
- Faculty of Biomedical Sciences, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.,CardioNomics Research Group, Clinical Imaging and Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A K Nightingale
- Faculty of Biomedical Sciences, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.,CardioNomics Research Group, Clinical Imaging and Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - N E Manghat
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Tanoue MT, Kjeldsen SE, Devereux RB, Okin PM. Relationship between abnormal P-wave terminal force in lead V1 and left ventricular diastolic dysfunction in hypertensive patients: the LIFE study. Blood Press 2016; 26:94-101. [DOI: 10.1080/08037051.2016.1215765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Michael T. Tanoue
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Sverre E. Kjeldsen
- Ullevål Hospital, University of Oslo, Oslo, Norway
- Department of Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Richard B. Devereux
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Peter M. Okin
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
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Gazi E, Gencer M, Hanci V, Temiz A, Altun B, Barutcu A, Gungor AN, Hacivelioglu S, Uysal A, Colkesen Y. Atrial conduction time, and left atrial mechanical and electromechanical functions in patients with polycystic ovary syndrome: interatrial conduction delay. Cardiovasc J Afr 2015; 26:217-21. [PMID: 26659435 PMCID: PMC4780013 DOI: 10.5830/cvja-2015-046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/12/2015] [Indexed: 02/04/2023] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women during the reproductive period. Cardiovascular risk factors are more frequent in patients with PCOS. We aimed to investigate the P-wave dispersion (Pd), inter- and intra-atrial conduction time and mechanical functions of the left atrium (LA) in patients with PCOS. Methods Forty-eight patients with PCOS and 38 normal healthy women were enrolled in this study. A 12-lead surface electrocardiogram was used to evaluate Pd. Left ventricular (LV) functions were measured using conventional and tissue Doppler imaging (TDI) methods. Inter- and intra-atrial conduction times were measured by TDI. LA volumes were measured echocardiographically with the biplane area–length method from the apical four-chamber view. Results Heart rate (82.02 ± 13.15 vs 74.24 ± 11.02 bpm, p = 0.014) and Pd were significantly increased in the PCOS patients [27 ± 5 vs 24 ± 6 ms, p = 0.035]. Transmitral E/A ratio was significantly lower in the PCOS patients than in the controls (1.5 ± 0.3 vs 1.7 ± 0.4 m/s, p = 0.023). Passive emptying volume (12.54 ± 4.39 vs 15.28 ± 3.85 ml/m2, p = 0.004) and passive emptying fraction [54.4 (21–69) vs 59.1% (28–74), p = 0.008] were significantly decreased in PCOS patients. Total emptying volume was significantly decreased (17.9 ± 5.49 vs 20.67 ± 4.29 ml/m2, p = 0.018) in PCOS patients. Interatrial (19 ± 7.4 vs 15 ± 6.4 ms, p = 0.035) and intra-atrial [8.5 (1–19) vs 5 ms (1–20), p = 0.026] electromechanical delays were found to be significantly higher in PCOS patients. Conclusion This study showed that patients with PCOS had increased inter- and intra-atrial conduction delays, and decreased LA passive emptying volumes and fractions.
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Affiliation(s)
- Emine Gazi
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey.
