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Li B, Liu X, Wang B, Liu X, Zhang W. QRS-T angle as a predictor of pulmonary arterial hypertension: A review. Medicine (Baltimore) 2023; 102:e32320. [PMID: 36637949 PMCID: PMC9839265 DOI: 10.1097/md.0000000000032320] [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: 10/25/2022] [Accepted: 11/29/2022] [Indexed: 01/14/2023] Open
Abstract
Spatial QRS-T angle is a vector projection of ventricular gradient, reflecting the heterogeneity of ventricular repolarization. The QRS vector is projected into three dimensional (3D) space to obtain the frontal QRSf vector and Tf vector. The frontal QRS-T Angle can be obtained by simple calculation. In several studies of diseases that cause pulmonary hypertension, there has been evidence that changes in the QRS-T Angle can predict disease. Electrocardiogram (ECG) is a cheap and noninvasive test, and its clinical significance in the diagnosis of pulmonary hypertension should be further studied.
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Affiliation(s)
- Bo Li
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Xuhan Liu
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Baoguo Wang
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Xiuqing Liu
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Weihua Zhang
- Department of Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
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2
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Improved evaluation of left ventricular hypertrophy using the spatial QRS-T angle by electrocardiography. Sci Rep 2022; 12:15106. [PMID: 36068245 PMCID: PMC9448768 DOI: 10.1038/s41598-022-16712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022] Open
Abstract
Electrocardiographic (ECG) signs of left ventricular hypertrophy (LVH) lack sensitivity. The aim was to identify LVH based on an abnormal spatial peaks QRS-T angle, evaluate its diagnostic performance compared to conventional ECG criteria for LVH, and its prognostic performance. This was an observational study with four cohorts with a QRS duration < 120 ms. Based on healthy volunteers (n = 921), an abnormal spatial peaks QRS-T angle was defined as ≥ 40° for females and ≥ 55° for males. In other healthy volunteers (n = 461), the specificity of the QRS-T angle to detect LVH was 96% (females) and 98% (males). In patients with at least moderate LVH by cardiac imaging (n = 225), the QRS-T angle had a higher sensitivity than conventional ECG criteria (93–97% vs 13–56%, p < 0.001 for all). In clinical consecutive patients (n = 783), of those who did not have any LVH, 238/556 (43%) had an abnormal QRS-T angle. There was an association with hospitalization for heart failure or all-cause death in univariable and multivariable analysis. An abnormal QRS-T angle rarely occurred in healthy volunteers, was a mainstay of moderate or greater LVH, was common in clinical patients without LVH but with cardiac co-morbidities, and associated with outcomes.
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3
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Stahi T, Kaminer K, Shavit I, Nussinovitch U. Diabetes without Overt Cardiac Disease Is Associated with Markers of Abnormal Repolarization: A Case-Control Study. Life (Basel) 2022; 12:life12081173. [PMID: 36013351 PMCID: PMC9410176 DOI: 10.3390/life12081173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022] Open
Abstract
Patients with diabetes mellitus (DM) are prone to advanced atherosclerosis, microvascular disease, and tissue fibrosis. Despite the increased risk for arrhythmias, little is known about cardiac repolarization abnormalities in DM. We aimed to determine whether abnormal T-wave morphology markers are common among patients with DM and no known cardiac disease. Patients were recruited and classified as having DM or impaired fasting glucose (IFG) according to accepted guidelines. Total cosine R to T (TCRT) and T-wave morphology dispersion (TMD) were computed with custom-designed software for randomly selected and averaged beats. Among 124 patients recruited; 47 were diagnosed with DM and 3 IFG. DM patients and the control group had similar clinical characteristics, other than statins and anti-diabetic drugs, which were more common among DM patients. Patients with DM/IFG had decreased TCRT values computed from a random beat (0.06 ± 0.10 vs. 0.43 ± 0.07, p < 0.01) and an average beat (0.08 ± 0.09 vs. 0.44 ± 0.06, p < 0.01), when compared with the control group. TMD parameters did not differ. In conclusion, TCRT is reduced in patients with DM and no known cardiac diseases. Further research is required to investigate whether repolarization-associated changes in DM are the consequence of subclinical atherosclerosis, diabetic cardiomyopathy, or a combination of the two.
