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Zhang Z, Li L, Zhang Z, Hu Z, Xiong Y, Zhou L, Yao Y. Electrocardiographic tracking of left ventricular hypertrophy in hypertension: incidence and prognostic outcomes from the SPRINT trial. Clin Hypertens 2024; 30:17. [PMID: 38946010 DOI: 10.1186/s40885-024-00275-8] [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: 01/30/2024] [Accepted: 05/22/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND This study explores the impact of intensive blood pressure (BP) control on left ventricular hypertrophy (LVH) incidence and evaluates the prognostic implications of LVH status (pre-existing/new-onset/persistent/regression) using Systolic Blood Pressure Intervention Trial (SPRINT) Electrocardiogram Data. METHODS Poisson regression was used to assess new-onset LVH and LVH regression rates. Multivariable-adjusted Cox proportional hazard models determined the risk of adverse cardiovascular events (ACE), a composite of myocardial infarction (MI), non-MI acute coronary syndrome, stroke, heart failure, or cardiovascular death, alongside safety adverse events. RESULTS In 8,016 participants, intensive BP control significantly reduced new-onset LVH (8.27 vs. 14.79 per 1000-person years; adjusted p<0.001) and increased LVH regression (14.89 vs. 11.89 per 1000-person years; adjusted p<0.001). Elevated ACE risk was notable in participants with pre-existing LVH [adjusted HR: 1.94 (95% CI: 1.25-2.99); p = 0.003], new-onset LVH [adjusted 1.74 (95% CI: 1.16-2.60); p = 0.007], and persistent LVH[adjusted HR: 1.96 (95% CI: 1.11-3.46); p = 0.020], compared to those without LVH. Intriguingly, LVH regression attenuated this risk increment [adjusted HR: 1.57 (95% CI: 0.98-2.53); p = 0.062]. Achieving a BP target of < 120/80 mmHg nullified the increased ACE risk in those with pre-existing LVH. CONCLUSIONS Intensive BP control is instrumental in both reducing the emergence of LVH and fostering its regression. Pre-existing, new-onset LVH and persistent LV remain a predictor of adverse cardiovascular prognosis, whereas LVH regression and achieving on-treatment BP < 120/80 mmHg in pre-existing LVH individuals may further mitigate residual cardiovascular risk. CLINICAL TRIAL REGISTRATION URL: ClinicalTrials.gov Unique Identifier: NCT01206062.
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Affiliation(s)
- Zhuxin Zhang
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R. China
| | - Le Li
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R. China
| | - Zhenhao Zhang
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R. China
| | - Zhao Hu
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R. China
| | - Yulong Xiong
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R. China
| | - Likun Zhou
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R. China
| | - Yan Yao
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, National Key Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R. China.
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Kikuko IH, Julario R, Puspitasari AN, Intan RE, Azmi Y, Nisa’i Fatimah F, Savitri CG, Firmanda DR, Suhandoko LP, Fildzah Dini AS. ECG abnormality and predictor of new-onset atrial fibrillation in hypertension and diabetes mellitus population: An observational analytic study from cardiovascular outpatient clinic at a National Cardiovascular Center in Indonesia. J Arrhythm 2023; 39:860-867. [PMID: 38045447 PMCID: PMC10692857 DOI: 10.1002/joa3.12938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/16/2023] [Accepted: 09/14/2023] [Indexed: 12/05/2023] Open
Abstract
Background Population-based studies have also found that diabetes mellitus (DM) and hypertension (HT) are independent risk factors for atrial fibrillation (AF). However, less is known about new-onset atrial fibrillation (NOAF) risk factors and its correlation with DM and HT. The aim of this study was to determine the prevalence and pattern of ECG abnormalities, and the predictor of NOAF in patients with HT and DM. Methods This cross-sectional study was conducted at a tertiary hospital from May until December 2021. All medical record data from outpatients who had both diagnoses HT and DM were included in this study. Data from patients with unstable hemodynamics and lack of complete medical record data were excluded. Then, patient history, medical records, ECG, and laboratory information were reviewed. Results There were 162 patients included in this study. Arrhythmia was found in 14.2% of the population, with new-onset AF (NOAF) as the most common finding with 8.6% incidence, followed by PVC (3.1%) and PAC (2.5%). Bivariate analysis showed that valvular heart disease, random blood glucose, LVEF, and infection status were associated with a higher incidence of NOA. Model from multivariate logistic regression showed that valvular heart disease and random blood glucose level were independently correlated with NOAF (p = .009). Conclusion It can be concluded that random blood glucose level at a certain point and valvular heart disease can be used as a risk predictor of NOAF in the hypertension population with concomitant DM.