| | - Meryem Gencer
- Department of Obstetrics and Gynecology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Volkan Hanci
- Department of Anesthesiology and Reanimation, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ahmet Temiz
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Burak Altun
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ahmet Barutcu
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ayse Nur Gungor
- Department of Obstetrics and Gynecology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Servet Hacivelioglu
- Department of Obstetrics and Gynecology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ahmet Uysal
- Department of Obstetrics and Gynecology, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Yucel Colkesen
- Department of Cardiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
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Beig JR, Tramboo NA, Rather HA, Hafeez I, Ananth V, Lone AA, Yaqoob I, Bhat IA, Ali M. Immediate effect of percutaneous transvenous mitral commissurotomy on atrial electromechanical delay and P-wave dispersion in patients with severe mitral stenosis. Indian Heart J 2015; 67 Suppl 2:S46-54. [PMID: 26688153 DOI: 10.1016/j.ihj.2015.10.375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/30/2015] [Accepted: 10/15/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mitral stenosis (MS) is associated with prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion, which are markers of atrial fibrillation (AF) risk. This study was conducted to assess the immediate effect of successful percutaneous transvenous mitral commissurotomy (PTMC) on these parameters. METHODS This single center observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area (MVA) of 0.74 ± 0.13 cm(2)), in sinus rhythm, who underwent successful PTMC at our hospital. P-wave dispersion (PWD) was calculated by subtracting minimum P-wave duration (P min) from maximum P-wave duration (Pmax), measured on a 12-lead surface ECG obtained from each patient in supine position at a paper speed of 50mm/s and 20mm/mV. Inter-atrial (AEMD), left intra-atrial (L-IAEMD), and right intra-atrial (R-IAEMD) electromechanical delays were measured on tissue Doppler imaging. PTMC was performed using the standard Inoue Balloon technique. All these parameters were evaluated and compared before and 24-48 h after PTMC. RESULTS Successful PTMC led to significant reduction in AEMD (p < 0.001), L-IAEMD (p < 0.001), and R-IAEMD (p < 0.001). There were no changes in Pmax, Pmin, and PWD immediately after PTMC. CONCLUSIONS Successful PTMC has a favorable early impact on inter- and intra-atrial electromechanical delays, which are considered as novel parameters of atrial electromechanical remodeling in MS patients. Prospective large-scale studies are required to confirm whether improvement in these markers translates into reduced long-term AF risk.
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Affiliation(s)
| | | | | | - Imran Hafeez
- Asst. Professor, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Vijai Ananth
- DM Fellow, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Ajaz A Lone
- Assoc. Professor, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Irfan Yaqoob
- Senior Resident, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Irfan A Bhat
- Senior Resident, Dept. of Cardiology, SKIMS, Srinagar, India
| | - Muzaffar Ali
- DM Fellow, Dept. of Cardiology, SKIMS, Srinagar, India
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German DM, Kabir MM, Dewland TA, Henrikson CA, Tereshchenko LG. Atrial Fibrillation Predictors: Importance of the Electrocardiogram. Ann Noninvasive Electrocardiol 2015; 21:20-9. [PMID: 26523405 DOI: 10.1111/anec.12321] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 08/10/2015] [Accepted: 08/18/2015] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with significant morbidity and mortality. Substantial interest has developed in the primary prevention of AF, and thus the identification of individuals at risk for developing AF. The electrocardiogram (ECG) provides a wealth of information, which is of value in predicting incident AF. The PR interval and P wave indices (including P wave duration, P wave terminal force, P wave axis, and other measures of P wave morphology) are discussed with regard to their ability to predict and characterize AF risk in the general population. The predictive value of the QT interval, ECG criteria for left ventricular hypertrophy, and findings of atrial and ventricular ectopy are also discussed. Efforts are underway to develop models that predict AF incidence in the general population; however, at present, little information from the ECG is included in these models. The ECG provides a great deal of information on AF risk and has the potential to contribute substantially to AF risk estimation, but more research is needed.
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Affiliation(s)
- David M German
- Department of Medicine, Oregon Health and Science University, Portland, OR
| | - Muammar M Kabir
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Thomas A Dewland
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Charles A Henrikson
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Larisa G Tereshchenko
- Department of Medicine, The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
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Li Q, Gu L, Zhang C, Liu W, Peng Y, Chai H, Xu Y, Wei J, Chen M, Huang D. A Predictive Study of the Dynamic Development of the P-Wave Terminal Force in Lead V1 in the Electrocardiogram in Relation to Long-Term Prognosis in Non-ST-Segment Elevation Acute Coronary Syndrome Patients during Hospitalization. Ann Noninvasive Electrocardiol 2015; 20:542-53. [PMID: 25664419 PMCID: PMC6931673 DOI: 10.1111/anec.12254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Changes in the ECG indicator PtfV1 reflect left atrial pressure and left ventricular diastolic function in NSTE-ACS patients during hospitalization. The value of PtfV1 in the evaluation of long-term prognosis in NSTE-ACS is still not clear. The purpose of this study was to investigate the relationship between the dynamic changes in P-wave terminal force in lead V1(PtfV1) in the ECG of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients during hospitalization and the long-term major adverse cardiovascular events (MACEs) of patients. METHODS A total of 595 patients who received coronary angiography and were confirmed as NSTE-ACS in the coronary heart disease database of Department of Cardiology of West China Hospital were continuously included. The PtfV1 and other clinical data at admission and discharge were collected and dynamically observed. The end events of follow-up observation were MACEs. RESULTS Follow-up was performed on 595 patients for 24.71 ± 1.95 months. There were 127 PtfV1(+) and 468 PtfV1(-) at admission, and the incidences of MACEs were 14.2% and 11.1%, respectively (P = 0.731). Compared with patients with persistent PtfV1(-) ECG at admission and discharge, 53 patients with persistent PtfV1(+) ECG at admission and discharge had increased risk for MACEs (HR: 2.221, 95% CI: 1.072-4.601, P = 0.032); 94 patients with new PtfV1(+) ECG at discharge also had significantly increased risk for MACEs (HR: 2.993, 95% CI: 1.660-5.397, P = 0.000). CONCLUSIONS NSTE-ACS patients with persistent PtfV1(+) ECG indicators at admission and discharge and new PtfV1(+) at discharge had significantly increased risk of MACEs.
