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Kazibwe R, Ahmad MI, Hughes TM, Chen LY, Soliman EZ. Malignant left ventricular hypertrophy and risk of cognitive impairment in SPRINT MIND trial. Am Heart J 2024; 276:31-38. [PMID: 39067559 DOI: 10.1016/j.ahj.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/14/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The association of malignant left ventricular hypertrophy (LVH), a specific subphenotype of LVH characterized by elevated levels of high-sensitivity cardiac troponin (hs-cTnT) or N-terminal pro-B-type natriuretic peptide (NT-proBNP), with cognitive decline remains understudied. METHODS This post-hoc analysis included a total of 8,027 (67.9 ± 9.3 years) SPRINT MIND trial participants who had with at least 1 follow-up cognitive assessment. Participants were classified into 6 groups on the basis of LVH status on electrocardiogram (ECG), and elevations in levels of hs-cTnT ≥14 ng/L or NT-proBNP ≥125 pg/mL at baseline visit. Multivariate Cox proportional hazard models were used to examine the association of LVH/biomarker groups with incident probable dementia, mild cognitive impairment (MCI) and a composite of MCI/probable dementia. RESULTS Over a median follow-up period of 5 years, there were 306, 597, and 818 incidents of MCI, probable dementia and a composite of MCI/probable dementia, respectively. Compared with participants without LVH and normal biomarker levels, those with concomitant LVH and elevated levels of both biomarkers were associated with a higher risk of probable dementia (HR, 2.50; 95% CI (1.26-4.95), MCI (HR, 1.78; 95% CI (0.99-3.23) and the composite of MCI/ probable dementia (HR, 1.89; 95% CI, 1.16-3.10). CONCLUSIONS Among SPRINT participants, malignant LVH is associated with incident probable dementia and mild cognitive impairment. These findings underscore the potential utility of measuring hs-cTnT and NT-proBNP levels when LVH is detected on ECG, aiding in the differentiation of individuals with a favorable risk for cognitive impairment from those with a higher risk.
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Affiliation(s)
- Richard Kazibwe
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy M Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lin Y Chen
- Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Internal Medicine, Cardiovascular Section, Wake Forest School of Medicine, Winston-Salem, NC
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Hendriks PM, Keuning ZA, Kors JA, van den Hoven AT, Geenen LW, Eindhoven JA, Baggen VJM, Cuypers JAAE, Kauling RM, Roos-Hesselink JW, van den Bosch AE. Prognostic value of the electrocardiogram in patients with bicuspid aortic valve disease. J Electrocardiol 2024; 86:153760. [PMID: 39153288 DOI: 10.1016/j.jelectrocard.2024.153760] [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: 01/23/2024] [Revised: 05/15/2024] [Accepted: 07/10/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Identifying bicuspid aortic valve (BAV) patients at risk for cardiac events remains challenging and the role of the electrocardiogram (ECG) has not yet been described. Therefore, this study aims to describe ECG parameters in BAV patients, and investigate their prognostic value. METHODS In this single-center prospective study patients with BAV without a prior aortic valve replacement (AVR) were included. Transthoracic echocardiogram and 12‑lead resting-ECG were obtained. Associations between ECG parameters and the composite endpoint of all-cause mortality and AVR were assessed using Cox-proportional hazard analysis. RESULTS 120 patients with BAV were included (median age 30 years, 61% male). Median aortic jet velocity was 2.4 m/s [IQR: 1.7-3.4] and 5 patients (4%) had severe aortic regurgitation. All patients were in sinus rhythm. Any ECG abnormality was present in 57 patients (48%). Median PR-interval was 156 [IQR: 138-170] msec. A deviating QRS axis was found in 17 patients (14%) and Cornell criteria for LVH were fulfilled in 20 patients (17%). Repolarization abnormalities were present in 12 patients (10%). Median follow-up duration was 7.0 [6.3-9.8] years, during which 23 patients underwent AVR and 2 patients died. After adjusting for age, a longer PR-interval was associated with worse intervention-free survival (HR 1.02, 95% CI: 1.01-1.04). CONCLUSION Almost half of the patients with BAV had abnormalities on their ECG. Moreover, the PR-interval may be an interesting prognostic marker for intervention-free survival in BAV patients.
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Affiliation(s)
- Paul M Hendriks
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Zoë A Keuning
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Allard T van den Hoven
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Laurie W Geenen
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jannet A Eindhoven
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Vivan J M Baggen
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Robert M Kauling
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; ERN-GUARD-Heart: European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Rotterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; ERN-GUARD-Heart: European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Rotterdam, the Netherlands.
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DeBauge A, Harvey CJ, Gupta A, Fairbank T, Ranka S, Jiwani S, Reddy M, Sheldon SH, Noheria A. Evaluation of electrocardiographic criteria for predicting left ventricular hypertrophy and dilation in presence of left bundle branch block. J Electrocardiol 2024; 87:153787. [PMID: 39348743 DOI: 10.1016/j.jelectrocard.2024.153787] [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: 07/15/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 10/02/2024]
Abstract
BACKGROUND The utility of standard published electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in patients with left bundle branch block (LBBB) is not established. We have previously shown that in ECGs demonstrating LBBB, QRS duration outperforms vectorcardiographic X, Y, Z lead and root-mean-squared (3D) amplitudes and voltage-time-integrals in diagnosing LVH and dilation. We sought to evaluate diagnostic yields of published LVH criteria versus QRS duration for ECG based diagnosis of LVH and dilation in presence of LBBB. METHODS We included adult patients with typical LBBB having ECG and transthoracic echocardiogram performed within 3 months of each other in 2010-2020. We obtained area under receiver-operator characteristic curve (AUC) for QRS duration and each of the published ECG LVH criteria to predict increased LV mass indexed (↑LVMi, women >95 g/m2, men >115 g/m2) and LV end diastolic volume indexed (↑LVEDVi, women >61 mL/m2, men >74 mL/m2). RESULTS Among 413 adults (53 % women, age 73 ± 12 yr) with LBBB, the traditional LVH criteria performed poorly to detect ↑LVMi or ↑LVEDVi. Cornell voltage-duration product had the highest AUCs (↑LVMi 0.634, ↑LVEDVi 0.580). QRS duration had a higher AUC for diagnosing ↑LVMi (women 0.657, men 0.703) and ↑LVEDVi (women 0.668, men 0.699) compared to any other criteria. CONCLUSIONS In patients with LBBB, prolonged QRS duration (women ≥150 ms, men ≥160 ms) is a superior predictor of LVH and dilation than traditional ECG-based LVH criteria.
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Affiliation(s)
- Ashley DeBauge
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Christopher J Harvey
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Amulya Gupta
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Tyan Fairbank
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Sagar Ranka
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sania Jiwani
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America.
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Qiu Y, Sun J, Wang Y, Jin C, Ju W, Yang G, Gu K, Liu H, Wang Z, Jiang X, Li M, Chen H, Chen M. Association between P-wave terminal force in lead V 1 and extent of left atrial low-voltage substrate in older patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:1153-1160. [PMID: 38030935 DOI: 10.1007/s10840-023-01710-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The P-wave terminal force in lead V1 (PTFV1) is a marker of cardiomyopathy and risk of atrial fibrillation (AF). Low-voltage area (LVA) in the left atrium (LA), which indicates underlying atrial fibrosis, could predict AF recurrence. This study aimed to investigate the correlation between PTFV1 and LVA in older patients with paroxysmal AF. METHODS From May 1, 2020, to October 31, 2021, a total of 162 patients aged 65-80 years with paroxysmal AF who underwent index ablation procedures were enrolled. PTFV1 was measured in sinus rhythm (SR) using 12-lead electrocardiograms prior to the ablation. Abnormal PTFV1 was defined as a ≥ 4 mVms depression. Additional LVA ablation beyond circumferential pulmonary vein isolation (CPVI) was performed if LVAs were found. RESULTS Among the 162 patients, 88 had a normal PTFV1 and 74 had an abnormal PTFV1 prior to ablation. There was a significant difference in LVA in patients with and without an abnormal PTFV1 (LVA, 11.0 vs. 5.1 cm2, P < 0.001; LVA burden, 8.9% vs. 4.5%, P < 0.001). PTFV1 and PTAV1 were highest in the upper tertile with extensive LVAs (P < 0.001). Multivariate analysis revealed that abnormal PTFV1 was an independent predictor of LVAs (β = 4.961; 95% CI, 2.135-7.788; P < 0.001). After a median follow-up of 23 months, the AF-free survival rate was similar between the normal PTFV1 group and the abnormal PTFV1 group (13/88 vs. 12/74, hazard ratio [HR], 0.933 [95% CI, 0.425-2.047]; P = 0.861). CONCLUSIONS Abnormal PTFV1 at baseline was independently associated with the extent of LVA in older patients with paroxysmal AF.
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Affiliation(s)
- Yue Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Jinyu Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Yuxuan Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Caiyi Jin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Kai Gu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Hailei Liu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Zidun Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Xiaohong Jiang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Mingfang Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China
| | - Hongwu Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, Jiangsu Province, China.
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Na SJ, Ko RE, Chung CR, Yang JH, Oh DK, Lee SY, Park MH, Lee H, Lim CM, Suh GY. Early detection of low QRS voltage and its association with mortality in patients with sepsis. Sci Rep 2024; 14:16066. [PMID: 38992092 PMCID: PMC11239899 DOI: 10.1038/s41598-024-66612-x] [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: 02/11/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024] Open
Abstract
Various electrocardiographic changes occur during sepsis, but data on the clinical importance of a low QRS voltage in sepsis are still limited. We aimed to evaluate the association between low QRS voltage identified early in sepsis and mortality in patients with sepsis. Between September 2019 and December 2020, all consecutive adult patients diagnosed with sepsis in the emergency room or general ward at Samsung Medical Center were enrolled. Patients without a 12-lead electrocardiogram recorded within 48 h of recognition of sepsis were excluded. In 432 eligible patients, 12-lead electrocardiogram was recorded within the median of 24 min from the first recognition of sepsis, and low QRS voltage was identified in 115 (26.6%) patients. The low QRS group showed more severe organ dysfunction and had higher levels of N-terminal pro-brain natriuretic peptide. The hospital mortality was significantly higher in the low QRS voltage group than in the normal QRS voltage group (49.6% vs. 28.1%, p < 0.001). Similarly, among the 160 patients who required intensive care unit admission, significantly more patients in the low QRS group died in the intensive care unit (35.9% vs. 18.2%, p = 0.021). Low QRS voltage was associated with increased hospital mortality in patients with sepsis.
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Affiliation(s)
- Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Kyu Oh
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Su Yeon Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Hyeon Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Haein Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Man Lim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Montazerin SM, Ekmekjian Z, Kiwan C, Correia JJ, Frishman WH, Aronow WS. Role of the Electrocardiogram for Identifying the Development of Atrial Fibrillation. Cardiol Rev 2024:00045415-990000000-00294. [PMID: 38970472 DOI: 10.1097/crd.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
Atrial fibrillation (AF), a prevalent cardiac arrhythmia, is associated with increased morbidity and mortality worldwide. Stroke, the leading cause of serious disability in the United States, is among the important complications of this arrhythmia. Recent studies have demonstrated that certain clinical variables can be useful in the prediction of AF development in the future. The electrocardiogram (ECG) is a simple and cost-effective technology that is widely available in various healthcare settings. An emerging body of evidence has suggested that ECG tracings preceding the development of AF can be useful in predicting this arrhythmia in the future. Various variables on ECG especially different P wave parameters have been investigated in the prediction of new-onset AF and found to be useful. Several risk models were also introduced using these variables along with the patient's clinical data. However, current guidelines do not provide a clear consensus regarding implementing these prediction models in clinical practice for identifying patients at risk of AF. Also, the role of intensive screening via ECG or implantable devices based on this scoring system is unclear. The purpose of this review is to summarize AF and various related terminologies and explain the pathophysiology and electrocardiographic features of this tachyarrhythmia. We also discuss the predictive electrocardiographic features of AF, review some of the existing risk models and scoring system, and shed light on the role of monitoring device for screening purposes.
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Affiliation(s)
| | - Zareh Ekmekjian
- From the Department of Medicine, NYMC Saint Michaels Medical Center, Newark, NJ
| | - Chrystina Kiwan
- From the Department of Medicine, NYMC Saint Michaels Medical Center, Newark, NJ
| | - Joaquim J Correia
- Department of Cardiology, NYMC Saint Michaels Medical Center, Newark, NJ
| | | | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
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Hirota N, Suzuki S, Motogi J, Umemoto T, Nakai H, Matsuzawa W, Takayanagi T, Hyodo A, Satoh K, Arita T, Yagi N, Kishi M, Semba H, Kano H, Matsuno S, Kato Y, Otsuka T, Uejima T, Oikawa Y, Hori T, Matsuhama M, Iida M, Yajima J, Yamashita T. Evaluating convolutional neural network-enhanced electrocardiography for hypertrophic cardiomyopathy detection in a specialized cardiovascular setting. Heart Vessels 2024; 39:524-538. [PMID: 38553520 DOI: 10.1007/s00380-024-02367-9] [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: 06/22/2023] [Accepted: 01/24/2024] [Indexed: 05/05/2024]
Abstract
The efficacy of convolutional neural network (CNN)-enhanced electrocardiography (ECG) in detecting hypertrophic cardiomyopathy (HCM) and dilated HCM (dHCM) remains uncertain in real-world applications. This retrospective study analyzed data from 19,170 patients (including 140 HCM or dHCM) in the Shinken Database (2010-2017). We evaluated the sensitivity, positive predictive rate (PPR), and F1 score of CNN-enhanced ECG in a ''basic diagnosis'' model (total disease label) and a ''comprehensive diagnosis'' model (including disease subtypes). Using all-lead ECG in the "basic diagnosis" model, we observed a sensitivity of 76%, PPR of 2.9%, and F1 score of 0.056. These metrics improved in cases with a diagnostic probability of ≥ 0.9 and left ventricular hypertrophy (LVH) on ECG: 100% sensitivity, 8.6% PPR, and 0.158 F1 score. The ''comprehensive diagnosis'' model further enhanced these figures to 100%, 13.0%, and 0.230, respectively. Performance was broadly consistent across CNN models using different lead configurations, particularly when including leads viewing the lateral walls. While the precision of CNN models in detecting HCM or dHCM in real-world settings is initially low, it improves by targeting specific patient groups and integrating disease subtype models. The use of ECGs with fewer leads, especially those involving the lateral walls, appears comparably effective.
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Affiliation(s)
- Naomi Hirota
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan.
