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Abdelmissih S, Abdelgwad M, Ali DME, Negm MSI, Eshra MA, Youssef A. High-dose Agomelatine Combined with Haloperidol Decanoate Improves Cognition, Downregulates MT2, Upregulates D5, and Maintains Krüppel-like Factor 9 But Alters Cardiac Electrophysiology. J Pharmacol Exp Ther 2024; 390:125-145. [PMID: 38816228 DOI: 10.1124/jpet.123.002087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024] Open
Abstract
Haloperidol decanoate (HD) has been implicated in cognitive impairment. Agomelatine (AGO) has been claimed to improve cognition. We aimed at investigating the effects of HD + low- or high-dose AGO on cognition, verifying the melatonergic/dopaminergic to the cholinergic hypothesis of cognition and exploring relevant cardiovascular issues in adult male Wistar albino rats. HD + high-dose AGO prolonged the step-through latency by +61.47% (P < 0.0001), increased the time spent in bright light by +439.49% (P < 0.0001), reduced the time spent in dim light by -66.25% (P < 0.0001), and increased the percent of alternations by +71.25% (P < 0.0001), despite the reductions in brain acetylcholine level by -10.67% (P < 0.0001). Neurodegeneration was minimal, while the mean power frequency of the source wave was reduced by -23.39% (P < 0.05). Concurrently, the relative expression of brain melatonin type 2 receptors was reduced by -18.75% (P < 0.05), against increased expressions of dopamine type 5 receptors by +22.22% (P < 0.0001) and angiopoietin-like 4 by +119.18% (P < 0.0001). Meanwhile, electrocardiogram (ECG) demonstrated inverted P wave, reduced P wave duration by -36.15% (P < 0.0001) and PR interval by -19.91% (P < 0.0001), prolonged RR interval by +27.97% (P < 0.05), increased R wave amplitude by +523.15% (P < 0.0001), and a depressed ST segment and inverted T wave. In rats administered AGO, HD, or HD+ low-dose AGO, Alzheimer's disease (AD)-like neuropathologic features were more evident, accompanied by extensive ECG and neurochemical alterations. HD + high-dose AGO enhances cognition but alters cardiac electrophysiology. SIGNIFICANCE STATEMENT: Given the issue of cognitive impairment associated with HD and the claimed cognitive-enhancing activity of AGO, combined high-dose AGO with HD improved cognition of adult male rats, who exhibited minimal neurodegenerative changes. HD+ high-dose AGO was relatively safe regarding triggering epileptogenesis, while it altered cardiac electrophysiology. In the presence of low acetylcholine, the melatonergic/dopaminergic hypothesis, added to angiopoietin-like 4 and Krüppel-like factor 9, could offer some clue, thus offering novel targets for pharmacologic manipulation of cognition.
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Affiliation(s)
- Sherine Abdelmissih
- Departments of Medical Pharmacology (S.A., A.Y.), Medical Biochemistry and Molecular Biology (M.A.), Pathology (M.S.I.N.), and Medical Physiology (M.A.E.), Faculty of Medicine, Kasr Al-Ainy, Cairo University, Cairo, Egypt; and Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Sohag University, Sohag, Egypt (D.M.E.A.)
| | - Marwa Abdelgwad
- Departments of Medical Pharmacology (S.A., A.Y.), Medical Biochemistry and Molecular Biology (M.A.), Pathology (M.S.I.N.), and Medical Physiology (M.A.E.), Faculty of Medicine, Kasr Al-Ainy, Cairo University, Cairo, Egypt; and Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Sohag University, Sohag, Egypt (D.M.E.A.)
| | - Doaa Mohamed Elroby Ali
- Departments of Medical Pharmacology (S.A., A.Y.), Medical Biochemistry and Molecular Biology (M.A.), Pathology (M.S.I.N.), and Medical Physiology (M.A.E.), Faculty of Medicine, Kasr Al-Ainy, Cairo University, Cairo, Egypt; and Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Sohag University, Sohag, Egypt (D.M.E.A.)
| | - Mohamed Sharif Ismail Negm
- Departments of Medical Pharmacology (S.A., A.Y.), Medical Biochemistry and Molecular Biology (M.A.), Pathology (M.S.I.N.), and Medical Physiology (M.A.E.), Faculty of Medicine, Kasr Al-Ainy, Cairo University, Cairo, Egypt; and Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Sohag University, Sohag, Egypt (D.M.E.A.)
| | - Mohamed Ali Eshra
- Departments of Medical Pharmacology (S.A., A.Y.), Medical Biochemistry and Molecular Biology (M.A.), Pathology (M.S.I.N.), and Medical Physiology (M.A.E.), Faculty of Medicine, Kasr Al-Ainy, Cairo University, Cairo, Egypt; and Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Sohag University, Sohag, Egypt (D.M.E.A.)
| | - Amal Youssef
- Departments of Medical Pharmacology (S.A., A.Y.), Medical Biochemistry and Molecular Biology (M.A.), Pathology (M.S.I.N.), and Medical Physiology (M.A.E.), Faculty of Medicine, Kasr Al-Ainy, Cairo University, Cairo, Egypt; and Department of Biochemistry and Molecular Biology, Faculty of Pharmacy, Sohag University, Sohag, Egypt (D.M.E.A.)
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Kloosterman M, Boonstra MJ, van der Schaaf I, Loh P, van Dam PM. Modeling ventricular repolarization gradients in normal cases using the equivalent dipole layer. J Electrocardiol 2024; 82:27-33. [PMID: 38000150 DOI: 10.1016/j.jelectrocard.2023.11.003] [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: 06/02/2023] [Revised: 09/20/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023]
Abstract
Background Electrical activity underlying the T-wave is less well understood than the QRS-complex. This study investigated the relationship between normal T-wave morphology and the underlying ventricular repolarization gradients using the equivalent dipole layer (EDL). Methods Body-surface-potential-maps (BSPM, 67‑leads) were obtained in nine normal cases. Subject specific MRI-based anatomical heart/torso-models with electrode positions were created. The boundary element method was used to account for the volume conductor effects. To simulate the measured T-waves, the EDL was used to apply different ventricular repolarization gradients: a) transmural, b) interventricular c) apico-basal and d) all three gradients (a-c) combined. The combined gradient (d) was optimized using an inverse procedure (Levenberg-Marquardt). Correspondence between simulated and measured T-waves was assessed using correlation coefficient (CC) and relative difference (RD). Results Realistic T-waves were simulated if repolarization times of: (a) the epicardium were smaller than the endocardium; (b) the left ventricle were smaller than the right ventricle and (c) the apex increased towards the base. The apico-basal gradient resulted in the highest correspondence between measured and simulated T-waves (CC = 0.84(0.81-0.91);RD = 0.68(0.60-0.71)) compared to a transmural gradient (CC = 0.77(0.71-0.80);RD = 1.46(0.82-1.75)) and an interventricular gradient (CC = 0.71(0.67-0.80);RD = 0.85(0.75-0.87)). All three gradients combined further improved the correspondence between measured and simulated T-waves (CC = 0.83(0.82-0.89);RD = 0.60(0.51-0.63)), especially after optimization (CC = 0.96(0.94-0.98);RD = 0.27(0.22-0.34)). Conclusion The application of all repolarization gradients combined resulted in the largest agreement between simulated and measured T-waves, followed by the apico-basal repolarization gradient. With these findings, we will optimize our EDL-based inverse procedure to assess repolarization abnormalities.
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Affiliation(s)
- M Kloosterman
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands,.
| | - M J Boonstra
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - I van der Schaaf
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - P Loh
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - P M van Dam
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands,; ECG Excellence, Weijland 38, 2415 BC Nieuwerbrug, the Netherlands
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Dahlberg P, Axelsson KJ, Rydberg A, Lundahl G, Gransberg L, Bergfeldt L. Spatiotemporal repolarization dispersion before and after exercise in patients with long QT syndrome type 1 versus controls: probing into the arrhythmia substrate. Am J Physiol Heart Circ Physiol 2023; 325:H1279-H1289. [PMID: 37773058 DOI: 10.1152/ajpheart.00335.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023]
Abstract
Congenital long QT syndrome (LQTS) carries an increased risk for syncope and sudden death. QT prolongation promotes ventricular extrasystoles, which, in the presence of an arrhythmia substrate, might trigger ventricular tachycardia degenerating into fibrillation. Increased electrical heterogeneity (dispersion) is the suggested arrhythmia substrate in LQTS. In the most common subtype LQT1, physical exercise predisposes for arrhythmia and spatiotemporal dispersion was therefore studied in this context. Thirty-seven patients (57% on β-blockers) and 37 healthy controls (mean age, 31 vs. 35; range, 6-68 vs. 6-72 yr) performed an exercise test. Frank vectorcardiography was used to assess spatiotemporal dispersion as Tampl, Tarea, the ventricular gradient (VG), and the Tpeak-end interval from 10-s signal averages before and 7 ± 2 min after exercise; during exercise too much signal disturbance excluded analysis. Baseline and maximum heart rates as well as estimated exercise intensity were similar, but heart rate recovery was slower in patients. At baseline, QT and heart rate-corrected QT (QTcB) were significantly longer in patients (as expected), whereas dispersion parameters were numerically larger in controls. After exercise, QTpeakcB and Tpeak-endcB increased significantly more in patients (18 ± 23 vs. 7 ± 10 ms and 12 ± 17 vs. 2 ± 6 ms; P < 0.001 and P < 0.01). There was, however, no difference in the change in Tampl, Tarea, and VG between groups. In conclusion, although temporal dispersion of repolarization increased significantly more after exercise in patients with LQT1, there were no signs of exercise-induced increase in global dispersion of action potential duration and morphology. The arrhythmia substrate/mechanism in LQT1 warrants further study.NEW & NOTEWORTHY Physical activity increases the risk for life-threatening arrhythmias in LQTS type 1 (LQT1). The arrhythmia substrate is presumably altered electrical heterogeneity (a.k.a. dispersion). Spatiotemporal dispersion parameters were therefore compared before and after exercise in patients versus healthy controls using Frank vectorcardiography, a novelty. Physical exercise prolonged the time between the earliest and latest complete repolarization in patients versus controls, but did not increase parameters reflecting global dispersion of action potential duration and morphology, another novelty.
