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Bergfeldt L, Hellsing R, Molnar D, Taha A, Lundahl G, Gransberg L, Bergström G. Abnormal QRS-T angles in 5796 women and men aged 50-64: an electrocardiographic analysis providing mechanistic insights. J Electrocardiol 2024; 86:153784. [PMID: 39190971 DOI: 10.1016/j.jelectrocard.2024.153784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/12/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Abnormal QRS-T angles are prognostic markers for cardiovascular deaths including sudden cardiac death. They occur in ∼5-6% of population-based cohorts but in ∼20% of patients with diabetes. The mechanistic background, electrical activation and/or recovery disturbances, is not known and the topic of this study. METHODS Applying Frank vectorcardiography (VCG) and simultaneously recorded scalar 12‑lead ECG, electrical activation and recovery of abnormal QRS-T angles were studied in 311 participants (5.4%) from a population-based cohort of 5796 women and men in the main Swedish CArdio-Pulmonary bio-Imaging Study (SCAPIS) in Gothenburg. Cut-off values for the peak and mean QRS-T angles were > 124° and > 119°, based on the >95th percentile among all 1080 participants in the pilot SCAPIS and reference values for normal directions (Q1-Q3) from 319 apparently healthy (30%) of them. RESULTS Of 311 cases 17% had known cardiac disease. Deviations of QRS and QRSarea-vectors from reference limits (90%) were significantly more common than deviations of T- and Tarea-vectors (65%). Standard ECG signs suggested pathophysiology in 20%; left bundle branch block (LBBB) and voltage criteria for left ventricular hypertrophy being most frequent (9-10%) each. Sub-group analysis of the 30 with LBBB showed very large variability in vector directions. CONCLUSIONS Our observations provide mechanistic insights about abnormal QRS-T angles of potential value for future prognostic and interventional studies. The results also have potential implications for LBB area pacing and the approach to left ventricular hypertrophy.
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Affiliation(s)
- Lennart Bergfeldt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Rut Hellsing
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Molnar
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Amar Taha
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunilla Lundahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Lennart Gransberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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2
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Hnatkova K, Andršová I, Novotný T, Britton A, Shipley M, Vandenberk B, Sprenkeler DJ, Junttila J, Reichlin T, Schlögl S, Vos MA, Friede T, Bauer A, Huikuri HV, Willems R, Schmidt G, Franz MR, Sticherling C, Zabel M, Malik M. QRS micro-fragmentation as a mortality predictor. Eur Heart J 2022; 43:4177-4191. [PMID: 35187560 PMCID: PMC9584751 DOI: 10.1093/eurheartj/ehac085] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/05/2022] [Accepted: 02/08/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Fragmented QRS complex with visible notching on standard 12-lead electrocardiogram (ECG) is understood to represent depolarization abnormalities and to signify risk of cardiac events. Depolarization abnormalities with similar prognostic implications likely exist beyond visual recognition but no technology is presently suitable for quantification of such invisible ECG abnormalities. We present such a technology. METHODS AND RESULTS A signal processing method projects all ECG leads of the QRS complex into optimized three perpendicular dimensions, reconstructs the ECG back from this three-dimensional projection, and quantifies the difference (QRS 'micro'-fragmentation, QRS-μf) between the original and reconstructed signals. QRS 'micro'-fragmentation was assessed in three different populations: cardiac patients with automatic implantable cardioverter-defibrillators, cardiac patients with severe abnormalities, and general public. The predictive value of QRS-μf for mortality was investigated both univariably and in multivariable comparisons with other risk factors including visible QRS 'macro'-fragmentation, QRS-Mf. The analysis was made in a total of 7779 subjects of whom 504 have not survived the first 5 years of follow-up. In all three populations, QRS-μf was strongly predictive of survival (P < 0.001 univariably, and P < 0.001 to P = 0.024 in multivariable regression analyses). A similar strong association with outcome was found when dichotomizing QRS-μf prospectively at 3.5%. When QRS-μf was used in multivariable analyses, QRS-Mf and QRS duration lost their predictive value. CONCLUSION In three populations with different clinical characteristics, QRS-μf was a powerful mortality risk factor independent of several previously established risk indices. Electrophysiologic abnormalities that contribute to increased QRS-μf values are likely responsible for the predictive power of visible QRS-Mf.
