ECG Changes in Response to Diuresis in an Ambulatory Patient With Congestive Heart Failure

Integrative review of electrocardiographic characteristics in patients with reduced, mildly reduced, and preserved heart failure

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.

A Robust Multilevel DWT Densely Network for Cardiovascular Disease Classification

Cardiovascular disease is the leading cause of death worldwide. Immediate and accurate diagnoses of cardiovascular disease are essential for saving lives. Although most of the previously reported works have tried to classify heartbeats accurately based on the intra-patient paradigm, they suffer from category imbalance issues since abnormal heartbeats appear much less regularly than normal heartbeats. Furthermore, most existing methods rely on data preprocessing steps, such as noise removal and R-peak location. In this study, we present a robust classification system using a multilevel discrete wavelet transform densely network (MDD-Net) for the accurate detection of normal, coronary artery disease (CAD), myocardial infarction (MI) and congestive heart failure (CHF). First, the raw ECG signals from different databases are divided into same-size segments using an original adaptive sample frequency segmentation algorithm (ASFS). Then, the fusion features are extracted from the MDD-Net to achieve great classification performance. We evaluated the proposed method considering the intra-patient and inter-patient paradigms. The average accuracy, positive predictive value, sensitivity and specificity were 99.74%, 99.09%, 98.67% and 99.83%, respectively, under the intra-patient paradigm, and 96.92%, 92.17%, 89.18% and 97.77%, respectively, under the inter-patient paradigm. Moreover, the experimental results demonstrate that our model is robust to noise and class imbalance issues.

A proposal for monitoring patients with heart failure via "smart phone technology"-based electrocardiograms

The ubiquitous smart phone/device technology (SPT) has enabled the safe acquisition/transmission (A/T) of clinical and laboratory patient data, including the electrocardiogram (ECG). SPT-based A/T of the ECG has been found useful in the detection of atrial fibrillation, in monitoring of the QTc interval, in patients undergoing antiarrhythmic drug loading, and in management of patients with acute ST-elevation myocardial infarction. Previous work has shown a relationship between changes in the voltage of the ECG QRS complexes, with perturbations in the edematous state of various etiologies, including heart failure (HF). It is proposed herein to employ serially SPT-based 3-lead ECG A/T for the monitoring and management of patients with HF in their ambient environment. The proposed method will enable patients with HF to acquire/transmit their 3-lead ECG to the caring HF team, using only their smart phone and it takes into consideration the advanced degrees of physical incapacitation and age-related infirmities inherent to the HF population.

The Effect of Diuresis on the Paced QRS Complexes in Pacing-Dependent Patients with Heart Failure

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.

aVR, an index of all ECG limb leads, with clinical utility for monitoring of patients with edematous states, including heart failure

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.

Attenuation of ECG voltage in cirrhotic patients

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.