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Pokhrel Bhattarai S, Block RC, Xue Y, Rodriguez DH, Tucker RG, Carey MG. Integrative review of electrocardiographic characteristics in patients with reduced, mildly reduced, and preserved heart failure. Heart Lung 2024; 63:142-158. [PMID: 37913557 DOI: 10.1016/j.hrtlng.2023.10.012] [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: 07/27/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Electrocardiographic (ECG) changes in heart failure with reduced, mildly reduced, and preserved ejection fractions can be critical in clinical assessment while waiting to perform echocardiograms or when it is unavailable. This integrative review aimed to identify ECG characteristics among hospitalized patients demonstrating three types of heart failure during acute decompensation. METHODS We searched an electronic database of PubMed, Web of Science, EMBASE, Scopus, Google Scholar, and ClinicalTrials.gov using medical subject headings (MeSH) terms and keywords. Sixteen studies were synthesized and reported. RESULTS Heart failure with reduced ejection fraction (HFrEF) was more common in men, comorbid with coronary artery diseases and diabetes mellitus, higher BNP/Pro-BNP, wide QRS, and left bundle branch block on ECG. On average, clients with heart failure with preserved ejection fraction (HFpEF) were older and more likely to have a history of atrial fibrillation, valvular heart diseases, hypertension, chronic obstructive pulmonary, and atrial fibrillation (AF) on ECG. Patients with mildly reduced (HFmrEF) were more similar to HFpEF in older patients, comorbid with hypertension, AF and valvular diseases, and AF on ECG. CONCLUSIONS ECG characteristics might be related to left ventricular ejection fraction. Demographics, BNP/Pro-BNP, and ECG changes might help differentiate different heart failure types. Therefore, ECG might be a prognostic tool while caring for heart failure patients when highly skilled resources are unavailable. These identified ECG characteristics help generate research hypotheses and warrant validation in future research.
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Affiliation(s)
- Sunita Pokhrel Bhattarai
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States.
| | | | - Ying Xue
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States
| | - Darcey H Rodriguez
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States; University of Rochester Medical Center, United States
| | - Rebecca G Tucker
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States
| | - Mary G Carey
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States; University of Rochester Medical Center, United States
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Sadaka M, Aboelela A, Arab S, Nawar M. Electrocardiogram as prognostic and diagnostic parameter in follow up of patients with heart failure. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2012.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Mohamed Sadaka
- Faculty of Medicine, Cardiology, Cardiovascular Department , Egypt
| | - Alaa Aboelela
- Faculty of Medicine, Cardiology, Cardiovascular Department , Egypt
| | - Sameh Arab
- Faculty of Medicine, Cardiology, Cardiovascular Department , Egypt
| | - Mostafa Nawar
- Faculty of Medicine, Cardiology, Cardiovascular Department , Egypt
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Sheng F, Chen B, He M, Zhang M, Shen G, Zhao X. The Effect of Diuresis on the Paced QRS Complexes in Pacing-Dependent Patients with Heart Failure. Ann Noninvasive Electrocardiol 2016; 21:175-80. [PMID: 26105564 DOI: 10.1111/anec.12286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Augmentation of the amplitude of QRS complexes with diuretic therapy for patients with congestive heart failure has been well documented. However, the effect of diuresis on the paced QRS complexes in pacing-dependent patients with heart failure is scarce. OBJECTIVE To investigate the effect of diuresis on the paced QRS complexes in pacing-dependent patients with heart failure. METHOD Thrity-two consecutive pacing-dependent patients with heart failure were enrolled in this study. Before and after diuresis, the sums of paced QRS amplitude of leads I+II (ΣpQRSI+II ), six limb leads (ΣpQRS6L ), leads V1 -V3 (ΣpQRSV1-V3 ), leads V4 -V6 (ΣpQRSV4-V6 ), leads V1 -V6 (ΣpQRSV1-V6 ), and lead aVR (pQRSaVR ), paced QRS duration (pQRSd ), paced QT intervals (pQT) and the body weight of each patient were measured, then the % changes (Δ%) in paced electrocardiogram (ECG) variables and the Δ% in body weight were evaluated. RESULTS Compared with before diuresis, paced ECG variables significantly increased and body weight significantly decreased after diuresis, Δ% in paced QRS amplitude(s) in all ECG variables (ΣpQRSI+II, ΣpQRS6L, ΣpQRSV1-V3 , ΣpQRSV4-V6 , ΣpQRSV1-V6 , and pQRSaVR ) correlated well with Δ% in body weight (r = 0.416, r = 0.849, r = 0.901, r = 0.371, r = 0.837, r = 0.619, and P = 0.018, P < 0.001, P < 0.001, P = 0.037, P < 0.001, P < 0.001), while there was no correlation between Δ% in pQRSd and pQT and Δ% in body weight. CONCLUSIONS The changes in amplitude of paced QRS complexes may be useful for the monitoring of therapy of pacing-dependent patients with heart failure.