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | | | | | - Hiroshi Nakai
- Information System Division, The Cardiovascular Institute, Tokyo, Japan
| | | | | | | | | | - Takuto Arita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Naoharu Yagi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Mikio Kishi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Hiroaki Semba
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Yuko Kato
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Takayuki Hori
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Minoru Matsuhama
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Mitsuru Iida
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo, 106-0031, Japan
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Abiodun OO, Anya T, Adekanmbi VT. Electrocardiographic Abnormalities in Nigerian Hypertensives With Echocardiographic Left Ventricular Hypertrophy. Cureus 2024; 16:e60170. [PMID: 38868248 PMCID: PMC11167321 DOI: 10.7759/cureus.60170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/14/2024] Open
Abstract
Introduction To enhance the diagnosis of anatomic left ventricular hypertrophy (LVH) using electrocardiography (ECG), we aimed to identify common ECG amplitude and non-amplitude abnormalities in Nigerian patients with hypertensive echocardiographic LVH. Method The study included 1,765 patients with essential hypertension aged 18 years and older from the Federal Medical Centre Abuja Hypertension Registry (FMCAHR). Participants underwent echocardiography and ECG following the American College of Cardiology and the American Society of Echocardiography guidelines. Results The prevalence of overall ECG LVH amplitude criteria (43.8%) and individual criteria of Cornell voltage (27.1%), Sokolow-Lyon voltage (23.2%), and Gubner-Ungerleider (13.9%) were higher than non-amplitude ECG abnormalities among patients with echocardiographic LVH. The sensitivity and specificity of LVH criteria were 43.8% and 79.5% for overall ECG LVH, 23.2% and 87.2% for Sokolow-Lyon voltage, 27.1% and 93.3% for Cornell voltage, and 13.9% and 95.4% for Gubner-Ungerleider criteria, respectively. After multivariable adjustment, non-amplitude ECG changes, including prolonged corrected QT (QTc) (odds ratio (OR): 1.68, 95% confidence interval (CI): 1.06-2.66), left ventricular (LV) strain pattern (OR: 1.83, CI: 1.23-2.72), left axis deviation (OR: 1.56, CI: 1.09-2.24), poor R wave progression (OR: 2.36, CI: 1.40-3.97), premature ventricular contractions (OR: 1.80, CI: 1.10-2.91), premature atrial contractions (OR: 2.06, CI: 1.10-3.87), atrial fibrillation (OR: 2.40, CI: 1.20-4.82), and left atrial abnormality (OR: 8.43, CI: 2.95-24.05), were associated with echocardiographic LVH (p < 0.05). Conclusion In our cohort of hypertensive patients, ECG LVH amplitude criteria were the most frequently observed abnormalities associated with echocardiographic LVH. Our findings suggest that despite the low sensitivity, ECG LVH amplitude criteria may remain valuable in diagnosing echocardiographic LVH.
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Affiliation(s)
| | - Tina Anya
- Internal Medicine/Cardiology, Federal Medical Centre, Abuja, NGA
| | - Victor T Adekanmbi
- Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, USA
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Ley L, Messmer F, Vaisnora L, Ghofrani HA, Bandorski D, Kostrzewa M. Electrocardiographic Changes after Endovascular Mechanical Thrombectomy in a Patient with Pulmonary Embolism-A Case Report and Literature Review. J Clin Med 2024; 13:2548. [PMID: 38731076 PMCID: PMC11084833 DOI: 10.3390/jcm13092548] [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: 03/05/2024] [Revised: 03/24/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Pulmonary embolism (PE) is a common disease with an annual incidence of about 1/1000 persons. About every sixth patient dies within the first 30 days after diagnosis. The electrocardiogram (ECG) is one of the first diagnostic tests performed, and is able to confirm the suspicion of PE with typical electrocardiographic signs. Some ECG signs and their regression are also prognostically relevant. Endovascular mechanical thrombectomy is one option for PE treatment, and aims to relieve right heart strain immediately. The first studies on endovascular mechanical thrombectomy using a dedicated device (FlowTriever System, Inari Medical, Irvine, CA, USA) yielded promising results. Methods: In the following, we report the case of a 66-year-old male patient who presented with New York Heart Association III dyspnea in our emergency department. Among typical clinical and laboratory results, he displayed very impressive electrocardiographic and radiological findings at the time of PE diagnosis. Results: After endovascular mechanical thrombectomy, the patient's complaints and pulmonary hemodynamics improved remarkably. In contrast, the ECG worsened paradoxically 18 h after intervention. Nevertheless, control echocardiography 4 days after the intervention no longer showed any signs of right heart strain, and dyspnea had disappeared completely. At a 4-month follow-up visit, the patient presented as completely symptom-free with a high quality of life. His ECG and echocardiography were normal and excluded recurrent right heart strain. Conclusions: Overall, the patient benefitted remarkably from endovascular mechanical thrombectomy, resulting in an almost complete resolution of electrocardiographic PE signs at the 4-month follow-up after exhibiting multiple typical electrocardiographic PE signs at time of diagnosis and initial electrocardiographic worsening 18 h post successful intervention.
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Affiliation(s)
- Lukas Ley
- Department of Radiology, Baden Cantonal Hospital, 5404 Baden, Switzerland; (F.M.); (M.K.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany
| | - Florian Messmer
- Department of Radiology, Baden Cantonal Hospital, 5404 Baden, Switzerland; (F.M.); (M.K.)
| | - Lukas Vaisnora
- Department of Cardiology, Baden Cantonal Hospital, 5404 Baden, Switzerland;
| | | | - Dirk Bandorski
- Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany;
| | - Michael Kostrzewa
- Department of Radiology, Baden Cantonal Hospital, 5404 Baden, Switzerland; (F.M.); (M.K.)
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10
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Polcwiartek C, Andersen MP, Christensen HC, Torp-Pedersen C, Sørensen KK, Kragholm K, Graff C. The Danish Nationwide Electrocardiogram (ECG) Cohort. Eur J Epidemiol 2024; 39:325-333. [PMID: 38407726 PMCID: PMC10995054 DOI: 10.1007/s10654-024-01105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
The electrocardiogram (ECG) is a non-invasive diagnostic tool holding significant clinical importance in the diagnosis and risk stratification of cardiac disease. However, access to large-scale, population-based digital ECG data for research purposes remains limited and challenging. Consequently, we established the Danish Nationwide ECG Cohort to provide data from standard 12-lead digital ECGs in both pre- and in-hospital settings, which can be linked to comprehensive Danish nationwide administrative registers on health and social data with long-term follow-up. The Danish Nationwide ECG Cohort is an open real-world cohort including all patients with at least one digital pre- or in-hospital ECG in Denmark from January 01, 2000, to December 31, 2021. The cohort includes data on standardized and uniform ECG diagnostic statements and ECG measurements including global parameters as well as lead-specific measures of waveform amplitudes, durations, and intervals. Currently, the cohort comprises 2,485,987 unique patients with a median age at the first ECG of 57 years (25th-75th percentiles, 40-71 years; males, 48%), resulting in a total of 11,952,430 ECGs. In conclusion, the Danish Nationwide ECG Cohort represents a novel and extensive population-based digital ECG dataset for cardiovascular research, encompassing both pre- and in-hospital settings. The cohort contains ECG diagnostic statements and ECG measurements that can be linked to various nationwide health and social registers without loss to follow-up.
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Affiliation(s)
- Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, DK-9000, Denmark.
| | - Mikkel Porsborg Andersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Prehospital Center, Region Zealand, Næstved, Denmark
| | - Helle Collatz Christensen
- Prehospital Center, Region Zealand, Næstved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, DK-9000, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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11
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Faggiano A, Gherbesi E, Tadic M, Carugo S, Grassi G, Cuspidi C. Do We Need New Electrocardiographic Criteria for Left Ventricular Hypertrophy? The Case of the Peguero-Lo Presti Criterion. A Narrative Review. Am J Hypertens 2024; 37:155-162. [PMID: 38112655 PMCID: PMC10906064 DOI: 10.1093/ajh/hpad117] [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: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
The cardiovascular risk associated with left ventricular hypertrophy (LVH) in the community and, particularly, in the hypertensive fraction of the general population, represents the rationale for its timely and accurate identification in order to implement adequate preventive strategies. Although electrocardiography (ECG) is the first-line and most economical method of diagnosing LVH its accuracy is largely suboptimal. Over the last 70 years, dozens of different ECG criteria, mostly based on measurements of QRS voltages, have been proposed. In this long journey, a few years ago Peguero et al. developed a novel ECG voltage criterion, currently recognized as Peguero-Lo Presti (PLP) suggesting that it has greater sensitivity than traditional ECG-LVH criteria. Considering that in the last 5 years numerous studies have investigated the diagnostic value of this new index, this review aimed to summarize the data published so far on this topic focusing both on the accuracy in identifying the presence of LVH compared with imaging techniques such as echocardiography (ECHO) and magnetic resonance imaging (MRI) and the value in predicting hard outcomes. The evidence in favor of the greater diagnostic accuracy of the PLP criterion in detecting LVH, phenotyped by ECHO or MRI, and in the stratification of hard outcomes compared with traditional ECG criteria does not appear to be sufficiently proven. Given that the diagnosis of LVH by all ECG criteria (including the PLP) exclusively based on the QRS amplitude is largely imprecise, the development of new multiparametric ECG criteria based on artificial intelligence could represent a real improvement in the diagnostic capacity of the ECG.
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Affiliation(s)
- Andrea Faggiano
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Marijana Tadic
- Department of Cardio-Thoracic-Vascular Diseases, University Heart Center Ulm, University Ulm, Ulm, Germany
| | - Stefano Carugo
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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12
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Haack L, Das N, Hoskoppal A, DeBrunner M, Alsaied T, Arora G. Right Atrial Enlargement on Electrocardiogram in Previously Healthy Young Patients. J Pediatr 2024; 265:113814. [PMID: 37918518 DOI: 10.1016/j.jpeds.2023.113814] [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: 08/17/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES To assess whether right atrial enlargement (RAE) on electrocardiogram (ECG) correlates with true RAE on echocardiogram in previously healthy young patients and to understand which patients with RAE on ECG may warrant additional testing. STUDY DESIGN A single-center, retrospective review of previously healthy young patients with (1) ECGs that were read as RAE by a pediatric cardiologist and (2) echocardiograms obtained within 90 days of the ECG. ECGs were reviewed to confirm RAE and determine which leads met criteria. The echocardiograms were then reviewed and RA measurements with z scores obtained. A z score >2 was considered positive for RAE on echocardiogram. RESULTS In total, 162 patients with median age 10.8 years were included in the study. A total of 23 patients had true RAE on echocardiogram, giving a positive predictive value (PPV) of 14%. In patients <1 year of age, the PPV increased to 35%. In patients older than 1 year, the PPV was low at 7%. Patients with true RAE were more likely to meet criteria for RAE in the anterior precordial leads (V1-V3) (48% vs 5%, P < .001) and meet criteria for right ventricular hypertrophy (22% vs 6%, P = .023). CONCLUSION Our findings show that RAE on ECG has a low PPV for RAE on echocardiogram in previously healthy young patients. The highest yield for RAE on echocardiogram was observed in patients who were <1 year of age, had RAE in the anterior precordial leads, or displayed right ventricular hypertrophy on ECG.
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Affiliation(s)
- Lindsey Haack
- Department of Pediatric Cardiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA.
| | - Nikkan Das
- Department of Pediatric Cardiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Arvind Hoskoppal
- Department of Pediatric Cardiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Mark DeBrunner
- Department of Pediatric Cardiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Tarek Alsaied
- Department of Pediatric Cardiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Gaurav Arora
- Department of Pediatric Cardiology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
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13
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Khorgami MR, Rezaei Y, Tabib A, Ghavidel AA, Omrani G, Mohebbi A, Peighambari MM, Emkanjoo Z, Oveisi M, Hajianfar G, Kazemborji B, Hosseini S, Samiei N. Prevalence of electrocardiographic abnormalities among Iranian children and adolescents and associations with blood pressure and obesity: findings from the SHED LIGHT study. Cardiol Young 2024:1-9. [PMID: 38234002 DOI: 10.1017/s1047951123004304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND There are few studies for detecting rhythm abnormalities among healthy children and adolescents. The aim of the study was to investigate the prevalence of abnormal electrocardiographic findings in the young Iranian population and its association with blood pressure and obesity. METHODS A total of 15084 children and adolescents were examined in a randomly selected population of Tehran city, Iran, between October 2017 and December 2018. Anthropometric values and blood pressure measurements were also assessed. A standard 12-lead electrocardiogram was recorded by a unique recorder, and those were examined by electrophysiologists. RESULTS All students mean age was 12.3 ± 3.1 years (6-18 years), and 52% were boys. A total of 2900 students (192.2/1000 persons; 95% confidence interval 186-198.6) had electrocardiographic abnormalities. The rate of electrocardiographic abnormalities was higher in boys than girls (p < 0.001). Electrocardiographic abnormalities were significantly higher in thin than obese students (p < 0.001), and there was a trend towards hypertensive individuals to have more electrocardiographic abnormalities compared to normotensive individuals (p = 0.063). Based on the multivariable analysis, individuals with electrocardiographic abnormalities were less likely to be girls (odds ratio 0.745, 95% confidence interval 0.682-0.814) and had a lower body mass index (odds ratio 0.961, 95% confidence interval 0.944-0.979). CONCLUSIONS In this large-scale study, there was a high prevalence of electrocardiographic abnormalities among young population. In addition, electrocardiographic findings were significantly influenced by increasing age, sex, obesity, and blood pressure levels. This community-based study revealed the implications of electrocardiographic screening to improve the care delivery by early detection.
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Affiliation(s)
- Mohammad Rafie Khorgami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Behyan Clinic, Pardis New Town, Tehran, Iran
| | - Avisa Tabib
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza A Ghavidel
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Omrani
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Mohebbi
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Peighambari
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Emkanjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Oveisi
- Faculty of Life Sciences & Medicine, Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Ghasem Hajianfar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahareh Kazemborji
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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14
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Duong SQ, Vaid A, My VTH, Butler LR, Lampert J, Pass RH, Charney AW, Narula J, Khera R, Sakhuja A, Greenspan H, Gelb BD, Do R, Nadkarni GN. Quantitative Prediction of Right Ventricular Size and Function From the ECG. J Am Heart Assoc 2024; 13:e031671. [PMID: 38156471 PMCID: PMC10863807 DOI: 10.1161/jaha.123.031671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Right ventricular ejection fraction (RVEF) and end-diastolic volume (RVEDV) are not readily assessed through traditional modalities. Deep learning-enabled ECG analysis for estimation of right ventricular (RV) size or function is unexplored. METHODS AND RESULTS We trained a deep learning-ECG model to predict RV dilation (RVEDV >120 mL/m2), RV dysfunction (RVEF ≤40%), and numerical RVEDV and RVEF from a 12-lead ECG paired with reference-standard cardiac magnetic resonance imaging volumetric measurements in UK Biobank (UKBB; n=42 938). We fine-tuned in a multicenter health system (MSHoriginal [Mount Sinai Hospital]; n=3019) with prospective validation over 4 months (MSHvalidation; n=115). We evaluated performance with area under the receiver operating characteristic curve for categorical and mean absolute error for continuous measures overall and in key subgroups. We assessed the association of RVEF prediction with transplant-free survival with Cox proportional hazards models. The prevalence of RV dysfunction for UKBB/MSHoriginal/MSHvalidation cohorts was 1.0%/18.0%/15.7%, respectively. RV dysfunction model area under the receiver operating characteristic curve for UKBB/MSHoriginal/MSHvalidation cohorts was 0.86/0.81/0.77, respectively. The prevalence of RV dilation for UKBB/MSHoriginal/MSHvalidation cohorts was 1.6%/10.6%/4.3%. RV dilation model area under the receiver operating characteristic curve for UKBB/MSHoriginal/MSHvalidation cohorts was 0.91/0.81/0.92, respectively. MSHoriginal mean absolute error was RVEF=7.8% and RVEDV=17.6 mL/m2. The performance of the RVEF model was similar in key subgroups including with and without left ventricular dysfunction. Over a median follow-up of 2.3 years, predicted RVEF was associated with adjusted transplant-free survival (hazard ratio, 1.40 for each 10% decrease; P=0.031). CONCLUSIONS Deep learning-ECG analysis can identify significant cardiac magnetic resonance imaging RV dysfunction and dilation with good performance. Predicted RVEF is associated with clinical outcome.