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Affiliation(s)
- Tomer Stahi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel; (T.S.); (I.S.)
| | - Keren Kaminer
- Department of Endocrinology, Rabin Medical Center, Petach Tikva 4941492, Israel;
| | - Itay Shavit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel; (T.S.); (I.S.)
| | - Udi Nussinovitch
- Alpha Helix Ventures, Petach Tikva 4921352, Israel
- Correspondence: ; Tel.: +972-53-526-8535
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4
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Andršová I, Hnatkova K, Šišáková M, Toman O, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Sex and Rate Change Differences in QT/RR Hysteresis in Healthy Subjects. Front Physiol 2022; 12:814542. [PMID: 35197861 PMCID: PMC8859307 DOI: 10.3389/fphys.2021.814542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
While it is now well-understood that the extent of QT interval changes due to underlying heart rate differences (i.e., the QT/RR adaptation) needs to be distinguished from the speed with which the QT interval reacts to heart rate changes (i.e., the so-called QT/RR hysteresis), gaps still exist in the physiologic understanding of QT/RR hysteresis processes. This study was designed to address the questions of whether the speed of QT adaptation to heart rate changes is driven by time or by number of cardiac cycles; whether QT interval adaptation speed is the same when heart rate accelerates and decelerates; and whether the characteristics of QT/RR hysteresis are related to age and sex. The study evaluated 897,570 measurements of QT intervals together with their 5-min histories of preceding RR intervals, all recorded in 751 healthy volunteers (336 females) aged 34.3 ± 9.5 years. Three different QT/RR adaptation models were combined with exponential decay models that distinguished time-based and interval-based QT/RR hysteresis. In each subject and for each modelling combination, a best-fit combination of modelling parameters was obtained by seeking minimal regression residuals. The results showed that the response of QT/RR hysteresis appears to be driven by absolute time rather than by the number of cardiac cycles. The speed of QT/RR hysteresis was found decreasing with increasing age whilst the duration of individually rate corrected QTc interval was found increasing with increasing age. Contrary to the longer QTc intervals, QT/RR hysteresis speed was faster in females. QT/RR hysteresis differences between heart rate acceleration and deceleration were not found to be physiologically systematic (i.e., they differed among different healthy subjects), but on average, QT/RR hysteresis speed was found slower after heart rate acceleration than after rate deceleration.
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Affiliation(s)
- Irena Andršová
- Faculty of Medicine, Department of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, Brno, Czechia
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Martina Šišáková
- Faculty of Medicine, Department of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, Brno, Czechia
| | - Ondřej Toman
- Faculty of Medicine, Department of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, Brno, Czechia
| | | | - Katharina M Huster
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tomáš Novotný
- Faculty of Medicine, Department of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, Brno, Czechia
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, United Kingdom.,Faculty of Medicine, Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czechia
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Jaber S, Nussinovitch U, Stahi T, Arnson Y. Association between T wave morphology parameters and abnormal cardiac SPECT imaging. J Electrocardiol 2021; 70:65-69. [PMID: 34929606 DOI: 10.1016/j.jelectrocard.2021.12.003] [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: 10/23/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND T-wave morphology dispersion (TMD) described the electrocardiographic T-wave heterogeneity during a single cardiac cycle. Total cosine R-to-T (TCRT) is the average of the cosines of the angles between the QRS and T vectors on the ECG. We examine the predictive value of TMD and TCRT calculation to assess abnormal myocardial perfusion. METHODS Retrospective single center cohort study including all patients referred for evaluation of ischemia by myocardial SPECT scanning with no known history of ischemic heart disease, from 1 January 2019 to 31 December 2019. Study endpoint was the correlation between the calculated TMD and TCRT values and detection of myocardial injury or ischemia by myocardial SPECT. RESULTS Among 606 patients, calculated TCRT was 0.401 ± 0.53 for the normal group and 0.283 ± 0.62 for the abnormal group (p = 0.007). Measured TMD was 22.9 ± 16.6 degrees (p < 0.001) in the normal group, compared to 31.5 ± 22.8 degrees (p < 0.001) for the abnormal group. CONCLUSIONS The results demonstrate a correlation between the decreased TCRT values and increase TMD and myocardial ischemia seen in SPECT results. The TCRT and TMD can be used as simple and non-invasive markers to predict abnormal SPECT results and ischemic heart disease in patients with no known cardiac history.