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Affiliation(s)
- Pia Dahlberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Vaestra Goetaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karl-Jonas Axelsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Vaestra Goetaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Rydberg
- Division of Pediatrics, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Gunilla Lundahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Gransberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Vaestra Goetaland, Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ömür SE, Zorlu Ç, Açıkel B. The effect of dapagliflozin therapy on ventricular repolarization parameters in electrocardiography in patients with diabetic cardiovascular disease. J Diabetes Complications 2023; 37:108547. [PMID: 37356234 DOI: 10.1016/j.jdiacomp.2023.108547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Dapagliflozin is an agent that has both antihyperglycemic effects and is significantly associated with a lower risk of cardiovascular events in patients with diabetes mellitus (DM). However, there is insufficient data and information about the effect of dapagliflozin on electrocardiographic (ECG) parameters. AIM The effects of dapagliflozin on ventricular repolarization parameters have not been fully elucidated yet. This study aimed to investigate whether dapagliflozin has a positive effect on ventricular repolarization heterogeneity parameters in patients with type 2 DM. METHOD We retrospectively enrolled 140 patients with a known diagnosis of type 2 DM who were newly prescribed dapagliflozin in addition to standard anti-diabetic therapy. The patients were divided into two groups according to whether they had cardiovascular disease (CVD). The effect of dapagliflozin treatment on ventricular repolarization parameters (frontal plane QRST angle, Tp-e interval, Tp-e/QTc, QTc, and QTc dispersion) was investigated, patient groups were compared before and after treatment. RESULTS Among 140 patients, 70 (50 %) had CVD and 70 (50 %) did not have CVD. Dapagliflozin treatment resulted in significant reductions in ventricular repolarization parameters over the study period in the CVD group with diabetes. Mean fQRST angle, Tp-e interval, Tp-e/QTc, QTc, and QTc dispersion were significantly lower than baseline values at 6-month follow-up visits in the CVD group (61.61 ± 9.22° vs 52.55 ± 8.31°, 74.45 ± 16.06 msec vs 63.27 ± 13.99 msec, 0.19 ± 0.03 vs 0.16 ± 0.03, 384.12 ± 47.93 msec vs 356.15 ± 43.31 mesc, 55.28 ± 5.50 msec vs 48.08 ± 6.48 msec for all pairwise comparisons p < 0.001). CONCLUSION Similar antihyperglycemic effects were found with dapagliflozin treatment in patients with and without CVD. However, significant reductions in ventricular repolarization parameters were observed only in patients with CVD.
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Affiliation(s)
- Sefa Erdi Ömür
- Department of Cardiology,Tokat Gaziosmanpaşa University, Tokat, Turkey.
| | - Çağrı Zorlu
- Department of Cardiology,Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Barış Açıkel
- Department of Cardiology,Tokat Gaziosmanpaşa University, Tokat, Turkey
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Gillette K, Gsell MAF, Strocchi M, Grandits T, Neic A, Manninger M, Scherr D, Roney CH, Prassl AJ, Augustin CM, Vigmond EJ, Plank G. A personalized real-time virtual model of whole heart electrophysiology. Front Physiol 2022; 13:907190. [PMID: 36213235 PMCID: PMC9539798 DOI: 10.3389/fphys.2022.907190] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/15/2022] [Indexed: 01/12/2023] Open
Abstract
Computer models capable of representing the intrinsic personal electrophysiology (EP) of the heart in silico are termed virtual heart technologies. When anatomy and EP are tailored to individual patients within the model, such technologies are promising clinical and industrial tools. Regardless of their vast potential, few virtual technologies simulating the entire organ-scale EP of all four-chambers of the heart have been reported and widespread clinical use is limited due to high computational costs and difficulty in validation. We thus report on the development of a novel virtual technology representing the electrophysiology of all four-chambers of the heart aiming to overcome these limitations. In our previous work, a model of ventricular EP embedded in a torso was constructed from clinical magnetic resonance image (MRI) data and personalized according to the measured 12 lead electrocardiogram (ECG) of a single subject under normal sinus rhythm. This model is then expanded upon to include whole heart EP and a detailed representation of the His-Purkinje system (HPS). To test the capacities of the personalized virtual heart technology to replicate standard clinical morphological ECG features under such conditions, bundle branch blocks within both the right and the left ventricles under two different conduction velocity settings are modeled alongside sinus rhythm. To ensure clinical viability, model generation was completely automated and simulations were performed using an efficient real-time cardiac EP simulator. Close correspondence between the measured and simulated 12 lead ECG was observed under normal sinus conditions and all simulated bundle branch blocks manifested relevant clinical morphological features.
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Affiliation(s)
- Karli Gillette
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Matthias A. F. Gsell
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- NAWI Graz, Institute of Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | | | - Thomas Grandits
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- NAWI Graz, Institute of Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | | | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Anton J. Prassl
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Christoph M. Augustin
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | | | - Gernot Plank
- Gottfried Schatz Research Center—Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
- *Correspondence: Gernot Plank,
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Brette F, Le Guennec JY, Thireau J. Why are you talking with snakes? To get new evolutionary insights in cardiac electrophysiology! J Gen Physiol 2022; 154:213071. [PMID: 35297958 PMCID: PMC8939362 DOI: 10.1085/jgp.202113060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Brette, Le Guennec, and Thireau discuss recent findings on evolutionary cardiac electrophysiology.
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Affiliation(s)
- Fabien Brette
- University of Bordeaux, CRCTB U1045, INSERM, Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux, France.,PhyMedExp INSERM, Centre National de la Recherche Scientifique, Université de Montpellier, CHRU Montpellier, Montpellier, France
| | - Jean-Yves Le Guennec
- PhyMedExp INSERM, Centre National de la Recherche Scientifique, Université de Montpellier, CHRU Montpellier, Montpellier, France
| | - Jérôme Thireau
- PhyMedExp INSERM, Centre National de la Recherche Scientifique, Université de Montpellier, CHRU Montpellier, Montpellier, France
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Sung E, Prakosa A, Trayanova NA. Analyzing the Role of Repolarization Gradients in Post-infarct Ventricular Tachycardia Dynamics Using Patient-Specific Computational Heart Models. Front Physiol 2021; 12:740389. [PMID: 34658925 PMCID: PMC8514757 DOI: 10.3389/fphys.2021.740389] [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: 07/13/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Aims: Disease-induced repolarization heterogeneity in infarcted myocardium contributes to VT arrhythmogenesis but how apicobasal and transmural (AB-TM) repolarization gradients additionally affect post-infarct VT dynamics is unknown. The goal of this study is to assess how AB-TM repolarization gradients impact post-infarct VT dynamics using patient-specific heart models. Method: 3D late gadolinium-enhanced cardiac magnetic resonance images were acquired from seven post-infarct patients. Models representing the patient-specific scar and infarct border zone distributions were reconstructed without (baseline) and with repolarization gradients along both the AB-TM axes. AB only and TM only models were created to assess the effects of each ventricular gradient on VT dynamics. VTs were induced in all models via rapid pacing. Results: Ten baseline VTs were induced. VT inducibility in AB-TM models was not significantly different from baseline (p>0.05). Reentry pathways in AB-TM models were different than baseline pathways due to alterations in the location of conduction block (p<0.05). VT exit sites in AB-TM models were different than baseline VT exit sites (p<0.05). VT inducibility of AB only and TM only models were not significantly different than that of baseline (p>0.05) or AB-TM models (p>0.05). Reentry pathways and VT exit sites in AB only and TM only models were different than in baseline (p<0.05). Lastly, repolarization gradients uncovered multiple VT morphologies with different reentrant pathways and exit sites within the same structural, conducting channels. Conclusion: VT inducibility was not impacted by the addition of AB-TM repolarization gradients, but the VT reentrant pathway and exit sites were greatly affected due to modulation of conduction block. Thus, during ablation procedures, physiological and pharmacological factors that impact the ventricular repolarization gradient might need to be considered when targeting the VTs.
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Affiliation(s)
- Eric Sung
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, United States
| | - Adityo Prakosa
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, United States
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States.,Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, MD, United States
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Myocardial repolarization is affected in patients with diabetic retinopathy. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.955574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chowdhury RA, Debney MT, Protti A, Handa BS, Patel KHK, Lyon AR, Shah AM, Ng FS, Peters NS. Rotigaptide Infusion for the First 7 Days After Myocardial Infarction-Reperfusion Reduced Late Complexity of Myocardial Architecture of the Healing Border-Zone and Arrhythmia Inducibility. J Am Heart Assoc 2021; 10:e020006. [PMID: 33870715 PMCID: PMC8200720 DOI: 10.1161/jaha.120.020006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Survivors of myocardial infarction are at increased risk of late ventricular arrhythmias, with infarct size and scar heterogeneity being key determinants of arrhythmic risk. Gap junctions facilitate the passage of small ions and morphogenic cell signaling between myocytes. We hypothesized that gap junctions enhancement during infarction–reperfusion modulates structural and electrophysiological remodeling and reduces late arrhythmogenesis. Methods and Results Infarction–reperfusion surgery was carried out in male Sprague‐Dawley rats followed by 7 days of rotigaptide or saline administration. The in vivo and ex vivo arrhythmogenicity was characterized by programmed electrical stimulation 3 weeks later, followed by diffusion‐weighted magnetic resonance imaging and Masson's trichrome histology. Three weeks after 7‐day postinfarction administration of rotigaptide, ventricular tachycardia/ventricular fibrillation was induced on programmed electrical stimulation in 20% and 53% of rats, respectively (rotigaptide versus control), resulting in reduction of arrhythmia score (3.2 versus 1.4, P=0.018), associated with the reduced magnetic resonance imaging parameters fractional anisotropy (fractional anisotropy: −5% versus −15%; P=0.062) and mean diffusivity (mean diffusivity: 2% versus 6%, P=0.042), and remodeling of the 3‐dimensional laminar structure of the infarct border zone with reduction of the mean (16° versus 19°, P=0.013) and the dispersion (9° versus 12°, P=0.015) of the myofiber transverse angle. There was no change in ECG features, spontaneous arrhythmias, or mortality. Conclusions Enhancement of gap junctions function by rotigaptide administered during the early healing phase in reperfused infarction reduces later complexity of infarct scar morphology and programmed electrical stimulation–induced arrhythmias, and merits further exploration as a feasible and practicable intervention in the acute myocardial infarction management to reduce late arrhythmic risk.
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Affiliation(s)
- Rasheda A Chowdhury
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Michael T Debney
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Andrea Protti
- King's British Heart Foundation Centre School of Cardiovascular Medicine and Sciences Kings College London London United Kingdom
| | - Balvinder S Handa
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Kiran H K Patel
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Alexander R Lyon
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Ajay M Shah
- King's British Heart Foundation Centre School of Cardiovascular Medicine and Sciences Kings College London London United Kingdom
| | - Fu Siong Ng
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
| | - Nicholas S Peters
- National Heart & Lung Institute and ElectroCardioMaths Programme of the Imperial Centre for Cardiac EngineeringImperial College London London United Kingdom
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Zhao D, Liang B, Peng J, Tang L, Su R, Luo L, Deng B, Wang S. Tp-e and (Tp-e)/QT ratio as a non-invasive risk factors for malignant ventricular arrhythmia in patients with idiopathic ventricular premature complexes. J Clin Lab Anal 2020; 35:e23636. [PMID: 33332643 PMCID: PMC7891518 DOI: 10.1002/jcla.23636] [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] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the role of Tp‐e and (Tp‐e)/QT ratio in differentiating benign ventricular premature complex (VPC) and malignant polymorphic ventricular tachycardia (PVT). Methods From January 2017 to December 2017, patients with documented polymorphic ventricular tachycardia (PVT) or ventricular fibrillation (VF) were consecutive included and classified as PVT/VF group. Sixty age‐ and sex‐matched healthy individuals were recruited as comparative control and subdivided into non‐VPC and VPC group. Clinical characteristics and Tp‐e and Tp‐e/QT ratio between the three groups were compared. Results Tp‐e and (Tp‐e)/QT ratio were significantly higher in patients of PVT/VF group compared with the other two groups (P < .001). Episodes of syncope were more frequent in patients with PVT/VF (P < .05). The sensitivity and specificity of a Tp‐e interval ≥86 ms for malignant arrhythmias triggered by VPCs were 88% and 66%, respectively, while the sensitivity and specificity of the Tp‐e/QT ratio ≥0.24 were 82% and 70%, respectively. Five patients complained recurrence of syncope in the PVT/VF group and 1 patient died with mean follow‐up of 18 months. Conclusion Tp‐e interval and the Tp‐Te/QT ratio is significantly increased in patients with PVT/VF and may be used as a novel non‐invasive marker of differentiating malignant and benign VPC.