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Affiliation(s)
- Irawati Hajar Kikuko
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Rerdin Julario
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - A’rofah Nurlina Puspitasari
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Ryan Enast Intan
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Yusuf Azmi
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Fahrun Nisa’i Fatimah
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Cornelia Ghea Savitri
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Dwika Rasyid Firmanda
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Lidya Pertiwi Suhandoko
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
| | - Atikah S. Fildzah Dini
- Department of Cardiology and Vascular Medicine, Faculty of MedicineAirlangga University, Dr. Soetomo General HospitalSurabayaIndonesia
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Yan X, Gong J, Wang Z, Wang F, Qi C. Association of lipoprotein(a) with left ventricular hypertrophy assessed by electrocardiogram in adults: a large cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1260050. [PMID: 38098866 PMCID: PMC10720892 DOI: 10.3389/fendo.2023.1260050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023] Open
Abstract
Background and aims Increasing evidence supports a causal relationship between lipoprotein(a) [Lp(a)] and atherosclerotic cardiovascular disease, yet its association with left ventricular hypertrophy (LVH) assessed by electrocardiogram (ECG) remains unknown. The aim of this study was to explore the relationship between Lp(a) and LVH assessed by ECG in general population. Methods and results In this cross-sectional study, we screened 4,052 adults from the participants of the third National Health and Nutrition Examination Survey for analysis. Lp(a) was regarded as an exposure variable. LVH defined by the left ventricular mass index estimated from ECG was considered as an outcome variable. Multivariate logistic regression and restricted cubic spline (RCS) were used to assess the relationship between Lp(a) and LVH. Individuals with LVH had higher Lp(a) compared to individuals without LVH (P< 0.001). In the fully adjusted model, Lp(a) was strongly associated with LVH when as a continuous variable (per 1-unit increment, OR: 1.366, 95% CI: 1.043-1.789, P = 0.024), and higher Lp(a) remained independently associated with a higher risk of LVH when participants were divided into four groups according to quartiles of Lp(a) (Q4 vs Q1, OR: 1.508, 95% CI: 1.185-1.918, P = 0.001). And in subgroup analysis, this association remained significant among participants< 60 years, ≥ 60 years, male, with body mass index< 30 kg/m2, with hypertension and without diabetes (P< 0.05). In addition, we did not observe a nonlinear and threshold effect of Lp(a) with LVH in the RCS analysis (P for nonlinearity = 0.113). Conclusion Lp(a) was closely associated with LVH assessed by ECG in general population.
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Affiliation(s)
- Xuejiao Yan
- Department of Cardiology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Jing Gong
- Department of Geriatrics, Nanjing Tongren Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhenwei Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangfang Wang
- Department of Cardiology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Chunjian Qi
- Medical Research Center, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
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Koga M, Izumo M, Yoneyama K, Akashi YJ, Yashima F, Tada N, Yamawaki M, Shirai S, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Prognostic Value of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation: Insights from the OCEAN-TAVI Registry. Am J Cardiol 2023; 204:130-139. [PMID: 37541149 DOI: 10.1016/j.amjcard.2023.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
Electrocardiogram (ECG) left ventricular hypertrophy (LVH) is associated with the prognosis of patients with aortic stenosis. However, the impact of the presence or absence of ECG-LVH on the clinical outcomes after transcatheter aortic valve implantation (TAVI) is limited. This study aimed to assess the prognostic value of ECG-LVH among patients with aortic stenosis treated by TAVI. A total of 1,667 patients who underwent TAVI were prospectively enrolled into the OCEAN-TAVI (Optimized CathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation) registry. A total of 1,446 patients (mean age 84 years; 29.9% men) were analyzed. The Sokolow-Lyon index was used to determine the presence of ECG-LVH. LVH was also assessed using transthoracic echocardiography (TTE). We investigated the association between ECG-LVH and all-cause and cardiovascular mortality. This study identified ECG-LVH and TTE-LVH in 743 (51.5%) and 1,242 patients (86.0%), respectively. The Kaplan-Meier analysis revealed that all-cause mortality was significantly higher among patients without ECG-LVH than among those with ECG-LVH (log-rank p <0.001). In the multivariable analysis, the absence of ECG-LVH was independently associated with all-cause mortality (hazard ratio 1.98, 95% confidence interval 1.39 to 2.82, p <0.001), regardless of the presence or absence of TTE-LVH. Furthermore, the presence of TTE-LVH with the absence of ECG-LVH was observed in 575 patients (40%), which was associated with cardiovascular mortality (hazard ratio 2.84, 95% confidence interval 1.56 to 5.17, p <0.001). In conclusion, the absence of ECG-LVH was independently associated with an increased risk of all-cause mortality after TAVI. Risk stratification using both ECG-LVH and TTE-LVH is a useful predictor of adverse clinical outcomes after TAVI.