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Affiliation(s)
- Qiao Li
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Li‐Dan Gu
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Chen Zhang
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Wei Liu
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Yong Peng
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Hua Chai
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Yuan‐Ning Xu
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Jia‐Fu Wei
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Mao Chen
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - De‐Jia Huang
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
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de Luna AB, Massó-van Roessel A, Robledo LAE. The Diagnosis and Clinical Implications of Interatrial Block. Eur Cardiol 2015; 10:54-59. [PMID: 30310424 PMCID: PMC6159419 DOI: 10.15420/ecr.2015.10.01.54] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/16/2015] [Indexed: 11/04/2022] Open
Abstract
Impaired interatrial conduction or interatrial block is now well-documented but is not described as an individual electrocardiographic (ECG) pattern in the majority of ECG literature. In fact the term atrial abnormality has been adopted to encompass both left atrial enlargement (LAE) and interatrial block. In this paper, we maintain that interatrial blocks and atrial enlargement are separate entities, and that interatrial blocks, similar to other types of blocks at sinoatrial, AV junctional, and ventricular level, exhibit a specific ECG pattern that may present first, second, and third degree types of conduction block. The third degree or advanced interatrial block (A-IAB) is frequently associated with atrial fibrillation/atrial flutter (AF/AFl), and constitutes a true newly-described syndrome.
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Tiffany Win T, Ambale Venkatesh B, Volpe GJ, Mewton N, Rizzi P, Sharma RK, Strauss DG, Lima JA, Tereshchenko LG. Associations of electrocardiographic P-wave characteristics with left atrial function, and diffuse left ventricular fibrosis defined by cardiac magnetic resonance: The PRIMERI Study. Heart Rhythm 2015; 12:155-62. [PMID: 25267584 PMCID: PMC4277898 DOI: 10.1016/j.hrthm.2014.09.044] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Abnormal P-terminal force in lead V1 (PTFV1) is associated with an increased risk of heart failure, stroke, atrial fibrillation, and death. OBJECTIVE Our goal was to explore associations of left ventricular (LV) diffuse fibrosis with left atrial (LA) function and electrocardiographic (ECG) measures of LA electrical activity. METHODS Patients without atrial fibrillation (n = 91; mean age 59.5 years; 61.5% men; 65.9% white) with structural heart disease (spatial QRS-T angle ≥105° and/or Selvester QRS score ≥5 on ECG) but LV ejection fraction >35% underwent clinical evaluation, cardiac magnetic resonance, and resting ECG. LA function indices were obtained by multimodality tissue tracking using 2- and 4-chamber long-axis images. T1 mapping and late gadolinium enhancement were used to assess diffuse LV fibrosis and presence of scar. P-prime in V1 amplitude (PPaV1) and duration (PPdV1), averaged P-wave-duration, PR interval, and P-wave axis were automatically measured using 12 SLTM algorithm. PTFV1 was calculated as a product of PPaV1 and PPdV1. RESULTS In linear regression after adjustment for demographic characteristics, body mass index, maximum LA volume index, presence of scar, and LV mass index, each decile increase in LV interstitial fibrosis was associated with 0.76 mV*ms increase in negative abnormal PTFV1 (95% confidence interval [CI] -1.42 to -0.09; P = .025), 15.3 ms prolongation of PPdV1 (95% CI 6.9 to 23.8; P = .001) and 5.4 ms prolongation of averaged P-duration (95% CI 0.9-10.0; P = .020). LV fibrosis did not affect LA function. PPaV1 and PTFV1 were associated with an increase in LA volumes and decrease in LA emptying fraction and LA reservoir function. CONCLUSION LV interstitial fibrosis is associated with abnormal PTFV1, prolonged PPdV1, and P-duration, but does not affect LA function.