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Affiliation(s)
- Son Q. Duong
- Division of Pediatric Cardiology, Department of PediatricsIcahn School of Medicine at Mount SinaiNew YorkNY
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Akhil Vaid
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Vy Thi Ha My
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Liam R. Butler
- Division of Pediatric Cardiology, Department of PediatricsIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Joshua Lampert
- Helmsley Center for Electrophysiology at The Mount Sinai HospitalNew YorkNY
| | - Robert H. Pass
- Division of Pediatric Cardiology, Department of PediatricsIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Alexander W. Charney
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Jagat Narula
- Mount Sinai Heart, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCT
- Section of Health Informatics, Department of BiostatisticsYale School of Public HealthNew HavenCT
- Biomedical Informatics and Data Science, Yale School of MedicineNew HavenCT
- Center for Outcomes Research and Evaluation, Yale‐New Haven HospitalNew HavenCT
| | - Ankit Sakhuja
- Division of Cardiovascular Critical Care, Department of Cardiac and Thoracic SurgeryWest Virginia UniversityMorgantownWV
| | - Hayit Greenspan
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount SinaiNew YorkNY
| | - Bruce D. Gelb
- Division of Pediatric Cardiology, Department of PediatricsIcahn School of Medicine at Mount SinaiNew YorkNY
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount SinaiNew YorkNY
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Ron Do
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Girish N. Nadkarni
- The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount SinaiNew YorkNY
- The Division of Data Driven and Digital Medicine (D3M), Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
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15
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Bacharova L, Chevalier P, Gorenek B, Jons C, Li Y, Locati ET, Maanja M, Pérez‐Riera AR, Platonov PG, Ribeiro ALP, Schocken D, Soliman EZ, Svehlikova J, Tereshchenko LG, Ugander M, Varma N, Elena Z, Ikeda T. ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy: The change of the paradigm. Ann Noninvasive Electrocardiol 2024; 29:e13097. [PMID: 37997698 PMCID: PMC10770819 DOI: 10.1111/anec.13097] [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: 08/10/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria. The classical paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces, reflected in the augmented QRS amplitude. However, the low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm. The theoretical background for voltage measured at the body surface is defined by the solid angle theorem, which relates the measured voltage to spatial and non-spatial determinants. The spatial determinants are represented by the extent of the activation front and the distance of the recording electrodes. The non-spatial determinants comprise electrical characteristics of the myocardium, which are comparatively neglected in the interpretation of the QRS patterns. Various clinical conditions are associated with LVH. These conditions produce considerable diversity of electrical properties alterations thereby modifying the resultant QRS patterns. The spectrum of QRS patterns observed in LVH patients is quite broad, including also left axis deviation, left anterior fascicular block, incomplete and complete left bundle branch blocks, Q waves, and fragmented QRS. Importantly, the QRS complex can be within normal limits. The new paradigm stresses the electrophysiological background in interpreting QRS changes, i.e., the effect of the non-spatial determinants. This postulates that the role of ECG is not to estimate LV size in LVH, but to understand and decode the underlying electrical processes, which are crucial in relation to cardiovascular risk assessment.
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Affiliation(s)
| | - Philippe Chevalier
- Neuromyogene InstituteClaude Bernard UniversityVilleurbanneFrance
- Service de RythmologieHospices Civils de LyonLyonFrance
| | - Bulent Gorenek
- Eskisehir Osmangazi University Cardiology DepartmentEskisehirTurkey
| | - Christian Jons
- Department of CardiologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Yi‐Gang Li
- Department of Cardiology, Xinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Emanuela T. Locati
- Department of Arrhythmology and ElectrophysiologyIRCCS Policlinico San DonatoMilanoItaly
| | - Maren Maanja
- Department of Clinical PhysiologyKarolinska University Hospital, and Karolinska InstitutetStockholmSweden
| | | | - Pyotr G. Platonov
- Department of Cardiology, Clinical SciencesLund UniversityLundSweden
| | - Antonio Luiz Pinho Ribeiro
- Internal Medicine, Faculdade de Medicina da Universidade Federal de Minas GeraisBelo HorizonteBrazil
- Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Douglas Schocken
- Division of Cardiology, Department of MedicineDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Elsayed Z. Soliman
- Section on Cardiovascular Medicine, Department of Medicine, Epidemiological Cardiology Research CenterWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Jana Svehlikova
- Institute of Measurement Sciences, Slovak Academy of SciencesBratislavaSlovak Republic
| | - Larisa G. Tereshchenko
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOhioUSA
| | - Martin Ugander
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Clinical PhysiologyKarolinska InstituteStockholmSweden
| | - Niraj Varma
- Cardiac Pacing & ElectrophysiologyHeart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
| | - Zaklyazminskaya Elena
- Medical Genetics LaboratoryPetrovsky National Research Centre of SurgeryMoscowRussia
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16
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Farina JM, Yinadsawaphan T, Jaroszewski DE, Aly MR, Botros M, Cheema KP, Fatunde OA, Sorajja D. The electrocardiographic manifestations of pectus excavatum before and after surgical correction. J Electrocardiol 2024; 82:19-26. [PMID: 38000149 DOI: 10.1016/j.jelectrocard.2023.11.007] [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: 09/13/2023] [Revised: 10/31/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Pectus excavatum (PEx) can cause cardiopulmonary limitations due to cardiac compression and displacement. There is limited data on electrocardiogram (ECG) alterations before and after PEx surgical repair, and ECG findings suggesting cardiopulmonary limitations have not been reported. The aim of this study is to explore ECG manifestations of PEx before and after surgery including associations with exercise capacity. METHODS A retrospective review of PEx patients who underwent primary repair was performed. ECGs before and after surgical correction were evaluated and the associations between preoperative ECG abnormalities and cardiopulmonary function were investigated. RESULTS In total, 310 patients were included (mean age 35.1 ± 11.6 years). Preoperative ECG findings included a predominant negative P wave morphology in V1, and this abnormal pattern significantly decreased from 86.9% to 57.4% (p < 0.001) postoperatively. The presence of abnormal P wave amplitude in lead II (>2.5 mm) significantly decreased from 7.1% to 1.6% postoperatively (p < 0.001). Right bundle branch block (RBBB) (9.4% versus 3.9%, p < 0.001), rsr' patterns (40.6% versus 12.9%, p < 0.001), and T wave inversion in leads V1-V3 (62.3% vs 37.7%, p < 0.001) were observed less frequently after surgery. Preoperative presence of RBBB (OR = 4.8; 95%CI 1.1-21.6) and T wave inversion in leads V1-3 (OR = 2.3; 95%CI 1.3-4.2) were associated with abnormal results in cardiopulmonary exercise testings. CONCLUSION Electrocardiographic abnormalities in PEx are frequent and can revert to normal following surgery. Preoperative RBBB and T wave inversion in leads V1-3 suggested a reduction in exercise capacity, serving as a marker for the need for further cardiovascular evaluation of these patients.
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Affiliation(s)
- Juan M Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA; Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Dawn E Jaroszewski
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Mohamed R Aly
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Michael Botros
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Kamal P Cheema
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | | | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
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17
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Pokhrel Bhattarai S, Block RC, Xue Y, Rodriguez DH, Tucker RG, Carey MG. Integrative review of electrocardiographic characteristics in patients with reduced, mildly reduced, and preserved heart failure. Heart Lung 2024; 63:142-158. [PMID: 37913557 DOI: 10.1016/j.hrtlng.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Electrocardiographic (ECG) changes in heart failure with reduced, mildly reduced, and preserved ejection fractions can be critical in clinical assessment while waiting to perform echocardiograms or when it is unavailable. This integrative review aimed to identify ECG characteristics among hospitalized patients demonstrating three types of heart failure during acute decompensation. METHODS We searched an electronic database of PubMed, Web of Science, EMBASE, Scopus, Google Scholar, and ClinicalTrials.gov using medical subject headings (MeSH) terms and keywords. Sixteen studies were synthesized and reported. RESULTS Heart failure with reduced ejection fraction (HFrEF) was more common in men, comorbid with coronary artery diseases and diabetes mellitus, higher BNP/Pro-BNP, wide QRS, and left bundle branch block on ECG. On average, clients with heart failure with preserved ejection fraction (HFpEF) were older and more likely to have a history of atrial fibrillation, valvular heart diseases, hypertension, chronic obstructive pulmonary, and atrial fibrillation (AF) on ECG. Patients with mildly reduced (HFmrEF) were more similar to HFpEF in older patients, comorbid with hypertension, AF and valvular diseases, and AF on ECG. CONCLUSIONS ECG characteristics might be related to left ventricular ejection fraction. Demographics, BNP/Pro-BNP, and ECG changes might help differentiate different heart failure types. Therefore, ECG might be a prognostic tool while caring for heart failure patients when highly skilled resources are unavailable. These identified ECG characteristics help generate research hypotheses and warrant validation in future research.
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Affiliation(s)
- Sunita Pokhrel Bhattarai
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States.
| | | | - Ying Xue
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States
| | - Darcey H Rodriguez
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States; University of Rochester Medical Center, United States
| | - Rebecca G Tucker
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States
| | - Mary G Carey
- University of Rochester School of Nursing, 255 Crittenden Boulevard, Box SON, Rochester, NY 14642, United States; University of Rochester Medical Center, United States
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Sager P, Rusch A, Weber L, Breuss A, Appert S, Brenner R, Buser M, Ammann P, Rickli H, Maeder MT. ECG left ventricular hypertrophy in aortic stenosis: Relationship with cardiac structure, invasive hemodynamics, and long-term mortality. Clin Cardiol 2024; 47:e24155. [PMID: 37740622 PMCID: PMC10765998 DOI: 10.1002/clc.24155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND In aortic stenosis (AS), left ventricular hypertrophy (LVH) is the response to pressure overload and represents the substrate for a maladaptive cascade, the so-called AS-related cardiac damage. We hypothesized that in AS patients electrocardiogram (ECG) LVH not only predicts echocardiography LVH but also other noninvasive and invasive markers of cardiac damage and prognosis after aortic valve replacement (AVR). METHODS In 279 patients with severe AS undergoing ECG, echocardiography, and cardiac catheterization before AVR, the Sokolow-Lyon index, the Cornell product, the Romhilt-Estes score, and the Peguero-Lo Presti score were assessed. RESULTS The mean left ventricular mass index was 109 ± 34 g/m2 , and 131 (47%) patients had echocardiography LVH. The areas under the receiver operator characteristics curve (AUC) for the Sokolow-Lyon index, the Cornell product, the Romhilt-Estes score, and the Peguero-Lo Presti score for the prediction of echocardiography LVH were 0.59, 0.70, 0.63, and 0.65. The Peguero-Lo Presti score had the numerically greatest AUC for the prediction of left ventricular end-diastolic pressure >15 mmHg, mean pulmonary artery wedge pressure >15 mmHg, pulmonary vascular resistance >3 Wood units, mean right atrial pressure >14 mmHg, and stroke volume index <31 mL/m2 . After a median follow-up of 1365 (interquartile range: 931-1851) days after AVR only the Peguero-Lo Presti score was significantly associated with all-cause mortality [hazard ratio: 1.24 (95% confidence interval: 1.01-1.54); per 1 mV increase; p = .045]. CONCLUSIONS Among severe AS patients, the Peguero-Lo Presti score is associated with abnormalities in cardiac structure including LVH, invasive measures of cardiac damage, and long-term mortality after AVR.
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Affiliation(s)
- Patrizia Sager
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
- University of BaselBaselSwitzerland
| | - Andreas Rusch
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
- Department of CardiologyKantonsspital MünsterlingenMünsterlingenSwitzerland
| | - Lukas Weber
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Alexander Breuss
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Sharon Appert
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Roman Brenner
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Marc Buser
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Peter Ammann
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Hans Rickli
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Micha T. Maeder
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
- University of BaselBaselSwitzerland
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Fairbank T, DeBauge A, Harvey CJ, Jiwani S, Ranka S, Beaver TA, Sheldon SH, Reddy M, Noheria A. Electrocardiographic Z-axis QRS-T voltage-time-integral in patients with typical right bundle branch block - Correlation with echocardiographic right ventricular size and function. J Electrocardiol 2024; 82:73-79. [PMID: 38043477 DOI: 10.1016/j.jelectrocard.2023.11.004] [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: 08/23/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Right bundle branch block (RBBB) can be benign or associated with right ventricular (RV) functional and structural abnormalities. Our aim was to evaluate QRS-T voltage-time-integral (VTI) compared to QRS duration and lead V1 R' as markers for RV abnormalities. METHODS We included adults with an ECG demonstrating RBBB and echocardiogram obtained within 3 months of each other, between 2010 and 2020. VTIQRS and VTIQRST were obtained for 12 standard ECG leads, reconstructed vectorcardiographic X, Y, Z leads and root-mean-squared (3D) ECG. Age, sex and BSA-adjusted linear regressions were used to assess associations of QRS duration, amplitudes, VTIs and lead V1 R' duration/VTI with echocardiographic tricuspid annular plane systolic excursion (TAPSE), RV tissue Doppler imaging S', basal and mid diameter, and systolic pressure (RVSP). RESULTS Among 782 patients (33% women, age 71 ± 14 years) with RBBB, R' duration in lead V1 was modestly associated with RV S', RV diameters and RVSP (all p ≤ 0.03). QRS duration was more strongly associated with RV diameters (both p < 0.0001). AmplitudeQRS-Z was modestly correlated with all 5 RV echocardiographic variables (all p ≤ 0.02). VTIR'-V1 was more strongly associated with TAPSE, RV S' and RVSP (all p ≤ 0.0003). VTIQRS-Z and VTIQRST-Z were among the strongest correlates of the 5 RV variables (all p < 0.0001). VTIQRST-Z.√BSA cutoff of ≥62 μVsm had sensitivity 62.7% and specificity 65.7% for predicting ≥3 of 5 abnormal RV variables (AUC 0.66; men 0.71, women 0.60). CONCLUSION In patients with RBBB, VTIQRST-Z is a stronger predictor of RV dysfunction and adverse remodeling than QRS duration and lead V1 R'.