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Affiliation(s)
- Samer Jaber
- Internal Medicine "F", Meir Medical Center, Kfar Sava, Israel
| | - Udi Nussinovitch
- Department of Cardiology, Meir Medical Center, Kfar Sava, Israel; Applicative Cardiovascular Research Center (ACRC), Meir Medical Center, Kfar Sava, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Tomer Stahi
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Yoav Arnson
- Department of Cardiology, Meir Medical Center, Kfar Sava, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Stahi T, Kaminer K, Gur E, Yao I, Nussinovitch U. T-wave morphology descriptors in patients with bulimia nervosa. Eat Weight Disord 2021; 26:661-666. [PMID: 32356143 DOI: 10.1007/s40519-020-00905-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/09/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Bulimia nervosa (BN) is associated with increased risk of cardiovascular disease and arrhythmias. Some reports found abnormal electrocardiographic markers of arrhythmias in BN, while others did not. This study investigated novel parameters of T-wave morphology that were reported to be associated with adverse cardiovascular outcomes in other patient groups, among patients with BN under medical care. METHOD Thirty-five BN patients and 76 healthy controls were included. Total cosine R to T (TCRT) and T-wave Morphology Dispersion (TMD) parameters were computed according to accepted standards for an average beat and a random beat. Patients were followed for 11.1 ± 0.1 years for the emergence of arrhythmias or events of sudden death. RESULTS Twenty-five (71.4%) BN patients were hospitalized when enrolled, for a mean duration of 1.1 ± 0.2 months. The rest were ambulatory patients. The BN group had lower blood pressure, more smokers, and used antidepressants, neuroleptic drugs and benzodiazepines more than controls did. Other demographic parameters were comparable between groups. TCRT and TMD parameters were statistically similar and within the normal ranges reported by other research groups. None of the BN patients had prolonged QTc interval or electrolyte abnormalities on inclusion. During the follow-up period, no clinical symptoms suggestive of arrhythmias were reported, and no cardiovascular-related hospitalizations or deaths occurred in either group. CONCLUSION Medically treated BN patients have normal T-wave morphology parameters and hence, low risk for repolarization-associated malignant ventricular arrhythmias. The prognostic importance of these novel repolarization parameters remains to be explored among untreated patients, those who ingest emetic substances and patients with electrolyte imbalance. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Tomer Stahi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren Kaminer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Endocrinology, Rabin Medical Center, Petach Tikva, Israel
| | - Eitan Gur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Eating Disorders Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Isaac Yao
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Udi Nussinovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Cardiology and the Applicative Cardiovascular Research Center (ACRC), Meir Medical Center, 4428164, Kfar Saba, Israel.