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Affiliation(s)
- Donghua Zhao
- Department of Cardiology, The First People's Hospital of Zhaoqing City, Zhaoqing City, China
| | - Bo Liang
- Department of Cardiology, The First People's Hospital of Zhaoqing City, Zhaoqing City, China
| | - Jian Peng
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liangyu Tang
- Department of Cardiology, The First People's Hospital of Zhaoqing City, Zhaoqing City, China
| | - Rongbin Su
- Department of Cardiology, The First People's Hospital of Zhaoqing City, Zhaoqing City, China
| | - Lingli Luo
- Department of Cardiology, The First People's Hospital of Zhaoqing City, Zhaoqing City, China
| | - Bin Deng
- Department of Cardiology, The First People's Hospital of Zhaoqing City, Zhaoqing City, China
| | - Shuyuan Wang
- Department of Cardiology, The First People's Hospital of Zhaoqing City, Zhaoqing City, China
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11
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Arteyeva NV. Dispersion of ventricular repolarization: Temporal and spatial. World J Cardiol 2020; 12:437-449. [PMID: 33014291 PMCID: PMC7509993 DOI: 10.4330/wjc.v12.i9.437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/11/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Repolarization heterogeneity (RH) is an intrinsic property of ventricular myocardium and the reason for T-wave formation on electrocardiogram (ECG). Exceeding the physiologically based RH level is associated with appearance of life-threatening ventricular arrhythmias and sudden cardiac death. In this regard, an accurate and comprehensive evaluation of the degree of RH parameters is of importance for assessment of heart state and arrhythmic risk. This review is devoted to comprehensive consideration of RH phenomena in terms of electrophysiological processes underlying RH, cardiac electric field formation during ventricular repolarization, as well as clinical significance of RH and its reflection on ECG parameters. The formation of transmural, apicobasal, left-to-right and anterior-posterior gradients of action potential durations and end of repolarization times resulting from the heterogenous distribution of repolarizing ion currents and action potential morphology throughout the heart ventricles, and the different sensitivity of myocardial cells in different ventricular regions to the action of pharmacological agents, temperature, frequency of stimulation, etc., are being discussed. The review is focused on the fact that RH has different aspects – temporal and spatial, global and local; ECG reflection of various RH aspects and their clinical significance are being discussed. Strategies for comprehensive assessment of ventricular RH using different ECG indices reflecting various RH aspects are presented.
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Affiliation(s)
- Natalia V Arteyeva
- Laboratory of Cardiac Physiology, Institute of Physiology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, Syktyvkar 167982, Russia
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12
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Bılge S, Tezel O, Acar YA, Cüce F, Karadaş Ö, Taşar M. Investigation of the Value of T peak to T end and QTc Intervals as Electrocardiographic Arrhythmia Susceptibility Markers in Acute Ischemic Stroke. Noro Psikiyatr Ars 2020; 57:171-176. [PMID: 32952418 PMCID: PMC7481971 DOI: 10.29399/npa.24996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/30/2019] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Arrhythmias are one of the most common causes of mortality in patients with acute ischemic stroke (AIS). This study aimed to investigate the relationships of arrhythmia susceptibility markers (QT, QTc, Tpe, Tpe-D, Tpe/QT, and Tpe/QTc) with the localization and volume of the ischemic area, the National Institutes of Health Stroke Scale (NIHSS) scores, and troponin levels in AIS. METHODS Patients diagnosed with AIS in the emergency department in the period from 01 November 2016 to 31 March 2019 were retrospectively reviewed. Patients admitted to the emergency department with no pathological ECG findings were included. The measurements of QT, QTc, Tpe, Tpe-D, Tpe/QTc, and Tpe/QT were performed under a digital microscope. The NIHSS scores, troponin values, and the ischemic area volume based on the diffusion-weighted magnetic resonance imaging findings at the time of admission were found. RESULTS A total of 135 patients, comprising 70 AIS patients and 65 individuals as controls, were included in the study. The male/female ratio was 73/62 and the mean age was 68.51±10.80 years. All of the ECG parameters in the AIS group and the control group were statistically significantly different between the groups except Tpe-D (p=0.454) (For QT, QTc, Tpe, Tpe/QTc, and Tpe/QT; p=0.003, 0.022, <0.001, 0.001, 0.001; respectively). QT, QTc, Tpe, Tpe/QTc, and Tpe/QT values were not significantly different between the groups with a NIHSS score of ≤5 and >5 (p=0.480, 0.688, 0.663, 0.512, 0.333, respectively). CONCLUSIONS Arrhythmia susceptibility markers including QT, QTc, Tpe, the values of Tpe-D, Tpe/QT, and Tpe/QTc are different in AIS patients compared to the individuals in the control group; therefore, these parameters can be included among the other parameters of close cardiac monitoring.
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Affiliation(s)
- Sedat Bılge
- Department of Emergency Medicine, Gülhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Onur Tezel
- Department of Emergency Medicine, Gülhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yahya Ayhan Acar
- Department of Emergency Medicine, Gülhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ferhat Cüce
- Department of Radiology, Gülhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Ömer Karadaş
- Department of Neurology, Gülhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mustafa Taşar
- Department of Radiology, Gülhane School of Medicine, University of Health Sciences, Ankara, Turkey
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13
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Subramanian M, Ahamed H, Prabhu M, Mathew N, Harikrishnan MS, Pai PG, Natarajan K. The prognostic value of dispersion of repolarization in stress cardiomyopathy. J Electrocardiol 2020; 62:79-85. [PMID: 32835984 DOI: 10.1016/j.jelectrocard.2020.03.006] [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: 09/22/2019] [Revised: 02/23/2020] [Accepted: 03/12/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Although abnormalities of ventricular repolarization are a hallmark of SC, their clinical impact on management remains to be determined. This study sought to evaluate the prognostic value of dispersion of repolarization in stress cardiomyopathy (SC) with regards to major cardiac events (MCE), recovery time, and recurrence. METHODS This study analyzed data from258 patients with SC, from January 2009 to January 2018. Standard 12 lead ECG recordings during the acute, subacute, and recovery phases were collected for each eligible patient. Logistic regression was used to identify independent predictors of MCE, a composite of 30 day all-cause mortality, cardiogenic shock, life-threatening ventricular arrhythmias, and stroke. RESULTS Among the 101 eligible patients (80.2% females, mean age 45.8 ± 11.5 years) in the study cohort, MCE occurred in 16 patients (15.8%). Cox regression analysis identified two independent predictors of MCE: increased ΔQT dispersion ≥ 40 ms (HR 1.31, 95% CI 1.05-9.77, p = 0.029) and increased Δnegative T wave amplitude dispersion ≤ -2.0 mV (HR 1.25, 95% CI 1.11-11.93, p = 0.018) during the subacute phase. The final regression model had good accuracy (sensitivity 81.3%, specificity 96.5%) and discriminative power (AUC 0.89, 95% CI 0.83-0.95). Kaplan-Meier analysis revealed that there was increasing MCE in patients with zero, one, or two predictors (log rank p < 0.001). In addition, patients with increased dispersion also had a significantly longer time to achieve complete recovery (21.4 ± 6.8 vs. 8.5 ± 4.3 days, p = 0.012) and a higher incidence of recurrence (31.3% vs. 2.4%, p = 0.011) of SC. CONCLUSION Evaluation of dynamic changes of dispersion of repolarization is a simple bed-side tool with high predictive accuracy for prognostication of short term adverse outcomes, delayed recovery, and recurrence in patients with SC.
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Affiliation(s)
- Muthiah Subramanian
- Department of Cardiology at Amrita Institute of Medical Sciences, Amritha Vishhwavidhyapeetham, Ponekkara, Kochi, Kerala 682041, India.
| | - Hisham Ahamed
- Department of Cardiology at Amrita Institute of Medical Sciences, Amritha Vishhwavidhyapeetham, Ponekkara, Kochi, Kerala 682041, India
| | - Mukund Prabhu
- Department of Cardiology at Amrita Institute of Medical Sciences, Amritha Vishhwavidhyapeetham, Ponekkara, Kochi, Kerala 682041, India
| | - Navin Mathew
- Department of Cardiology at Amrita Institute of Medical Sciences, Amritha Vishhwavidhyapeetham, Ponekkara, Kochi, Kerala 682041, India
| | - M S Harikrishnan
- Department of Cardiology at Amrita Institute of Medical Sciences, Amritha Vishhwavidhyapeetham, Ponekkara, Kochi, Kerala 682041, India.
| | - Praveen G Pai
- Department of Cardiology at Amrita Institute of Medical Sciences, Amritha Vishhwavidhyapeetham, Ponekkara, Kochi, Kerala 682041, India
| | - Kumaraswamy Natarajan
- Department of Cardiology at Amrita Institute of Medical Sciences, Amritha Vishhwavidhyapeetham, Ponekkara, Kochi, Kerala 682041, India
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Gul S, Yontar OC, Yenercag M, Seker OO, Erdogan G, Arslan U. Effect of angiotensin/neprilysin inhibition on ventricular repolarization and clinical arrhythmogenesis. CARDIO-IT 2020. [DOI: 10.15275/cardioit.2020.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The most common reason for sudden cardiac death in heart failure is malign ventricular arrhythmias. LCZ 696 improves hospitalization and sudden cardiac death outcomes in heart failure, however mechanisms in preventing sudden cardiac death are still unknown. There is little information available assessing effect of LCZ 696 on Tp-e interval and related calculations. In this study, we aimed to investigate the impact of Sacubitril/valsartan therapy on Tp-e interval, Tp-e/QT ratio and Tp-e/QTc ratio in heart failure patients and its reflections on clinical arrhythmogenesis. Methods: The study was designed as a prospective observational fashion. 265 patients with implantable cardioverter-defibrillator (ICD), who were on regular follow up at Samsun Training and Research Hospital Outpatient Heart Failure Clinic, were validated for the study. Clinical, echocardiographic, electrocardiogram and device data before initiation and six months after dose optimizing were obtained. Results: Stroke volume, cardiac output and ejection fraction significantly improved after LCZ 696 treatment. T wave related parameters, QT and QTC intervals significantly diminished. Furthermore, there was a negative correlation between baseline Tp-e interval duration and the absolute percentile increase of stroke volume(r:-0.234, p: 0.042) and cardiac output (r: -0.240, p: 0.037). Conclusion: In our study, switching Renin-Angiotensin-Aldosterone-System inhibitor with Angiotensin receptor/neprilysin inhibitor was associated with increase in left ventricle performance and decrease of sustained ventricular arrhythmias that required ICD shocks. These positive findings were accompanied by improvements in surface electrocaridogram changes such as Tp-e and related indices.