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Affiliation(s)
- Tyan Fairbank
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Ashley DeBauge
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Christopher J Harvey
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sania Jiwani
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sagar Ranka
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Timothy A Beaver
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America.
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Chen Y, Deng X, Lin D, Yang P, Wu S, Wang X, Zhou H, Chen X, Wang X, Wu W, Ke K, Huang W, Tan X. Predicting 1-, 3-, 5-, and 8-year all-cause mortality in a community-dwelling older adult cohort: relevance for predictive, preventive, and personalized medicine. EPMA J 2023; 14:713-726. [PMID: 38094581 PMCID: PMC10713970 DOI: 10.1007/s13167-023-00342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/14/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Population aging is a global public health issue involving increased prevalence of age-related diseases, and concomitant burden on medical resources and the economy. Ninety-two diseases have been identified as age-related, accounting for 51.3% of the global adult disease burden. The economic cost per capita for older people over 60 years is 10 times that of the younger population. From the aspects of predictive, preventive, and personalized medicine (PPPM), developing a risk-prediction model can help identify individuals at high risk for all-cause mortality and provide an opportunity for targeted prevention through personalized intervention at an early stage. However, there is still a lack of predictive models to help community-dwelling older adults do well in healthcare. OBJECTIVES This study aims to develop an accurate 1-, 3-, 5-, and 8-year all-cause mortality risk-prediction model by using clinical multidimensional variables, and investigate risk factors for 1-, 3-, 5-, and 8-year all-cause mortality in community-dwelling older adults to guide primary prevention. METHODS This is a two-center cohort study. Inclusion criteria: (1) community-dwelling adult, (2) resided in the districts of Chaonan or Haojiang for more than 6 months in the past 12 months, and (3) completed a health examination. Exclusion criteria: (1) age less than 60 years, (2) more than 30 incomplete variables, (3) no signed informed consent. The primary outcome of the study was all-cause mortality obtained from face-to-face interviews, telephone interviews, and the medical death database from 2012 to 2021. Finally, we enrolled 5085 community-dwelling adults, 60 years and older, who underwent routine health screening in the Chaonan and Haojiang districts, southern China, from 2012 to 2021. Of them, 3091 participants from Chaonan were recruited as the primary training and internal validation study cohort, while 1994 participants from Haojiang were recruited as the external validation cohort. A total of 95 clinical multidimensional variables, including demographics, lifestyle behaviors, symptoms, medical history, family history, physical examination, laboratory tests, and electrocardiogram (ECG) data were collected to identify candidate risk factors and characteristics. Risk factors were identified using least absolute shrinkage and selection operator (LASSO) models and multivariable Cox proportional hazards regression analysis. A nomogram predictive model for 1-, 3-, 5- and 8-year all-cause mortality was constructed. The accuracy and calibration of the nomogram prediction model were assessed using the concordance index (C-index), integrated Brier score (IBS), receiver operating characteristic (ROC), and calibration curves. The clinical validity of the model was assessed using decision curve analysis (DCA). RESULTS Nine independent risk factors for 1-, 3-, 5-, and 8-year all-cause mortality were identified, including increased age, male, alcohol status, higher daily liquor consumption, history of cancer, elevated fasting glucose, lower hemoglobin, higher heart rate, and the occurrence of heart block. The acquisition of risk factor criteria is low cost, easily obtained, convenient for clinical application, and provides new insights and targets for the development of personalized prevention and interventions for high-risk individuals. The areas under the curve (AUC) of the nomogram model were 0.767, 0.776, and 0.806, and the C-indexes were 0.765, 0.775, and 0.797, in the training, internal validation, and external validation sets, respectively. The IBS was less than 0.25, which indicates good calibration. Calibration and decision curves showed that the predicted probabilities were in good agreement with the actual probabilities and had good clinical predictive value for PPPM. CONCLUSION The personalized risk prediction model can identify individuals at high risk of all-cause mortality, help offer primary care to prevent all-cause mortality, and provide personalized medical treatment for these high-risk individuals from the PPPM perspective. Strict control of daily liquor consumption, lowering fasting glucose, raising hemoglobin, controlling heart rate, and treatment of heart block could be beneficial for improving survival in elderly populations. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13167-023-00342-4.
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Affiliation(s)
- Yequn Chen
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Xiulian Deng
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Dong Lin
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
- Centre for Precision Health, Edith Cowan University, Perth, WA 6027 Australia
| | - Peixuan Yang
- Department of Health Management Centre, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Shiwan Wu
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Xidong Wang
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Hui Zhou
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Ximin Chen
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Xiaochun Wang
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Weichai Wu
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Kaibing Ke
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Wenjia Huang
- Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041 Guangdong China
| | - Xuerui Tan
- Clinical Research Centre, First Affiliated Hospital of Shantou University Medical College, No. 22 Xinling Road, Jinping District, Shantou, 515041 Guangdong China
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21
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Hajianfar G, Khorgami M, Rezaei Y, Amini M, Samiei N, Tabib A, Borji BK, Kalayinia S, Shiri I, Hosseini S, Oveisi M. Comparison of Machine Learning Algorithms Using Manual/Automated Features on 12-Lead Signal Electrocardiogram Classification: A Large Cohort Study on Students Aged Between 6 to 18 Years Old. Cardiovasc Eng Technol 2023; 14:786-800. [PMID: 37848737 DOI: 10.1007/s13239-023-00687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023]
Abstract
PROPOSE An electrocardiogram (ECG) has been extensively used to detect rhythm disturbances. We sought to determine the accuracy of different machine learning in distinguishing abnormal ECGs from normal ones in children who were examined using a resting 12-Lead ECG machine, and we also compared the manual and automated measurement using the modular ECG Analysis System (MEANS) algorithm of ECG features. METHODS Altogether, 10745 ECGs were recorded for students aged 6 to 18. Manual and automatic ECG features were extracted for each participant. Features were normalized using Z-score normalization and went through the student's t-test and chi-squared test to measure their relevance. We applied the Boruta algorithm for feature selection and then implemented eight classifier algorithms. The dataset was split into training (80%) and test (20%) partitions. The performance of the classifiers was evaluated on the test data (unseen data) by 1000 bootstrap, and sensitivity (SEN), specificity (SPE), AUC, and accuracy (ACC) were reported. RESULTS In univariate analysis, the highest performance was heart rate and RR interval in the manual dataset and heart rate in an automated dataset with AUC of 0.72 and 0.71, respectively. The best classifiers in the manual dataset were random forest (RF) and quadratic-discriminant-analysis (QDA) with AUC, ACC, SEN, and SPE equal to 0.93, 0.98, 0.69, 0.99, and 0.90, 0.95, 0.75, 0.96, respectively. In the automated dataset, QDA (AUC: 0.89, ACC:0.92, SEN:0.71, SPE:0.93) and stack learning (SL) (AUC:0.89, ACC:0.96, SEN:0.61, SPE:0.99) reached best performances. CONCLUSION This study demonstrated that the manual measurement of 12-Lead ECG features had better performance than the automated measurement (MEANS algorithm), but some classifiers had promising results in discriminating between normal and abnormal cases. Further studies can help us evaluate the applicability and efficacy of machine-learning approaches for distinguishing abnormal ECGs in community-based investigations in both adults and children.
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Affiliation(s)
- Ghasem Hajianfar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Niayesh Highway, Valiasr Ave., Tehran, 19969111541, Iran
| | - Mohammadrafie Khorgami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Niayesh Highway, Valiasr Ave., Tehran, 19969111541, Iran.
| | - Yousef Rezaei
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Niayesh Highway, Valiasr Ave., Tehran, 19969111541, Iran
- Behyan Clinic, Pardis New Town, Tehran, Iran
| | - Mehdi Amini
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
- Department of Biomedical Engineering and Medical Physics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Niayesh Highway, Valiasr Ave., Tehran, 19969111541, Iran
| | - Avisa Tabib
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Niayesh Highway, Valiasr Ave., Tehran, 19969111541, Iran
| | - Bahareh Kazem Borji
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Niayesh Highway, Valiasr Ave., Tehran, 19969111541, Iran
| | - Samira Kalayinia
- Cardiogenetic Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Isaac Shiri
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Oveisi
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
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22
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Bacharova L, Chevalier P, Gorenek B, Jons C, Li YG, Locati ET, Maanja M, Pérez-Riera AR, Platonov PG, Ribeiro ALP, Schocken D, Soliman EZ, Svehlikova J, Tereshchenko LG, Ugander M, Varma N, Zaklyazminskaya E, Ikeda T. ISE/ISHNE Expert Consensus Statement on ECG Diagnosis of Left Ventricular Hypertrophy: The Change of the Paradigm. The joint paper of the International Society of Electrocardiology and the International Society for Holter Monitoring and Noninvasive Electrocardiology. J Electrocardiol 2023; 81:85-93. [PMID: 37647776 DOI: 10.1016/j.jelectrocard.2023.08.005] [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: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
The ECG diagnosis of LVH is predominantly based on the QRS voltage criteria, i.e. the increased QRS complex amplitude in defined leads. The classical ECG diagnostic paradigm postulates that the increased left ventricular mass generates a stronger electrical field, increasing the leftward and posterior QRS forces. These increased forces are reflected in the augmented QRS amplitude in the corresponding leads. However, the clinical observations document increased QRS amplitude only in the minority of patients with LVH. The low sensitivity of voltage criteria has been repeatedly documented. We discuss possible reasons for this shortcoming and proposal of a new paradigm.
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Affiliation(s)
- Ljuba Bacharova
- International Laser Center CVTI, Ilkovicova 3, 841 04 Bratislava, Slovak Republic.
| | - Philippe Chevalier
- Neuromyogene Institute, Claude Bernard University, Lyon 1, Villeurbanne, France; Service de Rythmologie, Hospices Civils de Lyon, Lyon, France.
| | - Bulent Gorenek
- Eskisehir Osmangazi University, Cardiology Department, Eskisehir, Turkiye.
| | - Christian Jons
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 200092 Shanghai, PR China.
| | - Emanuela T Locati
- Department of Arrhythmology and Electrophysiology, IRCCS Policlinico San Donato, Piazza E. Malan 2, 20097 San Donato Milanese, Milano, Italy.
| | - Maren Maanja
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
| | | | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
| | - Antonio Luiz P Ribeiro
- Internal Medicine, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Douglas Schocken
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Jana Svehlikova
- Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovak Republic.
| | - Larisa G Tereshchenko
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave JJN3-01, Cleveland, OH 44195, USA.
| | - Martin Ugander
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Clinical Physiology, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Niraj Varma
- Cardiac Pacing & Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave J2-2, Cleveland, OH 44195, USA.
| | - Elena Zaklyazminskaya
- Medical Genetics Laboratory, Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
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23
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Joyce JJ, Qi N, Chang RK, Ferns SJ, Baylen BG. Right and left ventricular mass development in early infancy: Correlation of electrocardiographic changes with echocardiographic measurements. J Electrocardiol 2023; 81:101-105. [PMID: 37659258 PMCID: PMC10843504 DOI: 10.1016/j.jelectrocard.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/19/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Right ventricular mass indexed to body surface area (RVMI) decreases and left ventricular mass index (LVMI) increases rapidly and substantially during early infancy. The relationship between these sizeable mass transformations and simultaneous electrocardiographic changes have not been previously delineated. METHODS Normal term infants (#45 initially enrolled) were prospectively evaluated at 2 days and at 2-week, 2-month, and 4-month clinic visits. Ventricular masses were estimated with 2D echocardiographic methods. QRS voltages were measured in leads V1, V6, I and aVF. RESULTS Mean QRS axis shifted from 135 (95%CI 124, 146) to 65 degrees (95%CI 49, 81) and correlated with both RVMI decrease and LVMI increase (R = 0.46⁎ vs. 0.25†, respectively. *p < 0.01, †p < 0.05). As RVMI decreased from mean 28.1 (95%CI 27.1, 29.1) to 23.3 g/m2 (95%CI 21.4, 25.2) so did V1R and V6S voltages. RVMI changes correlated with V1R, V6S, and V1R + V6S voltages (R = 0.29*, 0.23† and 0.35*, respectively. *p < 0.01, †p < 0.05) but not with V1R/S ratio. As LVMI increased from 44.6 (95%CI 42.9, 46.3) to 55.4 g/m2 (95%CI 52.3, 58.5) V6R and V6Q increased but V1S voltage did not. LVMI changes correlated with V6R, V6R-S, and V6(Q + R)-S voltages (R = 0.31*, 0.34*, and 0.38* respectively. *p < 0.01) but not with V1S or V6R/S (R = 0.01 and 0.18 respectively, p = NS). CONCLUSIONS During early infancy the RVMI decrease correlates best with the QRS axis shift and V1R + V6S voltage, and the LVMI increase correlates best with V6R-S and V6(Q + R)-S voltages.
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Affiliation(s)
- James J Joyce
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, CA, USA; Division of Pediatric Cardiology, Wolfson Children's Hospital, Jacksonville, FL, USA.
| | - Ning Qi
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, CA, USA
| | - Ruey-Kang Chang
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, CA, USA.
| | - Sunita J Ferns
- Division of Pediatric Cardiology, Wolfson Children's Hospital, Jacksonville, FL, USA
| | - Barry G Baylen
- Division of Pediatric Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center and The Lundquist Institute, Torrance, CA, USA
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Yamamoto T, Nambu Y, Bo R, Morichi S, Yanagiya M, Matsuo M, Awano H. Electrocardiographic R wave amplitude in V6 lead as a predictive marker of cardiac dysfunction in Duchenne muscular dystrophy. J Cardiol 2023; 82:363-370. [PMID: 37481234 DOI: 10.1016/j.jjcc.2023.07.003] [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: 03/30/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Duchenne muscular dystrophy (DMD) is an inherited muscular disease characterized by progressive and fatal muscle weakness. Electrocardiographic (ECG) abnormalities, including abnormal R wave amplitudes are frequently observed in DMD. However, clinical implications of abnormal R wave amplitudes remain unclear. Hence, DMD patients were examined for changes in R wave amplitude over time using synthesized 18-lead ECG and the relationship between R wave amplitude and cardiac function. METHODS The results of 969 ECG examinations of 193 patients with DMD who underwent electrocardiography and echocardiography on the same day were retrospectively reviewed. RESULTS A negative correlation was observed between R wave amplitude and age. Positive correlations between R wave amplitude and left ventricular ejection fraction were observed in leads V4, V5, V6, syn-V7, syn-V8, and syn-V9, with V6 showing the strongest correlation (r = 0.52). Mean R wave amplitude during cardiac dysfunction was lower than that observed with preserved cardiac function in leads V6 to syn-V9. Patients had preserved R wave amplitude up to three years before the onset of cardiac dysfunction, with a sharp decrease two years before cardiac dysfunction in leads V6 to syn-V9. CONCLUSIONS In DMD patients, the R wave amplitude decreases with age. The sharp decline in R amplitude two years before cardiac dysfunction indicates that electrophysiological damage to the myocardium of the left ventricle lateral to the posterior wall precedes the finding of cardiac dysfunction. The R amplitude in V6 of the standard 12-lead ECG is a convenient predictive marker of cardiac dysfunction, similar to that of the 18-lead ECG.