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Affiliation(s)
- Theingi Tiffany Win
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiology, Department of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Bharath Ambale Venkatesh
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gustavo J Volpe
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan Mewton
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patricia Rizzi
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravi K Sharma
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Joao A Lima
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Larisa G Tereshchenko
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
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Eranti A, Aro AL, Kerola T, Anttonen O, Rissanen HA, Tikkanen JT, Junttila MJ, Kenttä TV, Knekt P, Huikuri HV. Prevalence and Prognostic Significance of Abnormal P Terminal Force in Lead V
1
of the ECG in the General Population. Circ Arrhythm Electrophysiol 2014; 7:1116-21. [DOI: 10.1161/circep.114.001557] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antti Eranti
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
| | - Aapo L. Aro
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
| | - Tuomas Kerola
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
| | - Olli Anttonen
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
| | - Harri A. Rissanen
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
| | - Jani T. Tikkanen
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
| | - M. Juhani Junttila
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
| | - Tuomas V. Kenttä
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
| | - Paul Knekt
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
| | - Heikki V. Huikuri
- From the Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (A.E., T.K., O.A.); Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital (A.L.A.) and Department of Health, Functional Capacity and Welfare, National Institute of Health and Welfare (H.A.R., P.K.), Helsinki, Finland; and Department on Internal Medicine, Institute of Clinical Medicine, Medical Research Center Oulu, University Hospital & University of Oulu, Oulu, Finland (J.T.T., M
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Tereshchenko LG, Henrikson CA, Sotoodehnia N, Arking DE, Agarwal SK, Siscovick DS, Post WS, Solomon SD, Coresh J, Josephson ME, Soliman EZ. Electrocardiographic deep terminal negativity of the P wave in V(1) and risk of sudden cardiac death: the Atherosclerosis Risk in Communities (ARIC) study. J Am Heart Assoc 2014; 3:e001387. [PMID: 25416036 PMCID: PMC4338733 DOI: 10.1161/jaha.114.001387] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Identifying individuals at risk for sudden cardiac death (SCD) is of critical importance. Electrocardiographic (ECG) deep terminal negativity of P wave in V1 (DTNPV1), a marker of left atrial abnormality, has been associated with increased risk of all‐cause and cardiovascular mortality. We hypothesized that DTNPV1 is associated with increased risk of sudden cardiac death (SCD). Methods and Results This analysis included 15 375 participants (54.1±5.8 years, 45% men, 73% whites) from the Atherosclerosis Risk in Communities (ARIC) study. DTNPV1 was defined from the resting 12‐lead ECG as presence of biphasic P wave (positive/negative) in V1 with the amplitude of the terminal negative phase >100 μV, or one small box on ECG scale. After a median of 14 years of follow‐up, 311 cases of SCD occurred. In unadjusted Cox regression, DTNPV1 was associated with an 8‐fold increased risk of SCD (HR 8.21; [95%CI 5.27 to 12.79]). Stratified by race and study center, and adjusted for age, sex, coronary heart disease (CHD), and ECG risk factors, as well as atrial fibrillation (AF), stroke, CHD, and heart failure (HF) as time‐updated variables, the risk of SCD associated with DTNPV1 remained significant (2.49, [1.51–4.10]). DTNPV1 improved reclassification: additional 3.4% of individuals were appropriately reclassified into a higher SCD risk group, as compared with traditional CHD risk factors alone. In fully adjusted models DTNPV1 was associated with increased risk of non‐fatal events: AF (5.02[3.23–7.80]), CHD (2.24[1.43–3.53]), HF (1.90[1.19–3.04]), and trended towards increased risk of stroke (1.88[0.99–3.57]). Conclusion DTNPV1 is predictive of SCD suggesting its potential utility in risk stratification in the general population.