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Rahola JT, Kiviniemi AM, Ukkola OH, Tulppo MP, Junttila MJ, Huikuri HV, Kenttä TV, Perkiömäki JS. Temporal variability of T-wave morphology and risk of sudden cardiac death in patients with coronary artery disease. Ann Noninvasive Electrocardiol 2021; 26:e12830. [PMID: 33486851 PMCID: PMC8164143 DOI: 10.1111/anec.12830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
Background The possible relationship between temporal variability of electrocardiographic spatial heterogeneity of repolarization and the risk of sudden cardiac death (SCD) in patients with coronary artery disease (CAD) is not completely understood. Methods The standard deviation of T‐wave morphology dispersion (TMD‐SD), of QRST angle (QRSTA‐SD), and of T‐wave area dispersion (TW‐Ad‐SD) were analyzed on beat‐to‐beat basis from 10 min period of the baseline electrocardiographic recording in ARTEMIS study patients with angiographically verified CAD. Results After on average of 8.6 ± 2.3 years of follow‐up, a total of 66 of the 1,678 present study subjects (3.9%) had experienced SCD or were resuscitated from sudden cardiac arrest (SCA). TMD‐SD was most closely associated with the risk for SCD and was significantly higher in patients who had experienced SCD/SCA compared with those who remained alive (3.61 ± 2.83 vs. 2.64 ± 2.52, p = .008, respectively), but did not differ significantly between the patients who had experienced non‐SCD (n = 71, 4.2%) and those who remained alive (3.20 ± 2.73 vs. 2.65 ± 2.53, p = .077, respectively) or between the patients who succumbed to non‐cardiac death (n = 164, 9.8%) and those who stayed alive (2.64 ± 2.17 vs. 2.68 ± 2.58, p = .853). After adjustments with relevant clinical risk indicators of SCD/SCA, TMD‐SD still predicted SCD/SCA (HR 1.107, 95% CIs 1.035–1.185, p = .003). Conclusions Temporal variability of electrocardiographic spatial heterogeneity of repolarization represented by TMD‐SD independently predicts long‐term risk of SCD/SCA in patients with CAD.
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Affiliation(s)
- Janne T Rahola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Department of Physiology, Research Unit of Biomedicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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8
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Evaluation of a Proarrhythmic Repolarization Marker (Total Cosine R to T) in Patients With Uncomplicated Familial Mediterranean Fever. J Clin Rheumatol 2020; 26:334-337. [PMID: 32649405 DOI: 10.1097/rhu.0000000000001465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Familial Mediterranean fever (FMF) is a systemic autoinflammatory disorder characterized by recurrent attacks of fever and serous inflammation. The association between FMF and risk of cardiac arrhythmia is continuously questioned; some studies report abnormal cardiac repolarization, while others do not. Considering this controversy, we aim to perform in a large cohort of FMF patients a total cosine R to T (TCRT) analysis, a previously unexplored repolarization marker in this disorder. METHODS The study group included 56 FMF patients without amyloidosis, diagnosed with FMF according to published criteria and 131 control subjects, unaffected with FMF. A 12-lead electrocardiogram (ECG) was performed according to strict standards. Electrocardiogram files were processed with Python-based computer software. Patients were followed for 10 to 12 years, and the rate of cardiac complications was evaluated. RESULTS Other than FMF and prescription of colchicine, both groups had similar medical and demographic background. TCRT results were similar for a randomly selected beat (0.40 ± 0.06 vs 0.50 ± 0.04, p > 0.05) and for an averaged beat (0.39 ± 0.06 vs 0.50 ± 0.04, p > 0.05) in FMF patients and control subjects, respectively. Correction of average TCRT for heart rate also resulted in similar TCRTc values in patients and control groups (0.42 ± 0.07 s vs 0.51 ± 0.05 s, respectively, p > 0.05). During the follow-up period, none of the patients died, and no patient developed clinical symptoms suggestive of ventricular arrhythmias. CONCLUSIONS Colchicine treated uncomplicated FMF patients have normal TCRT and TCRTc values, implying low risk for cardiac arrhythmias in this population. Future studies should evaluate the sensitivity and specificity of this marker in high-risk FMF populations, such as those who developed AA amyloidosis.
