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Bastos RF, Tuleski GLR, Sousa MG. QT interval instability and QRS interval dispersion in healthy cats and cats with a hypertrophic cardiomyopathy phenotype. J Feline Med Surg 2023; 25:1098612X231151479. [PMID: 36745542 PMCID: PMC10812083 DOI: 10.1177/1098612x231151479] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Hypertrophic cardiomyopathy (HCM) is the most common heart disease in cats. Electrocardiographic (ECG) analysis can help with the diagnosis of HCM and also in the investigation of the secondary consequences of the disease. This study investigated ECG markers of QT interval variability (total instability [TI], short-term instability [STI], long-term instability [LTI], QT variance [QTv]), mean QT interval (QTa) and QT interval corrected for heart rate (QTac), as well as the duration (QRSd) and dispersion (QRSv) of the QRS interval in healthy cats and in those with HCM. METHODS Data were collected from 63 domestic cats: 40 in the control group and 23 in the HCM group. Fifty consecutive QT intervals were recorded for all cats and then QTa, QTac, QTv, TI, LTI and STI were calculated. QRSd and QRSv were also obtained for all animals. A Mann-Whitney U-test was used for group comparison. Receiver operating characteristic curves were plotted to evaluate the sensitivity and specificity of all markers for HCM. Logistic regression analysis was performed to assess the risks of cats having HCM, based on the studied indexes. RESULTS QTa (P <0.01), QTac (P <0.01), QRSd (P <0.01) and STI (P = 0.02) were higher in the HCM group. QTa >158.8 ms, QTac >27.4 ms and QRSd >0.045 s had an accuracy of 77.4%, 68.2% and 80.9%, respectively, in detecting HCM. Logistic regression showed that cats with QTa >158 ms, QTac >27.4 ms and QRSd >0.045 s had a 1.58-, 1,23- and 6.5-fold higher risk, respectively, of developing HCM. CONCLUSIONS AND RELEVANCE Cats with HCM had higher ventricular instability as assessed by STI and showed a prolongation of the QT and QRS intervals via the QTa, QTac and QRSd markers. These markers show potential as ancillary screening tools for identifying the presence of HCM.
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Affiliation(s)
- Rodrigo Franco Bastos
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Giovana LR Tuleski
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Marlos Gonçalves Sousa
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Curitiba, Brazil
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Matsuki A, Kawasaki T, Kawamata H, Sakai C, Harimoto K, Kamitani T, Yamano M, Matoba S. Ventricular late potentials and myocardial fibrosis in hypertrophic cardiomyopathy. J Electrocardiol 2019; 58:87-91. [PMID: 31790854 DOI: 10.1016/j.jelectrocard.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/02/2019] [Accepted: 10/11/2019] [Indexed: 01/07/2023]
Abstract
AIMS Ventricular late potentials (VLPs) represent delayed conduction due in part to myocardial fibrosis. We sought to examine the relationship of signal-averaged electrocardiography findings with myocardial fibrosis as assessed by cardiac magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM). METHODS This study consisted of 41 HCM patients with sinus rhythm who had undergone risk assessment including CMR and signal-averaged electrocardiography such as VLPs, filtered QRS duration, low amplitude signal duration of the terminal filtered QRS below 40 μV (LAS), and root mean square voltage of the late 40 ms of the filtered QRS (RMS). The concordance rate between VLPs and myocardial fibrosis as assessed by CMR was examined. RESULTS Late gadolinium enhancement (LGE) on CMR was detected in 13 patients, and VLPs were detected in 14. Filtered QRS duration, LAS, RMS, and VLPs were not associated with LGE. The results of LGE and VLPs were concordant in 26 patients, whereas 15 exhibited discordance. Patients with discordance had a higher maximum wall thickness (24.1 ± 4.0 mm versus 21.0 ± 5.9 mm, p < 0.05), higher LGE volume (2.3 ± 1.2 g/cm versus 0.0 ± 0.8 g/cm, p < 0.01), lower LGE volume/the total number of sites with LGE (1.5 ± 0.7 versus 3.1 ± 2.8, p < 0.01), and predominant LGE location of the interventricular septum and anterior wall (60% versus 8%, p < 0.01) than patients with concordance. CONCLUSION VLPs were not a reliable marker for the detection of myocardial fibrosis as assessed by LGE on CMR in our cohort of patients with HCM. CONDENSED ABSTRACT Ventricular late potentials on signal-averaged electrocardiography represent delayed conduction due in part to myocardial fibrosis but were not an alternative to cardiac magnetic resonance for detecting myocardial fibrosis in patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- Ayumi Matsuki
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan; Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuya Kawasaki
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan.