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Affiliation(s)
- Masashi Koga
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaki Izumo
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Kihei Yoneyama
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Shinichi Shirai
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University Hospital, Toyama, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Wang ZW, Xiao SJ, Liu NF. Association of lipoprotein(a) with left ventricular hypertrophy in patients with new-onset acute myocardial infarction: A large cross-sectional study. Clin Chim Acta 2023; 540:117226. [PMID: 36634905 DOI: 10.1016/j.cca.2023.117226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND The association of lipoprotein(a) [Lp(a)] with echocardiography-estimated left ventricular hypertrophy (LVH) in high-risk population remains uncertain, so we assessed the association between Lp(a) with echocardiography-derived LVH in patients with new-onset acute myocardial infarction (AMI). METHODS In this large, single-center, cross-sectional observational study, we enrolled 2,096 patients with new-onset AMI. Lp(a) was used as the independent variable and LVH was used as the dependent variable. Logistic regression, subgroup and sensitivity analysis were performed to test the association of Lp(a) with LVH. RESULTS The concentration of Lp(a) was higher in LVH group compared with the non-LVH group (P < 0.001). Multivariate logistic regression analysis showed that higher Lp(a) was strongly associated with higher risk of LVH, independently of traditional cardiovascular risk factors (Fully adjusted model, Q4 vs Q1, OR: 1.941, 95% CI: 1.343-2.803, P < 0.001). Subgroup analysis showed that the association of Lp(a) with LVH persisted in the subgroups of age (<60 and ≥60 years), sex (male and female), smoking (yes and no), diabetes (yes), hypertension (yes), hyperlipidemia (yes), and chronic kidney diseases (yes and no). Further sensitivity analysis indicated that Lp(a) remained significantly associated with LVH after further adjusting for high-sensitivity C-reactive protein or excluding patients with estimated glomerular filtration rate < 30 ml/min/1.73 m2 or dividing Lp(a) into multiple dichotomous variables. CONCLUSION Lp(a) was closely associated with LVH in patients with new-onset AMI.
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Affiliation(s)
- Zhen-Wei Wang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Sheng-Jue Xiao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Nai-Feng Liu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
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Wu L, Zhou B, Liu D, Wang L, Zhang X, Xu L, Yuan L, Zhang H, Ling Y, Shi G, Ke S, He X, Tian B, Chen Y, Qian X. LASSO Regression-Based Diagnosis of Acute ST-Segment Elevation Myocardial Infarction (STEMI) on Electrocardiogram (ECG). J Clin Med 2022; 11:jcm11185408. [PMID: 36143055 PMCID: PMC9505979 DOI: 10.3390/jcm11185408] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022] Open
Abstract
Electrocardiogram (ECG) is an important tool for the detection of acute ST-segment elevation myocardial infarction (STEMI). However, machine learning (ML) for the diagnosis of STEMI complicated with arrhythmia and infarct-related arteries is still underdeveloped based on real-world data. Therefore, we aimed to develop an ML model using the Least Absolute Shrinkage and Selection Operator (LASSO) to automatically diagnose acute STEMI based on ECG features. A total of 318 patients with STEMI and 502 control subjects were enrolled from Jan 2017 to Jun 2019. Coronary angiography was performed. A total of 180 automatic ECG features of 12-lead ECG were input into the model. The LASSO regression model was trained and validated by the internal training dataset and tested by the internal and external testing datasets. A comparative test was performed between the LASSO regression model and different levels of doctors. To identify the STEMI and non-STEMI, the LASSO model retained 14 variables with AUCs of 0.94 and 0.93 in the internal and external testing datasets, respectively. The performance of LASSO regression was similar to that of experienced cardiologists (AUC: 0.92) but superior (p < 0.05) to internal medicine residents, medical interns, and emergency physicians. Furthermore, in terms of identifying left anterior descending (LAD) or non-LAD, LASSO regression achieved AUCs of 0.92 and 0.98 in the internal and external testing datasets, respectively. This LASSO regression model can achieve high accuracy in diagnosing STEMI and LAD vessel disease, thus providing an assisting diagnostic tool based on ECG, which may improve the early diagnosis of STEMI.
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Affiliation(s)
- Lin Wu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Department of Endocrine and Metabolic Diseases, Guangdong Provincial Key Laboratory, The Third Affiliated Hospital of Sun Yat-sen University of Diabetology, No. 600, Tianhe Road, Guangzhou 510630, China
| | - Bin Zhou
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Dinghui Liu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Linli Wang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Ximei Zhang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Li Xu
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Lianxiong Yuan
- Department of Science and Technology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou 510630, China
| | - Hui Zhang
- Department of Medical Ultrasound, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, No. 1, Panfu Road, Guangzhou 510641, China
| | - Yesheng Ling
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Guangyao Shi
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Shiye Ke
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xuemin He
- Department of Endocrine and Metabolic Diseases, Guangdong Provincial Key Laboratory, The Third Affiliated Hospital of Sun Yat-sen University of Diabetology, No. 600, Tianhe Road, Guangzhou 510630, China
| | - Borui Tian
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Yanming Chen
- Department of Endocrine and Metabolic Diseases, Guangdong Provincial Key Laboratory, The Third Affiliated Hospital of Sun Yat-sen University of Diabetology, No. 600, Tianhe Road, Guangzhou 510630, China
- Correspondence: (Y.C.); (X.Q.); Tel.: +86-1892-210-2818 (Y.C.); +86-1371-926-1500 (X.Q.)
| | - Xiaoxian Qian
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Correspondence: (Y.C.); (X.Q.); Tel.: +86-1892-210-2818 (Y.C.); +86-1371-926-1500 (X.Q.)