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Affiliation(s)
- Sefa Gul
- Samsun training and Research Hospital
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15
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Hong M, Chun KH, Hwang I, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Clinical and genetic relationships between the QTc interval and risk of a stroke among atrial fibrillation patients undergoing catheter ablation. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2020. [DOI: 10.1186/s42444-020-00017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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16
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Blom LJ, Groeneveld SA, Wulterkens BM, van Rees B, Nguyen UC, Roudijk RW, Cluitmans M, Volders PGA, Hassink RJ. Novel use of repolarization parameters in electrocardiographic imaging to uncover arrhythmogenic substrate. J Electrocardiol 2020; 59:116-121. [PMID: 32062380 DOI: 10.1016/j.jelectrocard.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/23/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Measuring repolarization characteristics is challenging and has been reserved for experienced physicians. In electrocardiographic imaging (ECGI), activation-recovery interval (ARI) is used as a measure of local cardiac repolarization duration. We hypothesized that repolarization characteristics, such as local electrogram morphology and local and global dispersion of repolarization timing and duration could be of significance in ECGI. OBJECTIVE To further explore their potential in arrhythmic risk stratification we investigated the use of novel repolarization parameters in ECGI. MATERIALS AND METHODS We developed and compared methods for T-peak and T-end detection in reconstructed potentials. All methods were validated on annotated reconstructed electrograms (EGMs). Characteristics of the reconstructed EGMs and epicardial substrate maps in IVF patients were analyzed by using data recorded during sinus rhythm. The ECGI data were analyzed for EGM morphology, conduction, and repolarization. RESULTS We acquired ECGI data from 8 subjects for this study. In all patients we evaluated four repolarization parameters: Repolarization time, T-wave area, Tpeak-Tend interval, and T-wave alternans. Most prominent findings were steep repolarization time gradients in regions with flat EGMs. These regions were also characterized by low T-wave area and large differences in Tpeak-Tend interval. CONCLUSIONS Measuring novel repolarization parameters in reconstructed electrograms acquired with ECGI is feasible, can be done in a fully automated manner and may provide additional information on underlying arrhythmogenic substrate for risk stratification. Further studies are needed to investigate their potential use and clinical application.
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Affiliation(s)
- L J Blom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - S A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - B M Wulterkens
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - B van Rees
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - U C Nguyen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R W Roudijk
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - P G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
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17
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Srinivasan NT, Orini M, Providencia R, Simon R, Lowe M, Segal OR, Chow AW, Schilling RJ, Hunter RJ, Taggart P, Lambiase PD. Differences in the upslope of the precordial body surface ECG T wave reflect right to left dispersion of repolarization in the intact human heart. Heart Rhythm 2019; 16:943-951. [PMID: 30550836 PMCID: PMC6546969 DOI: 10.1016/j.hrthm.2018.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The relationship between the surface electrocardiogram (ECG) T wave to intracardiac repolarization is poorly understood. OBJECTIVE The purpose of this study was to examine the association between intracardiac ventricular repolarization and the T wave on the body surface ECG (SECGTW). METHODS Ten patients with a normal heart (age 35 ± 15 years; 6 men) were studied. Decapolar electrophysiological catheters were placed in the right ventricle (RV) and lateral left ventricle (LV) to record in an apicobasal orientation and in the lateral LV branch of the coronary sinus (CS) for transmural recording. Each catheter (CS, LV, RV) was sequentially paced using an S1-S2 restitution protocol. Intracardiac repolarization time and apicobasal, RV-LV, and transmural repolarization dispersion were correlated with the SECGTW, and a total of 23,946 T waves analyzed. RESULTS RV endocardial repolarization occurred on the upslope of lead V1, V2, and V3 SECGTW, with sensitivity of 0.89, 0.91, and 0.84 and specificity of 0.67, 0.68, and 0.65, respectively. LV basal endocardial, epicardial, and mid-endocardial repolarization occurred on the upslope of leads V6 and I, with sensitivity of 0.79 and 0.8 and specificity of 0.66 and 0.67, respectively. Differences between the end of the upslope in V1, V2, and V3 vs V6 strongly correlated with right to left dispersion of repolarization (intraclass correlation coefficient 0.81, 0.83, and 0.85, respectively; P <.001). Poor association between the T wave and apicobasal and transmural dispersion of repolarization was seen. CONCLUSION The precordial SECGTW reflects regional repolarization differences between right and left heart. These findings have important implications for accurately identifying biomarkers of arrhythmogenic risk in disease.
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Affiliation(s)
- Neil T Srinivasan
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michele Orini
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom; Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Rui Providencia
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
| | - Ron Simon
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
| | - Martin Lowe
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
| | - Oliver R Segal
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
| | - Anthony W Chow
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
| | - Richard J Schilling
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
| | - Ross J Hunter
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
| | - Peter Taggart
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Pier D Lambiase
- Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
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18
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Biendarra-Tiegs SM, Li X, Ye D, Brandt EB, Ackerman MJ, Nelson TJ. Single-Cell RNA-Sequencing and Optical Electrophysiology of Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes Reveal Discordance Between Cardiac Subtype-Associated Gene Expression Patterns and Electrophysiological Phenotypes. Stem Cells Dev 2019; 28:659-673. [PMID: 30892143 PMCID: PMC6534093 DOI: 10.1089/scd.2019.0030] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The ability to accurately phenotype cells differentiated from human induced pluripotent stem cells (hiPSCs) is essential for their application in modeling developmental and disease processes, yet also poses a particular challenge without the context of anatomical location. Our specific objective was to determine if single-cell gene expression was sufficient to predict the electrophysiology of iPSC-derived cardiac lineages, to evaluate the concordance between molecular and functional surrogate markers. To this end, we used the genetically encoded voltage indicator ArcLight to profile hundreds of hiPSC-derived cardiomyocytes (hiPSC-CMs), thus identifying patterns of electrophysiological maturation and increased prevalence of cells with atrial-like action potentials (APs) between days 11 and 42 of differentiation. To profile expression patterns of cardiomyocyte subtype-associated genes, single-cell RNA-seq was performed at days 12 and 40 after the populations were fully characterized with the high-throughput ArcLight platform. Although we could detect global gene expression changes supporting progressive differentiation, individual cellular expression patterns alone were not able to delineate the individual cardiomyocytes into atrial, ventricular, or nodal subtypes as functionally documented by electrophysiology measurements. Furthermore, our efforts to understand the distinct electrophysiological properties associated with day 12 versus day 40 hiPSC-CMs revealed that ion channel regulators SLMAP, FGF12, and FHL1 were the most significantly increased genes at day 40, categorized by electrophysiology-related gene functions. Notably, FHL1 knockdown during differentiation was sufficient to significantly modulate APs toward ventricular-like electrophysiology. Thus, our results establish the inability of subtype-associated gene expression patterns to specifically categorize hiPSC-derived cells according to their functional electrophysiology, and yet, altered FHL1 expression is able to redirect electrophysiological maturation of these developing cells. Therefore, noncanonical gene expression patterns of cardiac maturation may be sufficient to direct functional maturation of cardiomyocytes, with canonical gene expression patterns being insufficient to temporally define cardiac subtypes of in vitro differentiation.
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Affiliation(s)
- Sherri M Biendarra-Tiegs
- 1 Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,2 Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Xing Li
- 2 Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota.,3 Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Dan Ye
- 4 Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Emma B Brandt
- 1 Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,2 Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J Ackerman
- 4 Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,5 Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,6 Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy J Nelson
- 1 Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,2 Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota.,5 Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,6 Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.,7 Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Can QT interval prolongation or dispersion detected in a positive exercise ECG test predict critical coronary artery disease? ACTA ACUST UNITED AC 2019; 4:e7-e12. [PMID: 30963129 PMCID: PMC6451142 DOI: 10.5114/amsad.2019.83299] [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: 10/26/2018] [Accepted: 02/02/2019] [Indexed: 01/23/2023]
Abstract
Introduction Exercise electrocardiography (EET) is frequently used in coronary artery disease, but the specificity of this test is very low. In the literature, parameters such as QT prolongation and QT dispersion which show coronary artery disease and arrhythmia were not sufficiently investigated using EET. The aim of this study was to investigate whether QT interval prolongation or dispersion (QT disp) in a positive EET test could predict critical coronary artery disease (CAD). Material and methods Patients with a positive exercise test were included in the study. Data regarding QT, QTc (corrected QT interval) and QT disp values before, during and after EET were noted. Critical coronary artery occlusions (≥ 70%) was recorded from coronary angiographic images. Patients were divided into two groups (critical CAD and non-critical CAD). Results A total of 192 patients were found to be eligible for the study. There were 126 patients in the non-critical CAD group (group 1) and 66 patients in the critical CAD group (group 2). Recovery QTc, peak QT disp, and recovery QT disp were significantly increased in group 2 (p < 0.001 for each). Also, target heart rate (p = 0.012), basal systolic blood pressure (p = 0.005) and diastolic blood pressure (p < 0.001) were significantly higher in group 1. Recovery QTc (OR = 1.051) and recovery QT disp (OR = 1.117) were determined as the independent predictors for critical CAD. The ROC analysis results indicated that critical CAD could be diagnosed with 90% sensitivity when the recovery QTc cut-off value was set as 404 ms. Conclusions In patients with positive EET, prolonged QTc and QT disp values measured during the recovery period would predict critical CAD. Thus, the clinical accuracy of EET may be enhanced.
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20
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Son O, Boduroglu Y. Comparing of Tp-Te Interval and Tp-Te/Qt Ratio in Patients with Preserved, Mid-Range and Reduced Ejection Fraction Heart Failure. Open Access Maced J Med Sci 2019; 7:752-759. [PMID: 30962833 PMCID: PMC6447328 DOI: 10.3889/oamjms.2019.186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Heart failure (HF) is classified in three class: HF with preserved EF (HFpEF); normal or LVEF ≥ 50%, HF with reduced EF (HFrEF); LEVF < 40% and newly HF mid-range EF (HFmrEF); LVEF 40-49%. On Electrocardiography (ECG) T wave, Tpeak-Tend (Tp-Te) interval reflects transmural dispersion of repolarisation (TDR) which of these indexes have been proposed as predictors of risk for ventricular arrhythmia (VA) in many cardiac diseases. AIM Aim of this study to asses these indices of TDR among three HF class. METHODS Total of 192 patients were included in this study. RESULTS Many of indices like Tp-Te, Tp-Te/QT wasn't different between groups (P > 0.05). But mean Q-Tpeak (QTp), S-Tend (S-Te) and S-Tpeak (S-Tp) were found significantly different between groups (P < 0.05). Again S-Te was found different according to having fragmented QRS (fQRS) on ECG (P = 0.031). Comparing to mitral inflow E/A parameters showed significant differences for Tp-Te, Tp-Tec, Tp-Te/QT, Tp-Te/QTc and Tp-Tec/QTc parameters. Finally, we found correlations between S-Te and white blood cell (WBC) (r = - 0.171; P = 0.037) and S-Tp and WBC (r = - 0.170; P = 0.038) and between S-Te and fQRS (r = 0.158; P = 0.031). CONCLUSIONS We didn't find differences for many of indices of TDR like Tp-Te interval between groups except QTp, S-Te, S-Tp intervals. Also, S-Te and fQRS showed significant correlation. For prediction of ventricular arrhythmia and cardiovascular death newer indexes on ECG are needed to be established in the future which will make us facilitate to distinguish high risk patients.