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Affiliation(s)
- Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Road, Shepherd's Bush, London W12 0NN, UK
| | - Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Annie Britton
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Martin Shipley
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - David J Sprenkeler
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juhani Junttila
- Medical Research Center Oulu, University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon Schlögl
- Department of Cardiology and Pneumology, University Medical Center, Göttingen, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Friede
- German Center of Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Axel Bauer
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Heikki V Huikuri
- Medical Research Center Oulu, University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Georg Schmidt
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,German Center for Cardiovascular Research Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael R Franz
- Veteran Affairs and Georgetown University Medical Centers, Washington, DC, USA
| | | | - Markus Zabel
- Department of Cardiology and Pneumology, University Medical Center, Göttingen, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Road, Shepherd's Bush, London W12 0NN, UK.,Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
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3
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Günlü S, Aktan A. Evaluation of the Cardiac Conduction System in Fibromyalgia Patients With Complaints of Palpitations. Cureus 2022; 14:e28784. [PMID: 36225502 PMCID: PMC9533093 DOI: 10.7759/cureus.28784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to investigate the influence of fibromyalgia syndrome (FMS) on the cardiac conduction system and assess patients’ palpitation complaints using 24-h ambulatory ECG (Holter {Maynard, MA: Northeast Monitoring, Inc.}) monitoring. Methods Ninety patients with FMS and 70 healthy controls were included in this research. ECG was performed on all participants, and ECG parameters were calculated. Holter monitoring was conducted, and the recordings were analyzed. The results of time-domain heart rate variability (HRV) were evaluated. Results The patient group’s mean age was 38.3±6.3 years. There were no statistically significant differences in demographic or laboratory parameters across the groups (p>0.05). The findings of a 24-h Holter ECG recording did not vary significantly between the groups (p=0.182). In the study group, the values for the standard deviation of R-R intervals (SDNN), low frequency (LF), and low/high frequency (LF/HF), which are known as HRV indicators, were substantially different between the two groups (p<0.05). Conclusions The study indicated that the risk of arrhythmias did not increase even though FM patients complained of palpitations.
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Andršová I, Hnatkova K, Toman O, Šišáková M, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Intra-subject stability of different expressions of spatial QRS-T angle and their relationship to heart rate. Front Physiol 2022; 13:939633. [DOI: 10.3389/fphys.2022.939633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Three-dimensional angle between the QRS complex and T wave vectors is a known powerful cardiovascular risk predictor. Nevertheless, several physiological properties of the angle are unknown or poorly understood. These include, among others, intra-subject profiles and stability of the angle relationship to heart rate, characteristics of angle/heart-rate hysteresis, and the changes of these characteristics with different modes of QRS-T angle calculation. These characteristics were investigated in long-term 12-lead Holter recordings of 523 healthy volunteers (259 females). Three different algorithmic methods for the angle computation were based on maximal vector magnitude of QRS and T wave loops, areas under the QRS complex and T wave curvatures in orthogonal leads, and weighted integration of all QRS and T wave vectors moving around the respective 3-dimensional loops. These methods were applied to orthogonal leads derived either by a uniform conversion matrix or by singular value decomposition (SVD) of the original 12-lead ECG, giving 6 possible ways of expressing the angle. Heart rate hysteresis was assessed using the exponential decay models. All these methods were used to measure the angle in 659,313 representative waveforms of individual 10-s ECG samples and in 7,350,733 individual beats contained in the same 10-s samples. With all measurement methods, the measured angles fitted second-degree polynomial regressions to the underlying heart rate. Independent of the measurement method, the angles were found significantly narrower in females (p < 0.00001) with the differences to males between 10o and 20o, suggesting that in future risk-assessment studies, different angle dichotomies are needed for both sexes. The integrative method combined with SVD leads showed the highest intra-subject reproducibility (p < 0.00001). No reproducible delay between heart rate changes and QRS-T angle changes was found. This was interpreted as a suggestion that the measurement of QRS-T angle might offer direct assessment of cardiac autonomic responsiveness at the ventricular level.