| | - Hirofumi Kawamata
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Chieko Sakai
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Kuniyasu Harimoto
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Tadaaki Kamitani
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan
| | - Michiyo Yamano
- Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan; Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Romito G, Guglielmini C, Mazzarella MO, Cipone M, Diana A, Contiero B, Baron Toaldo M. Diagnostic and prognostic utility of surface electrocardiography in cats with left ventricular hypertrophy. J Vet Cardiol 2018; 20:364-375. [PMID: 30082249 DOI: 10.1016/j.jvc.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess the ability of electrocardiography (ECG) to predict left ventricular hypertrophy (LVH) in the cat and to investigate the prognostic value of selected ECG variables in cats with LVH. ANIMALS Fifty-seven privately owned cats: 22 clinically healthy cats and 35 cats with LVH. MATERIAL AND METHODS This is a clinical cohort study. Echocardiographic diagnosis and surface ECG were available. Electrocardiography analysis included rhythm diagnosis and specific electrocardiographic measurements. In cats with LVH, cause of death and outcome data were recorded and analyzed using Kaplan-Meier curves. RESULTS The presence of arrhythmia had sensitivity and specificity of 31% and 100%, respectively, for identifying LVH. Among ECG measurements, duration of QT interval (QT) and QT interval corrected for heart rate (QTc) was statistically different between healthy cats and cats with LVH (p = 0.007). Overall, the most accurate cutoffs to identify LVH were QT > 170 ms (sensitivity and specificity 48.3% and 91%, respectively) and QTc > 188 ms (sensitivity and specificity 62% and 77%, respectively). In healthy cats, the highest QT and QTc values were 180 ms and 200 ms, respectively. Mean survival time was 58 days and indeterminable for cats with QT > 180 ms and QT ≤ 180 ms, respectively (p = 0.042) and 125 days and indeterminable for cats with QTc > 200 ms and QTc ≤ 200 ms, respectively (p = 0.017). CONCLUSIONS Arrhythmias as well as prolonged QT and QTc are useful ECG parameters in identifying LVH and predicting survival in affected cats.
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Affiliation(s)
- G Romito
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - C Guglielmini
- Department of Animal Medicine, Production and Health, University of Padua, Italy
| | - M O Mazzarella
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - M Cipone
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - A Diana
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy
| | - B Contiero
- Department of Animal Medicine, Production and Health, University of Padua, Italy
| | - M Baron Toaldo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Italy.
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Magrì D, Santolamazza C, Limite L, Mastromarino V, Casenghi M, Orlando P, Pagannone E, Musumeci MB, Maruotti A, Ricotta A, Oliviero G, Piccirillo G, Volpe M, Autore C. QT spatial dispersion and sudden cardiac death in hypertrophic cardiomyopathy: Time for reappraisal. J Cardiol 2017; 70:310-315. [PMID: 28341542 DOI: 10.1016/j.jjcc.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/17/2017] [Accepted: 01/27/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND The 12-lead surface electrocardiographic (ECG) analysis is able to provide independent predictors of prognosis in several cardiovascular settings, including hypertrophic cardiomyopathy (HCM). The present single-center study investigated the possible ability of several ECG-derived variables in stratifying sudden cardiac death (SCD) risk and, possibly, in improving the accuracy of the 2014 European Society of Cardiology guidelines. METHODS A total of 221 consecutive HCM outpatients were recruited and prospectively followed. All of them underwent a full clinical and instrumental examination, including a 12-lead surface ECG to calculate the dispersion for the following intervals: QRS, Q-Tend (QT), Q-Tpeak (QTp), Tpeak-Tend (TpTe), J-Tpeak (JTp), and J-Tend (JT). The study composite end-point was SCD, aborted SCD, and appropriate implantable cardioverter defibrillator (ICD) interventions. RESULTS During a median follow-up of 4.4 years (25th-75th interquartile range: 2.4-9.4 years), 23 patients reached the end-point at 5-years (3 SCD, 3 aborted SCD, 17 appropriate ICD interventions). At multivariate analysis, the spatial QT dispersion corrected according to Bazett's formula (QTcd) remains independently associated to the study endpoint over the HCM Risk-SCD score (C-index 0.737). A QTcd cut-off value of 93ms showed the best accuracy in predicting the SCD endpoint within the entire HCM study cohort (sensitivity 56%, specificity 75%, positive predictive value 22%, negative predictive value 97%). CONCLUSION Our data suggest that the QTcd might be helpful in SCD risk stratification, particularly in those HCM categories classified at low-intermediate SCD risk according to the contemporary guidelines.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy.
