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Ho WHH, Lim DYZ, Thiagarajan N, Wang H, Loo WTW, Sng GGR, Lee JSW, Shen X, Dalakoti M, Sia C, Tan BYQ, Lim HY, Wang L, Chow W, Chua TSJ, Lim PCY, Yeo TJ, Chong DTT. Outcomes of Investigating T Wave Inversion With Echocardiography in an Unselected Young Male Preparticipation Cohort. J Am Heart Assoc 2023; 12:e026975. [PMID: 36942750 PMCID: PMC10122903 DOI: 10.1161/jaha.122.026975] [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: 05/29/2022] [Accepted: 12/19/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND Electrocardiography (ECG) may be performed as part of preparticipation sports screening. Recommendations on screening of athletes to identify individuals with previously unrecognized cardiac disease are robust; however, data guiding the preparticipation screening of unselected populations are scarce. T wave inversion (TWI) on ECG may suggest an undiagnosed cardiomyopathy. This study aims to describe the prevalence of abnormal TWI in an unselected young male cohort and the outcomes of an echocardiography-guided approach to investigating these individuals for structural heart diseases, focusing on the yield for cardiomyopathies. METHODS AND RESULTS Consecutive young male individuals undergoing a national preparticipation cardiac screening program for 39 months were studied. All underwent resting supine 12-lead ECG. Those manifesting abnormal TWI, defined as negatively deflected T waves of at least 0.1 mV amplitude in any 2 contiguous leads, underwent echocardiography. A total of 69 714 male individuals with a mean age of 17.9±1.1 years were studied. Of the individuals, 562 (0.8%) displayed abnormal TWI. This was most frequently observed in the anterior territory and least so in the lateral territory. A total of 12 individuals (2.1%) were diagnosed with a cardiomyopathy. Cardiomyopathy diagnoses were significantly associated with deeper maximum TWI depth and the presence of abnormal TWI in the lateral territory, but not with abnormal TWI in the anterior and inferior territories. No individual presenting with TWI restricted to solely leads V1 to V2, 2 inferior leads or both was diagnosed with a cardiomyopathy. CONCLUSIONS Cardiomyopathy diagnoses were more strongly associated with certain patterns of abnormal TWI. Our findings may support decisions to prioritize echocardiography in these individuals.
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Affiliation(s)
- Wilbert H. H. Ho
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Daniel Y. Z. Lim
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Nishanth Thiagarajan
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Hankun Wang
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Wesley T. W. Loo
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Gerald G. R. Sng
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Joshua S. W. Lee
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Xiayan Shen
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore
| | - Mayank Dalakoti
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational University Heart Centre SingaporeSingaporeSingapore
- Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Ching‐Hui Sia
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational University Heart Centre SingaporeSingaporeSingapore
- Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Benjamin Y. Q. Tan
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
- University Medicine ClusterNational University Health SystemSingaporeSingapore
| | - Huai Yang Lim
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Luo‐Kai Wang
- HQ Medical Corps, Singapore Armed ForcesSingaporeSingapore
| | - Weien Chow
- Department of CardiologyChangi General HospitalSingaporeSingapore
| | | | - Paul C. Y. Lim
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore
| | - Tee Joo Yeo
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational University Heart Centre SingaporeSingaporeSingapore
- Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Daniel T. T. Chong
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore
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Amidou SA, Houehanou YC, Gbaguidi GN, Lacroix P, Aboyans V, Sonou A, Magne J, Saka D, Lafia K, Houenassi MD, Preux PM, Houinato DS. Normal limits of electrocardiogram in Africans and their consequences on the prevalence of left ventricular hypertrophy in hypertensive individuals: Insights from the TAHES study. J Electrocardiol 2023; 76:71-78. [PMID: 36462323 DOI: 10.1016/j.jelectrocard.2022.11.004] [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: 07/31/2022] [Revised: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
AIMS To determine normal limits for major ECG variables, and the electrocardiographic impact of hypertension, in a rural sub-Saharan African setting. METHODS This cross-sectional study included adults aged ≥25 years from Tanvè Health Study (TAHES) cohort. ECG were recorded at rest at 25 mm/s using a standard 12‑lead device. Wave amplitudes and durations were measured. Corrected QT interval (QTc) was calculated using Bazett's formula. Sokolow-Lyon, Cornell and Peguero-Lo Presti criteria were determined to assess left ventricular hypertrophy (LVH). RESULTS ECG was recorded among 997 out of 1407 TAHES participants. After exclusion of subjects with hypertension or diabetes, normal limits, defined as the 2nd and 98th percentiles, were evaluated in 622 healthy participants (median: 37 years; 60.1% women). The following limits were established in men (women): heart rate: 50 to 100 (55 to 102) beats/min, P wave duration: 80 to 120 (80 to 120) ms, PR interval: 120 to 200 (120 to 200) ms, QTc: 315 to 470 (323 to 465) ms, QRS duration: 50 to 120 (50 to 110) ms. Upper limits (in millimeter) for the Sokolow-Lyon, Cornell and Peguero-Lo Presti for men (women) were 47 (38), 30 (22) and 39 (30), respectively, all above current reference limits. The prevalence of LVH in hypertensive subjects according to these criteria were lower than those estimated according to current LVH criteria. CONCLUSION The normal limits of ECG variables determined in this African population differ from those in Caucasians, indicating that ethnicity must be considered in ECG interpretation.