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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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Santos Rodrigues A, Augustauskas R, Lukoševičius M, Laguna P, Marozas V. Deep-Learning-Based Estimation of the Spatial QRS-T Angle from Reduced-Lead ECGs. SENSORS (BASEL, SWITZERLAND) 2022; 22:5414. [PMID: 35891094 PMCID: PMC9328169 DOI: 10.3390/s22145414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
The spatial QRS-T angle is a promising health indicator for risk stratification of sudden cardiac death (SCD). Thus far, the angle is estimated solely from 12-lead electrocardiogram (ECG) systems uncomfortable for ambulatory monitoring. Methods to estimate QRS-T angles from reduced-lead ECGs registered with consumer healthcare devices would, therefore, facilitate ambulatory monitoring. (1) Objective: Develop a method to estimate spatial QRS-T angles from reduced-lead ECGs. (2) Approach: We designed a deep learning model to locate the QRS and T wave vectors necessary for computing the QRS-T angle. We implemented an original loss function to guide the model in the 3D space to search for each vector's coordinates. A gradual reduction of ECG leads from the largest publicly available dataset of clinical 12-lead ECG recordings (PTB-XL) is used for training and validation. (3) Results: The spatial QRS-T angle can be estimated from leads {I, II, aVF, V2} with sufficient accuracy (absolute mean and median errors of 11.4° and 7.3°) for detecting abnormal angles without sacrificing patient comfortability. (4) Significance: Our model could enable ambulatory monitoring of spatial QRS-T angles using patch- or textile-based ECG devices. Populations at risk of SCD, like chronic cardiac and kidney disease patients, might benefit from this technology.
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Affiliation(s)
- Ana Santos Rodrigues
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania;
| | - Rytis Augustauskas
- Department of Automation, Kaunas University of Technology, 51367 Kaunas, Lithuania;
| | - Mantas Lukoševičius
- Faculty of Informatics, Kaunas University of Technology, 51368 Kaunas, Lithuania;
| | - Pablo Laguna
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain;
- Biomedical Research Networking Center (CIBER), 50018 Zaragoza, Spain
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, 51423 Kaunas, Lithuania;
- Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, 51367 Kaunas, Lithuania
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Giovanardi P, Vernia C, Tincani E, Giberti C, Silipo F, Fabbo A. Combined Effects of Age and Comorbidities on Electrocardiographic Parameters in a Large Non-Selected Population. J Clin Med 2022; 11:3737. [PMID: 35807018 PMCID: PMC9267325 DOI: 10.3390/jcm11133737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/24/2023] Open
Abstract
Background: Previous studies have evaluated average electrocardiographic (ECG) values in healthy subjects or specific subpopulations. However, none have evaluated ECG average values in not selected populations, so we examined ECG changes with respect to age and sex in a large primary population. Methods: From digitized ECG stored from 2008 to 2021 in the Modena province, 130,471 patients were enrolled. Heart rate, P, QRS and T wave axis, P, QRS and T wave duration, PR interval, QTc, and frontal QRS-T angle were evaluated. Results: All ECG parameters showed a dependence on age, but only some of them with a straight-line correlation: QRS axis (p < 0.001, R2 = 0.991, r = 0.996), PR interval (p < 0.001, R2 = 0.978, r = 0.989), QTc (p < 0.001, R2 = 0.935, r = 0.967), and, in over 51.5 years old, QRS-T angle (p < 0.001, R2 = 0.979, r = 0.956). Differences between females and males and in different clinical settings were observed. Conclusions: ECG changes with ageing are explainable by intrinsic modifications of the heart and thorax and with the appearance of cardiovascular diseases and comorbidities. Age-related reference values were computed and applicable in clinical practice. Significant deviations from mean values and from Z-scores should be investigated.
