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Stabenau HF, Sau A, Kramer DB, Peters NS, Ng FS, Waks JW. Limits of the spatial ventricular gradient and QRST angles in patients with normal electrocardiograms and no known cardiovascular disease stratified by age, sex, and race. J Cardiovasc Electrophysiol 2023; 34:2305-2315. [PMID: 37681403 DOI: 10.1111/jce.16062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Measurement of the spatial ventricular gradient (SVG), spatial QRST angles, and other vectorcardiographic measures of myocardial electrical heterogeneity have emerged as novel risk stratification methods for sudden cardiac death and other adverse cardiovascular events. Prior studies of normal limits of these measurements included primarily young, healthy, White volunteers, but normal limits in older patients are unknown. The influence of race and body mass index (BMI) on these measurements is also unclear. METHODS Normal 12-lead electrocardiograms (ECGs) from a single center were identified. Patients with abnormal cardiovascular, pulmonary, or renal history (assessed by International Classification of Disease [ICD-9/ICD-10] codes) or abnormal cardiovascular imaging were excluded. The SVG and QRST angles were measured and stratified by age, sex, and race. Multivariable linear regression was used to assess the influence of age, BMI, and heart rate (HR) on these measurements. RESULTS Among 3292 patients, observed ranges of SVG and QRST angles (peak and mean) differed significantly based on sex, age, and race. Sex differences attenuated with increasing age. Men tended to have larger SVG magnitude (60.4 [46.1-77.8] vs. 52.5 [41.3-65.8] mv*ms, p < .0001) and elevation, and more anterior/negative SVG azimuth (-14.8 [-25.1 to -4.3] vs. 1.3 [-9.8 to 10.5] deg, p < .0001) compared to women. Men also had wider QRST angles. Observed ranges varied significantly with BMI and HR. SVG and QRST angle measurements were robust to different filtering bandwidths and moderate fiducial point annotation errors, but were heavily affected by changes in baseline correction. CONCLUSIONS Age, sex, race, BMI, and HR significantly affect the range of SVG and QRST angles in patients with normal ECGs and no known cardiovascular disease, and should be accounted for in future studies. An online calculator for prediction of these "normal limits" given demographics is provided at https://bivectors.github.io/gehcalc/.
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Affiliation(s)
- Hans F Stabenau
- Division of Electrophysiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Harvard-Thorndike Arrhythmia Institute, Boston, Massachusetts, USA
| | - Arunashis Sau
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Daniel B Kramer
- Division of Electrophysiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Harvard-Thorndike Arrhythmia Institute, Boston, Massachusetts, USA
- National Heart and Lung Institute, Imperial College London, London, UK
- Harvard Medical School, Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Nicholas S Peters
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan W Waks
- Division of Electrophysiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Harvard-Thorndike Arrhythmia Institute, Boston, Massachusetts, USA
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Kapıcı Y, Tanrıverdi Z, Tekin A, Güc B, Abuş S, Karamustafalıoğlu O. Comparison of frontal QRS-T angle and inflammatory parameters between the patients with drug-naive first episode psychosis and healthy controls. J Electrocardiol 2023; 81:106-110. [PMID: 37677849 DOI: 10.1016/j.jelectrocard.2023.08.013] [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: 04/02/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Frontal QRS-T (fQRS-T) angle is a novel marker to predict many cardiovascular diseases. The present study aims to compare the fQRS-T angle of first episode psychosis (FEP) patients and healthy controls (HC) and evaluate the relationship between fQRS-T angle and blood count-related inflammatory markers such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to high-density lipoprotein cholesterol ratio (MHR). METHODS Electrocardiogram (ECG) and complete blood count (CBC) of 63 patients who were diagnosed with drug-naive FEP in the psychiatry clinic of a training and research hospital and 78 healthy controls (HC) individuals who had applied to the health committee polyclinic for recruitment or pre-military examination between 2016 and 2021 were included. RESULTS fQRS-T angle was wider in FEP patients (55.5o) than in healthy controls (22o) (p < .001). NLR, PLR, and MHR were higher in FEP patients than in healthy controls (p = .001, p < .001, and p < .001, respectively). fQRS-T angle was positively correlated with NLR (r = 0.52 and p < .001) and MHR (r = 0.39 and p = .002) in FEP patients. NLR (t = 2.196 and p = .032) and MHR (t = 5.469 and p < .001) values were found to be the predictors of fQRS-T angle in FEP patients. CONCLUSION In summary, we can conclude that patients with FEP tend to exhibit a wider fQRS-T angle compared to their healthy controls. Additionally, the values of NLR and MHR could potentially serve as useful indicators for predicting the fQRS-T angle in FEP patients. Conducting subsequent long-term studies could provide deeper insights into the interpretation of the fQRS-T angle and its potential connection to cardiovascular diseases in schizophrenia patients.