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Affiliation(s)
- Salmane Ariyoh Amidou
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France.
| | - Yessito Corine Houehanou
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Gwladys Nadia Gbaguidi
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France
| | - Philippe Lacroix
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France; Department of Thoracic and Vascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France
| | - Victor Aboyans
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France; Dept. of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Arnaud Sonou
- Dept. of Cardiology, National University Hospital, Cotonou, Benin
| | - Julien Magne
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France
| | - Dominique Saka
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Kamel Lafia
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | | | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France
| | - Dismand Stephan Houinato
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France
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Lim DYZ, Ho WHH, Wang L, Ang WK, Thiagarajan N, Sng GGR, Wang H, Loo WTW, Yang LH, Chow W, Chua TJ, Yeo TJ, Lim P, Chong TTD. Wolff-Parkinson-White Presenting as QRS Alternans and Other Differential Diagnoses in a Large Pre-Participation ECG Screening Cohort. Arq Bras Cardiol 2022; 119:940-945. [PMID: 36417617 PMCID: PMC9814817 DOI: 10.36660/abc.20220081] [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: 02/03/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Wolff-Parkinson-White (WPW) syndrome is a proarrhythmic condition that may require restriction from strenuous activities and is characterized by ECG signs, including delta waves. We observed cases of intermittent WPW patterns presenting as QRS alternans ('WPW alternans') in a large pre-participation ECG screening cohort of young men reporting for military conscription. OBJECTIVES We aimed to determine the WPW alternans pattern, case characteristics, and the prevalence of other relevant differential diagnoses presenting as QRS alternans in a pre-participation setting. METHODS One hundred twenty-five thousand one hundred fifty-eight prospective male military recruits were reviewed from January 2016 to December 2019. A review of electronic medical records identified cases of WPW alternans and WPW patterns or syndrome. Reviewing electronic medical records identified cases of relevant differential diagnoses that might cause QRS alternans. RESULTS Four individuals (2.2%) had WPW alternans out of 184 individuals with a final diagnosis of WPW pattern or syndrome. Two of these individuals manifested symptoms or ECG findings consistent with supraventricular tachycardia. The overall prevalence of WPW alternans was 0.003%, and the prevalence of WPW was 0.147%. WPW alternans represented 8.7% of individuals presenting with QRS alternans, and QRS alternans had a prevalence of 0.037% in the entire population. CONCLUSIONS WPW alternans is a variant of intermittent WPW, which comprised 2.2% of WPW cases in our pre-participation screening cohort. It does not necessarily indicate a low risk for supraventricular tachycardia. It must be recognized at ECG screening and distinguished from other pathologies that also present with QRS alternans.
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Affiliation(s)
- Daniel Y. Z. Lim
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Wilbert H. H. Ho
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Luokai Wang
- HQ Medical CorpsSingapore Armed ForcesCingapuraHQ Medical Corps, Singapore Armed Forces, Cingapura,Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| | - Wee Kiat Ang
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Nishanth Thiagarajan
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Gerald GR Sng
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Hankun Wang
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Wesley TW Loo
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Lim Huai Yang
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Weien Chow
- HQ Medical CorpsSingapore Armed ForcesCingapuraHQ Medical Corps, Singapore Armed Forces, Cingapura
| | - Terrance J Chua
- Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| | - Tee Joo Yeo
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura,Department of CardiologyNational University Heart Centre SingaporeCingapuraDepartment of Cardiology, National University Heart Centre Singapore, Cingapura,University Medicine ClusterNational University Health SystemCingapuraUniversity Medicine Cluster, National University Health System, Cingapura
| | - Paul Lim
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura,Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| | - Thuan Tee Daniel Chong
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura,Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
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Mancone M, Maestrini V, Fusto A, Adamo F, Scarparo P, D’Ambrosi A, Cinque A, Gatto MC, Salvi N, Agnes G, Pucci M, Birtolo LI, Marruncheddu L, Genuini I, De Lazzari C, Severino P, Giunta G, Lavalle C, Fegatelli DA, Vestri A, Fedele F. ECG evaluation in 11 949 Italian teenagers: results of screening in secondary school. J Cardiovasc Med (Hagerstown) 2022; 23:98-105. [PMID: 34570036 PMCID: PMC8855949 DOI: 10.2459/jcm.0000000000001259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/04/2021] [Accepted: 08/29/2021] [Indexed: 01/02/2023]
Abstract
AIM There is lack of evidence regarding the screening role of ECG for sudden cardiac death (SCD) prevention. Our aim was to evaluate the prevalence of ECG abnormalities among teenagers according to sport participation and competitive status. METHODS Eleven thousand nine hundred and forty-nine Italian pupils from 179 secondary schools (13-19 years) were consecutively enrolled. ECG abnormalities were divided into minor and major. Medical history, clinical examination and sport activity information were acquired. Further evaluations were suggested in case of major ECG abnormalities. Follow-up was performed at 2 years. RESULTS N = 1945 (16%) pupils had ECG abnormalities. Major ECG abnormalities were detected in 13% of the cohort, minor in 34%. ECG abnormalities were more common in nonathletes compared with athletes. A diagnosis of cardiac disease was reached in 25 (1.6%) of the pupils with major ECG abnormalities. CONCLUSION ECG abnormalities are common among young populations and more prevalent in nonathletes. Among pupils with major ECG abnormalities 1.6% had a cardiac disease diagnosis. Our results are in line with the data supporting ECG screening in the general young population.