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Affiliation(s)
- Paolo Giovanardi
- Cardiology Service, Department of Primary Care, Health Authority and Services of Modena, 41124 Modena, Italy
- Cardiology Unit, Ospedale S. Agostino–Estense, Azienda Ospedaliero-Universitaria Modena, 41126 Baggiovara, Italy
| | - Cecilia Vernia
- Department of Physics, Informatic and Mathematics, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Enrico Tincani
- Internal Medicine Division, Ospedale S. Agostino–Estense, Azienda Ospedaliero-Universitaria Modena, 41126 Baggiovara, Italy;
| | - Claudio Giberti
- Department of Sciences and Methods for Engineering, University of Modena and Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Federico Silipo
- Department of Clinical Engineering, Health Authority and Services and Azienda Ospedaliero-Universitaria Modena, 41124 Modena, Italy;
| | - Andrea Fabbo
- Geriatric Service—Cognitive Disorders and Dementia, Department of Primary Care, Health Authority and Services of Modena, 41124 Modena, Italy;
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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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Decompressive Craniectomy Improves QTc Interval in Traumatic Brain Injury Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228653. [PMID: 33233364 PMCID: PMC7700327 DOI: 10.3390/ijerph17228653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Abstract
Background: Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. Decompressive craniectomy (DC) is commonly used to reduce intra-cranial hypertension (ICH). Although DC decreases ICH rapidly, its effect on ECG has not been systematically studied. The aim of this study was to analyze the changes in ECG in patients undergoing DC. Methods: Adult patients without previously known cardiac diseases treated for isolated TBI with DC were studied. ECG variables, such as: spatial QRS-T angle (spQRS-T), corrected QT interval (QTc), QRS and T axes (QRSax and Tax, respectively), STJ segment and the index of cardio-electrophysiological balance (iCEB) were analyzed before DC and at 12–24 h after DC. Changes in ECG were analyzed according to the occurrence of cardiac arrhythmias and 28-day mortality. Results: 48 patients (17 female and 31 male) aged 18–64 were studied. Intra-cranial pressure correlated with QTc before DC (p < 0.01, r = 0.49). DC reduced spQRS-T (p < 0.001) and QTc interval (p < 0.01), increased Tax (p < 0.01) and changed STJ in a majority of leads but did not affect QRSax and iCEB. The iCEB was relatively increased before DC in patients who eventually experienced cardiac arrhythmias after DC (p < 0.05). Higher post-DC iCEB was also noted in non-survivors (p < 0.05), although iCEB values were notably heart rate-dependent. Conclusions: ICP positively correlates with QTc interval in patients with isolated TBI, and DC for relief of ICH reduces QTc and spQRS-T. However, DC might also increase risk for life-threatening cardiac arrhythmias, especially in ICH patients with notably prolonged QTc before and increased iCEB after DC.
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10
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Skampardoni S, Poulikakos D, Malik M, Green D, Kalra PA. The potential of electrocardiography for cardiac risk prediction in chronic and end-stage kidney disease. Nephrol Dial Transplant 2020; 34:1089-1098. [PMID: 30085289 DOI: 10.1093/ndt/gfy255] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular mortality is very high in chronic and end-stage kidney disease (ESKD). However, risk stratification data are lacking. Sudden cardiac deaths are among the most common cardiovascular causes of death in these populations. As a result, many studies have assessed the prognostic potential of various electrocardiographic parameters in the renal population. Recent data from studies of implantable loop recordings in haemodialysis patients from five different countries have shed light on a pre-eminent bradyarrhythmic risk of mortality. Importantly, heart block addressed by permanent pacing system was detected in a proportion of patients during the prolonged recording periods. Standard electrocardiogram is inexpensive, non-invasive and easily accessible. Hence, risk prediction models using this simple investigation tool could easily translate into clinical practice. We believe that electrocardiographic assessment is currently under-valued in renal populations. For this review, we identified studies from the preceding 10 years that assessed the use of conventional and novel electrocardiographic biomarkers as risk predictors in chronic and ESKD. The review indicates that conventional electrocardiographic markers are not reliable for risk stratification in the renal populations. Novel parameters have shown promising results in smaller studies, but further validation in larger populations is required.