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Affiliation(s)
- Larisa G Tereshchenko
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.G.T., W.S.P.) Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (L.G.T., C.A.H.)
| | - Charles A Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR (L.G.T., C.A.H.)
| | | | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.E.A.)
| | - Sunil K Agarwal
- Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A., J.C.)
| | - David S Siscovick
- University of Washington, Seattle, WA (N.S., D.S.S.) The New York Academy of Medicine, New York, NY (D.S.S.)
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.G.T., W.S.P.)
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.D.S.)
| | - Josef Coresh
- Department of Epidemiology, Internal Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD (S.K.A., J.C.)
| | - Mark E Josephson
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.E.J.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences and Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
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Enriquez A, Conde D, Hopman W, Mondragon I, Chiale PA, de Luna AB, Baranchuk A. Advanced interatrial block is associated with recurrence of atrial fibrillation post pharmacological cardioversion. Cardiovasc Ther 2014; 32:52-6. [PMID: 24417765 DOI: 10.1111/1755-5922.12063] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Management of atrial fibrillation (AF) is hampered by frequent recurrences after restoration of sinus rhythm. Delayed interatrial conduction has been associated with the development of AF in different clinical settings. The aim of our study was to assess whether advanced interatrial block (aIAB) was associated with AF recurrence after pharmacological cardioversion with two different antiarrhythmic drugs. METHODS We included 61 patients with recent onset AF without structural heart disease that underwent successful pharmacological cardioversion. Thirty-one patients received a single oral dose of propafenone, and 30 patients received iv vernakalant. A 12-lead ECG (filter 150 Hz, 25 mm/s, 10 mm/mV) after conversion was evaluated for the presence of interatrial block (IAB); partial (pIAB): P-wave duration > 120 ms, and advanced (aIAB): P-wave > 120 ms and biphasic morphology (±) in inferior leads. Clinical follow-up and electrocardiographic recordings were performed for a 12-month period. RESULTS Age was 58 ± 10.4 years and 50.8% were male. aIAB was present in 11 patients (18%) and pIAB in 10 (16.4%). At 1-year follow-up, 22 patients (36%) had AF recurrence. The recurrence rate with aIAB was 90.9% versus 70% in those with pIAB and 12.5% in normal P-wave duration (P = 0.001). The presence of aIAB was strongly associated with AF recurrence (odds ratio 18.4 in multivariable modeling). Recurrence was not affected by the drug used for cardioversion (P = 0.92). CONCLUSION Advanced interatrial block is associated with higher risk of AF recurrence at 1 year after pharmacological cardioversion, independent of the drug used.
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Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, ON, Canada
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Alp H, Baysal T, Altın H, Karataş Z, Karaarslan S. QT and P-wave dispersions in rheumatic heart disease: prospective long-term follow up. Pediatr Int 2014; 56:681-8. [PMID: 24628726 DOI: 10.1111/ped.12328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/04/2014] [Accepted: 02/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Simple electrocardiogram (ECG) markers have been used to evaluate conduction times. Acute rheumatic fever (ARF) is an autoimmune disease that affects these conduction times. The aim of this prospective long-term follow-up study was to evaluate QT, QTc and P-wave dispersions in children with ARF and chronic rheumatic heart disease (CRHD). METHODS Sixty-four patients with ARF, 33 patients with CRHD and 41 healthy, age- and sex-matched control subjects were included in the study. The ARF patients were divided into two subgroups: carditis and arthritis. Echocardiographic and ECG measurements at the onset of diagnosis and final evaluation were included. RESULTS QT, QTc and P-wave dispersions were significantly greater in both the ARF carditis and CRHD groups than the ARF arthritis and control subjects during the initial and final analysis (for all, P < 0.001). There was no significant statistical difference in QT, QTc and P-wave dispersion between the initial and final analysis in each groups. Severity of mitral regurgitation and left atrial enlargement were found to be positively correlated with P-wave dispersion (r = 0.438, P < 0.001; r = 0.127, P < 0.001, respectively). QT, QTc and P-wave dispersion greater than 52, 60 and 57 ms, respectively, had higher sensitivity and specificity for predicting ARF carditis. CONCLUSION These ECG measurements can be used in the diagnosis of ARF carditis as minor criteria with modified Jones criteria. In contrast, this increase in the dispersions is permanent in patients with ARF carditis.