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Affiliation(s)
- Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Antonio Fusto
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Francesco Adamo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Paola Scarparo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Alessandra D’Ambrosi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Alessandra Cinque
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Maria Chiara Gatto
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Nicolò Salvi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Gianluca Agnes
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Mariateresa Pucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Laura Marruncheddu
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Igino Genuini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | | | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Giuseppe Giunta
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infections Disease, Sapienza University of Rome, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infections Disease, Sapienza University of Rome, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
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Guettler N, Sammito S. Electrocardiographic abnormalities in medically screened German military aircrew. J Occup Med Toxicol 2021; 16:37. [PMID: 34465360 PMCID: PMC8407018 DOI: 10.1186/s12995-021-00327-x] [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] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A resting electrocardiogram (ECG) is a well-tolerated, non-invasive, and inexpensive test for overt electrical signs of cardiac pathology and is widely used in the screening of aircrew and other high-hazard occupations. Given the low number of pathological results leading to disqualification or restriction however, there is an ongoing debate as to how often screening ECGs should be performed in different age groups. METHODS We restrospectively analyzed 8275 resting 12-lead ECGs registered between 2007 and 2020 in the German Air Force Centre of Aerospace Medicine. Findings were categorized according to consensus recommendations published by the NATO Working Group on Occupational Cardiology in Military Aircrew, based on ECG screening criteria published for athletes which were used at the time of registration. Age, sex, height, weight, and body mass index of the probands were also captured. Additionally, 4839 pilot and non-pilot aircrew members were analyzed longitudinally over a maximum period of 13.4 years. RESULTS Out of all the ECGs only 18 revealed findings requiring further investigation, and only one individual was temporarily disqualified because of a ventricular pre-excitation (delta wave) as a sign of an antegrade conducting accessory pathway. The longitudinal analysis of 25,829 ECGs revealed 28 abnormalities requiring further investigation, and only two ECG findings (in probands aged 48.8 and 59.1 years) led to temporary, or permanent disqualification. In a third case, the ECG showed signs of a myocardial infarction, which was already known from the proband's history. CONCLUSIONS Initial ECG screening for asymptomatic aircrew revealed extremely low numbers of individuals requiring further investigation in our cohort. This would appear to justify an initial screening ECG and follow-up ECGs at certain intervals starting at a certain age, but routine ECG screening of applicants in professions with a higher risk tolerance or frequent, e.g. annual, follow-up ECGs in younger aircrew is not supported by our data because of the minimal yield of ECG findings requiring further investigation.
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Affiliation(s)
- Norbert Guettler
- German Air Force Centre of Aerospace Medicine, Cologne, Germany.,Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Giessen, Germany
| | - Stefan Sammito
- German Air Force Centre of Aerospace Medicine, Cologne, Germany. .,Department of Occupational Medicine, Medical Faculty, Otto von Guericke University, Magdeburg, Germany.
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Wen X, Huang YM, Shen TH, Gong YL, Dong RQ, Xia L, Xie TS. Prevalence of abnormal and borderline electrocardiogram changes in 13, 079 Chinese amateur marathon runners. BMC Sports Sci Med Rehabil 2021; 13:41. [PMID: 33879236 PMCID: PMC8056690 DOI: 10.1186/s13102-021-00268-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The 12-lead electrocardiogram (ECG) has been adopted as an important component of preparticipation cardiovascular screening. However, there are still controversies in the screening and few studies with a large sample size have reported the results of ECGs of marathon runners. Therefore, the purpose of this study was to assess the prevalence of normal, borderline, and abnormal ECG changes in marathon runners. METHODS The 12-lead ECG data of 13,079 amateur marathon runners between the ages of 18 and 35 years were included for analysis. The prevalence of ECG abnormalities among different gender groups was compared with chi-square tests. RESULTS In terms of training-related changes, sinus bradycardia, sinus arrhythmia, and left ventricular high voltage were found in approximately 15, 5, and 3.28% of the participants, respectively. The incidence of right axis deviation in the marathon runners was 1.78%, which was slightly higher than the incidence of left axis deviation (0.88%). No more than 0.1% of the amateur marathon runners exhibited ST-segment depression, T wave inversion (TWI), premature ventricular contraction, pathologic Q waves, and prolonged QT interval. CONCLUSIONS Training-related ECG changes, including sinus bradycardia, sinus arrhythmia, and left ventricular high voltage, were common in amateur marathon runners. Most abnormal ECG changes, including ST-segment depression, TWI, premature ventricular contraction, pathologic Q waves, and prolonged QT interval, were infrequently found in amateur marathon runners. The data also suggested Chinese amateur marathon runners may have a relatively lower prevalence of ECG abnormalities than black and white runners.
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Affiliation(s)
- Xu Wen
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou, China
| | - Yu-min Huang
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou, China
| | - Tong-Hui Shen
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Ying-Lan Gong
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Rui-qing Dong
- Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Ling Xia
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Tian-sheng Xie
- Zhejiang Sino-German Institute of Life science and Healthcare, School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou, China
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Sokunbi OJ, Okoromah CAN, Ekure EN, Olawale OA, Eke WS. Electrocardiographic pattern of apparently healthy African adolescent athletes in Nigeria. BMC Pediatr 2021; 21:97. [PMID: 33632178 PMCID: PMC7905616 DOI: 10.1186/s12887-021-02557-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Strategies to prevent sudden cardiac death (SCD) among young athletes have become topical worldwide and unrecognized cardiac pathology has been identified as a leading cause. Black ethnicity has been reported as an independent predictor of abnormal electrocardiography (ECG) findings among athletes and the frequency and significance of training-related ECG findings versus findings suggestive of an underlying pathology in the young African athletes is crucial. Methods This cross sectional study aimed to determine the prevalence and distribution of ECG patterns in young athletes and controls. A total of 360 participants (180 athletes and 180 controls) were recruited from six secondary schools in Lagos, Nigeria between November 2014 and July 2015. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. Results Abnormal ECG patterns were found in 48.3% of athletes and 35.6% of controls. Training-related ECG findings occurred in 33.3% of athletes and 18.3% of controls. Athletes and controls had 7.7% prevalence of training un-related ECG patterns respectively. Left ventricular hypertrophy was the most common ECG finding among the athletes and male athletes had a higher prevalence of ECG abnormalities compared to females. Conclusion Adolescent athletes in Nigeria have a high prevalence of training-related ECG patterns and athletes and non-athletes alike have similar proportions of ECG findings suggestive of underlying structural heart disease. Cardiovascular evaluation including ECG should be performed for young athletes prior to competition at any level and should also be considered as part of pre-school entry assessment for all children. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02557-8.