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Affiliation(s)
| | - Yoshinori Nambu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Bo
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shotaro Morichi
- Nagahama Institute of Bio-Science and Technology, Nagahama, Japan
| | - Misato Yanagiya
- Nagahama Institute of Bio-Science and Technology, Nagahama, Japan
| | - Masafumi Matsuo
- KNC Department of Nucleic Acid Drug Discovery, Kobe Gakuin University, Japan
| | - Hiroyuki Awano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan; Organization for Research Initiative and Promotion, Tottori University, Yonago, Japan
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DeBauge A, Fairbank T, Harvey CJ, Ranka S, Jiwani S, Sheldon SH, Reddy M, Beaver TA, Noheria A. Electrocardiographic prediction of left ventricular hypertrophy in women and men with left bundle branch block - Comparison of QRS duration, amplitude and voltage-time-integral. J Electrocardiol 2023; 80:34-39. [PMID: 37178633 PMCID: PMC10846562 DOI: 10.1016/j.jelectrocard.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Standard ECG criteria for left ventricular (LV) hypertrophy rely on QRS amplitudes. However, in the setting of left bundle branch block (LBBB), ECG correlates of LV hypertrophy are not well established. We sought to evaluate quantitative ECG predictors of LV hypertrophy in the presence of LBBB. METHODS We included adult patients with typical LBBB having ECG and transthoracic echocardiogram performed within 3 months of each other in 2010-2020. Orthogonal X, Y, Z leads were reconstructed from digital 12‑lead ECGs using Kors's matrix. In addition to QRS duration, we evaluated QRS amplitudes and voltage-time-integrals (VTIs) from all 12 leads, X, Y, Z leads and 3D (root-mean-squared) ECG. We used age, sex and BSA-adjusted linear regressions to predict echocardiographic LV calculations (mass, end-diastolic and end-systolic volumes, ejection fraction) from ECG, and separately generated ROC curves for predicting echocardiographic abnormalities. RESULTS We included 413 patients (53% women, age 73 ± 12 years). All 4 echocardiographic LV calculations were most strongly correlated with QRS duration (all p < 0.00001). In women, QRS duration ≥ 150 ms had sensitivity/specificity 56.3%/64.4% for increased LV mass and 62.7%/67.8% for increased LV end-diastolic volume. In men, QRS duration ≥ 160 ms had a sensitivity/specificity 63.1%/72.1% for increased LV mass and 58.3%/74.5% for increased LV end-diastolic volume. QRS duration was best able to discriminate eccentric hypertrophy (area under ROC curve 0.701) and increased LV end-diastolic volume (0.681). CONCLUSIONS In patients with LBBB, QRS duration (≥ 150 in women and ≥ 160 in men) is a superior predictor of LV remodeling esp. eccentric hypertrophy and dilation.
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Affiliation(s)
- Ashley DeBauge
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Tyan Fairbank
- The University of Kansas School of Medicine, Kansas City, KS, United States of America
| | - Christopher J Harvey
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sagar Ranka
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sania Jiwani
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Seth H Sheldon
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Madhu Reddy
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Timothy A Beaver
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Amit Noheria
- Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, KS, United States of America.
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Ahmad MI, Chen LY, Singh S, Luqman-Arafath TK, Kamel H, Soliman EZ. Interrelations between albuminuria, electrocardiographic left atrial abnormality, and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Int J Cardiol 2023; 383:102-109. [PMID: 37100232 DOI: 10.1016/j.ijcard.2023.04.036] [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: 03/18/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND The objective of the study was to examine the joint associations of albuminuria and electrocardiographic left atrial abnormality (ECG-LAA) with incident atrial fibrillation (AF) and whether this relationship varies by race. METHODS This analysis included 6670 participants free of clinical cardiovascular disease (CVD), including atrial fibrillation (AF), from the Multi-Ethnic Study of Atherosclerosis. ECG-LAA was defined as P-wave terminal force in V1 [PTFV1] >5000 μV × ms. Albuminuria was defined as urine albumin-creatinine ratio (UACR) ≥30 mg/g. Incident AF events through 2015 were ascertained from hospital discharge records and study-scheduled electrocardiograms. Cox proportional hazard models were used to examine the association of "no albuminuria + no ECG-LAA (reference)", "isolated albuminuria", "isolated ECG-LAA" and "albuminuria + ECG-LAA" with incident AF. RESULTS Over a median follow-up of 13.8 years, 979 incident cases of AF occurred. In adjusted models, the concomitant presence of ECG-LAA and albuminuria was associated with a higher risk of AF than either ECG-LAA or albuminuria in isolation (HR (95% CI): 2.43 (1.65-3.58), 1.33 (1.05-1.69), and 1.55 (1.27-1.88), respectively (interaction p-value = 0.50). Effect modification by race was observed with a 4-fold greater AF risk in Black participants with albuminuria + ECG-LAA (HR (95%CI): 4.37 (2.38-8.01) but no significant association in White participants (HR (95% CI) 0.60 (0.19-1.92) respectively; (interaction p-value for race x albuminuria-ECG-LAA combination = 0.05). CONCLUSIONS Concomitant presence of ECG-LAA and albuminuria confers a higher risk of AF compared to either one in isolation with a stronger association in Blacks than Whites.
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Affiliation(s)
- Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, WI, United States of America.
| | - Lin Y Chen
- Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, United States of America
| | - Sanjay Singh
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, WI, United States of America
| | - T K Luqman-Arafath
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, United States of America
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
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Hirota N, Suzuki S, Motogi J, Umemoto T, Nakai H, Matsuzawa W, Takayanagi T, Hyodo A, Satoh K, Arita T, Yagi N, Kishi M, Semba H, Kano H, Matsuno S, Kato Y, Otsuka T, Uejima T, Oikawa Y, Hori T, Matsuhama M, Iida M, Yajima J, Yamashita T. Identification of patients with dilated phase of hypertrophic cardiomyopathy using a convolutional neural network applied to multiple, dual, and single lead electrocardiograms. IJC HEART & VASCULATURE 2023; 46:101211. [PMID: 37152425 PMCID: PMC10160501 DOI: 10.1016/j.ijcha.2023.101211] [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: 01/26/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 05/09/2023]
Abstract
Background This study sought to develop an artificial intelligence-derived model to detect the dilated phase of hypertrophic cardiomyopathy (dHCM) on digital electrocardiography (ECG) and to evaluate the performance of the model applied to multiple-lead or single-lead ECG. Methods This is a retrospective analysis using a single-center prospective cohort study (Shinken Database 2010-2017, n = 19,170). After excluding those without a normal P wave on index ECG (n = 1,831) and adding dHCM patients registered before 2009 (n = 39), 17,378 digital ECGs were used. Totally 54 dHCM patients were identified of which 11 diagnosed at baseline, 4 developed during the time course, and 39 registered before 2009. The performance of the convolutional neural network (CNN) model for detecting dHCM was evaluated using eight-lead (I, II, and V1-6), single-lead, and double-lead (I, II) ECGs with the five-fold cross validation method. Results The area under the curve (AUC) of the CNN model to detect dHCM (n = 54) with eight-lead ECG was 0.929 (standard deviation [SD]: 0.025) and the odds ratio was 38.64 (SD 9.10). Among the single-lead and double-lead ECGs, the AUC was highest with the single lead of V5 (0.953 [SD: 0.038]), with an odds ratio of 58.89 (SD:68.56). Conclusion Compared with the performance of eight-lead ECG, the most similar performance was achieved with the model with a single V5 lead, suggesting that this single-lead ECG can be an alternative to eight-lead ECG for the screening of dHCM.
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Affiliation(s)
- Naomi Hirota
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
- Corresponding author at: Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-Ku, Tokyo 106-0031, Japan.
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | | | | | - Hiroshi Nakai
- Information System Division, The Cardiovascular Institute, Tokyo, Japan
| | | | | | | | | | - Takuto Arita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Naoharu Yagi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Mikio Kishi
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hiroaki Semba
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuko Kato
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takayuki Hori
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Minoru Matsuhama
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Mitsuru Iida
- Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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Olvet DM, Sadigh K. Comparing the effectiveness of asynchronous e-modules and didactic lectures to teach electrocardiogram interpretation to first year US medical students. BMC MEDICAL EDUCATION 2023; 23:360. [PMID: 37217893 DOI: 10.1186/s12909-023-04338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Medical students are expected to be competent in interpreting electrocardiograms (ECGs) by the time they graduate, but many are unable to master this skill. Studies suggest that e-modules are an effective way to teach ECG interpretation, however they are typically evaluated for use during clinical clerkships. We sought to determine if an e-module could replace a didactic lecture to teach ECG interpretation during a preclinical cardiology course. METHODS We developed an asynchronous, interactive e-module that consisted of narrated videos, pop-up questions and quizzes with feedback. Participants were first year medical students who were either taught ECG interpretation during a 2-hour didactic lecture (control group) or were given unlimited access to the e-module (e-module group). First-year internal medicine residents (PGY1 group) were included to benchmark where ECG interpretation skills should be at graduation. At three time-points (pre-course, post-course, and 1-year follow-up), participants were evaluated for ECG knowledge and confidence. A mixed-ANOVA was used to compare groups over time. Students were also asked to describe what additional resources they used to learn ECG interpretation throughout the study. RESULTS Data was available for 73 (54%) students in the control group, 112 (81%) in the e-module group and 47 (71%) in the PGY1 group. Pre-course scores did not differ between the control and e-module groups (39% vs. 38%, respectively). However, the e-module group performed significantly better than the control group on the post-course test (78% vs. 66%). In a subsample with 1-year follow-up data, the e-module group's performance decreased, and the control group remained the same. The PGY1 groups' knowledge scores were stable over time. Confidence in both medical student groups increased by the end of the course, however only pre-course knowledge and confidence were significantly correlated. Most students relied on textbooks and course materials for learning ECG, however online resources were also utilized. CONCLUSIONS An asynchronous, interactive e-module was more effective than a didactic lecture for teaching ECG interpretation, however continued practice is needed regardless of how students learn to interpret ECGs. Various ECG resources are available to students to support their self-regulated learning.
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Affiliation(s)
- Doreen M Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA.
| | - Kaveh Sadigh
- Department of Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, 11794, USA
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Cai A, Chen Z, Kang F. Giant T-wave Inversion in an Older Patient With Sudden Loss of Consciousness. JAMA Intern Med 2023; 183:482-483. [PMID: 36939691 DOI: 10.1001/jamainternmed.2022.6618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
This case report describes a patient in their 60s with long-term uncontrolled hypertension and possible hip fracture followed by loss of consciousness.
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Affiliation(s)
- Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhiming Chen
- Department of Emergency, Affiliated Stomatological Hospital of Jinan University, Daliang District, Foshan, Guangdong, China
| | - Fengguang Kang
- Department of Cardiology, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, Guangdong, China
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Ahmad MI, Mujtaba M, Floyd JS, Chen LY, Soliman EZ. Electrocardiographic markers of atrial cardiomyopathy and risk of heart failure in the multi-ethnic study of atherosclerosis (MESA) cohort. Front Cardiovasc Med 2023; 10:1143338. [PMID: 37180781 PMCID: PMC10169752 DOI: 10.3389/fcvm.2023.1143338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Background The association of electrocardiographic (ECG) markers of atrial cardiomyopathy with heart failure (HF) and its subtypes is unclear. Methods This analysis included 6,754 participants free of clinical cardiovascular disease (CVD), including atrial fibrillation (AF), from the Multi-Ethnic Study of Atherosclerosis. Five ECG markers of atrial cardiomyopathy (P-wave terminal force in V1 [PTFV1], deep-terminal negativity in V1 [DTNV1], P-wave duration [PWD], P-wave axis [PWA], advanced intra-atrial block [aIAB]) were derived from digitally recorded electrocardiograms. Incident HF events through 2018 were centrally adjudicated. An ejection fraction (EF) of 50% at the time of HF was used to classify HF as HF with reduced EF (HFrEF), HF with preserved EF (HFpEF), or unclassified HF. Cox proportional hazard models were used to examine the associations of markers of atrial cardiomyopathy with HF. The Lunn-McNeil method was used to compare the associations in HFrEF vs. HFpEF. Results 413 HF events occurred over a median follow-up of 16 years. In adjusted models, abnormal PTFV1 (HR (95%CI): 1.56(1.15-2.13), abnormal PWA (HR (95%CI):1.60(1.16-2.22), aIAB (HR (95%CI):2.62(1.47-4.69), DTNPV1 (HR (95%CI): 2.99(1.63-7.33), and abnormal PWD (HR (95%CI): 1.33(1.02-1.73), were associated with increased HF risk. These associations persisted after further adjustments for intercurrent AF events. No significant differences in the strength of association of each ECG predictor with HFrEF and HFpEF were noted. Conclusions Atrial cardiomyopathy defined by ECG markers is associated with HF, with no differences in the strength of association between HFrEF and HFpEF. Markers of atrial Cardiomyopathy may help identify individuals at risk of developing HF.
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Affiliation(s)
- Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, WI, United States
| | - Mohammadtokir Mujtaba
- Department of Internal Medicine, Section on Hospital Medicine, Geisel School of Medicine, Dartmouth, NH, United States
| | - James S. Floyd
- Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, United States
| | - Lin Y. Chen
- Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Oluwasanu AO, Akinyemi JO, Oluwasanu MM, Oseghe OB, Oladoyinbo OL, Bello J, Ajuwon AJ, Jegede AS, Danaei G, Akingbola O. Temporal trends in overweight and obesity and chronic disease risks among adolescents and young adults: A ten-year review at a tertiary institution in Nigeria. PLoS One 2023; 18:e0283210. [PMID: 37018171 PMCID: PMC10075485 DOI: 10.1371/journal.pone.0283210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/04/2023] [Indexed: 04/06/2023] Open
Abstract
There is an increasing prevalence of obesity among college/university students in low- and middle-income countries, similar to the trend observed in high-income countries. This study aimed to describe the trend and burden of overweight/obesity and emerging associated chronic disease risks among students at the University of Ibadan (UI), Nigeria. This is a ten-year retrospective review of medical records of students (undergraduate and post-graduate) admitted between 2009 and 2018 at UI. Records of 60,168 participants were analysed. The Body Mass Index (BMI) categories were determined according to WHO standard definitions, and blood pressure was classified according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). The mean age of the participants was 24.8, SD 8.4 years. The majority were ≤ 40 years (95.1%). There was a slight male preponderance (51.5%) with a male-to-female ratio of 1.1:1; undergraduate students constituted 51.9%. The prevalence of underweight, overweight, and obesity were 10.5%, 18.7% and 7.2%, respectively. We found a significant association between overweight/obesity and older age, being female and undergoing postgraduate study (p = 0.001). Furthermore, females had a higher burden of coexisting abnormal BMI characterised by underweight (11.7%), overweight (20.2%) and obese (10.4%). Hypertension was the most prevalent obesity-associated non-communicable disease in the study population, with a prevalence of 8.1%. Also, a third of the study population (35.1%) had prehypertension. Hypertension was significantly associated with older age, male sex, overweight/obesity and family history of hypertension (p = 0.001). This study identified a higher prevalence of overweight and obesity than underweight among the participants, a double burden of malnutrition and the emergence of non-communicable disease risks with potential lifelong implications on their health and the healthcare system. To address these issues, cost-effective interventions are urgently needed at secondary and tertiary-level educational institutions.