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Affiliation(s)
- Osman Son
- Department of Endocrinology, Private Acibadem Hospital, Eskisehir, Turkey
| | - Yalcin Boduroglu
- Department of Cardiology, Ahi Evran University Education and Research Hospital, Kirsehir, Turkey
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21
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Öztürk M, Turan OE, Karaman K, Bilge N, Ceyhun G, Aksu U, Aksakal E, Gulcu O, Kalkan K, Demirelli S. Evaluation of ventricular repolarization parameters during migraine attacks. J Electrocardiol 2018; 53:66-70. [PMID: 30684863 DOI: 10.1016/j.jelectrocard.2018.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/10/2018] [Accepted: 12/21/2018] [Indexed: 01/03/2023]
Abstract
AIMS Migraine is a chronic neurovascular disorder characterized by intermittent episodes of severe headache. Abnormalities in the autonomic nervous system (sympathetic and parasympathetic nervous systems) have been detected during migraine-free periods in patients with migraine. In these patients, disrupted autonomic innervations of the heart and coronary arteries may lead to electrocardiographic changes during a migraine attack. T-wave peak-to-end interval (Tp-e interval) and Tp-e/QT ratio are relatively new markers of ventricular arrhythmogenesis and repolarization heterogeneity. In the present observational study, we investigated the changes in ventricular repolarization during migraine attacks and attack-free periods by performing 12‑lead electrocardiography (ECG). METHODS This study included 63 patients (54 [86%] women; mean age: 33.3 ± 9.9 years) with migraine. The QT and corrected QT (QTc) intervals, Tp-e interval, and Tp-e/QT ratio of the patients during migraine attacks and attack-free periods were measured by performing 12‑lead ECG. RESULTS The QT and QTc intervals, Tp-e interval, and Tp-e/QT ratio were higher during migraine attacks than during attack-free periods (P < 0.001 for all). CONCLUSION These results indicate that migraine attacks are associated with an increase in ventricular repolarization parameters compared with attack-free periods possibly because of the dysregulation of the autonomic nervous system.
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Affiliation(s)
- Mustafa Öztürk
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey.
| | | | - Kayıhan Karaman
- Department of Cardiology, Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
| | - Nuray Bilge
- Department of Neurology, Atatürk University, Faculty of Medicine, Erzurum, Turkey
| | - Gökhan Ceyhun
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Ugur Aksu
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Emrah Aksakal
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Oktay Gulcu
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Selami Demirelli
- Department of Cardiology, University of Health Sciences, Erzurum Education and Research Hospital, Erzurum, Turkey
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22
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Arroja JD, Giannakopoulos G, Beale AL, Shah D, Meyer P. Prevalence and significance of notched T-waves in elite professional cyclists. Int J Cardiol 2018; 266:133-135. [PMID: 29699857 DOI: 10.1016/j.ijcard.2018.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/20/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To identify the frequency and significance of notched T-waves (NTW) in elite endurance athletes. METHODS Professional cyclists were followed for 4 years with a clinical, electrocardiographic and echocardiographic assessment. Electrocardiograms were classified according to the presence or absence of NTWs; clinical and echocardiographic correlates were assessed. RESULTS 42 Caucasian male cyclists were included. NTW were detected in 8 (19%) cyclists who showed significantly longer QT (461 ± 15 vs 422 ± 33 ms, p < 0.01) and QTc intervals (434 ± 19 vs 383 ± 21 ms, p < 0.01), a larger left ventricular end-diastolic volume (163 ± 27 vs 137 ± 23 mL, p = 0.014), end-diastolic volume index (84 ± 13 vs 73 ± 11 mL, p = 0.037) and end-diastolic apex-to-base length (9.9 ± 0.7 vs 9.3 ± 0.5 mm. p = 0.035). There were no detected arrhythmic events, and echocardiography did not reveal any abnormalities. CONCLUSIONS This is to our knowledge the first study reporting a high prevalence of NTW in athletes. In our small cohort of cyclists NTW were associated with QT interval prolongation and left ventricular changes. This may be indicative of underlying inhomogeneity of repolarisation. Expanding on this research could reveal a role for NTW in identifying ventricular morphological changes.
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Affiliation(s)
- Jose David Arroja
- Service de cardiologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret Gentil 4, 1205 Genève, Switzerland.
| | - Georgios Giannakopoulos
- Service de cardiologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret Gentil 4, 1205 Genève, Switzerland
| | - Anna Louise Beale
- Service de cardiologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret Gentil 4, 1205 Genève, Switzerland
| | - Dipen Shah
- Service de cardiologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret Gentil 4, 1205 Genève, Switzerland
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret Gentil 4, 1205 Genève, Switzerland
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Tural Onur S, Emet S, Sokucu SN, Onur I. T wave peak-to-end interval in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2157-2162. [PMID: 30034231 PMCID: PMC6049052 DOI: 10.2147/copd.s132538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction The interval from the peak to the end of the electrocardiographic (ECG) T wave (Tp–Te) can estimate cardiovascular mortality and ventricular tachyarrhythmias. Objectives In this study, we aimed to define a new ECG parameter in patients with COPD. Methods This was a cross-sectional observational study that included COPD patients who were diagnosed previously and followed up in the outpatient clinic. All data of the patients’ demographic features, history, spirometry, and electrocardiographs were analyzed. Results We enrolled 134 patients with COPD and 40 healthy volunteers as controls in our study. Patients already known to be having COPD who were under follow-up for their COPD and diagnosed as having COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. Men comprised 82.8% of the COPD group and 73.2% of controls. The mean age in the COPD and control group was 60.2±9.4 and 58.2±6.7 years, respectively. There was no significant difference between the groups for age or sex (p=0.207, p=0.267, respectively). There were 46 (34.3%) patients in group A, 23 (17.2%) patients in group B, 26 (19.4%) patients in group C, and 46 (29.1%) patients in group D as COPD group. There was a significant increase in Tp–Te results in all precordial leads in the COPD group compared with the control group (p<0.05). Precordial V4 lead has the most extensive area under the curve (0.831; sensitivity 76.5%, specificity 89.6%). Conclusion We present strong evidence that Tp–Te intervals were increased in patients with COPD, which suggests that there may be an association between COPD and ventricular arrhythmias and cardiac morbidity.
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Affiliation(s)
- Seda Tural Onur
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease, Zeytinburnu, Istanbul, Turkey,
| | - Samim Emet
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Sinem Nedime Sokucu
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease, Zeytinburnu, Istanbul, Turkey,
| | - Imran Onur
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
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24
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Boukens BJ, Meijborg VMF, Belterman CN, Opthof T, Janse MJ, Schuessler RB, Coronel R, Efimov IR. Local transmural action potential gradients are absent in the isolated, intact dog heart but present in the corresponding coronary-perfused wedge. Physiol Rep 2018; 5:e13251. [PMID: 28554962 PMCID: PMC5449556 DOI: 10.14814/phy2.13251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 11/24/2022] Open
Abstract
The left ventricular (LV) coronary‐perfused canine wedge preparation is a model commonly used for studying cardiac repolarization. In wedge studies, transmembrane potentials typically are recorded; whereas, extracellular electrical recordings are commonly used in intact hearts. We compared electrically measured activation recovery interval (ARI) patterns in the intact heart with those recorded at the same location in the LV wedge preparation. We also compared electrically recorded and optically obtained ARIs in the LV wedge preparation. Five Langendorff‐perfused canine hearts were paced from the right atrium. Local activation and repolarization times were measured with eight transmural needle electrodes. Subsequently, left ventricular coronary‐perfused wedge preparations were prepared from these hearts while the electrodes remained in place. Three electrodes remained at identical positions as in the intact heart. Both electrograms and optical action potentials were recorded (pacing cycle length 400–4000 msec) and activation and repolarization patterns were analyzed. ARIs found in the subepicardium were shorter than in the subendocardium in the LV wedge preparation but not in the intact heart. The transmural ARI gradient recorded at the cut surface of the wedge was not different from that recorded internally. ARIs recorded internally and at the cut surface in the LV wedge preparation, both correlated with optically recorded action potentials. ARI and RT gradients in the LV wedge preparation differed from those in the intact canine heart, implying that those observations in human LV wedge preparations also should be extrapolated to the intact human heart with caution.
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Affiliation(s)
- Bastiaan J Boukens
- Department of Biomedical Engineering, George Washington University, Washington, District of Columbia.,Department of Medical Biology, University of Amsterdam, Amsterdam, The Netherlands
| | - Veronique M F Meijborg
- Department of Experimental and Clinical Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Holland Heart House, Utrecht, The Netherlands
| | - Charly N Belterman
- Department of Experimental and Clinical Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Institut LIRYC, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Tobias Opthof
- Department of Experimental and Clinical Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Physiology, University of Utrecht, Utrecht, The Netherlands
| | - Michiel J Janse
- Department of Experimental and Clinical Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ruben Coronel
- Department of Experimental and Clinical Cardiology, University of Amsterdam, Amsterdam, The Netherlands.,Institut LIRYC, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France
| | - Igor R Efimov
- Department of Biomedical Engineering, George Washington University, Washington, District of Columbia.,Institut LIRYC, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac- Bordeaux, France
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25
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Conlon R, Tanner R, David S, Szeplaki G, Galvin J, Keaney J, Keelan E, Boles U. Evaluation of the Tp-Te Interval, QTc and P-Wave Dispersion in Patients With Coronary Artery Ectasia. Cardiol Res 2018; 8:280-285. [PMID: 29317970 PMCID: PMC5755659 DOI: 10.14740/cr631w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Coronary artery ectasia (CAE) is defined as a diffuse dilatation of the diameter of the ectatic segment of the coronary artery, 1.5 times greater than that of the adjacent segment. The Tp-Te interval, P-wave and QTc dispersions are relatively new electrocardiographic markers associated with an increased risk of developing arrhythmias. Despite CAE increasing in prevalence in recent years, there is a sparsity of data available about its arrhythmogenic effect. The aim of the study was to evaluate QTc, P-wave dispersion and Tp-Te and Tp-Te/QT ratio in patients with CAE. Methods A retrospective comparative study was designed for consecutive age- and sex-matched patients. Twenty patients with isolated CAE (group 1) and 20 control subjects (group 2), with normal coronary arteries, were included. All patients presented with chest pain and coronary angiogram was indicated. Outcome measures included Tp-Te interval, Tp-Te/QT ratio, QTc dispersion and P-wave dispersion. Measurement of electrocardiogram (ECG) parameters was conducted using standardized digital online software. Descriptive and inferential statistics were performed. Results Mean Tp-Te (95.5 ± 9.01 ms) and Tp-Te/QT ratio (0.22 ± 0.02) were significantly prolonged in CAE group (Tp-Te: 84 ± 5.62 ms, P = 0.00009; Tp-Te/QT ratio: 0.20 ± 0.01, P = 0.00004). In addition, QTc (31.2 ± 3.71 ms) and P-wave dispersion (31.9 ± 5.46 ms) were significantly increased in comparison to the control group (QTc: 27.6 ± 2.82 ms, P = 0.00532 and 20 ± 3.77 ms, P = 0.00003 respectively). However, there was no difference in ventricular activation time (VAT) between groups. Conclusions CAE ECGs were found to be associated with increased Tp-Te, Tp-Te/QT ratio, QTc intervals and P-wave dispersions. This may suggest that CAE existence has a pro-arrhythmogenic nature.