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Affiliation(s)
- Ogochukwu J Sokunbi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria.
| | - Christy A N Okoromah
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ekanem N Ekure
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olajide A Olawale
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Wuraola S Eke
- Department of Nursing Services, Lagos University Teaching Hospital, Lagos, Nigeria
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Ozo U, Sharma S. The Impact of Ethnicity on Cardiac Adaptation. Eur Cardiol 2020; 15:e61. [PMID: 32944090 DOI: 10.15420/ecr.2020.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/22/2020] [Indexed: 01/15/2023] Open
Abstract
Regular intensive exercise is associated with a plethora of electrical, structural and functional adaptations within the heart to promote a prolonged and sustained increase in cardiac output. Bradycardia, increased cardiac dimensions, enhanced ventricular filling, augmentation of stroke volume and high peak oxygen consumption are recognised features of the athlete's heart. The type and magnitude of these adaptations to physical exercise are governed by age, sex, ethnicity, sporting discipline and intensity of sport. Some athletes, particularly those of African or Afro-Caribbean (black) origin reveal changes that overlap with diseases implicated in sudden cardiac death. In such instances, erroneous interpretation has potentially serious consequences ranging from unfair disqualification to false reassurance. This article focuses on ethnic variation in the physiological cardiac adaption to exercise.
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Li KHC, Lee S, Yin C, Liu T, Ngarmukos T, Conte G, Yan GX, Sy RW, Letsas KP, Tse G. Brugada syndrome: A comprehensive review of pathophysiological mechanisms and risk stratification strategies. IJC HEART & VASCULATURE 2020; 26:100468. [PMID: 31993492 PMCID: PMC6974766 DOI: 10.1016/j.ijcha.2020.100468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
Brugada syndrome (BrS) is an inherited ion channel channelopathy predisposing to ventricular arrhythmias and sudden cardiac death. Originally believed to be predominantly associated with mutations in SCN5A encoding for the cardiac sodium channel, mutations of 18 genes other than SCN5A have been implicated in the pathogenesis of BrS to date. Diagnosis is based on the presence of a spontaneous or drug-induced coved-type ST segment elevation. The predominant electrophysiological mechanism underlying BrS remains disputed, commonly revolving around the three main hypotheses based on abnormal repolarization, depolarization or current-load match. Evidence from computational modelling, pre-clinical and clinical studies illustrates that molecular abnormalities found in BrS lead to alterations in excitation wavelength (λ), which ultimately elevates arrhythmic risk. A major challenge for clinicians in managing this condition is the difficulty in predicting the subset of patients who will suffer from life-threatening ventricular arrhythmic events. Several repolarization risk markers have been used thus far, but these neglect the contributions of conduction abnormalities in the form of slowing and dispersion. Indices incorporating both repolarization and conduction based on the concept of λ have recently been proposed. These may have better predictive values than the existing markers. Current treatment options include pharmacological therapy to reduce the occurrence of arrhythmic events or to abort these episodes, and interventions such as implantable cardioverter-defibrillator insertion or radiofrequency ablation of abnormal arrhythmic substrate.
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Affiliation(s)
- Ka Hou Christien Li
- Faculty of Medicine, Newcastle University, Newcastle, United Kingdom.,Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, SAR, PR China
| | - Sharen Lee
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, SAR, PR China
| | - Chengye Yin
- School of Biological and Chemical Sciences, Queen Mary University of London, London, United Kingdom
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Tachapong Ngarmukos
- Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, PA, USA
| | - Raymond W Sy
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China.,Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
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11
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Sex-related differences in cardiomyopathies. Int J Cardiol 2019; 286:239-243. [DOI: 10.1016/j.ijcard.2018.10.091] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/10/2018] [Accepted: 10/26/2018] [Indexed: 01/14/2023]
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12
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Sia CH, Dalakoti M, Tan BYQ, Lee ECY, Shen X, Wang K, Lee JS, Arulanandam S, Chow W, Yeo TJ, Yeo KK, Chua TSJ, Tan RS, Lam CSP, Chong DTT. A Population-wide study of electrocardiographic (ECG) norms and the effect of demographic and anthropometric factors on selected ECG characteristics in young, Southeast Asian males-results from the Singapore Armed Forces ECG (SAFE) study. Ann Noninvasive Electrocardiol 2019; 24:e12634. [PMID: 30707472 DOI: 10.1111/anec.12634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/15/2018] [Accepted: 12/28/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Routine use of pre-participation electrocardiograms (ECGs) has been used by the Singapore Armed Forces, targeting early detection of significant cardiac diseases. We aim to describe the impact of demographic and anthropometric factors on ECG variables and establish a set of electrocardiographic reference ranges specific to a young male multiethnic Southeast Asian cohort. METHODS AND RESULTS Between November 1, 2009, and December 31, 2014, 144,346 young male conscripts underwent pre-participation screening that included a 12-lead ECG, demographic and anthropometric measurements. The Chinese population had the longest PR interval (146.7 ± 19.7 vs. 145.21 ± 19.2 in Malays vs. 141.2 ± 18.8 ms in Indians), QRS duration (94.5 ± 9.8 vs. 92.6 ± 9.7 in Malays vs. 92.5 ± 9.4 ms in Indians) and QTcB interval (408.3 ± 21.3 vs. 403.5 ± 21.6 in Malays vs. 401.2 ± 21.4 ms in Indians) (all p < 0.001). Body mass index (BMI) >25 kg/m2 and body fat >25% were independently associated with lower prevalence of increased QRS voltage on ECG. Systolic blood pressure of >140 mmHg or diastolic blood pressure of >90 mmHg independently increased the prevalence of increased QRS voltage on ECG. CONCLUSIONS Electrocardiographic parameters vary across different ethnicities and in comparison with international norms. In our population, diagnosis of increased QRS voltage by ECG is less prevalent with obesity and increased body fat. Further analysis of gold standard measurements for the diagnosis of LVH in our population is ongoing, to improve the accuracy of the ECG screening process.
