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Sivri F, Özdemir B, Çelik MM, Aksoy F, Akçay B. Prognostic Value of T-wave Positivity in Lead aVR in COVID-19 Pneumonia. Rev Assoc Med Bras (1992) 2022; 68:882-887. [PMID: 35946762 PMCID: PMC9574967 DOI: 10.1590/1806-9282.20211096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/23/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE T-wave positivity in the lead aVR is a marker of ventricular repolarization abnormality and provides information on short- and long-term cardiovascular mortality in heart failure patients, those with anterior myocardial infarction, and patients who underwent hemodialysis for various reasons. The aim of this study was to investigate the relationship between T-wave positivity in the lead aVR on superficial electrocardiogram and mortality from COVID-19 pneumonia. METHODS This study retrospectively included 130 patients who were diagnosed with COVID-19 and treated as an outpatient or in the thoracic diseases ward in a single center between January 2021 and June 2021. All patients included in the study had clinical and radiological features and signs of COVID-19 pneumonia. The COVID-19 diagnosis of all patients was confirmed by polymerase chain reaction detected from an oropharyngeal swab. RESULTS A total of 130 patients were included in this study. Patients were divided into two groups: survived and deceased. There were 55 patients (mean age: 64.76-14.93 years, 58.18 male, 41.12% female) in the survived group and 75 patients (mean age: 65-15 years, 58.67 male, 41.33% female) in the deceased group. The univariate and multivariate regression analyses showed that positive transcatheter aortic valve replacement (OR 5.151; 95%CI 1.001-26.504; p=0.0012), lactate dehydrogenase (OR 1.006; 95%CI 1.001-1.010; p=0.012), and d-dimer (OR 1.436; 95%CI 1.115-1.848; p=0.005) were independent risk factors for mortality. CONCLUSION A positive transcatheter aortic valve replacement is useful in risk stratification for mortality from COVID-19 pneumonia.
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Affiliation(s)
- Fatih Sivri
- Hatay Dörtyol State Hospital – Hatay, Turkey.,Corresponding author:
| | - Burcu Özdemir
- Samsun Training and Research Hospital – Samsun, Turkey
| | | | - Fatih Aksoy
- Süleyman Demirel University – Isparta, Turkey
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Hatamnejad MR, Heydari AA, Salimi M, Jahangiri S, Bazrafshan M, Bazrafshan H. The utility of SYNTAX score predictability by electrocardiogram parameters in patients with unstable angina. BMC Cardiovasc Disord 2022; 22:8. [PMID: 35016624 PMCID: PMC8753933 DOI: 10.1186/s12872-022-02455-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background SYNTAX score is one of the risk assessment systems to predict cardiac events in acute coronary syndrome patients. Despite the large number of SYNTAX score benefits, invasive methods such as coronary angiography are necessary to perform the scoring. We hypothesized that ECG parameters could predict the SYNTAX score in unstable angina patients.
Methods During the retrospective cohort study, a total number of 876 patients were diagnosed with unstable angina. After applying the exclusion criteria, 600 patients were divided into tertiles based on the SYNTAX scores as low (0–22), intermediate (23–32), and high (≥ 33). The association between ECG parameters and SYNTAX score was investigated. Results The study included 65% men and 35% women with a mean age of 62.4 ± 9.97 years. The delayed transition zone of QRS complex, ST-depression in inferior-lateral territories or/and in all three territories, and T-wave inversion in lateral territory were significant (p < 0.05) independent predictors of intermediate SYNTAX score. High SYNTAX score was predicted by the presence of prolonged P wave duration, ST-depression in lateral territory or/and anterior-lateral territories, ST-elevation in aVR–III leads or/and aVR–III–V1 leads. Among those, all three territories ST-depression (AUC: 0.611, sensitivity: 75%, specificity: 51%) and aVR + III ST-elevation (AUC: 0.672, sensitivity: 50.12%, specificity: 80.50%) were the most accurate parameters to predict intermediate and high SYNTAX scores, respectively. Conclusion The present study demonstrates that accompanying the STE in the right side leads (aVR, III, V1) with ST-depression in other leads indicates the patients with high SYNTAX score; meanwhile, diffuse ST-depression without ST-elevation is a marker for intermediate SYNTAX score in unstable angina patients and can be applied for early risk stratification and intervention.