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Affiliation(s)
| | - Joshua Odunayo Akinyemi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mojisola Morenike Oluwasanu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine University of Ibadan, Ibadan, Nigeria
| | | | | | - Jelili Bello
- University Health Services, University of Ibadan, Ibadan, Nigeria
| | - Ademola Johnson Ajuwon
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine University of Ibadan, Ibadan, Nigeria
| | - Ayodele Samuel Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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Kol A, Kepez A, Akaslan D, Kanar B, Atas H, Mutlu B. Effects of balloon pulmonary angioplasty procedure on electrocardiographic parameters in patients with chronic thromboembolic pulmonary hypertension. J Electrocardiol 2023; 77:72-77. [PMID: 36736206 DOI: 10.1016/j.jelectrocard.2023.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
AIM The aim of the present study was to evaluate the value of electrocardiography (ECG) in predicting postoperative hemodynamic improvement in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing balloon pulmonary angioplasty (BPA). MATERIAL AND METHODS A total of 32 patients were included in the study. During ECG analysis, parameters that have been suggested to be related to right ventricular hypertrophy and/or dilatation were evaluated. The significance of the change in each parameter obtained at the pre-BPA visit and at the scheduled control visit 6 months after BPA was tested. In addition to ECG analysis, data related to right heart catheterization (RHC) and echocardiography, B-type natriuretic peptide (BNP) levels and World Health Organization (WHO) functional classifications of all patients were also recorded. The relationship between the amount of possible change in ECG parameters and the amount of possible change in hemodynamic parameters was investigated. RESULTS The Daniel score, which has been suggested to have prognostic value in acute pulmonary embolism, decreased from 8.22 ± 5.68 to 6.56 ± 5.55 after the BPA procedure (p: 0.035). Among all parameters studied, only T wave height (V2 t) in V2 derivation changed significantly from -0.77 ± 2.39 to 1.27 ± 2.58 mm (p: 0.036). The amount of change in V2 T was found to significantly correlate with the amount of change in systolic right ventricular pressure, mean pulmonary artery pressure, pulmonary vascular resistance, and systemic vascular resistance. CONCLUSION Postprocedural T wave changes in lead V2 might serve as a marker of hemodynamic improvement in patients with CTEPH who undergo BPA.
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Affiliation(s)
- Ayhan Kol
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Alper Kepez
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Dursun Akaslan
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Batur Kanar
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Halil Atas
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Bulent Mutlu
- Marmara University School of Medicine, Department of Cardiology, Istanbul, Turkey
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Bayés-de-Luna A, Bacharova L. New electrocardiographic aspects of the P wave: Its value in clinical cardiology. Ann Noninvasive Electrocardiol 2023; 28:e13053. [PMID: 36825831 DOI: 10.1111/anec.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023] Open
Abstract
In this article, we will comment on new aspects of P-wave morphology that help us to better diagnose atrial blocks and atrial enlargement, and their clinical implications. These include: (1) Atypical ECG patterns of advanced interatrial block; (2) The ECG diagnosis of left atrial enlargement versus interatrial block; (3) Atrial fibrillation and advanced interatrial block: The two sides of the same coin; and (4) P-wave parameters: Clinical implications.
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Affiliation(s)
- Antoni Bayés-de-Luna
- Cardiovascular Research Foundation. Cardiovascular ICCC- Program, Research Institute Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ljuba Bacharova
- Department of Biophotonics, International Laser Center CVTI, Bratislava, Slovak Republic
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Feng Y, Ning L, Zhang J, Wang H, Zhang H, Zhang R, Deng Z, Ni Y, Ye Y, Ma A, Zhang Y, Wang T. Prognosis and subtype analysis of left ventricular noncompaction in adults: A retrospective multicenter study. Clin Cardiol 2023; 46:390-396. [PMID: 36779545 PMCID: PMC10106667 DOI: 10.1002/clc.23991] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Left ventricular noncompaction (LVNC) is a heterogeneous myocardial disorder with an uncertain prognosis. There was a lack of studies on LVNC subtypes at present. This study sought to identify the prognosis of the overall population of LVNC and to describe the distribution of different subtypes and compare their prognosis. HYPOTHESIS Patients with different subtypes of LVNC may have different prognoses. METHODS Patients who fulfilled the Jenni criteria and/or Petersen criteria were included. Major adverse cardiovascular events (MACE) were defined as a combination of heart failure (HF) hospitalization and all-cause mortality. RESULTS A total of 200 patients from four hospitals were included. The mean age at diagnosis was 48.2 years, and 61.5% of the patients were male. Left ventricular ejection fraction (LVEF) < 50% was present in 54% of the patients. Over a mean retrospective time period of 22.2 months, 47 (23.5%) patients experienced MACE. Age (hazard ratio [HR] 1.03; 95% confidence interval [CI] 1.01-1.06; p = .004), LVEF < 50% (HR 2.32; 95% CI 1.09-4.91; p = .028) and ventricular tachycardia/ventricular fibrillation (HR 2.17; 95% CI 1.08-4.37; p = .03) were significantly associated with the risk of MACE. The most common subtype was dilated LVNC (51.3%), followed by benign LVNC (21.3%) and LVNC with arrhythmias (10.5%). Patients with dilated LVNC had significantly increased cumulative incidence of MACE, HF hospitalization, and all-cause mortality (p < .05). CONCLUSIONS Age, LVEF < 50%, and ventricular tachycardia/ventricular fibrillation were independent risk factors for prognosis of LVNC. The most common subtype was dilated LVNC, which had a worse prognosis.
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Affiliation(s)
- Yunfei Feng
- Department of Cardiovascular Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi Province, China
| | - Lili Ning
- Department of Cardiovascular Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi Province, China
| | - Jing Zhang
- Department of Cardiovascular Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi Province, China
| | - Huaigen Wang
- Department of Cardiovascular Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi Province, China
| | - Hanzhao Zhang
- Department of Cardiovascular Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi Province, China
| | - Ruochen Zhang
- Department of Cardiovascular Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi Province, China
| | - Zhengrong Deng
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China
| | - Yajuan Ni
- Department of Cardiovascular Medicine, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi Province, China
| | - Yulan Ye
- Department of Cardiovascular Medicine, Xi'an Gaoxin Hospital, Xi'an, Shaanxi Province, China
| | - Aiqun Ma
- Department of Cardiovascular Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi Province, China
| | - Yun Zhang
- Department of Radiology, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi Province, China
| | - Tingzhong Wang
- Department of Cardiovascular Medicine, Xi'an Jiaotong University Medical College First Affiliated Hospital, Xi'an, Shaanxi Province, China
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Hendriks PM, Kauling RM, Geenen LW, Eindhoven JA, Roos-Hesselink JW, Boomars KA, van den Bosch AE. Role of the electrocardiogram in the risk stratification of pulmonary hypertension. Heart 2023; 109:208-215. [PMID: 36171071 DOI: 10.1136/heartjnl-2022-321475] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/12/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The prognosis of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) remains dismal. Better risk prediction is needed. This study investigated the prognostic value of ECG characteristics. METHODS In this single-centre prospective study, consecutive treatment-naïve patients with PAH or CTEPH were included at time of diagnosis. From the 12-lead ECG, obtained at baseline, the following parameters were collected: heart rate (HR), rhythm, QRS axis, conduction times, P-top amplitudes in II, R-top and S-wave amplitudes in V1 and V5 and repolarisation disorders. Associations between the ECG and transplant-free survival was assessed by Kaplan-Meier curves and Cox-proportional hazard regressions. RESULTS In total, 140 patients were included (median age: 60.7 years, 63.6% female). The ECG was abnormal in 86.2%: sinus rhythm was not present in 9.3%, right QRS axis was observed in 47.8%, mean QRS duration was 101±17 ms. Only 42.5% of the patients had normal repolarisation, 34.5% had right ventricular strain and 14.4% non-specific repolarisation disorders. Over a median follow-up time of 3.49 (IQR: 1.37-6.42) years, 45 patients (32.5%) died or underwent lung transplantation. Transplant-free survival was worse in patients presenting with an abnormal ECG (64.0% vs 86.0%; p=0.037). The following ECG characteristics were associated with all-cause mortality or lung transplantation: heart rate (HR 1.02, 95% CI: 1.00 to 1.05), QRS duration >120 ms (HR 2.61, 95% CI: 1.01 to 6.71) and S-wave amplitude in V5 (HR 1.10, 95% CI: 1.04 to 1.17). CONCLUSION Only 13.8% of patients with PAH and CTEPH presented with a normal ECG, which is associated with favourable outcome. The ECG provides additional prognostic value to current clinical parameters and should be considered in risk prediction.
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Affiliation(s)
- Paul M Hendriks
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert M Kauling
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Laurie W Geenen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jannet A Eindhoven
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Karin A Boomars
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Herrera R, Haq I, Anavekar NS. 20-Year-Old Postpartum Woman With Hypoxia and Tachycardia. Mayo Clin Proc 2022; 97:1936-1941. [PMID: 36202499 DOI: 10.1016/j.mayocp.2022.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Roberto Herrera
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Ikram Haq
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Nandan S Anavekar
- Advisor to residents and Consultant in Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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Liu CM, Hsieh ME, Hu YF, Wei TY, Wu IC, Chen PF, Lin YJ, Higa S, Yagi N, Chen SA, Tseng VS. Artificial Intelligence-Enabled Model for Early Detection of Left Ventricular Hypertrophy and Mortality Prediction in Young to Middle-Aged Adults. Circ Cardiovasc Qual Outcomes 2022; 15:e008360. [PMID: 35959675 DOI: 10.1161/circoutcomes.121.008360] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Concealed left ventricular hypertrophy (LVH) is a prevalent condition that is correlated with a substantial risk of cardiovascular events and mortality, especially in young to middle-aged adults. Early identification of LVH is warranted. In this work, we aimed to develop an artificial intelligence (AI)-enabled model for early detection and risk stratification of LVH using 12-lead ECGs. METHODS By deep learning techniques on the ECG recordings from 28 745 patients (20-60 years old), the AI model was developed to detect verified LVH from transthoracic echocardiography and evaluated on an independent cohort. Two hundred twenty-five patients from Japan were externally validated. Cardiologists' diagnosis of LVH was based on conventional ECG criteria. The area under the curve (AUC), sensitivity, and specificity were applied to evaluate the model performance. A Cox regression model estimated the independent effects of AI-predicted LVH on cardiovascular or all-cause death. RESULTS The AUC of the AI model in diagnosing LVH was 0.89 (sensitivity: 90.3%, specificity: 69.3%), which was significantly better than that of the cardiologists' diagnosis (AUC, 0.64). In the second independent cohort, the diagnostic performance of the AI model was consistent (AUC, 0.86; sensitivity: 85.4%, specificity: 67.0%). After a follow-up of 6 years, AI-predicted LVH was independently associated with higher cardiovascular or all-cause mortality (hazard ratio, 1.91 [1.04-3.49] and 1.54 [1.20-1.97], respectively). The predictive power of the AI model for mortality was consistently valid among patients of different ages, sexes, and comorbidities, including hypertension, diabetes, stroke, heart failure, and myocardial infarction. Last, we also validated the model in the international independent cohort from Japan (AUC, 0.83). CONCLUSIONS The AI model improved the detection of LVH and mortality prediction in the young to middle-aged population and represented an attractive tool for risk stratification. Early identification by the AI model gives every chance for timely treatment to reverse adverse outcomes.
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Affiliation(s)
- Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.)
| | - Ming-En Hsieh
- Institute of Data Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan (M.-E.H., T.-Y.W., V.S.T.)
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan (Y.-F.H.)
| | - Tzu-Yin Wei
- Institute of Data Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan (M.-E.H., T.-Y.W., V.S.T.)
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (I.-C.W., P.-F.C.)
| | - Pei-Fen Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (I.-C.W., P.-F.C.)
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.)
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan (S.H.)
| | - Nobumori Yagi
- Division of Cardiovascular Medicine, Nakagami Hospital, Okinawa, Japan (N.Y.)
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-M.L., Y.-F.H., Y.-J.L., S.-A.C.).,Cardiovascular Center, Taichung Veterans General Hospital, Taiwan (S.-A.C.).,National Chung Hsing University, Taichung, Taiwan (S.-A.C.)
| | - Vincent S Tseng
- Institute of Data Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan (M.-E.H., T.-Y.W., V.S.T.).,Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan (V.S.T.)
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Zhao X, Huang G, Wu L, Wang M, He X, Wang JR, Zhou B, Liu Y, Lin Y, Liu D, Yu X, Liang S, Tian B, Liu L, Chen Y, Qiu S, Xie X, Han L, Qian X. Deep learning assessment of left ventricular hypertrophy based on electrocardiogram. Front Cardiovasc Med 2022; 9:952089. [PMID: 36035939 PMCID: PMC9406285 DOI: 10.3389/fcvm.2022.952089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Current electrocardiogram (ECG) criteria of left ventricular hypertrophy (LVH) have low sensitivity. Deep learning (DL) techniques have been widely used to detect cardiac diseases due to its ability of automatic feature extraction of ECG. However, DL was rarely applied in LVH diagnosis. Our study aimed to construct a DL model for rapid and effective detection of LVH using 12-lead ECG. Methods We built a DL model based on convolutional neural network-long short-term memory (CNN-LSTM) to detect LVH using 12-lead ECG. The echocardiogram and ECG of 1,863 patients obtained within 1 week after hospital admission were analyzed. Patients were evenly allocated into 3 sets at 3:1:1 ratio: the training set (n = 1,120), the validation set (n = 371) and the test set 1 (n = 372). In addition, we recruited 453 hospitalized patients into the internal test set 2. Different DL model of each subgroup was developed according to gender and relative wall thickness (RWT). Results The LVH was predicted by the CNN-LSTM model with an area under the curve (AUC) of 0.62 (sensitivity 68%, specificity 57%) in the test set 1, which outperformed Cornell voltage criteria (AUC: 0.57, sensitivity 48%, specificity 72%) and Sokolow-Lyon voltage (AUC: 0.51, sensitivity 14%, specificity 96%). In the internal test set 2, the CNN-LSTM model had a stable performance in predicting LVH with an AUC of 0.59 (sensitivity 65%, specificity 57%). In the subgroup analysis, the CNN-LSTM model predicted LVH by 12-lead ECG with an AUC of 0.66 (sensitivity 72%, specificity 60%) for male patients, which performed better than that for female patients (AUC: 0.59, sensitivity 50%, specificity 71%). Conclusion Our study established a CNN-LSTM model to diagnose LVH by 12-lead ECG with higher sensitivity than current ECG diagnostic criteria. This CNN-LSTM model may be a simple and effective screening tool of LVH.