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Affiliation(s)
- Ching-Hui Sia
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Mayank Dalakoti
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Benjamin Y Q Tan
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Edward C Y Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Xiayan Shen
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Kangjie Wang
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Joshua S Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Shalini Arulanandam
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Weien Chow
- HQ Medical Corps, Singapore Armed Forces, Singapore, Singapore
| | - Tee Joo Yeo
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Terrance S J Chua
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Daniel T T Chong
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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13
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Vilardell P, Brugada J, Aboal J, Loma-Osorio P, Falces C, Andrea R, Figueras-Coll M, Brugada R. Characterization of electrocardiographic findings in young students. ACTA ACUST UNITED AC 2018; 73:139-144. [PMID: 30287239 DOI: 10.1016/j.rec.2018.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The resting 12-lead electrocardiogram (ECG) has been used in the evaluation of young asymptomatic individuals to detect pre-existing heart disease, but systematic ECG use is controversial and there are no data on this population in our environment. We aimed to determine the prevalence and spectrum of electrocardiographic findings in a population of secondary school students. METHODS We conducted an observational, cross-sectional study of resting ECG findings in all 13 to 14-year-old secondary school students in a region of the province of Gerona between 2009 and 2017. ECG findings were classified into 3 groups according to the modified criteria of Corrado et al.: normal ECG findings, ECG findings suggestive of adaptive changes, and pathologic findings. Students with pathologic ECG findings were referred to a tertiary hospital, and complementary tests were performed according to a pre-established protocol. RESULTS A total of 1911 ECGs were obtained, with a participation rate of 79% of all high school students. In all, 1321 students (69%) had a normal ECG, 554 (29%) showed ECG findings suggestive of adaptive changes, and 36 (2%) had pathologic ECG findings. Among the group with pathologic findings, 5 (14%) had cardiovascular disease. The prevalence of heart disease in this group of asymptomatic secondary school students was 0.3%. CONCLUSIONS One third of the students had ECG findings that were mostly suggestive of physiological adaptation. One seventh of the students with pathologic ECG findings had pre-existing heart disease, although the overall prevalence of pre-existing heart disease was low.
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Affiliation(s)
- Pau Vilardell
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain.
| | - Josep Brugada
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - Carlos Falces
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Rut Andrea
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Marc Figueras-Coll
- Servicio de Pediatría, Hospital Universitario Josep Trueta de Girona, Girona, Spain
| | - Ramon Brugada
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro de Genética Cardiovascular, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
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14
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Chen X, Zhu C, Zhou H, Zhang Y, Cai Z, Wu H, Ren X, Gao L, Zhang J, Li Y. Key Role of the Membrane Trafficking of Nav1.5 Channel Protein in Antidepressant-Induced Brugada Syndrome. Front Physiol 2018; 9:1230. [PMID: 30233406 PMCID: PMC6134322 DOI: 10.3389/fphys.2018.01230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/15/2018] [Indexed: 12/28/2022] Open
Abstract
Anti-depressant treatment has been found to be associated with the development of Brugada syndrome (BrS) through poorly defined mechanisms. Herein, this study aimed to explore the molecular basis for amitriptyline-induced BrS. The effects of long-term treatments of amitriptyline on Nav1.5 were investigated using neonatal rat ventricular myocytes. The electrophysiological properties, expression and distribution of Nav1.5 were studied using the patch clamp, Western blot and confocal laser microscopy assays. Interactions between Nav1.5 and its interacting proteins, including ankyrin-G and dystrophin, were evaluated by co-immunoprecipitation. A larger decrease in the peak INa occurred after long-term treatments to amitriptyline (56.64%) than after acute exposure to amitriptyline (28%). Slow recovery from inactivation of Nav1.5 was observed after acute or long-term treatments to amitriptyline. The expression of Nav1.5 on the cell membrane showed a larger decrease by long-term treatments to amitriptyline than by acute exposure to amitriptyline. After long-term treatments to amitriptyline, we observed reduced Nav1.5 proteins on the cell membrane and the disrupted co-localization of Nav1.5 and ankyrin-G or dystrophin. Co-immunoprecipitation experiments further testified that the combination of Nav1.5 and ankyrin-G or dystrophin was severely weakened after long-term treatments to amitriptyline, implying the failed interaction between Nav1.5 and ankyrin-G or dystrophin. Our data suggest that the long-term effect of amitriptyline serves as an important contribution to BrS induced by amitriptyline. The mechanisms of BrS induced by amitriptyline were related to Nav1.5 trafficking and could be explained by the disrupted interaction of ankyrin-G, dystrophin and Nav1.5.