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Lipponen JA, Kurl S, Laukkanen JA. Global electrical heterogeneity as a predictor of cardiovascular mortality in men and women. Europace 2019; 20:1841-1848. [PMID: 29868797 DOI: 10.1093/europace/euy113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/20/2018] [Indexed: 11/14/2022] Open
Abstract
Aims The aim of this study was to investigate the contribution of depolarization and repolarization abnormalities, specially abnormalities in global electrical heterogeneity of heart in cardiovascular disease (CVD) and all-cause mortality. Methods and results Eight hundred and forty men and 911 women, average age of 63 years participated in this study with average follow-up was 14 years. Six electrocardiogram/vector electrocardiogram (ECG/VECG) markers QRS-duration, QTc-interval, QRST-angle, sum of absolute QRST integral (SAI QRST), T-wave roundness, and TV1-amplitude were estimated from VECG measurements. Hazard ratios (HRs) for CVD events (164 deaths) and all-cause mortality (383 deaths) for ECG parameters were calculated. Electrocardiogram or vector electrocardiogram parameter models adjusted for risk clinical factors showed that strongest predictors for CVD mortality were QRST-angle (HR 3.44, 95% confidence interval 2.12-5.36), QTc-interval (2.72, 1.73-4.29), and T-wave roundness (2.09, 1.26-3.46) among men. The strongest ECG/VECG parameters for CVD death were QRST-angle (2.47, 1.37-4.45), SAI QRST (2.37, 1.23-4.6), and QTc-interval (2.15, 1.16-4.01) among female participants. Multivariable adjusted models revealed that strongest independent ECG predictors for CVD death were QRST-angle, QTc-interval, resting heart rate, and T-roundness for men, QRST-angle and SAI QRST for women. QRST-angle, QTc-interval, resting heart rate, and T-roundness were associated with all-cause mortality in male population, although none of the ECG/VECG parameters predicted all-cause mortality among women. Conclusion Characteristics of global electrical heterogeneity QRST-angle and QTc-interval in men and QRST-angle and SAI QRST among females were strong and independent risk markers for cardiovascular mortality. These parameters provide new additional ECG tools for cardiovascular risk stratification.
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Affiliation(s)
- Jukka A Lipponen
- Department of Applied Physics, University of Eastern Finland, Yliopistonranta 1, Kuopio, Finland
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Internal Medicine, Central Finland Health Care District, Jyväskylä, Finland.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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10
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Tse G, Gong M, Wong CW, Chan C, Georgopoulos S, Chan YS, Yan BP, Li G, Whittaker P, Ciobanu A, Ali‐Hasan‐Al‐Saegh S, Wong SH, Wu WKK, Bazoukis G, Lampropoulos K, Wong WT, Tse LA, Baranchuk AM, Letsas KP, Liu T. Total cosine R-to-T for predicting ventricular arrhythmic and mortality outcomes: A systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2018; 23:e12495. [PMID: 28901628 PMCID: PMC6931891 DOI: 10.1111/anec.12495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The total cosine R-to-T (TCRT), a vectorcardiographic marker reflecting the spatial difference between the depolarization and repolarization wavefronts, has been used to predict ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death (SCD) in different clinical settings. However, its prognostic value has been controversial. OBJECTIVE This systematic review and meta-analysis evaluated the significance of TRCT in predicting arrhythmic and/or mortality endpoints. METHODS PubMed and Embase databases were searched through December 31, 2016. RESULTS Of the 890 studies identified initially, 13 observational studies were included in our meta-analysis. A total of 11,528 patients, mean age 47 years old, 72% male, were followed for 43 ± 6 months. Data from five studies demonstrated lower TCRT values in myocardial infarction patients with adverse events (syncope, ventricular arrhythmias, or sudden cardiac death) compared to those without these events (mean difference = -0.36 ± 0.05, p < .001; I2 = 48%). By contrast, only two studies analyzed outcomes in heart failure, and pooled meta-analysis did not demonstrate significant difference in TCRT between event-positive and event-negative patients (mean difference = -0.01 ± 0.10, p > .05; I2 = 80%). CONCLUSION TCRT is lower in MI patients at high risk of adverse events when compared to those free from such events. It can provide additional risk stratification beyond the use of clinical parameters and traditional electrocardiogram markers. Its value in other diseases such as heart failure requires further studies.