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Affiliation(s)
- Xiaoli Zhao
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guifang Huang
- China Unicom (Guangdong) Industrial Internet Ltd., Guangzhou, China
| | - Lin Wu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min Wang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuemin He
- Department of Endocrine and Metabolic Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jyun-Rong Wang
- LCFC (Hefei) Electronics Technology Co., Ltd., Hefei, China
- Hefei LCFC Information Technology Co., Ltd., Hefei, China
| | - Bin Zhou
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yesheng Lin
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dinghui Liu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xianguan Yu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Suzhen Liang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Borui Tian
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Linxiao Liu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanming Chen
- Department of Endocrine and Metabolic Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuhong Qiu
- China Unicom (Guangdong) Industrial Internet Ltd., Guangzhou, China
| | - Xujing Xie
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lanqing Han
- Center for Artificial Intelligence, Research Institute of Tsinghua, Pearl River Delta, Guangzhou, China
| | - Xiaoxian Qian
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Cunha PS, Laranjo S, Heijman J, Oliveira MM. The Atrium in Atrial Fibrillation - A Clinical Review on How to Manage Atrial Fibrotic Substrates. Front Cardiovasc Med 2022; 9:879984. [PMID: 35859594 PMCID: PMC9289204 DOI: 10.3389/fcvm.2022.879984] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/03/2022] [Indexed: 12/27/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and is associated with a significant clinical and economic burden. Rigorous assessment of the presence and degree of an atrial arrhythmic substrate is essential for determining treatment options, predicting long-term success after catheter ablation, and as a substrate critical in the pathophysiology of atrial thrombogenesis. Catheter ablation of AF has developed into an essential rhythm-control strategy. Nowadays is one of the most common cardiac ablation procedures performed worldwide, with its success inversely related to the extent of atrial structural disease. Although atrial substrate evaluation remains complex, several diagnostic resources allow for a more comprehensive assessment and quantification of the extent of left atrial structural remodeling and the presence of atrial fibrosis. In this review, we summarize the current knowledge on the pathophysiology, etiology, and electrophysiological aspects of atrial substrates promoting the development of AF. We also describe the risk factors for its development and how to diagnose its presence using imaging, electrocardiograms, and electroanatomic voltage mapping. Finally, we discuss recent data regarding fibrosis biomarkers that could help diagnose atrial fibrotic substrates.
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Affiliation(s)
- Pedro Silva Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jordi Heijman
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Mário Martins Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central Lisbon Hospital University Center, Lisbon, Portugal
- Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
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The derivation and validation of the Manchester Acute Coronary Syndrome Electrocardiograph model for the identification of non-ST-elevation myocardial ischaemia in the Emergency Department. Am J Emerg Med 2022; 57:27-33. [DOI: 10.1016/j.ajem.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
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Haq KT, Cooper BL, Berk F, Roberts A, Swift LM, Posnack NG. Demographic and Methodological Heterogeneity in Electrocardiogram Signals From Guinea Pigs. Front Physiol 2022; 13:925042. [PMID: 35721548 PMCID: PMC9202081 DOI: 10.3389/fphys.2022.925042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Electrocardiograms (ECG) are universally used to measure the electrical activity of the heart; however, variations in recording techniques and/or subject demographics can affect ECG interpretation. In this study, we investigated variables that are likely to influence ECG metric measurements in cardiovascular research, including recording technique, use of anesthesia, and animal model characteristics. Awake limb lead ECG recordings were collected in vivo from adult guinea pigs using a platform ECG system, while recordings in anesthetized animals were performed using both a platform and needle ECG system. We report significant heterogeneities in ECG metric values that are attributed to methodological differences (e.g., ECG lead configuration, ECG recording platform, presence or absence of anesthesia) that persist even within the same cohort of animals. Further, we report that variability in animal demographics is preserved in vivo ECG recordings—with animal age serving as a significant contributor, while sex-specific influences were less pronounced. Methodological approaches and subject demographics should be fully considered when interpreting ECG values in animal models, comparing datasets between studies, or developing artificial intelligence algorithms that utilize an ECG database.
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Affiliation(s)
- Kazi T. Haq
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
| | - Blake L. Cooper
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
- Department of Pharmacology & Physiology, Washington D.C., DC, United States
| | - Fiona Berk
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
| | - Anysja Roberts
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
| | - Luther M. Swift
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
| | - Nikki Gillum Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
- Department of Pharmacology & Physiology, Washington D.C., DC, United States
- Department of Pediatrics, Washington D.C., DC, United States
- *Correspondence: Nikki Gillum Posnack,
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Chen HY, Lin CS, Fang WH, Lee CC, Ho CL, Wang CH, Lin C. Artificial Intelligence-Enabled Electrocardiogram Predicted Left Ventricle Diameter as an Independent Risk Factor of Long-Term Cardiovascular Outcome in Patients With Normal Ejection Fraction. Front Med (Lausanne) 2022; 9:870523. [PMID: 35479951 PMCID: PMC9035739 DOI: 10.3389/fmed.2022.870523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Heart failure (HF) is a global disease with increasing prevalence in an aging society. However, the survival rate is poor despite the patient receiving standard treatment. Early identification of patients with a high risk of HF is important but challenging. Left ventricular end-diastolic diameter (LV-D) increase was an independent risk factor of HF and adverse cardiovascular (CV) outcomes. In this study, we aimed to develop an artificial intelligence (AI) enabled electrocardiogram (ECG) system to detect LV-D increase early. Objective We developed a deep learning model (DLM) to predict left ventricular end-diastolic and end-systolic diameter (LV-D and LV-S) with internal and external validations and investigated the relationship between ECG-LV-D and echocardiographic LV-D and explored the contributions of ECG-LV-D on future CV outcomes. Methods Electrocardiograms and corresponding echocardiography data within 7 days were collected and paired for DLM training with 99,692 ECGs in the development set and 20,197 ECGs in the tuning set. The other 7,551 and 11,644 ECGs were collected from two different hospitals to validate the DLM performance in internal and external validation sets. We analyzed the association and prediction ability of ECG-LVD for CV outcomes, including left ventricular (LV) dysfunction, CV mortality, acute myocardial infarction (AMI), and coronary artery disease (CAD). Results The mean absolute errors (MAE) of ECG-LV-D were 5.25/5.29, and the area under the receiver operating characteristic (ROC) curves (AUCs) were 0.8297/0.8072 and 0.9295/0.9148 for the detection of mild (56 ≦ LV-D < 65 mm) and severe (LV-D ≧ 65 mm) LV-D dilation in internal/external validation sets, respectively. Patients with normal ejection fraction (EF) who were identified as high ECHO-LV-D had the higher hazard ratios (HRs) of developing new onset LV dysfunction [HR: 2.34, 95% conference interval (CI): 1.78–3.08], CV mortality (HR 2.30, 95% CI 1.05–5.05), new-onset AMI (HR 2.12, 95% CI 1.36–3.29), and CAD (HR 1.59, 95% CI 1.26–2.00) in the internal validation set. In addition, the ECG-LV-D presents a 1.88-fold risk (95% CI 1.47–2.39) on new-onset LV dysfunction in the external validation set. Conclusion The ECG-LV-D not only identifies high-risk patients with normal EF but also serves as an independent risk factor of long-term CV outcomes.
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Affiliation(s)
- Hung-Yi Chen
- Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Wen-Hui Fang
- Department of Family and Community Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Artificial Intelligence of Things Center, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chia-Cheng Lee
- Medical Informatics Office, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Division of Colorectal Surgery, Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Liang Ho
- Division of Hematology and Oncology, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei, Taiwan
| | - Chin Lin
- Artificial Intelligence of Things Center, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Medical Technology Education Center, National Defense Medical Center, School of Medicine, Taipei, Taiwan
- *Correspondence: Chin Lin,
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Tao L, Dai YJ, Shang ZY, Li XQ, Wang XH, Ntaios G, Chen HS. Atrial cardiopathy and non-stenotic intracranial complicated atherosclerotic plaque in patients with embolic stroke of undetermined source. J Neurol Neurosurg Psychiatry 2022; 93:351-359. [PMID: 34872980 DOI: 10.1136/jnnp-2021-327517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/21/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess (1) the association between atrial cardiopathy (AC) and non-stenotic intracranial complicated atherosclerotic plaque (NICAP) in patients with embolic stroke of undetermined source (ESUS) or small-vessel disease (SVD), and (2) the performance of previously proposed biomarkers to identify AC as the underlying aetiology in ESUS. METHODS Based on our high-resolution MRI (HR-MRI) cohort, 403 subjects (243 ESUS and 160 SVD) were enrolled in the final analysis. All patients underwent intracranial HR-MRI to assess the presence of ipsilateral NICAP. Biomarkers of AC (ie, P-wave terminal force in lead V1 (PTFV1) on ECG, N-terminal probrain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T and left atrial diameter) were collected within 24 hours after admission. RESULTS Among patients without ipsilateral NICAP, we found an association between the presence of AC (adjusted OR (aOR): 4.76, 95% CI 2.48 to 9.14), increased PTFV1 (aOR: 5.70, 95% CI: 2.43 to 13.39) and NT-proBNP (aOR: 1.65, 95% CI: 1.16 to 2.35) with ESUS. This association was not evident among patients with ipsilateral NICAP. The discrimination between ESUS versus SVD by AC/AC-related biomarkers was significantly improved after excluding ipsilateral NICAP. Similarly, the discrimination between ESUS and SVD by ipsilateral NICAP was notably augmented after excluding AC, PTFV1 and NT-proBNP. INTERPRETATION AC is more prevalent in patients who had ESUS without ipsilateral NICAP compared with patients with, implying that AC and ipsilateral NICAP are two distinct, competing aetiologies of ESUS. Among the AC biomarkers studied in this analysis, PTFV1 seems to be the most informative.
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Affiliation(s)
- Lin Tao
- Department of Neurology, General Hospital of Northern Theatre command, Shenyang, Liaoning, China
| | - Ying-Jie Dai
- Department of Neurology, General Hospital of Northern Theatre command, Shenyang, Liaoning, China
| | - Zi-Yang Shang
- Department of Neurology, General Hospital of Northern Theatre command, Shenyang, Liaoning, China
| | - Xiao-Qiu Li
- Department of Neurology, General Hospital of Northern Theatre command, Shenyang, Liaoning, China
| | - Xin-Hong Wang
- Department of Neurology, General Hospital of Northern Theatre command, Shenyang, Liaoning, China
| | - George Ntaios
- Department of Internal Medicine, University of Thessaly, Volos, Greece
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre command, Shenyang, Liaoning, China
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Rankinen J, Haataja P, Lyytikäinen LP, Huhtala H, Lehtimäki T, Kähönen M, Eskola M, Tuohinen S, Pérez-Riera AR, Jula A, Rissanen H, Nikus K, Hernesniemi J. Prevalence and long-term prognostic implications of prolonged QRS duration in left ventricular hypertrophy: a population-based observational cohort study. BMJ Open 2022; 12:e053477. [PMID: 35228283 PMCID: PMC8886432 DOI: 10.1136/bmjopen-2021-053477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES ECG left ventricular hypertrophy (ECG-LVH) has been associated with left ventricular dysfunction and adverse prognosis, but little is known about the prevalence and prognostic significance of different levels of QRS duration in the presence of ECG-LVH in a general population. DESIGN Population-based observational prospective cohort study. PARTICIPANTS Nationally representative random cluster of Finnish adult population. METHODS We assessed the prevalence and long-term (median 15.9 years) prognostic significance of QRS duration in ECG-LVH, and compared the risk to individuals without ECG-LVH in a predominantly middle-aged random sample of 6033 Finnish subjects aged over 30 years (mean age 52.2, SD 14.6 years), who participated in a health examination including a 12-lead ECG. MAIN OUTCOME MEASURES Cardiovascular and all-cause mortality, incidence of heart failure (HF). RESULTS ECG-LVH was present in 1337 (22.2%) subjects; 403 of these (30.1%) had QRS duration ≥100 ms and 100 (7.5%) had ≥110 ms. The increased risk of mortality in ECG-LVH became evident after a QRS threshold of ≥100 ms. After controlling for known clinical risk factors, QRS 100-109 ms was associated with increased cardiovascular (HR 1.38, 95% CI 1.01 to 1.88, p=0.045) and QRS≥110 ms with cardiovascular (1.74, 95% CI 1.07 to 2.82, p=0.025) and all-cause mortality (1.52, 95% CI 1.02 to 2.25, p=0.039) in ECG-LVH. The risk of new-onset HF was two-fold in subjects with QRS 100-109 ms and threefold in subjects with QRS ≥110 ms, even after adjustment for incident myocardial infarction within the follow-up. When the prognosis was compared with subjects without ECG-LVH, subjects with ECG-LVH but QRS duration <100 ms displayed similar mortality rates with or without ECG-LVH but higher rates of incident HF. CONCLUSIONS In ECG-LVH, the risk of excess mortality and new-onset HF markedly increases with longer QRS duration, but even QRS duration within normal limits in ECG-LVH carried a risk of HF compared with the risk in individuals without ECG-LVH.
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Affiliation(s)
- Jani Rankinen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland
- Department of Internal Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Petri Haataja
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
- Department of Clinical Chemistry, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland
- Department of Clinical Chemistry, Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Markku Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Suvi Tuohinen
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Andrés Ricardo Pérez-Riera
- Design of Studies and Scientific Writing Laboratory, Faculdade de Medicina do ABC, Santo Andre, São Paulo, Brazil
| | - Antti Jula
- Finnish Institute for Health and Welfare, Helsinki/Turku, Finland
| | - Harri Rissanen
- Finnish Institute for Health and Welfare, Helsinki/Turku, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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45
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Yang Y, Ahn JM, Kang DY, Ko E, Kim S, Kim TO, Kim JH, Lee J, Lee SA, Kim DH, Kim HJ, Kim JB, Choo SJ, Park SJ, Park DW. Implication of Different ECG Left Ventricular Hypertrophy in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2022; 11:e023647. [PMID: 35112886 PMCID: PMC9245797 DOI: 10.1161/jaha.121.023647] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Various ECG criteria for left ventricular hypertrophy (LVH) have been proposed, but their association with clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement is unknown. We investigated the prevalence of ECG LVH according to different criteria and its prognostic impact on clinical outcomes after transcatheter aortic valve replacement. Methods and Results In this prospective observational cohort, we evaluated 700 patients who underwent transcatheter aortic valve replacement between March 2010 and December 2019. Baseline preprocedural LVH was defined by 3 ECG criteria—Sokolow‐Lyon, Romhilt‐Estes, and Cornell voltage criteria. The primary outcome was major adverse cardiac or cerebrovascular event (MACCE; composite of death, myocardial infarction, stroke, or rehospitalization from cardiovascular cause); the key secondary outcome was all‐cause and cardiovascular mortality. Among 596 eligible patients, the prevalence of LVH was determined as 56.3% by Sokolow‐Lyon, 31.1% by Romhilt‐Estes, and 48.1% by Cornell criteria. Regardless of the criteria, patients with ECG LVH had more severe aortic stenosis hemodynamics and higher left ventricular mass index. After multivariate adjustment, the presence of LVH by the Cornell criteria was significantly associated with lower risks of MACCE (adjusted hazard ratio [HR], 0.68; 95% CI, 0.51–0.91; P=0.009), all‐cause mortality (adjusted HR, 0.55; 95% CI, 0.34–0.90 [P=0.017]), and cardiovascular mortality (adjusted HR, 0.40; 95% CI, 0.20–0.79 [P=0.008]). However, this association was absent with the Sokolow‐Lyon and Romhilt‐Estes criteria. Conclusions ECG LVH by Cornell criteria only was significantly associated with lower risks of MACCE and all‐cause or cardiovascular mortality. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03298178.