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Affiliation(s)
- Xi Chen
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chao Zhu
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hao Zhou
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Zhang
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhongqi Cai
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Honglin Wu
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fuzhou, China
| | - Xiaomeng Ren
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lei Gao
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiancheng Zhang
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fuzhou, China
| | - Yang Li
- Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China
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15
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Seng MC, Shen X, Wang K, Chong DT, Fam JM, Hamid N, Amanullah MR, Yeo KK, Ewe SH, Chua TS, Ding ZP, Sahlén A. Allometric Relationships for Cardiac Size and Longitudinal Function in Healthy Chinese Adults - Normal Ranges and Clinical Correlates. Circ J 2018; 82:1836-1843. [PMID: 29695648 DOI: 10.1253/circj.cj-18-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiac size measurements require indexing to body size. Allometric indexing has been investigated in Caucasian populations but a range of different values for the so-called allometric power exponent (b) have been proposed, with uncertainty as to whether allometry offers clinical utility above body surface area (BSA)-based indexing. We derived optimal values for b in normal echocardiograms and validated them externally in cardiac patients. METHODS AND RESULTS Values for b were derived in healthy adult Chinese males (n=1,541), with optimal b for left ventricular mass (LVM) of 1.66 (95% confidence interval 1.41-1.92). LV hypertrophy (LVH) defined as indexed LVM >75 g/m1.66 was associated with adverse outcomes in an external validation cohort (n=738) of patients with acute coronary syndrome (odds ratio for reinfarction: 2.4 (1.1-5.4)). In contrast, LVH defined by BSA-based indexing or allometry using exponent 2.7 exhibited no significant association with outcomes (P=NS for both). Cardiac longitudinal function also varied with body size: septal and RV free wall s', TAPSE and lateral e' all scaled allometrically (b=0.3-0.9). CONCLUSIONS An optimal b of 1.66 for LVM in healthy Chinese was found to validate well, with superior clinical utility both to that of BSA-based indexing and to b=2.7. The effect of allometric indexing of cardiac function requires further study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Anders Sahlén
- National Heart Centre Singapore.,Karolinska Institutet
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16
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Rodríguez-Capitán J, Fernández-Meseguer A, García-Pinilla JM, Calvo-Bonacho E, Jiménez-Navarro M, García-Margallo T, Cabrera-Bueno F, Echeverria-Lucotti I, Gómez-Doblas JJ, De Teresa-Galván E. Frequency of different electrocardiographic abnormalities in a large cohort of Spanish workers. Europace 2017; 19:1855-1863. [PMID: 28339570 DOI: 10.1093/europace/euw283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/13/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Our aim was to describe the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. Methods and results Between May 2008 and November 2010, 13 495 consecutive 12-lead resting electrocardiograms (ECGs) were obtained during health examinations of working adults aged 16-74 years in 5 cities in different regions of Spain. Of those, 13 179 ECGs suitable for interpretation were included in this study. All tracings were classified by the same cardiologist, according to the Minnesota Code criteria. The mean age of the sample was 40 years, and 73.4% were male. Frequencies of complete right bundle branch block, complete left bundle branch block, and left ventricular hypertrophy were 1.1, 0.2, and 3.6%, respectively. Major Q wave abnormalities were observed in 1.7% of the subjects, T wave abnormalities in 0.7%, early repolarization in 2.4%, and other ST segment abnormalities in 0.2%. Atrial fibrillation was present in 0.08% of the workers and atrial flutter in 0.02%. Frequencies of the Wolff-Parkinson-White pattern, Brugada pattern, long QT pattern, and short QT pattern were 0.2, 0.068, 0.038, and 0.015%, respectively. Conclusion This study shows the electrocardiographic findings of a large sample of Spanish workers from several different employment sectors. The frequencies of many ECG patterns related to an adverse prognosis (left ventricular hypertrophy, complete left bundle branch block, T wave abnormalities, ST segment abnormalities, and atrial fibrillation) were low.
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Affiliation(s)
| | | | - José Manuel García-Pinilla
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria de Málaga Instituto Biosanitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | | | - Manuel Jiménez-Navarro
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria de Málaga Instituto Biosanitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | | | - Fernando Cabrera-Bueno
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria de Málaga Instituto Biosanitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | | | - Juan José Gómez-Doblas
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria de Málaga Instituto Biosanitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Eduardo De Teresa-Galván
- Unidad de Gestión Clínica del Corazón, Hospital Clínico Universitario Virgen de la Victoria de Málaga Instituto Biosanitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
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17
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Brown B, Somauroo J, Green DJ, Wilson M, Drezner J, George K, Oxborough D. The Complex Phenotype of the Athlete's Heart: Implications for Preparticipation Screening. Exerc Sport Sci Rev 2017; 45:96-104. [PMID: 28306678 DOI: 10.1249/jes.0000000000000102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Preparticipation screening is vital to exclude inherited cardiac conditions that have the potential to cause sudden cardiac death in seemingly healthy athletes. Recent research has questioned traditional theories of load-induced, dichotomous cardiac adaptation. We therefore considered whether a one-size-fits-all approach to screening can account for interindividual differences brought about by sporting discipline, training volume, ethnicity, body size, sex, and age.