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Affiliation(s)
- Sofia Skampardoni
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Renal Department, Salford Royal NHS Trust, Salford, UK
| | - Dimitrios Poulikakos
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Renal Department, Salford Royal NHS Trust, Salford, UK
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, UK
| | - Darren Green
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Renal Department, Salford Royal NHS Trust, Salford, UK
| | - Philip A Kalra
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Renal Department, Salford Royal NHS Trust, Salford, UK
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11
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Hnatkova K, Toman O, Šišáková M, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Sex and race differences in J-Tend, J-Tpeak, and Tpeak-Tend intervals. Sci Rep 2019; 9:19880. [PMID: 31882660 PMCID: PMC6934529 DOI: 10.1038/s41598-019-56328-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
To facilitate the precision of clinical electrocardiographic studies of J-to-Tpeak (JTp) and Tpeak-to-Tend (Tpe) intervals, the study investigated their differences between healthy females and males, and between subjects of African and Caucasian origin. In 523 healthy subjects (254 females; 236 subjects of African origin), repeated Holter recordings were used to measure QT, JT, JTp, and Tpe intervals preceded by both stable and variable heart rates. Subject-specific curvilinear regression models were used to obtain individual QTc, JTc, JTpc and Tpec intervals. Rate hysteresis, i.e., the speed with which the intervals adapted after heart rate changes, was also investigated. In all sex-race groups, Tpe intervals were not systematically heart rate dependent. Similar to QTc intervals, women had JTc, and JTpc intervals longer than males (difference 20–30 ms, p < 0.001). However, women had Tpec intervals (and rate uncorrected Tpe intervals) shorter by approximately 10 ms compared to males (p < 0.001). Subjects of African origin had significantly shorter QTc intervals than Caucasians (p < 0.001). Gradually diminishing race-difference was found for JTc, JTpc and Tpec intervals. JTc and JTpc were moderately increasing with age but Tpe/Tpec were not. Rate hysteresis of JTp was approximately 10% longer compared to that of JT (p < 0.001). In future clinical studies, Tpe interval should not be systematically corrected for heart rate and similar to the QT interval, the differences in JT, JTp and Tpe intervals should be corrected for sex. The differences in QT and JT, and JTp intervals should also be corrected for race.
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Affiliation(s)
- Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, 72 Du Cane Road, Shepherd's Bush, London, W12 0NN, England
| | - Ondřej Toman
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Martina Šišáková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Peter Smetana
- Wilhelminenspital der Stadt Wien, Montleartstraße 37, 1160, Vienna, Austria
| | - Katharina M Huster
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, 72 Du Cane Road, Shepherd's Bush, London, W12 0NN, England.
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12
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Poulikakos D, Hnatkova K, Skampardoni S, Green D, Kalra P, Malik M. Sudden Cardiac Death in Dialysis: Arrhythmic Mechanisms and the Value of Non-invasive Electrophysiology. Front Physiol 2019; 10:144. [PMID: 30873044 PMCID: PMC6401645 DOI: 10.3389/fphys.2019.00144] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 02/07/2019] [Indexed: 01/10/2023] Open
Abstract
Sudden Cardiac Death (SCD) is the leading cause of cardiovascular death in dialysis patients. This review discusses potential underlying arrhythmic mechanisms of SCD in the dialysis population. It examines recent evidence from studies using implantable loop recorders and from electrophysiological studies in experimental animal models of chronic kidney disease. The review summarizes advances in the field of non-invasive electrophysiology for risk prediction in dialysis patients focusing on the predictive value of the QRS-T angle and of the assessments of autonomic imbalance by means of heart rate variability analysis. Future research directions in non-invasive electrophysiology are identified to advance the understanding of the arrhythmic mechanisms. A suggestion is made of incorporation of non-invasive electrophysiology procedures into clinical practice. Key Concepts: - Large prospective studies in dialysis patients with continuous ECG monitoring are required to clarify the underlying arrhythmic mechanisms of SCD in dialysis patients. - Obstructive sleep apnoea may be associated with brady-arrhythmias in dialysis patients. Studies are needed to elucidate the burden and impact of sleeping disorders on arrhythmic complications in dialysis patients. - The QRS-T angle has the potential to be used as a descriptor of uremic cardiomyopathy. - The QRS-T angle can be calculated from routine collected surface ECGs. Multicenter collaboration is required to establish best methodological approach and normal values. - Heart Rate Variability provides indirect assessment of cardiac modulation that may be relevant for cardiac risk prediction in dialysis patients. Short-term recordings with autonomic provocations are likely to overcome the limitations of out of hospital 24-h recordings and should be prospectively assessed.