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Affiliation(s)
- Gary Tse
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong Kong SARChina
- Faculty of MedicineLi Ka Shing Institute of Health SciencesChinese University of Hong KongHong Kong SARChina
| | - Mengqi Gong
- Department of CardiologyTianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Cheuk Wai Wong
- Li Ka Shing Faculty of MedicineUniversity of Hong KongHong Kong SARChina
| | - Cynthia Chan
- Li Ka Shing Faculty of MedicineUniversity of Hong KongHong Kong SARChina
| | - Stamatis Georgopoulos
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Yat Sun Chan
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong Kong SARChina
| | - Bryan P. Yan
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong Kong SARChina
| | - Guangping Li
- Department of CardiologyTianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Paula Whittaker
- Division of Population HealthHealth Services Research and Primary CareSchool of Health SciencesUniversity of ManchesterManchesterUnited Kingdom
| | - Ana Ciobanu
- Department of CardiologyTheodor Burghele Clinical HospitalCarol Davila University of Medicine and PharmacyBucharestRomania
| | | | - Sunny H. Wong
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong Kong SARChina
- Faculty of MedicineLi Ka Shing Institute of Health SciencesChinese University of Hong KongHong Kong SARChina
| | - William K. K. Wu
- Faculty of MedicineLi Ka Shing Institute of Health SciencesChinese University of Hong KongHong Kong SARChina
- Department of Anesthesia and Intensive CareState Key Laboratory of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
| | - George Bazoukis
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Konstantinos Lampropoulos
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Wing Tak Wong
- School of Life SciencesThe Chinese University of Hong KongHong KongChina
| | - Lap Ah Tse
- Division of Occupational and Environmental HealthJC School of Public Health and Primary CareThe Chinese University of Hong KongHong KongChina
| | - Adrian M. Baranchuk
- Department of MedicineKingston General HospitalQueen's UniversityKingstonONCanada
| | - Konstantinos P. Letsas
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Tong Liu
- Department of CardiologyTianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
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11
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Chen L, Cai S, Li B, Jiang Q, Ke M, Zhao Y, Chen S, Zou M. A novel signal acquisition platform of human cardiovascular information with noninvasive method. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2017; 88:054301. [PMID: 28571401 DOI: 10.1063/1.4982952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardiovascular diseases (CVDs) are considered the major cause of death worldwide, so more researchers pay more and more attention to the development of a non-invasive method to obtain as much cardiovascular information (CVI) as possible for early screening and diagnosing. It is known that considerable brain information could be probed by a variety of stimuli (such as video, light, and sound). Therefore, it is quite possible that much more CVI could be extracted via giving the human body some special interrelated stimulus. Based on this hypothesis, we designed a novel signal platform to acquire more CVI with a special stimulus, which is to give a gradual decrease and a different settable constant pressure to six air belts placed on two-side brachia, wrists, and ankles, respectively. During the stimulating process, the platform is able to collect 24-channel dynamic signals related with CVI synchronously. Moreover, to improve the measurement accuracy of signal acquisition, a high precision reference chip and a software correction are adopted in this platform. Additionally, we have also shown some collection instances and analysis results in this paper for its reliability. The results suggest that our platform can not only be applied on study in a deep-going way of relationship between collected signals and CVDs but can also serve as the basic tool for developing a new noninvasive cardiovascular function detection instrument and system that can be used both at home and in the hospital.
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Affiliation(s)
- Longcong Chen
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Shaoxi Cai
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Bo Li
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Qifeng Jiang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Ming Ke
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Yi Zhao
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Sijia Chen
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Misha Zou
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
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Hasan MA, Abbott D. A review of beat-to-beat vectorcardiographic (VCG) parameters for analyzing repolarization variability in ECG signals. ACTA ACUST UNITED AC 2016; 61:3-17. [DOI: 10.1515/bmt-2015-0005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 04/17/2015] [Indexed: 11/15/2022]
Abstract
AbstractElevated ventricular repolarization lability is believed to be linked to the risk of ventricular tachycardia/ventricular fibrillation. However, ventricular repolarization is a complex electrical phenomenon, and abnormalities in ventricular repolarization are not completely understood. To evaluate repolarization lability, vectorcardiography (VCG) is an alternative approach where the electrocardiographic (ECG) signal can be considered as possessing both magnitude and direction. Recent research has shown that VCG is advantageous over ECG signal analysis for identification of repolarization abnormality. One of the key reasons is that the VCG approach does not rely on exact identification of the T-wave offset, which improves the reproducibility of the VCG technique. However, beat-to-beat variability in VCG is an emerging area for the investigation of repolarization abnormality though not yet fully realized. Therefore, the purpose of this review is to explore the techniques, findings, and efficacy of beat-to-beat VCG parameters for analyzing repolarization lability, which may have potential utility for further study.