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Low QRS Voltage in Limb Leads Indicates Accompanying Precordial Voltage Attenuation Resulting in Underestimation of Left Ventricular Hypertrophy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412867. [PMID: 34948477 PMCID: PMC8700898 DOI: 10.3390/ijerph182412867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 12/01/2022]
Abstract
Low QRS voltage (LQRSV) in electrocardiography (ECG) often occurs in limb leads without apparent cause. However, its clinical significance is obscure in healthy populations. We reviewed patients aged over 60 who were scheduled for non-cardiac surgery in two hospitals. Patients underwent pre-operative ECG, echocardiography, pulmonary function test, and chest X-ray. Patients with LQRSV isolated to limb leads and patients without LQRSV were selected from separate hospitals. Among the 9832 patients screened in one hospital, 292 (3.0%) showed LQRSV in limb leads. One-hundred and ninety-four without LQRSV were selected as the control from the 216 patients screened at the other hospital. For primary analysis, patients with structural heart disease or classic etiologies of LQRSV were excluded. Patients with LQRSV had a higher proportion of male and a greater body mass index. Precordial QRS voltages were smaller, whereas left ventricular mass index and the prevalence of echocardiographic left ventricular hypertrophy (LVH) was higher in patients with LQRSV than in those without. Consequentially, diagnostic performance of precordial voltage criteria for LVH was particularly poor in patients with LQRSV in limb leads. LQRSV in limb leads frequently occurs without apparent etiologies. ECG voltage criteria may underestimate LVH in a relatively healthy population with LQRSV in limb leads.
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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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Chillo P. Sensitivity and Specificity of an Electrocardiogram to Detect Echocardiographic Left Ventricular Hypertrophy in a Sample of 326 Tanzanian Adults: Differences in Men and Women. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2021. [DOI: 10.2147/rrcc.s313115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Clinical applicability and diagnostic performance of electrocardiographic criteria for left ventricular hypertrophy diagnosis in older adults. Sci Rep 2021; 11:11516. [PMID: 34075174 PMCID: PMC8169892 DOI: 10.1038/s41598-021-91083-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/19/2021] [Indexed: 12/25/2022] Open
Abstract
Recently, a new ECG criterion, the Peguero-Lo Presti (PLP), improved overall accuracy in the diagnosis of left ventricular hypertrophy (LVH)—compared to traditional ECG criteria, but with few patients with advanced age. We analyzed patients with older age and examined which ECG criteria would have better overall performance. A total of 592 patients were included (83.1% with hypertension, mean age of 77.5 years) and the PLP criterion was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively) using LVH defined by the echocardiogram as the gold standard. The PLP had higher AUC than the CV, RE and SL (respectively, 0.70 vs 0.66 vs 0.64 vs 0.67), increased sensitivity compared with the SL, CV and RE5 (respectively, 51.9% [95% CI 45.4–58.3%] vs 28.2% [95% CI 22.6–34.4%], p < 0.0001; vs 35.3% [95% CI 29.2–41.7%], p < 0.0001; vs 44.4% [95% CI 38.0–50.9%], p = 0.042), highest F1 score (58.3%) and net benefit for most of the 20–60% threshold range in the decision curve analysis. Overall, despite the best diagnostic performance in older patients, the PLP criterion cannot rule out LVH consistently but can potentially be used to guide clinical decision for echocardiogram ordering in low-resource settings.
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De la Garza Salazar F, Rodríguez Díaz EA, González Cantú A, Azpiri López JR, Kuri Ayache M, Romero Ibarguengoitia ME. Diagnostic utility of the electrocardiographic left ventricular hypertrophy criteria in specific populations. Acta Cardiol 2021; 76:272-279. [PMID: 32041487 DOI: 10.1080/00015385.2020.1721718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Several electrocardiographic (ECG) criteria have been validated for the diagnosis of left ventricular hypertrophy (LVH); the majority in Caucasian subjects from Europe and North America. Diagnostic utility of ECG criteria to detect LVH has never been established in our population; nonetheless they are frequently used. OBJECTIVE To evaluate the diagnostic utility of different LVH ECG criteria in a Northern Mexican population and to determine the effect of gender, age, body mass index (BMI), hypertension and ischaemic heart disease (IHD) on their performance. METHODS We conducted an observational, case-control study in patients divided according to the presence of LVH in an echocardiogram (Echo). We calculated the accuracy, sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 22 ECG criteria. RESULTS Four hundred thirty-two patients were studied (202 had LVH). The Dalfó criterion (ECG18. SV3 + RaVL) had the best diagnostic performance with a Se of 56%, Sp of 71.3%, PPV 62.9%, NPV 65% and a diagnostic accuracy (95%CI) of 64.1% (59.5-68.6). This criterion had the highest accuracy in both genders, in all BMI, in older patients (>60 years) and in those with positive Echo ischaemic heart disease (IHD); it also performed well in patients with history of IHD and in hypertensive patients. VDP Cornell had the best accuracy in patients less than 60 years old, and in patients with non-ischaemic findings by Echo. CONCLUSIONS The Dalfó criteria had the overall best accuracy in the detection of LVH, and specific populations.