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Affiliation(s)
- Fuqiang Sheng
- Department of Cardiology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Bin Chen
- Department of Cardiology, East Hospital, Affiliated Shanghai 6th Renmin Hospital, Shanghai, China
| | - Maorong He
- Department of Cardiology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Meilin Zhang
- Department of Cardiology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Guoying Shen
- Department of Cardiology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Xiaowei Zhao
- Department of Cardiology, Shanghai Songjiang District Central Hospital, Shanghai, China
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Protective effect of heme oxygenase-1 on Wistar rats with heart failure through the inhibition of inflammation and amelioration of intestinal microcirculation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:353-65. [PMID: 26346675 PMCID: PMC4554778 DOI: 10.11909/j.issn.1671-5411.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/11/2015] [Accepted: 04/02/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Myocardial infarction (MI) has likely contributed to the increased prevalence of heart failure (HF). As a result of reduced cardiac function, splanchnic blood flow decreases, causing ischemia in villi and damage to the intestinal barrier. The induction of heme oxygenase-1 (HO-1) could prevent, or lessen the effects of stress and inflammation. Thus, the effect and mechanism thereof of HO-1 on the intestines of rats with HF was investigated. METHODS Male Wistar rats with heart failure through ligation of the left coronary artery were identified with an left ventricular ejection fraction of < 45% through echocardiography and then divided into various experimental groups based on the type of peritoneal injection they received [MI: saline; MI + Cobalt protoporphyrin (CoPP): CoPP solution; and MI + Tin mesoporphyrin IX dichloride (SnMP): SnMP solution]. The control group was comprised of rats without coronary ligation. Echocardiography was performed before ligation for a baseline and eight weeks after ligation in order to evaluate the cardiac function of the rats. The bacterial translocation (BT) incidence, mesenteric microcirculation, amount of endotoxins in the vein serum, ileum levels of HO-1, carbon oxide (CO), nitric oxide (NO), interleukin (IL)-10, tumour necrosis factor-α (TNF-α), and the ileum morphology were determined eight weeks after the operation. RESULTS The rats receiving MI + CoPP injections exhibited a recovery in cardiac function, an amelioration of mesenteric microcirculation and change in morphology, a lower BT incidence, a reduction in serum and ileac NO and TNF-α levels, and an elevation in ileac HO-1, CO, and interleukin-10 (IL-10) levels compared to the MI group (P < 0.05). The rats that received the MI + SnMP injections exhibited results inverse to the MI (P < 0.05) group. CONCLUSIONS HO-1 exerted a protective effect on the intestines of rats with HF by inhibiting the inflammation and amelioration of microcirculation through the CO pathway. This protective effect could be independent from the recovery of cardiac function.
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Madias JE. aVR, an index of all ECG limb leads, with clinical utility for monitoring of patients with edematous states, including heart failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1567-76. [PMID: 19889188 DOI: 10.1111/j.1540-8159.2009.02568.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nonreproducibility of precordial electrocardiogram (ECG) leads in serial ECGs has led to emphasis on the limb leads for some applications. Since modern electrocardiographs measure leads I and II and calculate on line the other four limb leads, the former can substitute for the set of six limb leads. Furthermore, based on the mathematical relationship of lead aVR and leads I and II, it was hypothesized that aVR could be used as a representative index of the set of the six limb leads. The aim of this study was to evaluate whether ECG lead aVR could function as an index of all limb leads, in clinical electrocardiography. METHODS Automation-derived and manually derived QRS voltage amplitude measurements of all limb leads in ECGs of a series of 100 randomly selected consecutive patients, and ECGs of 36 patients with various edematous states (EDST), congestive heart failure (CHF), or undergoing hemodialysis (HD), and aVR were inter-correlated with the sums of leads I and II (SigmaI&II), and the entire set of the six limb leads (Sigma6LbLds). RESULTS Correlation of aVR with SigmaI&II and Sigma6LbLds was excellent (P < 0.00005); also, aVR was found to be a reliable index of the six limb leads in repeat ECGs in the patients with various EDST, CHF, or undergoing HD, in whom changes in aVR correlated with changes in patients' body weight. CONCLUSION aVR could be taken as an index of all ECG limb leads in analysis in general, and in monitoring patients with EDST, CHF, and HD in particular.