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Affiliation(s)
- Yaşar Kapıcı
- Kahta State Hospital, Psychiatry Department, Adıyaman, Turkey.
| | - Zülkif Tanrıverdi
- Harran University, Faculty of Medicine, Cardiology Department, Şanlıurfa, Turkey
| | - Atilla Tekin
- Adıyaman University, Faculty of Medicine, Psychiatry Department, Adıyaman, Turkey
| | - Bulut Güc
- Şanlıurfa Balıklıgöl State Hospital, Psychiatry Department, Şanlıurfa, Turkey
| | - Sabri Abuş
- Adıyaman Education and Research Hospital, Cardiology Department, Adıyaman, Turkey
| | - Oğuz Karamustafalıoğlu
- Psychiatry, İstanbul University-Cerrahpaşa, Institue of Forensic Sciences, İstanbul, Turkey
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Chen Z, Wang Y. Interleukin-6 levels can be used to estimate cardiovascular and all-cause mortality risk in dialysis patients: A meta-analysis and a systematic review. Immun Inflamm Dis 2023; 11:e818. [PMID: 37102647 PMCID: PMC10132186 DOI: 10.1002/iid3.818] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Although previous studies have explored the correlation of interleukin (IL)-6 with mortality risk in dialysis patients, the findings have been conflicting. Hence, this meta-analysis aimed to comprehensively assess the use of IL-6 measurement for estimating cardiovascular mortality and all-cause mortality in dialysis patients. METHODS The Embase, PubMed, Web of Science, and MEDLINE databases were searched to identify relevant studies. After screening out the eligible studies, the data were extracted. RESULTS Twenty-eight eligible studies with 8370 dialysis patients were included. Pooled analyses revealed that higher IL-6 levels were related to increased cardiovascular mortality risk (hazard ratio [HR] = 1.55, 95% confidence interval [CI]: 1.20-1.90) and all-cause mortality risk (HR = 1.11, 95% CI: 1.05-1.17) in dialysis patients. Further subgroup analyses suggested that higher IL-6 levels were associated with elevated cardiovascular mortality in hemodialysis patients (HR = 1.59, 95% CI: 1.36-1.81) but not in peritoneal dialysis patients (HR = 1.56, 95% CI: 0.46-2.67). Moreover, sensitivity analyses indicated that the results were robust. Egger's test revealed potential publication bias among studies exploring the correlation of IL-6 levels with cardiovascular mortality (p = .004) and all-cause mortality (p < .001); however, publication bias was not observed when using Begg's test (both p > .05). CONCLUSIONS This meta-analysis reveals that higher IL-6 levels could indicate higher risks of cardiovascular mortality and all-cause mortality in dialysis patients. These findings suggest that monitoring IL-6 cytokine may help to enhance dialysis management and improve the general prognosis of patients.
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Affiliation(s)
- Zeyu Chen
- Department of CardiologyThe First People's Hospital of ZiyangZiyangChina
| | - Yan Wang
- Department of NephrologyThe First People's Hospital of ZiyangZiyangChina
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Muromtseva GA, Aidu EAI, Makarova YK, Kutsenko VA, Yarovaya EB, Trunov VG, Balanova YA, Kapustina AV, Evstifeeva SE, Efanov AY, Shalnova SA, Drapkina OM. Associations of increased spatial QRS-T angle with cardiovascular risk factors: data from the regional sample of ESSE-RF study. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-3000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To study the associations of increased spatial QRS-T angle (sQRS-Ta ≥90°) with cardiovascular risk factors (RFs).Material and methods. We analyzed 1411 electrocardiography (ECG) records of men and women aged 25-64 years from a random regional sample of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. Relationships of sQRS-Ta with the following RFs were assessed: hypertension (HTN), systolic blood pressure (SBP) ≥140 mm Hg, diastolic BP (DBP) ≥90 mm Hg, pulse pressure (PP) ≥60 mm Hg; glucose ≥7,0 mmol/l, hypercholesterolemia; hypertriglyceridemia; high-density lipoprotein cholesterol (HDL-C) ≤1,0/1,2 mmol/l in men/women, low-density lipoprotein cholesterol (LDL-C) >3,0 mmol/l; C-reactive protein (CRP) >1 mg/L; overweight, obesity and abdominal obesity; heart rate (HR) >80 bpm; age >52 years.Results. Weak but significant correlations of sQRS-Ta with age (in women), SBP, DBP, PP, body mass index, waist circumference, lipids, glucose, CRP were revealed. Univariate logistic regression demonstrated significant associations of increased sQRS-Ta with HTN, elevated SBP and PP, overweight, obesity and abdominal obesity, hypercholesterolemia, elevated LDL-C and CRP, hyperglycemia, age >52 years and heart rate >80 bpm. There were no associations of increased sQRS-Ta with male sex, elevated DBP, smoking, hypertriglyceridemia, and low HDL-C levels. The sQRS-Ta associations characteristic of women was similar with associations found among the entire sample. Men with increased sQRS-Ta had no associations with any of analyzed RFs. In multivariate models, increased sQRS-Ta was associated with the following combination of RFs: age >52 years, heart rate >80 bpm, HTN, increased PP, overwaight, and male sex. According to direct stepwise selection among all subjects and in women, the main contribution to sQRS-Ta was made by SBP, age, HDL-C and heart rate.Conclusion. Despite the significance of stepwise regression model (p=0,0001), the low coefficient of determination R2 may indicate other not yet identified determinants with relevant associations with sQRS-Ta.