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Affiliation(s)
- Ronan Conlon
- Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
| | - Richard Tanner
- Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
| | - Santhosh David
- Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
| | - Gabor Szeplaki
- Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
| | - Joseph Galvin
- Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
| | - John Keaney
- Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
| | - Edward Keelan
- Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
| | - Usama Boles
- Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland.,Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
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Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with mitral valve stenosis before and after balloon valvuloplasty. Anatol J Cardiol 2017; 18:353-360. [PMID: 29044094 PMCID: PMC5731285 DOI: 10.14744/anatoljcardiol.2017.7876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: Sympathetic activity increases in patients with mitral stenosis (MS). The association between prolonged Tpeak-Tend (Tp-e) interval and increased sympathetic activity has been demonstrated. This study aimed to evaluate Tp-e interval, Tp-e/QT ratio, and Tp-e/corrected QT interval (QTc) ratio in patients with MS before and after balloon valvuloplasty. Methods: Thirty patients with severe MS and 30 sex-, body mass index-, and and age-matched healthy control subjects were enrolled. The severity of MS was defined following clinical, transthoracic, and transesophageal echocardiographic examinations. All patients underwent successful mitral balloon valvuloplasty. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured using 12-lead electrocardiogram. First, the abovementioned parameters were compared between patients with MS and healthy control subjects. Second, these parameters were compared before and after balloon valvuloplasty in patients with MS. Results: The mean Tp-e interval was significantly prolonged in patients with MS compared with healthy control subjects (85.02±9.12 ms vs. 75.38±6.04 ms; p<0.001). In addition, Tp-e/QT ratio and Tp-e/QTc ratio were significantly higher in patients with MS than in healthy control subjects (0.217±0.025 vs. 0.196±0.02 and 0.203±0.02 vs. 0.184±0.019; p<0.001).The mean valve area significantly increased after balloon valvuloplasty compared with that before balloon valvuloplasty (1.83±0.32 cm2 vs. 1.18±0.15 cm2; p<0.001). Compared with those before balloon valvuloplasty, Tp-e interval (85.02±9.12 ms vs. 78.06±9.2 ms; p<0.001), Tp-e/QT ratio (0.217±0.02 vs. 0.201±0.02; p<0.001), and Tp-e/QTc ratio (0.203±0.02 vs. 0.184±0.02; p<0.001) decreased after balloon valvuloplasty. Conclusion: We revealed that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio increased in patients with severe MS. Furthermore, balloon valvuloplasty had a favorable effect on parameters associated with myocardial repolarization.
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27
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Ravikumar V, VajraVelu HR, Ayyavoo S, Ramraj B. Correlation of Adiposity Indices with Electrocardiographic Ventricular Variables and Vascular Stiffness in Young Adults. J Clin Diagn Res 2017; 11:CC21-CC24. [PMID: 28764153 DOI: 10.7860/jcdr/2017/27641.10062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/17/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Excess adiposity constitute an important public health problem because of the associated increased risk of hypertension, coronary heart disease, type 2 diabetes and other disorders. Not only the contribution of general measures of adiposity but also central measures of adiposity have been observed. AIM To compare and correlate the central and general adiposity indices with ventricular electrocardiographic variables and vascular stiffness indices in normal, overweight and obese young adults. MATERIALS AND METHODS This was a cross-sectional study. Nearly ninety subjects were enrolled and were divided into 30 normal weight, 30 overweight and 30 obese group based on the BMI classification of WHO for Asian population with their age ranging from 18-25 years. Waist and hip circumferences were measured using stretchable tape. Two novel indices-conicity index and abdominal volume index were calculated using standard formula. ECG and pulse wave were recorded using the Physiopac - Medicaid systems. Statistical analysis was done using SPSS version 19.0 software. ANOVA test was done to compare the variables among three groups. Pearson's correlation coefficients were applied to establish the correlations between variables. RESULTS In our study Body Mass Index (BMI) and Conicity Index (CI) was significantly and strongly correlated with the ventricular electrocardiographic variables especially with QRS duration, QTc interval and with vascular stiffness indices. These indices can be used to assess the electrocardiographic abnormalities and vascular stiffness status. CONCLUSION Excess adipose tissue in young adults was closely linked to ventricular depolarization and repolarization abnormalities and also to increased vascular stiffness. Adiposity indices in particular (BMI, CI) provide a simple and non invasive approach to assess these abnormalities at the earliest in order to prevent future complications.
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Affiliation(s)
- Varrshine Ravikumar
- Student, Department of Physiology, SRM MCH and RC, Chennai, Tamil Nadu, India
| | - Hemamalini Ramasamy VajraVelu
- Associate Professor, Department of Physiology, Ponnaiyah Ramajayam Institute of Medical Sciences, Kancheepuram, Chennai, Tamil Nadu, India
| | - Saravanan Ayyavoo
- Professor and Head, Department of Physiology, SRM MCH and RC, Chennai, Tamil Nadu, India
| | - Balaji Ramraj
- Associate Professor, Community Medicine, SRM MCH and RC, Chennai, Tamil Nadu, India
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28
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Maffessanti F, Wanten J, Potse M, Regoli F, Caputo ML, Conte G, Sürder D, Illner A, Krause R, Moccetti T, Auricchio A, Prinzen FW. The relation between local repolarization and T-wave morphology in heart failure patients. Int J Cardiol 2017; 241:270-276. [DOI: 10.1016/j.ijcard.2017.02.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022]
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29
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Osadchii OE. Role of abnormal repolarization in the mechanism of cardiac arrhythmia. Acta Physiol (Oxf) 2017; 220 Suppl 712:1-71. [PMID: 28707396 DOI: 10.1111/apha.12902] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In cardiac patients, life-threatening tachyarrhythmia is often precipitated by abnormal changes in ventricular repolarization and refractoriness. Repolarization abnormalities typically evolve as a consequence of impaired function of outward K+ currents in cardiac myocytes, which may be caused by genetic defects or result from various acquired pathophysiological conditions, including electrical remodelling in cardiac disease, ion channel modulation by clinically used pharmacological agents, and systemic electrolyte disorders seen in heart failure, such as hypokalaemia. Cardiac electrical instability attributed to abnormal repolarization relies on the complex interplay between a provocative arrhythmic trigger and vulnerable arrhythmic substrate, with a central role played by the excessive prolongation of ventricular action potential duration, impaired intracellular Ca2+ handling, and slowed impulse conduction. This review outlines the electrical activity of ventricular myocytes in normal conditions and cardiac disease, describes classical electrophysiological mechanisms of cardiac arrhythmia, and provides an update on repolarization-related surrogates currently used to assess arrhythmic propensity, including spatial dispersion of repolarization, activation-repolarization coupling, electrical restitution, TRIaD (triangulation, reverse use dependence, instability, and dispersion), and the electromechanical window. This is followed by a discussion of the mechanisms that account for the dependence of arrhythmic vulnerability on the location of the ventricular pacing site. Finally, the review clarifies the electrophysiological basis for cardiac arrhythmia produced by hypokalaemia, and gives insight into the clinical importance and pathophysiology of drug-induced arrhythmia, with particular focus on class Ia (quinidine, procainamide) and Ic (flecainide) Na+ channel blockers, and class III antiarrhythmic agents that block the delayed rectifier K+ channel (dofetilide).
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Affiliation(s)
- O. E. Osadchii
- Department of Health Science and Technology; University of Aalborg; Aalborg Denmark
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30
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Kane C, Terracciano CMN. Concise Review: Criteria for Chamber-Specific Categorization of Human Cardiac Myocytes Derived from Pluripotent Stem Cells. Stem Cells 2017; 35:1881-1897. [PMID: 28577296 PMCID: PMC5575566 DOI: 10.1002/stem.2649] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/25/2017] [Accepted: 05/12/2017] [Indexed: 11/30/2022]
Abstract
Human pluripotent stem cell‐derived cardiomyocytes (PSC‐CMs) have great potential application in almost all areas of cardiovascular research. A current major goal of the field is to build on the past success of differentiation strategies to produce CMs with the properties of those originating from the different chambers of the adult human heart. With no anatomical origin or developmental pathway to draw on, the question of how to judge the success of such approaches and assess the chamber specificity of PSC‐CMs has become increasingly important; commonly used methods have substantial limitations and are based on limited evidence to form such an assessment. In this article, we discuss the need for chamber‐specific PSC‐CMs in a number of areas as well as current approaches used to assess these cells on their likeness to those from different chambers of the heart. Furthermore, describing in detail the structural and functional features that distinguish the different chamber‐specific human adult cardiac myocytes, we propose an evidence‐based tool to aid investigators in the phenotypic characterization of differentiated PSC‐CMs. Stem Cells2017;35:1881–1897
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Affiliation(s)
- Christopher Kane
- Imperial College London, National Heart and Lung Institute, Hammersmith Campus, BHF Centre for Regenerative Medicine, London, United Kingdom
| | - Cesare M N Terracciano
- Imperial College London, National Heart and Lung Institute, Hammersmith Campus, BHF Centre for Regenerative Medicine, London, United Kingdom
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31
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Diagnostic and prognostic values of the V-index, a novel ECG marker quantifying spatial heterogeneity of ventricular repolarization, in patients with symptoms suggestive of non-ST-elevation myocardial infarction. Int J Cardiol 2017; 236:23-29. [DOI: 10.1016/j.ijcard.2017.01.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/13/2017] [Indexed: 11/18/2022]
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32
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Cardiac activation–repolarization patterns and ion channel expression mapping in intact isolated normal human hearts. Heart Rhythm 2017; 14:265-272. [DOI: 10.1016/j.hrthm.2016.10.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Indexed: 11/23/2022]
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33
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Johannesen L, Vicente J, Hosseini M, Strauss DG. Automated Algorithm for J-Tpeak and Tpeak-Tend Assessment of Drug-Induced Proarrhythmia Risk. PLoS One 2016; 11:e0166925. [PMID: 28036330 PMCID: PMC5201230 DOI: 10.1371/journal.pone.0166925] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 11/07/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prolongation of the heart rate corrected QT (QTc) interval is a sensitive marker of torsade de pointes risk; however it is not specific as QTc prolonging drugs that block inward currents are often not associated with torsade. Recent work demonstrated that separate analysis of the heart rate corrected J-Tpeakc (J-Tpeakc) and Tpeak-Tend intervals can identify QTc prolonging drugs with inward current block and is being proposed as a part of a new cardiac safety paradigm for new drugs (the "CiPA" initiative). METHODS In this work, we describe an automated measurement methodology for assessment of the J-Tpeakc and Tpeak-Tend intervals using the vector magnitude lead. The automated measurement methodology was developed using data from one clinical trial and was evaluated using independent data from a second clinical trial. RESULTS Comparison between the automated and the prior semi-automated measurements shows that the automated algorithm reproduces the semi-automated measurements with a mean difference of single-deltas <1 ms and no difference in intra-time point variability (p for all > 0.39). In addition, the time-profile of the baseline and placebo-adjusted changes are within 1 ms for 63% of the time-points (86% within 2 ms). Importantly, the automated results lead to the same conclusions about the electrophysiological mechanisms of the studied drugs. CONCLUSIONS We have developed an automated algorithm for assessment of J-Tpeakc and Tpeak-Tend intervals that can be applied in clinical drug trials. Under the CiPA initiative this ECG assessment would determine if there are unexpected ion channel effects in humans compared to preclinical studies. The algorithm is being released as open-source software. TRIAL REGISTRATION NCT02308748 and NCT01873950.