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Affiliation(s)
- Fernando De la Garza Salazar
- Universidad de Monterrey, Mexico
- Departamento de Medicina Interna, Hospital Christus Muguerza Alta Especialidad, Monterrey, Mexico
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12
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Roy D, Mazumder O, Sinha A, Khandelwal S. Multimodal cardiovascular model for hemodynamic analysis: Simulation study on mitral valve disorders. PLoS One 2021; 16:e0247921. [PMID: 33662019 PMCID: PMC7932118 DOI: 10.1371/journal.pone.0247921] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/16/2021] [Indexed: 12/31/2022] Open
Abstract
Valvular heart diseases are a prevalent cause of cardiovascular morbidity and mortality worldwide, affecting a wide spectrum of the population. In-silico modeling of the cardiovascular system has recently gained recognition as a useful tool in cardiovascular research and clinical applications. Here, we present an in-silico cardiac computational model to analyze the effect and severity of valvular disease on general hemodynamic parameters. We propose a multimodal and multiscale cardiovascular model to simulate and understand the progression of valvular disease associated with the mitral valve. The developed model integrates cardiac electrophysiology with hemodynamic modeling, thus giving a broader and holistic understanding of the effect of disease progression on various parameters like ejection fraction, cardiac output, blood pressure, etc., to assess the severity of mitral valve disorders, naming Mitral Stenosis and Mitral Regurgitation. The model mimics an adult cardiovascular system, comprising a four-chambered heart with systemic, pulmonic circulation. The simulation of the model output comprises regulated pressure, volume, and flow for each heart chamber, valve dynamics, and Photoplethysmogram signal for normal physiological as well as pathological conditions due to mitral valve disorders. The generated physiological parameters are in agreement with published data. Additionally, we have related the simulated left atrium and ventricle dimensions, with the enlargement and hypertrophy in the cardiac chambers of patients with mitral valve disorders, using their Electrocardiogram available in Physionet PTBI dataset. The model also helps to create 'what if' scenarios and relevant analysis to study the effect in different hemodynamic parameters for stress or exercise like conditions.
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Affiliation(s)
- Dibyendu Roy
- TCS Research, Tata Consultancy Services Limited, Kolkata, India
- * E-mail:
| | - Oishee Mazumder
- TCS Research, Tata Consultancy Services Limited, Kolkata, India
| | - Aniruddha Sinha
- TCS Research, Tata Consultancy Services Limited, Kolkata, India
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13
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Heger J, Trimaille A, Kibler M, Marchandot B, Peillex M, Carmona A, Matsushita K, Trinh A, Reydel A, Zeyons F, Petit-Eisenmann H, Jesel L, Ohlmann P, Morel O. Electrocardiographic Strain Pattern Is a Major Determinant of Rehospitalization for Heart Failure After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e014481. [PMID: 33459031 PMCID: PMC7955442 DOI: 10.1161/jaha.119.014481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Electrocardiographic strain pattern (ESP) has recently been associated with increased adverse outcome in aortic stenosis and after surgical aortic valve replacement. Our study sought to determine the impact and incremental value of ESP pattern in predicting adverse outcome after transcatheter aortic valve replacement. Methods and Results A total of 585 patients with severe aortic stenosis (mean age, 83±7 years; men, 39.8%) were enrolled for transcatheter aortic valve replacement from November 2012 to May 2018. ESP was defined as ≥1-mm concave down-sloping ST-segment depression and asymmetrical T-wave inversion in the lateral leads. The primary end points of the study were all-cause mortality, rehospitalization for heart failure, myocardial infarction, and stroke. A total of 178 (30.4%) patients were excluded because of left bundle-branch block (n=103) or right bundle-branch block (n=75). Among the 407 remaining patients, 106 had ESP (26.04%). At a median follow-up of 20.00 months (11.70-29.42 months), no impact of electric strain on overall and cardiac death could be established. By contrast, incidence of rehospitalization for heart failure was significantly higher (33/106 [31.1%] versus 33/301 [11%]; P<0.001) in patients with ESP. By multivariate analyses, ESP remained a strong predictor of rehospitalization for heart failure (hazard ratio, 2.75 [95% CI, 1.61-4.67]; P<0.001). Conclusions In patients with aortic stenosis who were eligible for transcatheter aortic valve replacement, ESP is frequent and associated with an increased risk of postinterventional heart failure regardless of preoperative left ventricular hypertrophy. ESP represents an easy, objective, reliable, and low-cost tool to identify patients who may benefit from intensified postinterventional follow-up.