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Affiliation(s)
- G. A. Muromtseva
- National Medical Research Center of Therapy and Preventive Medicine
| | - E. A.-I. Aidu
- National Medical Research Center of Therapy and Preventive Medicine
| | - Yu. K. Makarova
- National Medical Research Center of Therapy and Preventive Medicine; Lomonosov Moscow State University
| | - V. A. Kutsenko
- National Medical Research Center of Therapy and Preventive Medicine; Lomonosov Moscow State University
| | - E. B. Yarovaya
- National Medical Research Center of Therapy and Preventive Medicine; Lomonosov Moscow State University
| | - V. G. Trunov
- A.A. Kharkevich Institute for Information Transmission Problems
| | - Yu. A. Balanova
- National Medical Research Center of Therapy and Preventive Medicine
| | - A. V. Kapustina
- National Medical Research Center of Therapy and Preventive Medicine
| | - S. E. Evstifeeva
- National Medical Research Center of Therapy and Preventive Medicine
| | - A. Yu. Efanov
- Tyumen State Medical University; Scientific and Practical Medical Center
| | - S. A. Shalnova
- National Medical Research Center of Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center of Therapy and Preventive Medicine
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Sandstedt M, Bergfeldt L, Sandstedt J, Lundqvist A, Fryk E, Jansson PA, Bergström G, Mattsson Hultén L. Wide QRS-T angles are associated with markers of increased inflammatory activity independently of hypertension and diabetes. Ann Noninvasive Electrocardiol 2020; 25:e12781. [PMID: 32638456 PMCID: PMC7679831 DOI: 10.1111/anec.12781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 01/10/2023] Open
Abstract
Background Wide QRS‐T angles and inflammatory activity are markers of future cardiovascular events including sudden cardiac death (SCD). The association between wide QRS‐T angles and inflammatory activation is however not fully understood. Methods 1,094 study participants of both sexes, 50–64 years old, were included from a randomly selected population‐based cohort as a part of the Swedish CArdioPulmonary bioImage Study (SCAPIS) pilot study. Serum samples were analyzed for markers of inflammation, cardiac wall stress/injury, and the metabolic syndrome. Wide QRS‐T angles were defined using Frank vectorcardiography. Variables were analyzed through unsupervised principal component analysis (PCA) as well as Orthogonal Projections to Latent Structures (OPLS) modeling. In addition, a subset of study participants was analyzed in a post hoc matched group design. Results Wide QRS‐T angles correlated positively with markers of inflammation, cardiac wall stress/injury, the metabolic syndrome, and male sex in both PCA and OPLS models. In the matched post hoc analysis, participants with wide QRS‐T angles had significantly higher counts of white blood cells (WBC) and neutrophils in comparison with matched controls. WBC as well as the number of neutrophils, monocytes, basophils, eosinophils and levels of C‐reactive protein, IL‐1, IL‐4, IL‐6, TNF‐α, and NT‐pro‐BNP were also significantly higher in comparison with healthy controls. Conclusions Markers of inflammatory activation and cardiac injury/wall stress were significantly higher in the presence of wide QRS‐T angles. These results corroborate an association between abnormal electrophysiological function and inflammatory activation and may have implications for the prediction of SCD.
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Affiliation(s)
- Mikael Sandstedt
- Region Västra Götaland, Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Bergfeldt
- Region Västra Götaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Sandstedt
- Region Västra Götaland, Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Lundqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emanuel Fryk
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Anders Jansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Gothia Forum, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lillemor Mattsson Hultén
- Region Västra Götaland, Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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