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Affiliation(s)
- Lars Johannesen
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Jose Vicente
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
- BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
| | - Meisam Hosseini
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - David G. Strauss
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
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Soylu K, İnci S, Aksan G, Nar G, Yüksel EP, Ocal HS, Çapraz M, Yüksel S, Şahin M. Evaluation of inhomogeneities of repolarization in patients with psoriasis vulgaris. Arch Med Sci 2016; 12:1225-1231. [PMID: 27904512 PMCID: PMC5108400 DOI: 10.5114/aoms.2016.62922] [Citation(s) in RCA: 6] [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: 10/15/2014] [Accepted: 01/08/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The arrhythmia potential has not been investigated adequately in psoriatic patients. In this study, we assessed the ventricular repolarization dispersion, using the Tp-e interval and the Tp-e/QT ratio, and investigated the association with inflammation. MATERIAL AND METHODS Seventy-one psoriasis vulgaris patients and 70 age- and gender-matched healthy individuals were enrolled in the study. The severity of the disease was calculated using Psoriasis Area and Severity Index scoring. The QTd was defined as the difference between the maximum and minimum QT intervals. The Tp-e interval was defined as the interval from the peak of the T wave to the end of the T wave. The Tp-e interval was corrected for heart rate. The Tp-e/QT ratio was calculated using these measurements. RESULTS There were no significant differences between the groups with respect to basal clinical and laboratory characteristics (p > 0.05). The Tp-e interval, the corrected Tp-e interval (cTp-e) and the Tp-e/QT ratio were also significantly higher in psoriasis patients compared to the control group (78.5 ±8.0 ms vs. 71.4 ±7.6 ms, p < 0.001, 86.3 ±13.2 ms vs. 77.6 ±9.0 ms, p < 0.001 and 0.21 ±0.02 vs. 0.19 ±0.02, p < 0.001 respectively). A significant correlation was detected between the cTp-e time and the Tp-e/QT ratio and the PASI score in the group of psoriatic patients (r = 0.51, p < 0.001; r = 0.59, p < 0.001, respectively). CONCLUSIONS In our study, we detected a significant increase in the Tp-e interval and the Tp-e/QT ratio in patients with psoriasis vulgaris. The Tp-e interval and the Tp-e/QT ratio may be predictors for ventricular arrhythmias in patients with psoriasis vulgaris.
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Affiliation(s)
- Korhan Soylu
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sinan İnci
- Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Gazi State Hospital, Samsun, Turkey
| | - Gökay Nar
- Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
| | - Esra Pancar Yüksel
- Department of Dermatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | - Mustafa Çapraz
- Department of Internal Medicine, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Serkan Yüksel
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Mahmut Şahin
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Transmural electrophysiological heterogeneity, the T-wave and ventricular arrhythmias. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 122:202-214. [DOI: 10.1016/j.pbiomolbio.2016.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/21/2016] [Accepted: 05/03/2016] [Indexed: 01/05/2023]
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In Silico Evaluation of the Potential Antiarrhythmic Effect of Epigallocatechin-3-Gallate on Cardiac Channelopathies. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:7861653. [PMID: 27882075 PMCID: PMC5110949 DOI: 10.1155/2016/7861653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/21/2016] [Accepted: 09/29/2016] [Indexed: 01/17/2023]
Abstract
Ion channels are transmembrane proteins that allow the passage of ions according to the direction of their electrochemical gradients. Mutations in more than 30 genes encoding ion channels have been associated with an increasingly wide range of inherited cardiac arrhythmias. In this line, ion channels become one of the most important molecular targets for several classes of drugs, including antiarrhythmics. Nevertheless, antiarrhythmic drugs are usually accompanied by some serious side effects. Thus, developing new approaches could offer added values to prevent and treat the episodes of arrhythmia. In this sense, green tea catechins seem to be a promising alternative because of the significant effect of Epigallocatechin-3-Gallate (E3G) on the electrocardiographic wave forms of guinea pig hearts. Thus, the aim of this study was to evaluate the benefits-risks balance of E3G consumption in the setting of ion channel mutations linked with aberrant cardiac excitability phenotypes. Two gain-of-function mutations, Nav1.5-p.R222Q and Nav1.5-p.I141V, which are linked with cardiac hyperexcitability phenotypes were studied. Computer simulations of action potentials (APs) show that 30 μM E3G reduces and suppresses AP abnormalities characteristics of these phenotypes. These results suggest that E3G may have a beneficial effect in the setting of cardiac sodium channelopathies displaying a hyperexcitability phenotype.
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Mugnai G, Benfari G, Fede A, Rossi A, Chierchia GB, Vassanelli F, Menegatti G, Ribichini FL. Tpeak-to-Tend/QT is an independent predictor of early ventricular arrhythmias and arrhythmic death in anterior ST elevation myocardial infarction patients. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:473-480. [DOI: 10.1177/2048872615598616] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 07/12/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Giacomo Mugnai
- Department of Cardiology, University Hospital of Verona, Italy
| | | | - Alfredo Fede
- Department of Cardiology, University Hospital of Verona, Italy
| | - Andrea Rossi
- Department of Cardiology, University Hospital of Verona, Italy
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Colli Franzone P, Pavarino LF, Scacchi S. Joint influence of transmural heterogeneities and wall deformation on cardiac bioelectrical activity: A simulation study. Math Biosci 2016; 280:71-86. [PMID: 27545966 DOI: 10.1016/j.mbs.2016.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/25/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
The aim of this work is to investigate, by means of numerical simulations, the influence of myocardial deformation due to muscle contraction and relaxation on the cardiac repolarization process in presence of transmural intrinsic action potential duration (APD) heterogeneities. The three-dimensional electromechanical model considered consists of the following four coupled components: the quasi-static transversely isotropic finite elasticity equations for the deformation of the cardiac tissue; the active tension model for the intracellular calcium dynamics and cross-bridge binding; the anisotropic Bidomain model for the electrical current flow through the deforming cardiac tissue; the membrane model of ventricular myocytes, including stretch-activated channels. The numerical simulations are based on our finite element parallel solver, which employs Multilevel Additive Schwarz preconditioners for the solution of the discretized Bidomain equations and Newton-Krylov methods for the solution of the discretized non-linear finite elasticity equations. Our findings show that: (i) the presence of intrinsic transmural cellular APD heterogeneities is not fully masked by electrotonic current flow or by the presence of the mechanical deformation; (ii) despite the presence of transmural APD heterogeneities, the recovery process follows the activation sequence and there is no significant transmural repolarization gradient; (iii) with or without transmural APD heterogeneities, epicardial electrograms always display the same wave shape and discordance between the polarity of QRS complex and T-wave; (iv) the main effects of the mechanical deformation are an increase of the dispersion of repolarization time and APD, when computed over the total cardiac domain and over the endo- and epicardial surfaces, while there is a slight decrease along the transmural direction.
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Affiliation(s)
- P Colli Franzone
- Dipartimento di Matematica, Università di Pavia, Via Ferrata 1, Pavia 27100, Italy.
| | - L F Pavarino
- Dipartimento di Matematica, Università di Milano, Via Saldini 50, Milano 20133, Italy.
| | - S Scacchi
- Dipartimento di Matematica, Università di Milano, Via Saldini 50, Milano 20133, Italy.
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Viskin S, Havakuk O, Antzelevitch C, Rosso R. Malignant early repolarization: It’s the T-wave, stupid…. Heart Rhythm 2016; 13:903-4. [DOI: 10.1016/j.hrthm.2015.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Indexed: 01/01/2023]
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Transmural, interventricular, apicobasal and anteroposterior action potential duration gradients are all essential to the genesis of the concordant and realistic T wave: A whole-heart model study. J Electrocardiol 2016; 49:569-78. [PMID: 27034121 DOI: 10.1016/j.jelectrocard.2016.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND It has been reported that ventricular repolarization dispersion resulting from transmural, apicobasal and interventricular action potential duration (APD) gradients makes the T wave concordant with the QRS complex. METHOD AND RESULTS A whole-heart model integrating transmural, apicobasal, interventricular and anteroposterior APD gradients was used, and the corresponding electrocardiograms were simulated to study the influence of these APD gradients on the T-wave amplitudes. The simulation results showed that changing a single APD gradient (e.g., interventricular APD gradient alone) only made substantial changes to the T-wave amplitudes in a limited number of leads and was not able to generate T waves with amplitudes comparable with clinical findings in all leads. A combination of transmural, apicobasal and interventricular APD gradients could simulate T waves with amplitudes similar to clinical values in the limb leads only. Adding the anteroposterior APD gradient into the model greatly improved the consistency between the simulated T-wave amplitudes and the clinical values. CONCLUSION The simulation results support that the transmural, apicobasal, interventricular and the anteroposterior APD gradient are all essential to the genesis of the clinical T wave.
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Ngoenmak T, Treepongkaruna S, Buddharaksa Y, Khositseth A. Effects of Domperidone on QT Interval in Children with Gastroesophageal Reflux Disease. Pediatr Neonatol 2016; 57:60-4. [PMID: 26141480 DOI: 10.1016/j.pedneo.2015.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/24/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Domperidone has been widely used in children with gastroesophageal reflux disease (GERD). Studies on the effects of domperidone on corrected QT interval (QTc) in young children are limited. Our aim was to study the effect of domperidone on the repolarization abnormalities assessed by electrocardiogram (ECG) in young children. METHODS ECG was performed in children <2 years of age before and after taking domperidone orally 0.3 mg/kg three times/day for at least a 1 week period. Each ECG was reviewed and QT, RR, and Tpeak to Tend intervals (TpTe) were measured to calculate the QTc and TpTe/QT ratio. RESULTS A total of 22 patients (12 male) with a median age of 8.5 months (1-24 months) were enrolled. Most patients (59.1%) were under 1 year of age. The median baseline QTc (410 milliseconds, 350-450 milliseconds) was not significantly different from the QTc after taking domperidone (410 milliseconds, 320-560 milliseconds), p = 0.159. Only two patients showed a QTc increase ≥450 milliseconds. The baseline TpTe interval and TpTe/QT (105 milliseconds, 60-170 milliseconds and 0.27 milliseconds, 0.15-0.43 milliseconds) were significantly greater than the TpTe interval and TpTe/QT in children after taking domperidone (90 milliseconds, 60-140 milliseconds and 0.22 milliseconds, 0.15-0.29 milliseconds), p = 0.001 and 0.004, respectively. CONCLUSIONS Our data demonstrate that domperidone treatment over a short-term period in children <2 years of age did not lengthen QTc significantly; however, QTc increased ≥450 milliseconds in two patients with concomitant lansoprazole. Routine baseline and follow-up ECG may not be necessary in each individual case receiving only domperidone.
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Affiliation(s)
- Thitima Ngoenmak
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; Department of Pediatrics, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
| | - Suporn Treepongkaruna
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Yuthapong Buddharaksa
- Department of Pediatrics, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand
| | - Anant Khositseth
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
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Abdelghani SA, Rosenthal TM, Morin DP. Surface Electrocardiogram Predictors of Sudden Cardiac Arrest. Ochsner J 2016; 16:280-289. [PMID: 27660578 PMCID: PMC5024811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Heart disease is a major cause of death in industrialized nations, with approximately 50% of these deaths attributable to sudden cardiac arrest. If patients at high risk for sudden cardiac arrest can be identified, their odds of surviving fatal arrhythmias can be significantly improved through prophylactic implantable cardioverter defibrillator placement. This review summarizes the current knowledge pertaining to surface electrocardiogram (ECG) predictors of sudden cardiac arrest. METHODS We conducted a literature review focused on methods of predicting sudden cardiac arrest through noninvasive electrocardiographic testing. RESULTS Several electrocardiographic-based methods of risk stratification of sudden cardiac arrest have been studied, including QT prolongation, QRS duration, fragmented QRS complexes, early repolarization, Holter monitoring, heart rate variability, heart rate turbulence, signal-averaged ECG, T wave alternans, and T-peak to T-end. These ECG findings have shown variable effectiveness as screening tools. CONCLUSION At this time, no individual ECG finding has been found to be able to adequately stratify patients with regard to risk for sudden cardiac arrest. However, one or more of these candidate surface ECG parameters may become useful components of future multifactorial risk stratification calculators.