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Affiliation(s)
- John E Madias
- Mount Sinai School of Medicine of the New York University, Elmhurst Hospital Center, New York, USA.
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Madias JE. Mechanism of attenuation of the QRS voltage in heart failure: a hypothesis. Europace 2009; 11:995-1000. [DOI: 10.1093/europace/eup127] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Low QRS voltage and its causes. J Electrocardiol 2008; 41:498-500. [DOI: 10.1016/j.jelectrocard.2008.06.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 06/23/2008] [Accepted: 06/23/2008] [Indexed: 11/23/2022]
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Madias JE. The Importance of the P-Waves in the Differentiation of Attenuation of the QRS Voltage Due to Pericardial Effusion Versus Due to Peripheral Edema. J Card Fail 2008; 14:55-60. [DOI: 10.1016/j.cardfail.2007.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 06/27/2007] [Accepted: 08/01/2007] [Indexed: 11/16/2022]
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Madias JE, Guglin ME. Augmentation of ECG QRS complexes after fluid removal via a mechanical ultrafiltration pump in patients with congestive heart failure. Ann Noninvasive Electrocardiol 2008; 12:291-7. [PMID: 17970953 DOI: 10.1111/j.1542-474x.2007.00177.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Augmentation of the amplitude of ECG QRS complexes, correlating with loss of weight or fluid volume removed, has been documented in patients with congestive heart failure (CHF). METHODS We investigated the effect of an ultrafiltration (UF) pump on the fluid removal and the amplitude of ECG QRS complexes in patients with CHF. Nine patients aged 48.3 +/- 10.4 years with CHF were treated with an UF system, and weights, fluid removed, and sums of the amplitude of QRS complexes (SigmaQRS), were inter-correlated. RESULTS UF resulted in removal of 4.62 +/- 1.82 L of fluid, 5.0 +/- 2.9% decrease in the weights (P = 0.002) and 18.1 +/- 16.8% increase in the SigmaQRS (P = 0.012). There was a moderate correlation of % increase in the SigmaQRS and net fluid volume losses (UF + urine - oral intake), (r = 0.67, P = 0.0471, and a poor correlation between % increase in the SigmaQRS and % decrease in weights (r = 0.11, P = 0.77). Correlations of the change in weights after UF with the fluid removed by UF, or with the volume of total fluid loss (including insensible losses) were moderate but barely statistically significant (r = 0.65, P = 0.0559), and (r = 0.65, P = 0.0577), correspondingly. CONCLUSION Augmentation of the amplitude of QRS complexes correlates well with net fluid loss in response to UF in patients with CHF, and can be employed as an index of effectiveness of therapy. Also, a model of fluid losses in patients treated for CHF is being proposed.
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Affiliation(s)
- John E Madias
- Mount Sinai School of Medicine of the New York University, Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York, USA.
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Superiority of the limb leads over the precordial leads on the 12-lead ECG in monitoring fluctuating fluid overload in a patient with congestive heart failure. J Electrocardiol 2007; 40:395-9. [DOI: 10.1016/j.jelectrocard.2006.10.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 10/23/2006] [Indexed: 01/24/2023]
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Madias JE. Low Voltage ECG in Myocarditis: Peripheral Edema as a Plausible Contributing Mechanism. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:448-52. [PMID: 17367370 DOI: 10.1111/j.1540-8159.2007.00691.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 24-year-old woman was hospitalized with acute myocarditis that led to multiple organ, including heart, failure, with fluid retention. An echocardiogram showed left ventricular ejection fraction approximately 10%, and her electrocardiogram (ECG) revealed low voltage. She rapidly recovered and was discharged 15 days after admission. On evaluation at 1, 10, and 22 weeks after discharge, she was asymptomatic, with unlimited exercise tolerance. An echocardiogram 11 weeks after discharge from the hospital showed left ventricular ejection fraction of approximately 60%. Correlations of weights with ECG QRS voltage parameters in the hospital revealed r = 0.80 and 0.83, with P = 0.021 and 0.029, suggesting that >or=64% of the attenuation of the QRS potentials could be accounted for by the corresponding gain in weight.