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Affiliation(s)
- Benjamin Brown
- 1Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; 2School of Sports Science, Exercise and Health, The University of Western Australia, Western Australia, Australia; 4Department of Sports Medicine, ASPETAR, Qatar; and 5Department of Family Medicine, University of Washington, Seattle, WA
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18
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Tse G, Liu T, Li KHC, Laxton V, Chan YWF, Keung W, Li RA, Yan BP. Electrophysiological Mechanisms of Brugada Syndrome: Insights from Pre-clinical and Clinical Studies. Front Physiol 2016; 7:467. [PMID: 27803673 PMCID: PMC5067537 DOI: 10.3389/fphys.2016.00467] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022] Open
Abstract
Brugada syndrome (BrS), is a primary electrical disorder predisposing affected individuals to sudden cardiac death via the development of ventricular tachycardia and fibrillation (VT/VF). Originally, BrS was linked to mutations in the SCN5A, which encodes for the cardiac Na+ channel. To date, variants in 19 genes have been implicated in this condition, with 11, 5, 3, and 1 genes affecting the Na+, K+, Ca2+, and funny currents, respectively. Diagnosis of BrS is based on ECG criteria of coved- or saddle-shaped ST segment elevation and/or T-wave inversion with or without drug challenge. Three hypotheses based on abnormal depolarization, abnormal repolarization, and current-load-mismatch have been put forward to explain the electrophysiological mechanisms responsible for BrS. Evidence from computational modeling, pre-clinical, and clinical studies illustrates that molecular abnormalities found in BrS lead to alterations in excitation wavelength (λ), which ultimately elevates arrhythmic risk. A major challenge for clinicians in managing this condition is the difficulty in predicting the subset of patients who will suffer from life-threatening VT/VF. Several repolarization risk markers have been used thus far, but these neglect the contributions of conduction abnormalities in the form of slowing and dispersion. Indices incorporating both repolarization and conduction and based on the concept of λ have recently been proposed. These may have better predictive values than the existing markers.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong KongHong Kong, Hong Kong
- Li Ka Shing Institute of Health Sciences, Chinese University of Hong KongHong Kong, Hong Kong
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical UniversityTianjin, China
| | - Ka H. C. Li
- Faculty of Medicine, Newcastle UniversityNewcastle, UK
| | - Victoria Laxton
- Intensive Care Department, Royal Brompton and Harefield NHS TrustLondon, UK
| | - Yin W. F. Chan
- School of Biological Sciences, University of CambridgeCambridge, UK
| | - Wendy Keung
- Stem Cell and Regenerative Medicine Consortium, Li Ka Shing Faculty of Medicine, The University of Hong KongPokfulam, Hong Kong
| | - Ronald A. Li
- Ming Wai Lau Centre for Reparative Medicine, Karolinska InstitutetSolna, Sweden
| | - Bryan P. Yan
- Department of Medicine and Therapeutics, Chinese University of Hong KongHong Kong, Hong Kong
- Department of Epidemiology and Preventive Medicine, Monash UniversityMelbourne, VIC, Australia
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19
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Moulin SRA, Mill JG, Rosa WCM, Hermisdorf SR, Caldeira LDC, Zago-Gomes EMDP. QT interval prolongation associated with low magnesium in chronic alcoholics. Drug Alcohol Depend 2015; 155:195-201. [PMID: 26249264 DOI: 10.1016/j.drugalcdep.2015.07.019] [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: 03/17/2015] [Revised: 06/17/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Alcoholism is a psychoactive drug-dependence with high prevalence throughout the world. Alcoholism has already been shown to be associated with electrical heart disorders, such as QT interval prolongation. Long QT, rare among healthy individuals (0.0017-0.31%), can trigger tachyarrhythmias and sudden death and might be caused by alcohol consumption itself and the resulting hypomagnesaemia. METHODS This case-control study assessed active alcoholics and alcoholics who have been abstinent for at least seven days to compare changes in electrocardiographic, clinical and laboratory analyses among groups. RESULTS A total of 166 alcoholics were evaluated, of which 62 were active and 104 abstinent alcoholics. Long QT was more prevalent among active alcoholics compared to abstinent alcoholics (16% vs. 2%, respectively, odds ratio (OR) 9.81, p=0.011), as was hypomagnesaemia (23% vs. 10%, OR 3.11, p=0.013). Serum magnesium levels were inversely proportional to the length of the corrected QT interval among active alcoholics (β=-35.1ms, p=0.005). CONCLUSIONS Active chronic alcoholics exhibited a higher association of long QT and hypomagnesaemia. Low serum magnesium levels were predictive of QT interval prolongation. Because the above changes potentially trigger fatal arrhythmias, it is of fundamental importance to consider the diagnostic possibility by routinely requesting electrocardiograms and serum magnesium level assessment during the treatment of chronic alcoholic patients.
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Affiliation(s)
- Stephanie Rezende Alvarenga Moulin
- Cassiano Antônio Moraes University Hospital (Hospital Universitário Cassiano Antônio Moraes-HUCAM), Federal University of Espírito Santo (Universidade Federal do Espírito Santo-UFES), Brazil.