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Spatial/Frontal QRS-T Angle Predicts All-Cause Mortality and Cardiac Mortality: A Meta-Analysis. PLoS One 2015; 10:e0136174. [PMID: 26284799 PMCID: PMC4540436 DOI: 10.1371/journal.pone.0136174] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 07/31/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A number of studies have assessed the predictive effect of QRS-T angles in various populations since the last decade. The objective of this meta-analysis was to evaluate the prognostic value of spatial/frontal QRS-T angle on all-cause death and cardiac death. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from their inception until June 5, 2014. Studies reporting the predictive effect of spatial/frontal QRS-T angle on all-cause/cardiac death in all populations were included. Relative risk (RR) was used as a measure of effect. RESULTS Twenty-two studies enrolling 164,171 individuals were included. In the combined analysis in all populations, a wide spatial QRS-T angle was associated with an increase in all-cause death (maximum-adjusted RR: 1.40; 95% confidence interval [CI]: 1.32 to 1.48) and cardiac death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90), a wide frontal QRS-T angle also predicted a higher rate of all-cause death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90). Largely similar results were found using different methods of categorizing for QRS-T angles, and similar in subgroup populations such as general population, populations with suspected coronary heart disease or heart failure. Other stratified analyses and meta-analyses using unadjusted data also generated consistent findings. CONCLUSIONS Spatial QRS-T angle held promising prognostic value on all-cause death and cardiac death. Frontal QRS-T angle was also a promising predictor of all-cause death. Given the good predictive value of QRS-T angle, a combined stratification strategy in which QRS-T angle is of vital importance might be expected.
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Kania M, Maniewski R, Kobylecka M, Zaczek R, Królicki L, Opolski G, Janusek D. Prognostic value of the total cosine R to T measured in high resolution body surface potential mapping during exercise test. Biomed Signal Process Control 2015. [DOI: 10.1016/j.bspc.2015.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
For proper distribution of preventative resources, a more robust method of cardiac risk stratification should be encouraged in addition to merely reduced ejection fraction. To this end, the QRS-T angle, an electrocardiogram-derived measure of the difference in mean vectors of depolarization and repolarization, has been found associated with sudden cardiac death and other mortal and morbid outcomes in multiple observational studies over the past decade. The use of both frontal and spatial QRS-T angle in the prediction of future cardiac events including sudden cardiac death, all-cause mortality, and further cardiac morbidity is reviewed here.
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Affiliation(s)
- Andrew Oehler
- Internal Medicine Department, Oregon Health and Science University, Portland, OR
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Usefulness of the QRS-T angle to improve long-term risk stratification of patients with acute myocardial infarction and depressed left ventricular ejection fraction. Am J Cardiol 2014; 113:1312-9. [PMID: 24685325 DOI: 10.1016/j.amjcard.2014.01.406] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/08/2014] [Accepted: 01/08/2014] [Indexed: 11/21/2022]
Abstract
In light of the low cost, the widespread availability of the electrocardiogram, and the increasing economic burden of the health-related problems, we aimed to analyze the prognostic value of automatic frontal QRS-T angle to predict mortality in patients with left ventricular (LV) systolic dysfunction after acute myocardial infarction (AMI). About 467 consecutive patients discharged with diagnosis of AMI and with LV ejection fraction ≤40% were followed during 3.9 years (2.1 to 5.9). From them, 217 patients (47.5%) died. The frontal QRS-T angle was higher in patients who died (116.6±52.8 vs 77.9±55.1, respectively, p<0.001). The QRS-T angle value of 90° was the most accurate to predict all-cause cardiac death. After multivariate analysis, frontal QRS-T angle remained as an excellent predictor of all-cause and cardiac deaths, increasing the mortality 6% per each 10°. For the global mortality, the hazard ratio for a QRS-T angle>90° was 2.180 (1.558 to 3.050), and for the combined end point of cardiac death and appropriate implantable cardioverter defribrillator therapy, it was 2.385 (1.570 to 3.623). This independent predictive value was maintained even after adjusting by bundle brunch block, ST-elevation AMI, and its localization. In conclusion, a wide automatic frontal QRS-T angle (>90°) is a good discriminator of long-term mortality in patients with LV systolic dysfunction after an AMI. The ability to easily measure it from a standard 12-lead electrocardiogram together with its prognostic value makes the frontal QRS-T angle an attractive tool to help clinicians to improve risk stratification of those patients.