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Affiliation(s)
- John E Madias
- Mount Sinai School of Medicine of the New York University, New York, USA.
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Abstract
Two patients with cirrhosis (CIR), ascites (ASC), and peripheral oedema (PEROD) are presented. They were followed for many years, had multiple hospital admissions and clinic evaluations, had repeated laboratory testing, and many ECGs recorded. As their condition worsened, they developed attenuation of the ECG voltage (ATTECGV), which was more pronounced during intervals of increased fluid overload. Attenuation of the ECG voltage was decreased at times of successful diuresis and amelioration of PEROD, while abdominal paracenteses for ASC did not have any influence on the ATTECGV, suggesting that ATTECGV in patients with CIR is due to the associated PEROD, and not to ASC.
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Affiliation(s)
- John E Madias
- Mount Sinai School of Medicine of the New York University and the Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373, New York, NY, USA.
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Madias JE. The Resting Electrocardiogram in the Management of Patients with Congestive Heart Failure: Established Applications and New Insights. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:123-8. [PMID: 17241326 DOI: 10.1111/j.1540-8159.2007.00586.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The resting electrocardiogram (ECG) furnishes essential information for the diagnosis, management, and prognostic evaluation of patients with congestive heart failure (CHF). Almost any ECG diagnostic entity may turn out to be useful in the care of patients with CHF, revealing the non-specificity of the ECG in CHF. Nevertheless a number of CHF/ECG correlates have been proposed and found to be indispensable in clinical practice; they include, among others, the ECG diagnoses of myocardial ischemia and infarction, atrial fibrillation, left ventricular hypertrophy/dilatation, left bundle branch block and intraventricular conduction delays, left atrial abnormality, and QT-interval prolongation. In addition to the above well-known applications of the ECG for patients with CHF, a recently described association of peripheral edema (PERED), sometimes even imperceptible by physical examination, with attenuated ECG potentials, could extend further the diagnostic range of the clinician. These ECG voltage attenuations are of extracardiac mechanism, and impact the amplitude of QRS complexes, P-waves, and T-waves, occasionally resulting also in shortening of the QRS complex and QT interval duration. PERED alleviation, in response to therapy of CHF, reverses all above alterations. These fresh diagnostic insights have potential application in the follow-up of patients with CHF, and in their selection for implantation of cardioverter/defibrillator and/or cardiac resynchronization systems. If sought, PERED-induced ECG changes are abundantly present in the hospital and clinic environments; if their detection and monitoring are incorporated in the clinician's "routine," considerable improvements in the care of patients with CHF may be realized.
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Affiliation(s)
- John E Madias
- Mount Sinai School of Medicine of the New York University and the Division of Cardiology, Elmhurst Hospital Center, New York 11373, USA.
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Madias JE. ECG Changes in Response to Diuresis in an Ambulatory Patient With Congestive Heart Failure. ACTA ACUST UNITED AC 2006; 12:277-83. [PMID: 17033277 DOI: 10.1111/j.1527-5299.2006.05518.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This case report describes an ambulatory patient with congestive heart failure and peripheral edema who lost 18 lb in response to enhanced diuresis over the course of 1 week. The ECG showed increases in the amplitude of P waves, QRS complexes, and T waves; the duration of P waves, QRS complexes, and QT intervals; and the dispersion of P and QT. The clinical implications of these ECG changes are discussed.
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Affiliation(s)
- John E Madias
- Mount Sinai School of Medicine of New York University, New York, NY, USA
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Madias JE. Congestive Heart Failure, Peripheral Edema, and Standard and Signal-Averaged ECGs. ACTA ACUST UNITED AC 2006; 12:179-80. [PMID: 16773765 DOI: 10.1111/j.1527-5299.2006.05585.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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