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Affiliation(s)
- Hayrullah Alp
- Department of Pediatric Cardiology, Malatya State Hospital, Malatya, Turkey
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Francia P, Ricotta A, Balla C, Adduci C, Semprini L, Frattari A, Modestino A, Mercanti F, Sensini I, Caprinozzi M, Tocci G, Volpe M. P-wave duration in lead aVR and the risk of atrial fibrillation in hypertension. Ann Noninvasive Electrocardiol 2014; 20:167-74. [PMID: 25200638 DOI: 10.1111/anec.12197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypertension entails atrial remodeling that affect P-wave (PW) duration on electrocardiogram (ECG). PW indices (e.g., variance, dispersion, and terminal force) are associated with a higher risk for atrial fibrillation (AF), but their calculation requires multiple measurements of PW duration, limiting their use in clinical practice. We evaluated whether PW duration in specific ECG leads may identify patients with increased susceptibility to AF in a population of hypertensive patients. METHODS In a case-control study, AF and control subjects were matched for age, sex, and left atrial (LA) dimensions. PW duration was measured from digitally stored ECGs. Logistic regression was used to assess the association of PW duration and indices with AF. RESULTS We enrolled 44 hypertensive AF patients (16 paroxysmal and 28 persistent) and 44 hypertensive controls. AF and control subjects were matched for sex (males, n = 27), age (67 ± 8 years), LA diameter (40 ± 5 mm), and were comparable for left ventricular mass (45 ± 11 g/m(2.7) vs 48 ± 12 g/m(2.7) , P = 0.19), ejection fraction (58 ± 7% in both groups), and prevalence of mild valvular heart disease (7% vs 5%; P = 0.64). PW duration in lead aVR was significantly higher in AF patients as compared with controls (115 ± 18 ms vs 101 ± 14 ms; P < 0.0001) and was the best independent predictor of AF in multivariable logistic regression (PW ≥ 100 ms: RR = 3.7; 95% CI: 1.3-10.3; P = 0.02). CONCLUSIONS Simple measurement of PW duration in lead aVR allows effective identification of AF patients in a population of hypertensives. Confirmation of this finding in a larger population would provide a simple and effective risk marker of AF in hypertensive patients.
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Affiliation(s)
- Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
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Holmqvist F, Platonov PG, Solomon SD, Petersson R, McNitt S, Carlson J, Zareba W, Moss AJ. P-wave morphology is associated with echocardiographic response to cardiac resynchronization therapy in MADIT-CRT patients. Ann Noninvasive Electrocardiol 2014; 18:510-8. [PMID: 24303967 DOI: 10.1111/anec.12121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In this study we hypothesized that signs of atypical atrial activation would be associated with cardiac resynchronization therapy (CRT) response in patients with mildly symptomatic heart failure (CHF), left ventricular dysfunction, and wide QRS complex. METHODS Patients included in the CRT-D arm in MADIT-CRT were studied (n = 892). Unfiltered signal-averaged P waves were analyzed to determine orthogonal P-wave morphology (typical morphologies were predefined as having positive signals in Leads X and Y and a negative or negative-positive signal in Lead Z. All other patterns were classified as atypical). The association between P-wave morphology and data on echocardiographic response at 1 year was analyzed. RESULTS Atypical P-wave morphology was found in 21% (n = 186) of the patients at baseline. Patients with atypical P-wave morphology were more often female (31% vs. 24%, P = 0.025), had lower BMI (28 ± 5 kg/m(2) vs. 29 ± 5 kg/m(2) , P = 0.008), had more ischemic CHF (60% vs. 52%, P = 0.026) and had smaller left atrial volumes (90 ± 20 mL vs. 94 ± 22 mL, P = 0.034). Atypical P-wave morphology at baseline was associated with superior response to CRT at 1 year with a larger reduction in left ventricular end-diastolic volume (-23 ± 12% vs. -20 ± 11%, P = 0.009), left ventricular end-systolic volume (-36 ± 16% vs. -31 ± 16%, P = 0.006), and left atrial volume (-31 ± 12% vs. -27 ± 12%, P = 0.005), with a slightly larger absolute increase in left ventricular ejection fraction (LVEF) (12 ± 5% vs. 11 ± 5%, P = 0.009). These associations were found to be independent of traditional predictors. CONCLUSION The presence of atypical P-wave morphology recorded is independently associated with a favorable echocardiographic cardiac remodeling response to CRT.