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Affiliation(s)
- Joé Heger
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Antonin Trimaille
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Marion Kibler
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Marilou Peillex
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Adrien Carmona
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Kensuke Matsushita
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Annie Trinh
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Antje Reydel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Floriane Zeyons
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Hélène Petit-Eisenmann
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Laurence Jesel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France.,Unité mixte de recherche (UMR) Institut national de la santé et de la recherche médicale (INSERM) 1260 Regenerative Nanomedicine Université de Strasbourg France
| | - Patrick Ohlmann
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire Nouvel Hôpital CivilCentre Hospitalier UniversitaireUniversité de Strasbourg Strasbourg France.,Unité mixte de recherche (UMR) Institut national de la santé et de la recherche médicale (INSERM) 1260 Regenerative Nanomedicine Université de Strasbourg France
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Left Ventricular Hypertrophy Increases Susceptibility to Bupivacaine-induced Cardiotoxicity through Overexpression of Transient Receptor Potential Canonical Channels in Rats. Anesthesiology 2020; 133:1077-1092. [PMID: 32915958 DOI: 10.1097/aln.0000000000003554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Local anesthetics, particularly potent long acting ones such as bupivacaine, can cause cardiotoxicity by inhibiting sodium ion channels; however, the impact of left ventricular hypertrophy on the cardiotoxicity and the underlying mechanisms remain undetermined. Transient receptor potential canonical (TRPC) channels are upregulated in left ventricular hypertrophy. Some transient receptor potential channel subtypes have been reported to pass relatively large cations, including protonated local anesthetics; this is known as the "pore phenomenon." The authors hypothesized that bupivacaine-induced cardiotoxicity is more severe in left ventricular hypertrophy due to upregulated TRPC channels. METHODS The authors used a modified transverse aortic constriction model as a left ventricular hypertrophy. Cardiotoxicity caused by bupivacaine was compared between sham and aortic constriction male rats, and the underlying mechanisms were investigated by recording sodium ion channel currents and immunocytochemistry of TRPC protein in cardiomyocytes. RESULTS The time to cardiac arrest by bupivacaine was shorter in aortic constriction rats (n =11) than in sham rats (n = 12) (mean ± SD, 1,302 ± 324 s vs. 1,034 ± 211 s; P = 0.030), regardless of its lower plasma concentration. The half-maximal inhibitory concentrations of bupivacaine toward sodium ion currents were 4.5 and 4.3 μM, which decreased to 3.9 and 2.6 μM in sham and aortic constriction rats, respectively, upon coapplication of 1-oleoyl-2-acetyl-sn-glycerol, a TRPC3 channel activator. In both groups, sodium ion currents were unaffected by QX-314, a positively charged lidocaine derivative, that hardly permeates the cell membrane, but was significantly decreased with QX-314 and 1-oleoyl-2-acetyl-sn-glycerol coapplication (sham: 79 ± 10% of control; P = 0.004; aortic constriction: 47± 27% of control; P = 0.020; n = 5 cells per group). Effects of 1-oleoyl-2-acetyl-sn-glycerol were antagonized by a specific TRPC3 channel inhibitor. CONCLUSIONS Left ventricular hypertrophy exacerbated bupivacaine-induced cardiotoxicity, which could be a consequence of the "pore phenomenon" of TRPC3 channels upregulated in left ventricular hypertrophy. EDITOR’S PERSPECTIVE
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15
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Leong Abdullah MFI, Tan KL, Narayanan S, Yuvashnee N, Chear NJY, Singh D, Grundmann O, Henningfield JE. Is kratom ( Mitragyna speciosa Korth.) use associated with ECG abnormalities? Electrocardiogram comparisons between regular kratom users and controls. Clin Toxicol (Phila) 2020; 59:400-408. [PMID: 32870119 DOI: 10.1080/15563650.2020.1812627] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Little is known about the cardiotoxic effects of kratom (Mitragyna speciosa Korth.), a medicinal plant. This analytical cross-sectional study investigated the prevalence of electrocardiogram (ECG) abnormalities and QTc intervals in regular kratom users compared with non-kratom-using control subjects. METHODS We enrolled regular kratom users and non-kratom-using control subjects from three communities. Demographic data, clinical data, kratom use characteristics, and ECG findings were recorded. The mitragynine content of kratom juice was quantified using a validated gas chromatography-mass spectrometry (GC-MS) method. RESULTS A total of 200 participants (100 kratom users and 100 control subjects) participated in this study. The prevalence of ECG abnormalities in kratom users (28%) did not differ from that of control subjects (32%). Kratom use was not associated with ECG abnormalities, except for significantly higher odds of sinus tachycardia (OR = 8.61, 95% CI = 1.06-70.17, p = 0.035) among kratom users compared with control subjects. The odds of observing borderline QTc intervals were significantly higher for kratom users compared with control subjects, regardless of the age of first use, the duration of use, the daily quantity consumed, and the length of time that had elapsed between last kratom use and ECG assessment. Nevertheless, there were no differences in the odds of having prolonged QTc intervals between kratom users and controls. The estimated average daily intake of mitragynine consumed by kratom users was 434.28 mg. CONCLUSION We found no link between regular kratom use and electrocardiographic abnormalities with an estimated average daily intake of 434.28 mg of mitragynine.