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Affiliation(s)
- Mohammad Reza Hatamnejad
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Cardiology Medicine, Al-Zahra Charity Hospital, Shiraz University of Medical Sciences, Zand St, PO Box: 71348-14336, Shiraz, Iran
| | | | - Maryam Salimi
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soodeh Jahangiri
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Bazrafshan
- Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Cardiology Medicine, Al-Zahra Charity Hospital, Shiraz University of Medical Sciences, Zand St, PO Box: 71348-14336, Shiraz, Iran.
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Ekizler FA, Cay S, Ulvan N, Tekin Tak B, Cetin EHO, Kafes H, Ozeke O, Ozcan F, Topaloglu S, Tufekcioglu O, Aras D. Importance of lead aVR on predicting adverse cardiac events in patients with noncompaction cardiomyopathy. Ann Noninvasive Electrocardiol 2020; 25:e12719. [PMID: 31609051 PMCID: PMC7358825 DOI: 10.1111/anec.12719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 12/17/2022] Open
Abstract
Background Noncompaction cardiomyopathy (NCCM) is a relatively rare cardiac abnormality with high rates of mortality and morbidity. T‐wave amplitudes during ventricular repolarization in lead aVR (TaVR) have been reported to be associated with the prognosis of various cardiovascular diseases. This study sought to investigate the prevalence and prognostic role of positive TaVR in patients with NCCM. Methods We evaluated consecutive 161 patients with NCCM (65.8% men, mean age 42.5 ± 15.2 years old). Presentation electrocardiogram was assessed regarding classical parameters as well as T‐wave amplitudes in lead aVR. The primary endpoint was defined as composite lethal arrhythmic events, including sudden cardiac death, ventricular fibrillation, or sustained ventricular tachycardia or appropriate implantable cardioverter–defibrillator shock. Heart failure requiring hospitalization, cardiovascular death, and all‐cause mortality were also investigated as secondary endpoints. Results Patients with positive TaVR showed higher rates for arrhythmic events, hospitalization for heart failure, and death compared with patients without it. In multivariate Cox model, after adjusting for other known clinical and electrocardiographic risk factors, the positive TaVR was found to be a strong independent predictor of primary endpoint (HR: 4.8, 95% CI: 1.2–19.3; p = .025) and all‐cause death (HR: 3.5, 95% CI: 1.0–12.1; p = .045). Conclusion Our findings revealed that positive TaVR is significantly and independently associated with adverse outcomes in NCCM patients. This unique ECG criterion in the often ignored lead provides incremental information beyond what is available with other traditional risk factors.
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Affiliation(s)
| | - Serkan Cay
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Nedret Ulvan
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Bahar Tekin Tak
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Elif Hande Ozcan Cetin
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Habibe Kafes
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Omac Tufekcioglu
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
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Siren M, Koivula K, Eskola MJ, Martiskainen M, Huhtala H, Laurikka J, Mikkelsson J, Järvelä K, Niemelä KO, Punkka O, Karhunen PJ, Nikus KC. The prognostic significance of a positive or isoelectric T wave in lead aVR in patients with acute coronary syndrome and ischemic ECG changes in the presenting ECG - Long-term follow-up data of the TACOS study. J Electrocardiol 2020; 60:131-137. [PMID: 32361088 DOI: 10.1016/j.jelectrocard.2020.04.009] [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: 02/04/2020] [Revised: 04/03/2020] [Accepted: 04/11/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND A positive T wave in lead aVR (aVRT+) is an independent prognostic predictor of cardiovascular mortality in the general population as well as in cardiovascular disease. SUBJECTS AND METHODS We evaluated the prognostic impact of aVRT+ in an ECG recorded as close to hospital discharge as possible in acute coronary syndrome patients (n = 527). We divided the patients into three categories based on the findings in the admission ECG: ST elevation, global ischemia and other ST/T changes. RESULTS In the whole study population, and in all the three ECG subgroups, the 10-year all-cause mortality rate was higher in the aVRT+ group than in the aVRT- group. In Cox regression analysis, the age and gender adjusted hazard ratio (HR) for aVRT+ to predict all-cause mortality in the whole study population was 1.43 (95% confidence interval [CI] 1.12-1.83; p = 0.004). To predict cardiovascular mortality, the age and gender adjusted HR for aVRT+ was 1.54 (95% CI 1.14-2.07; p = 0.005) in the whole study population and 2.07 (95% CI 1.07-4.03; p = 0.032) in the category with other ST/T changes. CONCLUSION In ACS patients with or without ST elevation, but with ischemic ST/T changes in their presenting ECG, a positive or isoelectric T wave in lead aVR in an ECG recorded in the subacute in-hospital stage is associated with all-cause and cardiovascular mortality during long-term follow-up. Clinicians should pay attention to this simple ECG finding at hospital discharge.