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Affiliation(s)
- Dimitrios Poulikakos
- Renal Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- Centre for Cardiac Research, Institute of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sofia Skampardoni
- Renal Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- Centre for Cardiac Research, Institute of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom
| | - Darren Green
- Renal Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- Centre for Cardiac Research, Institute of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom
| | - Philip Kalra
- Renal Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom
- Centre for Cardiac Research, Institute of Cardiovascular Sciences, The University of Manchester, Manchester, United Kingdom
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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13
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Skampardoni S, Green D, Hnatkova K, Malik M, Kalra PA, Poulikakos D. QRS-T Angle Predicts Cardiac Risk and Correlates With Global Longitudinal Strain in Prevalent Hemodialysis Patients. Front Physiol 2019; 10:145. [PMID: 30858805 PMCID: PMC6397862 DOI: 10.3389/fphys.2019.00145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 02/07/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Cardiovascular disease is the commonest cause of death in hemodialysis (HD) patients but accurate risk prediction is lacking. The spatial QRS – T angle is a promising electrophysiological marker for sudden cardiac death risk stratification. The aim of this study was to assess the prognostic value of spatial QRS-T angle derived from standard 12 lead electrocardiograms (ECG) and its association with echocardiographic parameters in HD patients. Methods: This prospective study of 178 prevalent HD patients (aged 67 ± 14 years, 72% men) collected ECG and echocardiographic data on an annual basis. Baseline echocardiograms at study entry were used for cross-sectional comparisons with ECGs. Study endpoints were all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE). The QRS – T angle was calculated from standard 10-s ECG as the total cosine R to T (TCRT) using singular value decomposition and expressed in degrees. TCRT above 100° was defined as abnormal. Results: During a follow-up period of 36 ± 19 months, 74 patients died, including 17 cardiac deaths, and 54 suffered from MACE. In multivariate Cox regression analysis, QRS-T angle by TCRT at baseline was associated with increased cardiovascular mortality both as a continuous value and dichotomized below or above 100° (HR 1.016, p = 0.029, CI: 1.002–1.030 and HR 3.506, CI: 1.118–10.995, p = 0.031 respectively) and with MACE dichotomized at 100° (HR 1.902, CI: 1.046–3.459; p = 0.035). In multivariate regression analysis including baseline parameters, echocardiographic global longitudinal strain (GLS) was significantly correlated with TCRT (F 9.648, r2 = 0.192, standardized β = 0.331, unstandardized β = 3.567, t = 4.4429, CI: 1.976–5.157, p < 0.001). Conclusion: TCRT correlates with GLS and is independently associated with cardiac deaths and MACE in HD patients.
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Affiliation(s)
- Sofia Skampardoni
- Department of Renal Medicine, Salford Royal NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Darren Green
- Department of Renal Medicine, Salford Royal NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Dimitrios Poulikakos
- Department of Renal Medicine, Salford Royal NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
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14
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Huikuri HV, Malik M, Schmidt G, Lombardi F, Zabel M. Value of measurement of QRS-T angle from a standard 12-lead electrocardiogram. Int J Cardiol 2019; 277:24-25. [PMID: 30665556 DOI: 10.1016/j.ijcard.2018.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Heikki V Huikuri
- Research Unit of Internal Medicine, University of Oulu, University Hospital of Oulu, Oulu, Finland.
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Federico Lombardi
- Cardiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Italy
| | - Markus Zabel
- Universitätsmedizin Göttingen Leiter des Schwerpunkts Klinische Elektrophysiologie, Germany
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15
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Steger A, Müller A, Barthel P, Dommasch M, Huster KM, Hnatkova K, Sinnecker D, Hapfelmeier A, Malik M, Schmidt G. Polyscore of Non-invasive Cardiac Risk Factors. Front Physiol 2019; 10:49. [PMID: 30778303 PMCID: PMC6369149 DOI: 10.3389/fphys.2019.00049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/17/2019] [Indexed: 12/11/2022] Open
Abstract
Non-invasive risk stratification of cardiac patients has been the subject of numerous studies. Most of these investigations either researched unique risk predictors or compared the predictive power of different predictors. Fewer studies suggested a combination of a small number of non-invasive indices to increase the accuracy of high-risk group selection. To advance non-invasive risk assessment of cardiac patients, we propose a combination score (termed the Polyscore) of seven different cardiac risk stratifiers that predominantly quantify autonomic cardiovascular control and regulation, namely the slope of heart rate turbulence, deceleration capacity of heart rate, non-invasively assessed baroreflex sensitivity, resting respiration frequency, expiration triggered sinus arrhythmia, post-ectopic potentiation of systolic blood pressure, and frequency of supraventricular and ventricular ectopic beats. These risk stratification tests have previously been researched and their dichotomies defining abnormal results have been derived from previous reports. The Polyscore combination was defined as the number of positive tests among these seven risk predictors, giving a numerical scale which ranges from 0 (all tests normal) to 7 (all tests abnormal). The Polyscore was tested in a population of 941 contemporarily treated survivors of acute myocardial infarction (median age 61 years, 182 females) of whom 72 (7.65%) died during a 5-year follow-up. In these patients, all the risk predictors combined in the Polyscore were assessed during in-hospital 30-min simultaneous non-invasive recordings of high-frequency orthogonal electrocardiogram, continuous blood pressure and respiration. Compared to Polyscore 0 stratum, the hazard ratios of mortality during follow-up increased almost exponentially in strata 1 through 7 (vs. stratus 0, the hazard ratios were 1.37, 1.96, 7.03, 15.0, 35.7, 48.2, and 114, in strata 1 to 7, respectively; p < 0.0001). This allowed selecting low-risk (Polyscore ≤ 2), intermediate risk (Polyscore 3 or 4) and high-risk (Polyscore ≥ 5) sub-groups of the population that differed greatly in the Kaplan–Meier probabilities of mortality during follow-up. Since the Polyscore was derived from recordings of only 30-min duration, it can be reasonably applied in different clinical situations including population-wide screening. We can therefore conclude that the Polyscore is a reasonable method for cardiac risk stratification that is ready for prospective validation in future independent studies.