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Affiliation(s)
- Yujin Yang
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Jung-Min Ahn
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Do-Yoon Kang
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Euihong Ko
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Seonok Kim
- Department of Clinical Epidemiology and Biostatistics University of Ulsan College of Medicine Seoul Republic of Korea
| | - Tae Oh Kim
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Ju Hyeon Kim
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Junghoon Lee
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Seung-Ah Lee
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
| | - Duk-Woo Park
- Division of Cardiology Department of Internal Medicine University of Ulsan College of Medicine Seoul Republic of Korea
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46
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Boonstra MJ, Brooks DH, Loh P, van Dam PM. CineECG: A novel method to image the average activation sequence in the heart from the 12-lead ECG. Comput Biol Med 2022; 141:105128. [PMID: 34973587 DOI: 10.1016/j.compbiomed.2021.105128] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/03/2022]
Abstract
The standard 12-lead electrocardiogram (ECG) is a diagnostic tool to asses cardiac electrical activity. The vectorcardiogram is a related tool that represents that activity as the direction of a vector. In this work we investigate CineECG, a new 12-lead ECG based analysis method designed to directly estimate the average cardiac anatomical location of activation over time. We describe CineECG calculation and a novel comparison parameter, the average isochrone position (AIP). In a model study, fourteen different activation sequences were simulated and corresponding 12-lead ECGs were computed. The CineECG was compared to AIP in terms of location and direction. In addition, 67-lead body surface potential maps from ten patients were used to study the sensitivity of CineECG to electrode mispositioning and anatomical model selection. Epicardial activation maps from four patients were used for further evaluation. The average distance between CineECG and AIP across the fourteen sequences was 23.7 ± 2.4 mm, with significantly better agreement in the terminal (27.3 ± 5.7 mm) versus the initial QRS segment (34.2 ± 6.1 mm). Up to four cm variation in electrode positioning produced an average distance of 6.5 ± 4.5 mm between CineECG trajectories, while substituting a generic heart/torso model for a patient-specific one produced an average difference of 6.1 ± 4.8 mm. Dominant epicardial activation map features were recovered. Qualitatively, CineECG captured significant features of activation sequences and was robust to electrode misplacement. CineECG provides a realistic representation of the average cardiac activation in normal and diseased hearts. In particular, the terminal segment of the CineECG might be useful to detect pathology.
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Affiliation(s)
- Machteld J Boonstra
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dana H Brooks
- Electrical and Computer Engineering, Northeastern University, Boston, MA, 02115, USA
| | - Peter Loh
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter M van Dam
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; ECG Excellence BV, Nieuwerbrug aan den Rijn, the Netherlands.
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47
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Kassis N, Kumar A, Gangidi S, Milinovich A, Kalra A, Bhargava A, Menon V, Wazni OM, Rickard J, Khot UN. Prognostic value of initial electrocardiography in predicting long-term all-cause mortality in COVID-19. J Electrocardiol 2022; 75:1-9. [PMID: 36272350 PMCID: PMC9554203 DOI: 10.1016/j.jelectrocard.2022.10.003] [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: 08/12/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The electrocardiography (ECG) has short-term prognostic value in coronavirus disease 2019 (COVID-19), yet its ability to predict long-term mortality is unknown. This study aimed to elucidate the predictive role of initial ECG on long-term all-cause mortality in patients diagnosed with COVID-19. METHODS In this prospective cohort study, adults with COVID-19 who underwent ECG testing within a 17-hospital health system in Northeast Ohio and Florida between 03/2020-06/2020 were identified. An expert ECG reader analyzed all studies blinded to patient status. The associations of ECG characteristics with long-term all-cause mortality and intensive care unit (ICU) admission were assessed using Cox proportional hazards regression model and multivariable logistic regression models, respectively. Status of long-term mortality was adjudicated on 01/07/2022. RESULTS Of 837 patients (median age 65 years, 51% female, 44% Black), 683 (81.6%) were hospitalized, 281 (33.6%) required ICU admission, 67 (8.0%) died in-hospital, and 206 (24.6%) died at final follow-up after a median (IQR) of 21 (9-103) days after ECG. Overall, 179 (20.7%) patients presented with sinus tachycardia, 12 (1.4%) with atrial flutter, and 45 (5.4%) with atrial fibrillation (AF). After multivariable adjustment, sinus tachycardia (E-value for HR=3.09, lower CI=2.2) and AF (E-value for HR=3.13, lower CI=2.03) each independently predicted all-cause mortality. At final follow-up, patients with AF had 64.5% probability of death compared with 20.5% for those with normal sinus rhythm (P<.0001). CONCLUSIONS Sinus tachycardia and AF on initial ECG strongly predict long-term all-cause mortality in COVID-19. The ECG can serve as a powerful long-term prognostic tool in COVID-19.
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Affiliation(s)
- Nicholas Kassis
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Shravani Gangidi
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alex Milinovich
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ajay Bhargava
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Oussama M. Wazni
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Rickard
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Umesh N. Khot
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA,Corresponding author at: Cleveland Clinic Heart, Vascular and Thoracic Institute, Center for Healthcare Delivery Innovation, Desk J2-4, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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48
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De la Garza Salazar F, Romero Ibarguengoitia ME, Azpiri López JR, González Cantú A. Optimizing ECG to detect echocardiographic left ventricular hypertrophy with computer-based ECG data and machine learning. PLoS One 2021; 16:e0260661. [PMID: 34847202 PMCID: PMC8631676 DOI: 10.1371/journal.pone.0260661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy detected by echocardiography (Echo-LVH) is an independent predictor of mortality. Integration of the Philips DXL-16 algorithm into the electrocardiogram (ECG) extensively analyses the electricity of the heart. Machine learning techniques such as the C5.0 could lead to a new decision tree criterion to detect Echo-LVH. OBJECTIVES To search for a new combination of ECG parameters predictive of Echo-LVH. The final model is called the Cardiac Hypertrophy Computer-based model (CHCM). METHODS We extracted the 458 ECG parameters provided by the Philips DXL-16 algorithm in patients with Echo-LVH and controls. We used the C5.0 ML algorithm to train, test, and validate the CHCM. We compared its diagnostic performance to validate state-of-the-art criteria in our patient cohort. RESULTS We included 439 patients and considered an alpha value of 0.05 and a power of 99%. The CHCM includes T voltage in I (≤0.055 mV), peak-to-peak QRS distance in aVL (>1.235 mV), and peak-to-peak QRS distance in aVF (>0.178 mV). The CHCM had an accuracy of 70.5% (CI95%, 65.2-75.5), a sensitivity of 74.3%, and a specificity of 68.7%. In the external validation cohort (n = 156), the CHCM had an accuracy of 63.5% (CI95%, 55.4-71), a sensitivity of 42%, and a specificity of 82.9%. The accuracies of the most relevant state-of-the-art criteria were: Romhilt-Estes (57.4%, CI95% 49-65.5), VDP Cornell (55.7%, CI95%47.6-63.7), Cornell (59%, CI95%50.8-66.8), Dalfó (62.9%, CI95%54.7-70.6), Sokolow Lyon (53.9%, CI95%45.7-61.9), and Philips DXL-16 algorithm (54.5%, CI95%46.3-62.5). CONCLUSION ECG computer-based data and the C5.0 determined a new set of ECG parameters to predict Echo-LVH. The CHCM classifies patients as Echo-LVH with repolarization abnormalities or LVH with increased voltage. The CHCM has a similar accuracy, and is slightly more sensitive than the state-of-the-art criteria.
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Affiliation(s)
- Fernando De la Garza Salazar
- School of Medicine, Medical Specialties, University of Monterrey, Monterrey, Nuevo León, Mexico
- Department of Internal Medicine, Hospital Christus Muguerza Alta Especialidad, Monterrey, Nuevo León, Mexico
| | - Maria Elena Romero Ibarguengoitia
- School of Medicine, Medical Specialties, University of Monterrey, Monterrey, Nuevo León, Mexico
- Department of Medical Education and Research in Health, Christus Muguerza Health Systems, Monterrey, Nuevo León, Mexico
| | - José Ramón Azpiri López
- Department of Cardiology, Hospital Christus Muguerza, Alta Especialidad, Monterrey, Nuevo León, Mexico
| | - Arnulfo González Cantú
- School of Medicine, Medical Specialties, University of Monterrey, Monterrey, Nuevo León, Mexico
- Department of Medical Education and Research in Health, Christus Muguerza Health Systems, Monterrey, Nuevo León, Mexico
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49
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Tavares CAM, Samesima N, Lazar Neto F, Hajjar LA, Godoy LC, Padrão EMH, Facin M, Jacob Filho W, Farkouh ME, Pastore CA. Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study. BMC Cardiovasc Disord 2021; 21:547. [PMID: 34789151 PMCID: PMC8600759 DOI: 10.1186/s12872-021-02332-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Advanced age is associated with both left bundle branch block (LBBB) and hypertension and the usefulness of ECG criteria to detect left ventricular hypertrophy (LVH) in patients with LBBB is still unclear. The diagnostic performance and clinical applicability of ECG-based LVH criteria in patients with LBBB defined by stricter ECG criteria is unknown. The aim of this study was to compare diagnostic accuracy and clinical utility of ECG criteria in patients with advanced age and strict LBBB criteria. Methods Retrospective single-center study conducted from Jan/2017 to Mar/2018. Patients undergoing both ECG and echocardiogram examinations were included. Ten criteria for ECG-based LVH were compared using LVH defined by the echocardiogram as the gold standard. Sensitivity, specificity, predictive values, likelihood ratios, AUC, and the Brier score were used to compare diagnostic performance and a decision curve analysis was performed. Results From 4621 screened patients, 68 were included, median age was 78.4 years, (IQR 73.3–83.4), 73.5% with hypertension. All ECG criteria failed to provide accurate discrimination of LVH with AUC range between 0.54 and 0.67, and no ECG criteria had a balanced tradeoff between sensitivity and specificity. No ECG criteria consistently improved the net benefit compared to the strategy of performing routine echocardiogram in all patients in the decision curve analysis within the 10–60% probability threshold range. Conclusion ECG-based criteria for LVH in patients with advanced age and true LBBB lack diagnostic accuracy or clinical usefulness and should not be routinely assessed. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02332-8.
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Affiliation(s)
- Caio Assis Moura Tavares
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nelson Samesima
- Unidade de Eletrocardiografia, Instituto do Coracao, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar, 44, andar AB, Sao Paulo, SP, 05403-900, Brazil
| | - Felippe Lazar Neto
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ludhmila Abrahão Hajjar
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucas C Godoy
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Peter Munk Cardiac Centre and Heart and Stroke/Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, Toronto, ON, Canada
| | - Eduardo Messias Hirano Padrão
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mirella Facin
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wilson Jacob Filho
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke/Richard Lewar Centre of Excellence in Cardiovascular Research, University of Toronto, Toronto, ON, Canada
| | - Carlos Alberto Pastore
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. .,Unidade de Eletrocardiografia, Instituto do Coracao, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr Enéas de Carvalho Aguiar, 44, andar AB, Sao Paulo, SP, 05403-900, Brazil.
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50
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Vandenberk B, Engelen MM, Van De Sijpe G, Vermeulen J, Janssens S, Vanassche T, Verhamme P, De Munter P, Lorent N, Willems R. Repolarization abnormalities on admission predict 1-year outcome in COVID-19 patients. IJC HEART & VASCULATURE 2021; 37:100912. [PMID: 34751251 PMCID: PMC8565995 DOI: 10.1016/j.ijcha.2021.100912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/29/2021] [Indexed: 12/26/2022]
Abstract
Background ECG abnormalities in COVID-19 have been widely reported, however data after discharge is limited. The aim was to describe ECG abnormalities on admission and following recovery of COVID-19, and their associated mortality. Methods All patients hospitalized in a tertiary care hospital between March 7th and July 1st 2020 with COVID-19 were included in a retrospective registry. The first ECG on admission was collected, together with an ECG after hospital discharge in the absence of acute pathology. Automated measures and clinical ECG interpretations were collected. Multivariate Cox regression analysis was performed to predict 1-year all-cause mortality. Results In total 420 patients were included, of which 83 patients (19.8%) died during the 1-year follow-up period. Repolarization abnormalities were present in 189 patients (45.0%). The extent of repolarization abnormalities was an independent predictor of 1-year all-cause mortality (HR per region 1.30, 95%CI 1.04–1.64) together with age (/year HR 1.06, 95%CI 1.04–1.08), heart rate (/bpm HR 1.02, 95%CI 1.01–1.03), neurological disorders (HR 2.41, 95%CI 1.47–3.93), active cancer (HR 2.75, 95%CI 1.57–4.82), CRP (per 10 mg/L HR 1.05, 95%CI 1.02–1.08) and eGFR (per 10 mg/L HR 0.90, 95%CI 0.83–0.98). In 245 patients (68.1%) an ECG post discharge was available. New repolarization abnormalities were more frequent in patients who died after discharge (4.7% versus 41.7%, p < 0.001) and 8 (3.3%) had new ventricular conduction defects, none of whom died during follow-up. Conclusions The presence and extent of repolarization abnormalities predicted outcome in patients with COVID-19. New repolarization abnormalities after discharge were associated with post-discharge mortality.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Libin Cardiovascular Institute, University of Calgary, Canada.,Cardiology, University Hospitals Leuven, Belgium
| | - Matthias M Engelen
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
| | - Greet Van De Sijpe
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | | | - Stefan Janssens
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
| | - Paul De Munter
- General Internal Medicine, University Hospitals Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium
| | - Natalie Lorent
- Respiratory Diseases, University Hospitals Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Belgium.,Cardiology, University Hospitals Leuven, Belgium
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