| | | | - Luca Limite
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | | | - Matteo Casenghi
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | - Paola Orlando
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | - Erika Pagannone
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | | | - Antonello Maruotti
- Department of Scienze Economiche, Politiche e delle Lingue Moderne, Libera Università SS Maria Assunta, Rome, Italy; Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - Agnese Ricotta
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | - Giada Oliviero
- Department of Cardiovascular Sciences, University of Insubria, Varese, Italy
| | - Gianfranco Piccirillo
- Department of Cardiovascular, Respiratory, Anesthesiological, Nephrologic and Geriatrics Sciences, "Sapienza" University, Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy; IRCCS, Neuromed, Pozzilli (IS), Italy
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
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Lutfi MF. QT Interval Derived Measurements in Patients with Cardiac Syndrome X Compared to Coronary Artery Disease. Front Physiol 2016; 7:422. [PMID: 27708590 PMCID: PMC5030246 DOI: 10.3389/fphys.2016.00422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022] Open
Abstract
Previous studies assessing effect of ischemia on ventricular repolarization are mostly directed toward patients with coronary artery disease (CAD); however, similar reports on cardiac syndrome X (CSX) are scarce. Whether microvascular dysfunction of CSX and ischemia induced by CAD produce comparable effect on ventricular repolarization is unclear and deserve further studies. In the present study, ECG measures of ventricular repolarization were compared between CAD and CSX patients (40 subjects in each group). Following evaluation of sociodemographic characteristics, medical and past medical history, a resting ECG was used to assess measurements of ventricular repolarization in each patient, namely, QT interval (QT), corrected QT interval (QTc), QT dispersion (QTd), corrected QT dispersion (QTcd), adjacent QT dispersion (AdQTd), QT dispersion ratio (QTdR), JT dispersion (JTd), and Corrected JT dispersion (JTcd). Results showed comparable QT intervals and QTd in CAD and CSX patients even after adjustment for the possible variations in gender, age and body mass index of the studied groups. Although JTd was increased in CSX subjects (26.6 ± 7.2 ms) compared with CAD patients (22.7 ± 6.5 ms, p = 0.019), statistical significance disappeared after correcting JT for variations in heart rate. QT and QTc were significantly below 440 ms in CAD as well as CSX patients (p < 0.001). In contrast, maximum QTd, maximum QTcd and AdQTd of CAD and CSX patients were significantly above 440 ms (p < 0.001). The means of JTd and JTcd were significantly above 22 ms and 24 ms respectively (p < 0.001, p = 0.001) in CSX but not CAD patients (p = 0.529, p = 0.281). The present findings clearly demonstrate comparable measures of ventricular repolarization in CAD and CSX patients and consequently an equal risk of cardiac events in both groups.
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Affiliation(s)
- Mohamed F Lutfi
- Department of Physiology, Faculty of Medicine and Health Sciences, Al-Neelain University Khartoum, Sudan
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Magrì D, Piccirillo G, Ricotta A, De Cecco CN, Mastromarino V, Serdoz A, Muscogiuri G, Gregori M, Casenghi M, Cauti FM, Oliviero G, Musumeci MB, Maruotti A, Autore C. Spatial QT Dispersion Predicts Nonsustained Ventricular Tachycardia and Correlates with Confined Systodiastolic Dysfunction in Hypertrophic Cardiomyopathy. Cardiology 2015; 131:122-9. [DOI: 10.1159/000377622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/28/2015] [Indexed: 11/19/2022]
Abstract
Objectives: An increased dispersion of myocardial repolarization represents one of the mechanisms underlying the arrhythmic risk in hypertrophic cardiomyopathy (HCM). We investigated spatial myocardial repolarization dispersion indices in HCM patients with nonsustained ventricular tachycardia (NSVT) and, contextually, their main clinical determinants. Methods: Fifty-two well-matched HCM outpatients were categorized into two groups according to the presence or the absence of NSVT at 24-hour Holter electrocardiogram (ECG) monitoring. Each patient underwent a clinical examination, including Doppler echocardiogram integrated with tissue Doppler imaging, cardiac magnetic resonance, and 12-lead surface ECG to calculate the dispersion for the following intervals: QRS, Q-Tend (QTe), Q-Tpeak, Tpeak-Tend (TpTe), J-Tpeak, and J-Tend. Results: The NSVT group showed only QTe dispersion and TpTe dispersion values to be significantly higher than their counterparts. NSVT occurrence was independently predicted by late gadolinium enhancement presence (p = 0.021) and QTe Bazett dispersion (p = 0.030), the latter strongly associated with the myocardial performance index (MPI) obtained at the basal segment of the interventricular septum (p = 0.0004). Conclusion: Our data support QTe dispersion as an easy and noninvasive tool for identifying HCM patients with NSVT propensity. The strong relationship between QTe dispersion and MPI allows us to hypothesize an intriguing link between electrical instability and confined myocardial areas of systodiastolic dysfunction.
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