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Affiliation(s)
| | - Todd M. Rosenthal
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Daniel P. Morin
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Winter J, Shattock MJ. Geometrical considerations in cardiac electrophysiology and arrhythmogenesis. Europace 2015; 18:320-31. [PMID: 26585597 DOI: 10.1093/europace/euv307] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/14/2015] [Indexed: 11/14/2022] Open
Abstract
The rate of repolarization (RRepol) and so the duration of the cardiac action potential are determined by the balance of inward and outward currents across the cardiac membrane (net ionic current). Plotting action potential duration (APD) as a function of the RRepol reveals an inverse non-linear relationship, arising from the geometric association between these two factors. From the RRepol-APD relationship, it can be observed that a longer action potential will exhibit a greater propensity to shorten, or prolong, for a given change in the RRepol (i.e. net ionic current), when compared with one that is initially shorter. This observation has recently been used to explain why so many interventions that prolong the action potential exert a greater effect at slow rates (reverse rate-dependence). In this article, we will discuss the broader implications of this simple principle and examine how common experimental observations on the electrical behaviour of the myocardium may be explained in terms of the RRepol-APD relationship. An argument is made, with supporting published evidence, that the non-linear relationship between the RRepol and APD is a fundamental, and largely overlooked, property of the myocardium. The RRepol-APD relationship appears to explain why interventions and disease with seemingly disparate mechanisms of action have similar electrophysiological consequences. Furthermore, the RRepol-APD relationship predicts that prolongation of the action potential, by slowing repolarization, will promote conditions of dynamic electrical instability, exacerbating several electrophysiological phenomena associated with arrhythmogenesis, namely, the rate dependence of dispersion of repolarization, APD restitution, and electrical alternans.
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Affiliation(s)
- James Winter
- Cardiovascular Division, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, UK
| | - Michael J Shattock
- Cardiovascular Division, The Rayne Institute, 4th Floor, Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, UK
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Galeotti L, van Dam PM, Johannesen L, Vicente J, Strauss DG. Computer simulations to investigate the causes of T-wave notching. J Electrocardiol 2015; 48:927-32. [DOI: 10.1016/j.jelectrocard.2015.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Indexed: 11/30/2022]
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45
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Winter J, Lee AW, Niederer S, Shattock MJ. Vagal modulation of dispersion of repolarisation in the rabbit heart. J Mol Cell Cardiol 2015; 85:89-101. [DOI: 10.1016/j.yjmcc.2015.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/08/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
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Rosenthal TM, Stahls PF, Abi Samra FM, Bernard ML, Khatib S, Polin GM, Xue JQ, Morin DP. T-peak to T-end interval for prediction of ventricular tachyarrhythmia and mortality in a primary prevention population with systolic cardiomyopathy. Heart Rhythm 2015; 12:1789-97. [PMID: 25998895 DOI: 10.1016/j.hrthm.2015.04.035] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND The electrocardiographic T-wave peak to T-wave end interval (Tpe) correlates with dispersion of ventricular repolarization (DVR). Increased DVR increases propensity toward electrical reentry that can cause ventricular tachyarrhythmia. The baseline rate-corrected Tpe (Tpec) has been shown to predict ventricular tachyarrhythmia and death in multiple patient populations but not among cardiomyopathic patients undergoing insertion of an implantable cardioverter-defibrillator (ICD) for primary prevention. OBJECTIVE The purpose of this study was to assess the risk stratification ability of the Tpec in patients with systolic cardiomyopathy without prior ventricular tachyarrhythmia (ie, the primary prevention population). METHODS We performed prospective follow-up of 305 patients (73% men; left ventricular ejection fraction [LVEF] 23 ± 7%) with LVEF ≤35% and an ICD implanted for primary prevention. Baseline ECGs were analyzed with automated algorithms. Endpoints were ventricular tachycardia (VT)/ventricular fibrillation (VF), death, and a combined endpoint of VT/VF or death, assessed by device follow-up and Social Security Death Index query. RESULTS The average Tpec was 107 ± 22 ms. During device clinic follow-up of 31 ± 23 months, 82 patients (27%) had appropriate ICD therapy for VT/VF, and during mortality follow-up of 49 ± 21 months, 91 patients (30%) died. On univariable analysis, Tpec predicted VT/VF, death, and the combined endpoint of VT/VF or death (P < .05 for each endpoint). Multivariable analysis included univariable predictors among demographics, clinical data, laboratory data, medications used, and electrocardiography parameters. After correction, Tpec remained predictive of VT/VF (hazard ratio [HR] per 10-ms increase 1.16, P = .009), all-cause mortality (HR per 10 ms 1.13, P = .05), and the combined endpoint (HR per 10 ms 1.17, P = .001). CONCLUSION Tpec independently predicts both VT/VF and overall mortality in patients with systolic dysfunction and ICDs implanted for primary prevention.
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Affiliation(s)
- Todd M Rosenthal
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Paul F Stahls
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Freddy M Abi Samra
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Michael L Bernard
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Sammy Khatib
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Glenn M Polin
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | | | - Daniel P Morin
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana; Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana.
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Arteyeva NV, Azarov JE, Vityazev VA, Shmakov DN. Action potential duration gradients in the heart ventricles and the cardiac electric field during ventricular repolarization (a model study). J Electrocardiol 2015; 48:678-85. [PMID: 25818745 DOI: 10.1016/j.jelectrocard.2015.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND We simulated contributions of transmural, apicobasal, anteroposterior and interventricular action potential duration (APD) gradients to the body surface potential distribution (BSPD) with constant or varied magnitudes of the transmural and apicobasal gradients. METHODS Simulations were done in the framework of the discrete computer model of the rabbit heart ventricles on the basis of realistic activation sequence and APDs. The APD gradients were set constant at 20 ms or varied in the range of ±80 ms. RESULTS The apicobasal, transmural and interventricular APD gradients of 20 ms produced similar BSPDs, whereas the BSPD inversion was caused by the inverted apicobasal or transmural 80 ms gradients. The transmural APD gradient produced transversal and mainly apicobasal T-wave vectors due to wall curvature and cancellation effects. The "normal" transversal and apicobasal repolarization gradients were decreased and increased by activation sequence, respectively. CONCLUSION The different APD gradients contributed consistently to the development of BSPD.
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Affiliation(s)
- Natalia V Arteyeva
- Laboratory of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 50, Pervomayskaya St., Syktyvkar, Russia
| | - Jan E Azarov
- Laboratory of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 50, Pervomayskaya St., Syktyvkar, Russia; Department of Physiology, Medical Institute of Syktyvkar State University, 11, Babushkin St., Syktyvkar, Russia.
| | - Vladimir A Vityazev
- Laboratory of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 50, Pervomayskaya St., Syktyvkar, Russia; Department of Physiology, Medical Institute of Syktyvkar State University, 11, Babushkin St., Syktyvkar, Russia
| | - Dmitry N Shmakov
- Laboratory of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 50, Pervomayskaya St., Syktyvkar, Russia
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Kim SA, Kim MN, Shim WJ, Park SM. Layer-specific dyssynchrony and its relationship to the change of left ventricular function in hypertensive patients. Heart Vessels 2015; 31:528-34. [PMID: 25573260 DOI: 10.1007/s00380-014-0626-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
Left ventricular (LV) remodeling in systemic arterial hypertension causes electrical conduction delay and impairs synchronous contraction, which may contribute to the development of heart failure. This study aimed to assess the change of LV mechanics in hypertension by layer-specific dyssynchrony. One hundred and twenty-one patients with primary hypertension and LV ejection fraction >50 % (mean age, 62 ± 10 years) and 31 normotensive controls (mean age, 63 ± 9 years) were prospectively included. Layer-specific dyssynchrony index (DI) was defined as standard deviation of time interval (TI) from the onset of Q wave to peak longitudinal strain obtained from 18 segments in each endocardial, myocardial, and epicardial layer. The global TI between the onset of Q wave to peak global longitudinal strain in each layer was obtained and the time difference (TD) of global TI between layers was calculated. DIs were significantly different in three layers (P < 0.001 in both groups), and were significantly greater in hypertensive patients than in controls except epicardial DI. End diastolic filling pressure and LV global longitudinal strain were related with endocardial DI. TD between endocardium and myocardium was greater in hypertensive patients than in controls (P = 0.001). Layer-specific DI revealed delayed contraction in each layer and between layers in hypertensive patients, which were apparent in endocardium and between endocardium and myocardium. Increased layer-specific DIs were associated with subclinical LV dysfunction, although LV ejection fraction was preserved. These may be helpful to understand layer-specific mechanical property of LV myocardium and for early detection of subclinical impairment of myocardial function.
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Affiliation(s)
- Su-A Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea
| | - Mi-Na Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea
| | - Wan-Joo Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea.
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Bueno-Orovio A, Kay D, Grau V, Rodriguez B, Burrage K. Fractional diffusion models of cardiac electrical propagation: role of structural heterogeneity in dispersion of repolarization. J R Soc Interface 2015; 11:20140352. [PMID: 24920109 PMCID: PMC4208367 DOI: 10.1098/rsif.2014.0352] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Impulse propagation in biological tissues is known to be modulated by structural heterogeneity. In cardiac muscle, improved understanding on how this heterogeneity influences electrical spread is key to advancing our interpretation of dispersion of repolarization. We propose fractional diffusion models as a novel mathematical description of structurally heterogeneous excitable media, as a means of representing the modulation of the total electric field by the secondary electrical sources associated with tissue inhomogeneities. Our results, analysed against in vivo human recordings and experimental data of different animal species, indicate that structural heterogeneity underlies relevant characteristics of cardiac electrical propagation at tissue level. These include conduction effects on action potential (AP) morphology, the shortening of AP duration along the activation pathway and the progressive modulation by premature beats of spatial patterns of dispersion of repolarization. The proposed approach may also have important implications in other research fields involving excitable complex media.
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Affiliation(s)
- Alfonso Bueno-Orovio
- Oxford Centre for Collaborative Applied Mathematics, University of Oxford, Oxford OX1 3LB, UK Department of Computer Science, University of Oxford, Oxford OX1 3QD, UK
| | - David Kay
- Department of Computer Science, University of Oxford, Oxford OX1 3QD, UK
| | - Vicente Grau
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, UK
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Oxford OX1 3QD, UK
| | - Kevin Burrage
- Department of Computer Science, University of Oxford, Oxford OX1 3QD, UK School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland 4001, Australia
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50
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Postema PG. What value is there in an electrocardiogram X years before your cardiovascular event? J Electrocardiol 2015; 48:112-4. [DOI: 10.1016/j.jelectrocard.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Indexed: 11/26/2022]
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