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Affiliation(s)
- Fredrik Holmqvist
- Department of Cardiology, Lund University, Lund, Sweden; Center for Integrative Electrocardiology, Lund University, Lund, Sweden
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Chhabra L, Devadoss R, Chaubey VK, Spodick DH. Interatrial block in the modern era. Curr Cardiol Rev 2014; 10:181-9. [PMID: 24827803 PMCID: PMC4040870 DOI: 10.2174/1573403x10666140514101748] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 01/25/2013] [Accepted: 01/28/2014] [Indexed: 12/13/2022] Open
Abstract
Interatrial block (IAB; P-wave duration ≥ 110 ms), which represents a delay in the conduction between the atria, is a pandemic conduction abnormality that is frequently underappreciated in clinical practice. Despite its comprehensive documentation in the medical literature, it has still not received adequate attention and also not adequately described and discussed in most cardiology textbooks. IAB can be of varying degrees and classified based on the degree of P-duration and its morphology. It can transform into a higher degree block and can also manifest transiently. IAB may be a preceding or causative risk factor for various atrial arrhythmias (esp. atrial fibrillation) and also be associated with various other clinical abnormalities ranging from left atrial dilation and thromboembolism including embolic stroke and mesenteric ischemia. IAB certainly deserves more attention and prospective studies are needed to formulate a standard consensus regarding appropriate management strategies.
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48
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Tereshchenko LG, Shah AJ, Li Y, Soliman EZ. Electrocardiographic deep terminal negativity of the P wave in V1 and risk of mortality: the National Health and Nutrition Examination Survey III. J Cardiovasc Electrophysiol 2014; 25:1242-8. [PMID: 24837486 DOI: 10.1111/jce.12453] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Deep terminal negativity of P wave in V1 (DTNPV1), defined as negative P prime larger than one small box (1 mm, or 0.1 mV), could be easily detected by simple visual inspection of the resting 12-lead ECG. The objective of this study was to determine the relationship between DTNPV1 and all-cause-, cardiovascular disease (CVD), and ischemic heart disease (IHD) mortality in the National Health and Nutrition Examination Survey III (NHANES III). METHODS AND RESULTS After exclusion of participants with atrial fibrillation and missing data, DTNPV1 was automatically measured from standard 12-lead ECG in 8,146 participants. Minnesota and Novacode algorithms were used for the determination of major and minor ECG abnormalities. National Death Index was used to identify the date and cause of death. During a median follow-up of 13.8 years, a total of 2,975 deaths (1,303 CVD and 742 IHD deaths) occurred. After adjustment for age, gender, race/ethnicity, IHD, heart failure, chronic obstructive pulmonary disease, cancer, diabetes, body mass index, smoking, dyslipidemia, hypertension, use of antihypertensive and lipid-lowering medications, and ECG abnormalities, DTNPV1 was associated with significantly increased risk of all-cause death (HR [95% CI]: 1.30 [1.10, 1.53]; P = 0.002), CVD death (HR [95% CI]: 1.36 [1.08, 1.72]; P = 0.010), and IHD death (HR [95% CI]: 1.36 [1.00, 1.85]; P = 0.047). CONCLUSION In a large sample of the adult United States population, DTNPV1 is independently associated with increased risk of death due to all-cause, CVD, and IHD, findings suggesting its potential usefulness as a simple marker to identify individuals at risk of poor outcomes.
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Affiliation(s)
- Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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Abstract
Use of medications for attention-deficit hyperkinetic disorder and preparticipation sports physical examination has led to an increase in number of electrocardiograms (ECG) performed during adolescence. Interpreting ECGs in children and young adults must take into account the evolutionary changes with age and the benign variants, which are usually not associated with heart disease. It is crucial for primary-care providers to recognize the changes on ECG associated with heart disease and risk of sudden death. In this article, the significance, sensitivity, specificity, and the diagnostic workup of these findings in the asymptomatic teenager are discussed.
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Affiliation(s)
- Harinder R Singh
- Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubein, Detroit, MI 48201, USA.
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Mahmoud K. Effect of coronary slow flow on dispersion of P-wave & QT-interval and its relationship with Thrombolysis in Myocardial Infarction frame count. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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