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Affiliation(s)
- Alexander Steger
- Klinik für Innere Medizin I, Technische Universität München, Munich, Germany
| | - Alexander Müller
- Klinik für Innere Medizin I, Technische Universität München, Munich, Germany
| | - Petra Barthel
- Klinik für Innere Medizin I, Technische Universität München, Munich, Germany
| | - Michael Dommasch
- Klinik für Innere Medizin I, Technische Universität München, Munich, Germany
| | | | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Daniel Sinnecker
- Klinik für Innere Medizin I, Technische Universität München, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Georg Schmidt
- Klinik für Innere Medizin I, Technische Universität München, Munich, Germany
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16
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Zabel M, Sticherling C, Willems R, Lubinski A, Bauer A, Bergau L, Braunschweig F, Brugada J, Brusich S, Conen D, Cygankiewicz I, Flevari P, Taborsky M, Hansen J, Hasenfuß G, Hatala R, Huikuri HV, Iovev S, Kääb S, Kaliska G, Kasprzak JD, Lüthje L, Malik M, Novotny T, Pavlović N, Schmidt G, Shalganov T, Sritharan R, Schlögl S, Szavits Nossan J, Traykov V, Tuinenburg AE, Velchev V, Vos MA, Willich SN, Friede T, Svendsen JH, Merkely B. Rationale and design of the EU-CERT-ICD prospective study: comparative effectiveness of prophylactic ICD implantation. ESC Heart Fail 2018; 6:182-193. [PMID: 30299600 PMCID: PMC6351896 DOI: 10.1002/ehf2.12367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/30/2018] [Indexed: 01/10/2023] Open
Abstract
Aims The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU‐CERT‐ICD) aims to assess its current clinical value. Methods and results The EU‐CERT‐ICD is a prospective investigator‐initiated non‐randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non‐randomized control group). The primary endpoint is all‐cause mortality; the co‐primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost‐effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12‐lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years. Conclusions The EU‐CERT‐ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers.