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Affiliation(s)
- Marko Siren
- Faculty of Medicine and Health Technology, Tampere University, Finland.
| | - Kimmo Koivula
- Faculty of Medicine and Health Technology, Tampere University, Finland; South-Karelia Central Hospital, Finland
| | | | | | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Finland
| | | | | | - Kati Järvelä
- Heart Center, Tampere University Hospital, Finland
| | | | - Olli Punkka
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Pekka J Karhunen
- Faculty of Medicine and Health Technology, Tampere University, Finland; Fimlab Laboratories Tampere University Hospital, Tampere, Finland
| | - Kjell C Nikus
- Faculty of Medicine and Health Technology, Tampere University, Finland; Heart Center, Tampere University Hospital, Finland
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T wave positivity in lead aVR is associated with mortality after transcatheter aortic valve implantation. ACTA ACUST UNITED AC 2019; 4:e55-e62. [PMID: 31211271 PMCID: PMC6549042 DOI: 10.5114/amsad.2019.84449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/31/2019] [Indexed: 12/03/2022]
Abstract
Introduction Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (SAVR) in patients with increased comorbidity. Lead aVR in surface ECG has valuable information about prediction of mortality in many cardiovascular diseases. Our aim was to determine the relationship between ischemic changes in lead aVR and mortality in TAVI patients. Material and methods We retrospectively examined 86 patients with TAVI. The ST segment deviation in lead aVR (STaVR) and T wave polarity (TPaVR) on surface ECG were measured. The absolute values of TPaVR and STaVR were calculated. A ratio (TP/STaVR or vice versa) was obtained from the division of the larger absolute value by the smaller one. Results The patients were divided into two groups as living and deceased. The living group had 68 patients, and the deceased group had 18 patients. The number of positive TPaVR patients after TAVI, TPaVR after TAVI, and TP/STaVR ratio after TAVI were significantly higher in the deceased group. The deceased group had a significantly shorter aortic annulus-LMCA distance. Presence of positive TPaVR (OR = 8.765, 95% CI: 1.088–70.618, p = 0.041), aortic annulus-LMCA distance (for each 1 mm increase, OR = 0.306, 95% CI: 0.158–0.595, p < 0.001) and TP/STaVR ratio (for each 0.1 increase, OR = 1.966, 95% CI: 1.276–3.024, p = 0.002) were determined as independent predictors for mortality. Conclusions Ischemic changes in lead aVR may provide valuable information about mortality after TAVI.