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Affiliation(s)
| | - Kok Leng Tan
- Regenerative Medicine Cluster, Advance Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Malaysia
| | - Suresh Narayanan
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Novline Yuvashnee
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | | | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Malaysia
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Jack E Henningfield
- Pinney Associates Inc., Bethesda, MD, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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De la Garza-Salazar F, Romero-Ibarguengoitia ME, Rodriguez-Diaz EA, Azpiri-Lopez JR, González-Cantu A. Improvement of electrocardiographic diagnostic accuracy of left ventricular hypertrophy using a Machine Learning approach. PLoS One 2020; 15:e0232657. [PMID: 32401764 PMCID: PMC7219774 DOI: 10.1371/journal.pone.0232657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/20/2020] [Indexed: 11/17/2022] Open
Abstract
The electrocardiogram (ECG) is the most common tool used to predict left ventricular hypertrophy (LVH). However, it is limited by its low accuracy (<60%) and sensitivity (30%). We set forth the hypothesis that the Machine Learning (ML) C5.0 algorithm could optimize the ECG in the prediction of LVH by echocardiography (Echo) while also establishing ECG-LVH phenotypes. We used Echo as the standard diagnostic tool to detect LVH and measured the ECG abnormalities found in Echo-LVH. We included 432 patients (power = 99%). Of these, 202 patients (46.7%) had Echo-LVH and 240 (55.6%) were males. We included a wide range of ventricular masses and Echo-LVH severities which were classified as mild (n = 77, 38.1%), moderate (n = 50, 24.7%) and severe (n = 75, 37.1%). Data was divided into a training/testing set (80%/20%) and we applied logistic regression analysis on the ECG measurements. The logistic regression model with the best ability to identify Echo-LVH was introduced into the C5.0 ML algorithm. We created multiple decision trees and selected the tree with the highest performance. The resultant five-level binary decision tree used only six predictive variables and had an accuracy of 71.4% (95%CI, 65.5-80.2), a sensitivity of 79.6%, specificity of 53%, positive predictive value of 66.6% and a negative predictive value of 69.3%. Internal validation reached a mean accuracy of 71.4% (64.4-78.5). Our results were reproduced in a second validation group and a similar diagnostic accuracy was obtained, 73.3% (95%CI, 65.5-80.2), sensitivity (81.6%), specificity (69.3%), positive predictive value (56.3%) and negative predictive value (88.6%). We calculated the Romhilt-Estes multilevel score and compared it to our model. The accuracy of the Romhilt-Estes system had an accuracy of 61.3% (CI95%, 56.5-65.9), a sensitivity of 23.2% and a specificity of 94.8% with similar results in the external validation group. In conclusion, the C5.0 ML algorithm surpassed the accuracy of current ECG criteria in the detection of Echo-LVH. Our new criteria hinge on ECG abnormalities that identify high-risk patients and provide some insight on electrogenesis in Echo-LVH.
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Affiliation(s)
- Fernando De la Garza-Salazar
- Universidad de Monterrey, Escuela de Medicina, Especialidades Médicas, Monterrey, Nuevo León, Mexico
- Departamento de Medicina Interna, Hospital Christus Muguerza Alta Especialidad, Monterrey, Nuevo Leon, Mexico
| | - Maria Elena Romero-Ibarguengoitia
- Universidad de Monterrey, Escuela de Medicina, Especialidades Médicas, Monterrey, Nuevo León, Mexico
- Direccion de Enseñanza e Investigación en Salud, Hospital Christus Muguerza, Alta Especialdiad, Monterrey, Nuevo León, México
| | | | - Jose Ramón Azpiri-Lopez
- Departamento de Cardiología, Hospital Christus Muguerza, Alta Especialidad, Monterrey, Nuevo León, México
| | - Arnulfo González-Cantu
- Universidad de Monterrey, Escuela de Medicina, Especialidades Médicas, Monterrey, Nuevo León, Mexico
- Direccion de Enseñanza e Investigación en Salud, Hospital Christus Muguerza, Alta Especialdiad, Monterrey, Nuevo León, México
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Prognostic utility of electrocardiograms in patients with hypertension older than 65 years. The PAFRES study. Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Ferdinand KC, Maraboto C. Is Electrocardiography-Left Ventricular Hypertrophy an Obsolete Marker for Determining Heart Failure Risk With Hypertension? J Am Heart Assoc 2020; 8:e012457. [PMID: 30943801 PMCID: PMC6507210 DOI: 10.1161/jaha.119.012457] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
See Article Johnson et al.
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Affiliation(s)
- Keith C Ferdinand
- 1 Department of Medicine Tulane University Heart and Vascular Institute Tulane University School of Medicine New Orleans LA
| | - Carola Maraboto
- 1 Department of Medicine Tulane University Heart and Vascular Institute Tulane University School of Medicine New Orleans LA
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Abstract
Hypertension (HTN) is a major modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality. The left ventricle (LV) is a primary target for HTN end-organ damage. In addition to being a marker of HTN, LV geometrical changes: concentric remodeling, concentric or eccentric LV hypertrophy (LVH) are major independent risk factors for not only CVD morbidity and mortality but also for all-cause mortality and neurological pathologies. Blood pressure control with lifestyle changes and antihypertensive agents has been demonstrated to prevent and regress LVH. Herein, we provide a comprehensive review of literature on the relationship between HTN and LV geometry abnormalities with a focus on diagnosis, prognosis, pathophysiological mechanisms, and treatment approaches.