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Affiliation(s)
- Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | | | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Andrzej Lubinski
- Department of Cardiology, Medical University of Lodz (MUL) WAM Hospital, Lodz, Poland
| | - Axel Bauer
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | | | - Josep Brugada
- IDIBAPS, Department of Cardiology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sandro Brusich
- Department of Cardiovascular Disease, KBC Rijeka, Rijeka, Croatia
| | - David Conen
- Department of Cardiology, University Hospital, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz (MUL), Lodz, Poland
| | - Panagiota Flevari
- 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Milos Taborsky
- Department of Cardiology, University Hospital, Olomouc, Czech Republic
| | | | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Robert Hatala
- Slovak Medical University NUSCH, Bratislava, Slovakia
| | - Heikki V Huikuri
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Svetoslav Iovev
- Department of Cardiology, St. Ekaterina University Hospital, Sofia, Bulgaria
| | - Stefan Kääb
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | | | - Jaroslaw D Kasprzak
- Chair and Department of Cardiology, Bieganski Hospital, Medical University of Lodz (MUL), Lodz, Poland
| | - Lars Lüthje
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, UK
| | - Tomas Novotny
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Nikola Pavlović
- Department of Cardiology, KBC Sestre Milosrdnice, Zagreb, Croatia
| | - Georg Schmidt
- Med. Klinik und Poliklinik I, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | | | - Rajeeva Sritharan
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Simon Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | | | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Anton E Tuinenburg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vasil Velchev
- Department of Cardiology, St. Anna Hospital, Sofia, Bulgaria
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Béla Merkely
- Department of Cardiology, Semmelweis University Heart Center, Budapest, Hungary
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17
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Kalra PA, Green D, Poulikakos D. Arrhythmia in hemodialysis patients and its relation to sudden death. Kidney Int 2018; 93:781-783. [PMID: 29571451 DOI: 10.1016/j.kint.2017.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 12/15/2022]
Abstract
Sudden death in patients on hemodialysis is believed to be due to arrhythmia, but the evidence for this is surprisingly limited. Five studies involving implantable loop recorders in patients on hemodialysis have now been published, and 4 have shown that bradyarrhythmia rather than tachyarrhythmia are the pre-eminent arrhythmic associations of fatal events. The Monitoring in Dialysis study, reported in this issue, sheds new light on the relationships of arrhythmia to the conventional 3-session weekly hemodialysis cycle.
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Affiliation(s)
- Philip A Kalra
- Department of Renal Medicine, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, UK.
| | - Darren Green
- Department of Renal Medicine, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, UK
| | - Dimitrios Poulikakos
- Department of Renal Medicine, Salford Royal Hospital, Manchester Academic Health Science Centre, Manchester, UK
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18
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Malik M. Shallow meta analysis. Ann Noninvasive Electrocardiol 2018; 23:e12543. [DOI: 10.1111/anec.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marek Malik
- National Heart and Lung Institute; Imperial College; London England UK
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19
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Poulikakos D, Hnatkova K, Banerjee D, Malik M. Association of QRS-T angle and heart rate variability with major cardiac events and mortality in hemodialysis patients. Ann Noninvasive Electrocardiol 2018; 23:e12570. [PMID: 29938866 DOI: 10.1111/anec.12570] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/02/2018] [Accepted: 05/14/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Mortality in hemodialysis (HD) patients is high with significant proportion attributed to fatal arrhythmias. In a pilot study, we showed that intradialytic electrocardiographic (ECG) monitoring can yield stable profiles of selected repolarisation descriptors and heart rate variability (HRV) parameters. This study investigated the relationship of these ECG markers with major adverse cardiac events (MACE) and mortality. METHODS Continuous ECGs were obtained during HD and repeated five times at 2-week intervals. The QRS-T angle calculated as Total Cosine R to T (TCRT) and T-wave morphology dispersion (TMD) were calculated in overlapping 10 s ECG segments. High- (HF) and low (LF)-frequency components and the LF/HF ratio of HRV were calculated every 5 min. These indices were averaged during the first hour of dialysis and subsequently overall recordings in each subject. RESULTS All ECG parameters were available in 72 patients aged 61 ± 15, 23 (31.9%) females and 26 (36.1%) diabetics. After a median follow up of 54.8 months, 16 patients died, 20 were transplanted, and 9 suffered MACE. TCRT (in degrees) was higher and LF/HF was lower in patients who died compared to survivors (112 ± 30 vs. 73 ± 35, p = 0.000 and 0.222 ± 0.418 vs. 0.401 ± 0.274, p = 0.000, respectively) and in MACE positive compared to negative (117 ± 40 vs. 77 ± 34, p = 0.017 and 0.125 ± 0.333 vs.0.401 ± 0.274, p = 0.007 respectively). In multivariate Cox regression analysis of mortality risk adjusted for age, diabetes mellitus, and coronary artery disease, TCRT and LF/HF remained significant predictors (p < 0.05). CONCLUSION QRS-T angle and HRV may serve risk assessment in future prospective studies in HD patients.
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Affiliation(s)
- Dimitrios Poulikakos
- Renal Unit, Centre for Cardiac Research, Institute of Cardiovascular Sciences, Salford Royal NHS Foundation Trust, Manchester, UK
| | | | - Debasish Banerjee
- Renal and Transplantation Unit, St. Georges University Hospital NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Marek Malik
- Imperial College, National Heart and Lung Institute, London, UK
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