| | | | - Werther Clay Monico Rosa
- Cassiano Antônio Moraes University Hospital (Hospital Universitário Cassiano Antônio Moraes-HUCAM), Federal University of Espírito Santo (Universidade Federal do Espírito Santo-UFES), Brazil
| | - Silas Rubens Hermisdorf
- Cassiano Antônio Moraes University Hospital (Hospital Universitário Cassiano Antônio Moraes-HUCAM), Federal University of Espírito Santo (Universidade Federal do Espírito Santo-UFES), Brazil
| | - Lunielle da Cruz Caldeira
- Cassiano Antônio Moraes University Hospital (Hospital Universitário Cassiano Antônio Moraes-HUCAM), Federal University of Espírito Santo (Universidade Federal do Espírito Santo-UFES), Brazil
| | - E Maria da Penha Zago-Gomes
- Cassiano Antônio Moraes University Hospital (Hospital Universitário Cassiano Antônio Moraes-HUCAM), Federal University of Espírito Santo (Universidade Federal do Espírito Santo-UFES), Brazil
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20
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Kim SS, Choi WH, Kim HY, Kim SH, Bang DH, Kang KW, An CH, Lim JG, Kwak JJ, Kwon SU, Doh JH, Namgung J, Lee SY, Lee WR. Clinical implications of T-wave inversion in an asymptomatic population undergoing annual medical screening (from the Korean Air Forces Electrocardiogram Screening). Am J Cardiol 2014; 113:1561-6. [PMID: 24731653 DOI: 10.1016/j.amjcard.2014.02.008] [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] [Received: 11/14/2013] [Revised: 02/04/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
This study aimed to determine prevalence, differentiate underlying causes, and identify the benign group in subjects with asymptomatic T-wave inversion (TWI). We retrospectively read 12-lead electrocardiograms from 3,929 consecutive asymptomatic men in the air force (3,929 participants, mean age 39.3 ± 8.7 years) who underwent medical screening at the Aerospace Medical Center, Korea, from September 2010 to August 2012. TWIs other than in right precordial leads (V1 and V2) were present in 23 men (0.6%). All subjects with persistent TWI for 1 year (n = 18) underwent additional study, with the exception of 1 patient who refused further evaluation. Of 17 subjects with investigated persistent TWI, 8 (47.1%) had an apically displaced papillary muscle, 5 (29.4%) exhibited idiopathic TWI, 3 (17.6%) had apical hypertrophic cardiomyopathy, and 1 (5.9%) had Maron type 2 hypertrophic cardiomyopathy with dynamic left ventricular outflow obstruction. The depth of TWI was significantly shallow in the benign group (idiopathic TWI, 1.6 ± 0.5 mm) compared with potentially nonbenign group (the others; 5.5 ± 3.3 mm, p = 0.021). Lateral lead TWI was significantly correlated with potentially nonbenign group (46% vs 0%, p = 0.049). In conclusion, asymptomatic TWI is not rare (0.6%), even in a healthy population such as Korean Air Force society, and at least 29.4% of subjects with TWI are considered to belong to the benign group that does not require aggressive evaluation and criteria of TWI ≤2 mm other than lateral leads without co-morbidity could help to distinguish the benign group from the potentially nonbenign group.
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Affiliation(s)
- Sung Su Kim
- Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea
| | - Won Ho Choi
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Korea.
| | - Hyung Yoon Kim
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Korea
| | - Se Hun Kim
- Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Korea
| | - Dong-Ho Bang
- Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Korea
| | - Kyung Wook Kang
- Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Korea
| | - Chang Ho An
- Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Korea
| | - Jung Gu Lim
- Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Korea
| | - Jae-Jin Kwak
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Korea
| | - Sung Uk Kwon
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Korea
| | - Joon Hyung Doh
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Korea
| | - June Namgung
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Korea
| | - Sung Yun Lee
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Korea
| | - Won Ro Lee
- Department of Internal Medicine, Vision 21 Cardiac and Vascular Center, Inje University College of Medicine, Ilsan Paik Hospital, Korea
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Abstract
The increasing globalization of sport has resulted in athletes from a wide range of ethnicities emerging onto the world stage. Fuelled by the untimely death of a number of young professional athletes, data generated from the parallel increase in preparticipation cardiovascular evaluation has indicated that ethnicity has a substantial influence on cardiac adaptation to exercise. From this perspective, the group most intensively studied comprises athletes of African or Afro-Caribbean ethnicity (black athletes), an ever-increasing number of whom are competing at the highest levels of sport and who often exhibit profound electrical and structural cardiac changes in response to exercise. Data on other ethnic cohorts are emerging, but remain incomplete. This Review describes our current knowledge on the impact of ethnicity on cardiac adaptation to exercise, starting with white athletes in whom the physiological electrical and structural changes--collectively termed the 'athlete's heart'--were first described. Discussion of the differences in the cardiac changes between ethnicities, with a focus on black athletes, and of the challenges that these variations can produce for the evaluating physician is also provided. The impact of ethnically mediated changes on preparticipation cardiovascular evaluation is highlighted, particularly with respect to false positive results, and potential genetic mechanisms underlying racial differences in cardiac adaptation to exercise are described.
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Affiliation(s)
- Nabeel Sheikh
- Division of Clinical Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Sanjay Sharma
- Division of Clinical Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK
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22
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Kobza R, Cuculi F, Abächerli R, Toggweiler S, Suter Y, Frey F, Schmid JJ, Erne P. Twelve-lead electrocardiography in the young: physiologic and pathologic abnormalities. Heart Rhythm 2012; 9:2018-22. [PMID: 23102624 DOI: 10.1016/j.hrthm.2012.08.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED BACKGROUND/ OBJECTIVE: The purpose of the present study was to analyze the prevalence of physiologic and pathologic ECG abnormalities in a cohort of young conscripts that represents the whole young generation of today. METHODS ECGs of all Swiss citizens who underwent conscription for the army during a 29-month period were analyzed manually. RESULTS ECGs of 43,401 conscripts (mean age 19.2 ± 1.1 years) were analyzed; 158 conscripts were female. Incomplete right bundle branch block was found in 5870 (13.5%) and left anterior fascicular block in 360 (0.83%). First-degree AV block was present in 329 (0.8%) and Mobitz type I (Wenckebach) second-degree AV block in 3 (0.01%). Early repolarization was observed in 1035 (2.4%), T-wave inversion in 39 (0.09%), and minor T-wave changes in 182 (0.42%). Brugada-like abnormalities were observed in 6 (0.01%). None of the conscripts had atrial fibrillation or flutter. CONCLUSION ECG abnormalities can be found in a relatively large proportion of young individuals. Incomplete right bundle branch block, left fascicular block, and first-degree AV block are the most frequent findings. No conscript presented with atrial fibrillation or flutter.
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Affiliation(s)
- Richard Kobza
- Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
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