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Abstract
This contribution discusses the QRS-T angle as well as the QRST integral map. Both of these topics have been tested in their application in extracting the major features of depolarization and repolarization: their spatio-temporal behaviour, and how much of their global or local nature might be deduced from signals that can be observed clinically. Recently, it is in particular the QRS-T angle that has received considerable attention, a method that stems directly from vectorcardiography, a subdomain of electrocardiography. The QRST integral map is a display of a map on the body surface of the integrals over time of the ECG signals observed at sets of electrodes. The common biophysical background of both techniques is highlighted. In particular it is explained why, in healthy myocardium, both provide a similar view on the global timing of the depolarization and repolarization of all cardiac myocytes, more specifically, on the dispersion of their action potential durations. In the presence of ischemia, the view obtained is of the integral over time of the transmembrane potentials, which comprises a 'mixture' of their timing and magnitude. The analysis of results of a simulation study emphasizes the large discrepancies that may be observed between the QRS-T angle in the frontal plane and its 3D variant. It is shown that the required vector representation of the signals may be derived from the 12-lead ECG by using the transfer matrix proposed in 1990 by Kors and colleagues.
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Affiliation(s)
- Adriaan van Oosterom
- Medical Faculty, Radboud University Nijmegen Medical and Biophysics, Nijmegen, The Netherlands.
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Beat-to-beat vectorcardiographic analysis of ventricular depolarization and repolarization in myocardial infarction. PLoS One 2012; 7:e49489. [PMID: 23166683 PMCID: PMC3498118 DOI: 10.1371/journal.pone.0049489] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 10/12/2012] [Indexed: 12/20/2022] Open
Abstract
Objectives Increased beat-to-beat variability in the QT interval has been associated with heart disease and mortality. The purpose of this study was to investigate the beat-to-beat spatial and temporal variations of ventricular depolarization and repolarization in vectorcardiogram (VCG) for characterising myocardial infarction (MI) patients. Methods Standard 12-lead ECGs of 84 MI patients (22 f, 63±12 yrs; 62 m, 56±10 yrs) and 69 healthy subjects (17 f, 42±18 yrs; 52 m, 40±13 yrs) were investigated. To extract the beat-to-beat QT intervals, a template-matching algorithm and the singular value decomposition method have been applied to synthesise the ECG data to VCG. Spatial and temporal variations in the QRS complex and T-wave loops were studied by investigating several descriptors (point-to-point distance variability, mean loop length, T-wave morphology dispersion, percentage of loop area, total cosine R-to-T). Results Point-to-point distance variability of QRS and T-loops (0.13±0.04 vs. 0.10±0.04, p< 0.0001 and 0.16±0.07 vs. 0.13±0.06, p< 0.05) were significantly larger in the MI group than in the control group. The average T-wave morphology dispersion was significantly higher in the MI group than in the control group (62°±8° vs. 38°±16°, p< 0.0001). Further, its beat-to-beat variability appeared significantly lower in the MI group than in the control group (12°±5° vs. 15°±6°, p< 0.005). Moreover, the average percentage of the T-loop area was found significantly lower in the MI group than the controls (46±17 vs. 55±15, p< 0.001). Finally, the average and beat-to-beat variability of total cosine R-to-T were not found statistically significant between both groups. Conclusions Beat-to-beat assessment of VCG parameters may have diagnostic attributes that might help in identifying MI patients.
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Postexercise recovery of the spatial QRS/T angle as a predictor of sudden cardiac death. Heart Rhythm 2012; 9:1083-9. [DOI: 10.1016/j.hrthm.2012.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Indexed: 11/21/2022]
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