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İçen YK, Urgun OD, Dönmez Y, Demirtaş AO, Koc M. Lead aVR is a predictor for mortality in heart failure with preserved ejection fraction. Indian Heart J 2018; 70:816-821. [PMID: 30580850 PMCID: PMC6306362 DOI: 10.1016/j.ihj.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/25/2018] [Accepted: 07/02/2018] [Indexed: 12/28/2022] Open
Abstract
Background Normally, lead augmented vector right (aVR) has a negative T wave polarity (TaVR) in the electrocardiography (ECG). Positive TaVR and ST segment deviation in lead aVR (STaVR) have negative effects on mortality in heart failure with reduced ejection fraction patients. Aim Our aim was to investigate the relationship between lead aVR changes and mortality in heart failure with preserved ejection fraction (HFpEF) patients. Methods We retrospectively examined 249 patients in 2011–2015 years (mean age 70.8 ± 11.9 years and follow-up period 38.3 ± 9.6 months). ECG, echocardiographic, and laboratory findings were recorded and compared in the study. Existence of positive TaVR, STaVR, and quantitative TaVR values were recorded and the absolute numerical values of TaVR and STaVR were recorded from the 12-lead surface ECG (T/STaVR ratio or vice versa). Results The patients were divided into two groups: living (171) and deceased (78). Age, systolic blood pressure, left atrial diameter, QRS duration, positive TaVR frequency, STaVR, absolute value of TaVR, and ratio were significantly higher in the deceased group. Age (OR: 1.106), STaVR (OR: 2.349), TaVR (OR: 1.612), and T/STaVR ratio (OR: 5.156) were determined as independent predictors for mortality. Conclusions ST segment and T wave polarity changes in lead aVR closely associated with mortality in patients with HFpEF.
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Affiliation(s)
- Yahya Kemal İçen
- Health Science University Adana City Education and Research Hospital Cardiology Department, Adana, 01000, Turkey.
| | - Orsan Deniz Urgun
- Health Science University Adana City Education and Research Hospital Cardiology Department, Adana, 01000, Turkey.
| | - Yurdaer Dönmez
- Health Science University Adana City Education and Research Hospital Cardiology Department, Adana, 01000, Turkey.
| | - Abdullah Orhan Demirtaş
- Health Science University Adana City Education and Research Hospital Cardiology Department, Adana, 01000, Turkey.
| | - Mevlut Koc
- Health Science University Adana City Education and Research Hospital Cardiology Department, Adana, 01000, Turkey.
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Separham A, Sohrabi B, Tajlil A, Pourafkari L, Sadeghi R, Ghaffari S, Nader ND. Prognostic value of positive T wave in lead aVR in patients with non-ST segment myocardial infarction. Ann Noninvasive Electrocardiol 2018; 23:e12554. [PMID: 29676045 PMCID: PMC6931446 DOI: 10.1111/anec.12554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Lead aVR provides prognostic information in various settings in patients with ischemia. We aim to investigate the role of a positive T wave in lead aVR in non-ST segment myocardial infarction (NSTEMI). METHODS In a prospective cohort study, we included 400 patients with NSTEMI. Presentation electrocardiogram (ECG) was investigated for presence of a positive T wave as well as ST segment elevation (STE) in aVR and study variables were compared. Predictors of primary outcome defined as hospital major adverse cardiovascular events (MACE) and secondary outcome, defined as three-vessel coronary disease and/or left main coronary artery stenosis (3VD/LMCA) stenosis in angiography, were determined in multivariate logistic regression analysis. RESULTS Patients with a positive T wave in aVR were significantly older and were more likely to be female. Left ventricular ejection fraction was significantly lower in patients of positive T group. Positive T group was more likely to have 3VD/LMCA stenosis (58.3% vs. 19.8%, p < .001). The prevalence of a positive T wave in aVR was significantly higher in MACE group (54.9 % vs. 24.8%, p < .001). However, in multivariate analysis, it was not an independent predictor of MACE (OR: 1.083 95% CI: [0.496-2.365], p: .841). Though, it was independently associated with presence of 3VD/LMCA stenosis (OR: 3.747 95% CI: [2.058-6.822], p < .001). CONCLUSION Though positive T wave in lead aVR was more common in patients with MACE; it was not an independent predictor. Additionally, a positive T wave in aVR was an independent predictor of 3VD/LMCA stenosis in NSTEMI.
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Affiliation(s)
- Ahmad Separham
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Bahram Sohrabi
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Arezou Tajlil
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Leili Pourafkari
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
- University at BuffaloBuffaloNew York
| | - Robabeh Sadeghi
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | - Samad Ghaffari
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
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