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20
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Chen R, Bai K, Lu F, Zhao Y, Pan Y, Wang F, Zhang L. Electrocardiographic left ventricular hypertrophy and mortality in an oldest-old hypertensive Chinese population. Clin Interv Aging 2019; 14:1657-1662. [PMID: 31571845 PMCID: PMC6756150 DOI: 10.2147/cia.s218106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/29/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose Previous studies have identified that electrocardiographic pattern of left ventricular hypertrophy (ECG LVH) is associated with mortality, but studies of its correlation in the oldest-old hypertensive population is extremely limited. We investigated the correlation between ECG LVH and mortality in a hypertensive Chinese population aged 80 years and older. Patients and methods In this study, we included 284 Chinese participants older than 80 years. All included participants with hypertension (sitting systolic blood pressure [BP] 160 to 200 mmHg; sitting diastolic BP <110 mmHg) were ascertained at the baseline. ECG LVH was defined as a Sokolow-Lyon voltage calculated as the amplitude of SV1+ (max RV5 or RV6) greater than 3.5 mV. We categorized participants into two groups by the status of baseline ECG LVH. We used Cox regression models to calculate hazard ratio (HRs) for mortality due to ECG LVH, including cardiovascular mortality and all-cause mortality. Results In this study, with a 28-month median follow-up, a total of 35 (12.3%) patients died; 21 of those died due to cardiovascular causes. Compared with participants without ECG LVH, there was an increased risk of cardiovascular mortality in participants with ECG LVH (adjusted HR 4.25 [95% confidence interval [CI], 1.50–12.06]) but ECG LVH did not predict all-cause mortality (adjusted HR 2.31 [95% CI, 0.93–5.72]). Conclusion Our study shows that ECG LVH predicts the risk of cardiovascular mortality in an oldest-old hypertensive Chinese population.
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Affiliation(s)
- Rui Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People's Republic of China
| | - Kunhao Bai
- Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Yingxin Zhao
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Yujing Pan
- Renal Division, Department of Medicine, Peking University International Hospital, Beijing, People's Republic of China
| | - Fang Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People's Republic of China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, People's Republic of China.,National Institute of Health Data Science at Peking University, Beijing, People's Republic of China.,Center for Data Science in Health and Medicine, Peking University, Beijing, People's Republic of China
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Meyer ML, Soliman EZ, Drager D, Heiss G. Short-term repeatability of electrocardiographic criteria of left ventricular hypertrophy. Ann Noninvasive Electrocardiol 2019; 25:e12688. [PMID: 31498512 DOI: 10.1111/anec.12688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a marker of cardiac end-organ damage and a risk factor for cardiovascular morbidity and mortality. Although clinical trials and cohort studies commonly use the electrocardiogram (ECG) for LVH assessment, the repeatability of ECG-LVH criteria has not been sufficiently examined. Therefore, we evaluated the repeatability of ECG-LVH criteria. METHODS Participants (n = 63) underwent two standard ECGs at each of two visits, two weeks apart. The ECGs were processed centrally to calculate Cornell voltage (CV) LVH, Cornell voltage product (CVP) LVH, Sokolow-Lyon (SL) LVH, and Sokolow-Lyon product (SLP) LVH. We also used the waveforms measurements contributing to these LVH criteria as continuous variables, referred to here as CV-index, CVP-index, and SL-index. We calculated the intraclass correlation coefficient (ICC), minimal detectable change (95% confidence), and the prevalence-adjusted bias-adjusted kappa (PABAK). RESULTS ICCs (95% confidence intervals (CI)) were 0.97 (0.96, 0.98) for CV-index, 0.97 (0.95, 0.98) for CVP-index, and 0.93 (0.90, 0.96) for log of SL-index. Minimal detectable change between repeat measures of CV-index, CVP-index, and log of SL-index were ≥236.7 mV, ≥26.7 mV, and ≥0.09 mV, respectively. The within-visit PABAK was 1 for all ECG-LVH criteria, except for the first visit SLP-LVH (PABAK = 0.93). Between-visit PABAK ranged from 0.83 to 0.97 across LVH criteria. CONCLUSIONS CV, CVP, and SL ECG-LVH as continuous variables have excellent repeatability, and as binary variables have excellent within-visit agreement and good between-visit agreement. These results alleviate concerns about the repeatability the ECG-LVH use in clinical trials and epidemiologic studies.
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Affiliation(s)
- Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Dominique Drager
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Guedes Ramallo P, Morillas Blasco P, Gómez Martínez MJ, Núñez Martínez L, Romero Valero A, Peris Castelló F, Rodríguez Santiago FM, Vicente Ibarra N, Quintanilla Tello MA, Castilla Cabanes E, Fácila Rubio L, Pallarés-Carratalá V. Prognostic utility of electrocardiograms in patients with hypertension older than 65 years. The PAFRES study. Rev Clin Esp 2019; 220:100-108. [PMID: 31272678 DOI: 10.1016/j.rce.2019.05.007] [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: 03/14/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Left ventricular hypertrophy is the most common marker of target organ damage in arterial hypertension. Electrocardiograms are typically performed to identify left ventricular hypertrophy. The aim of this study was to analyse the prognostic utility of other electrocardiographic abnormalities in patients with arterial hypertension, beyond ventricular hypertrophy. MATERIALS AND METHODS The study included 1003 patients older than 65years with arterial hypertension. We recorded risk factors, previous cardiovascular history and medical treatment and analysed various electrocardiographic abnormalities including the Sokolow-Lyon index, the Cornell index, ventricular overload and branch blocks. The study conducted a 2-year follow-up, recording the major cardiovascular events (mortality, myocardial infarction, stroke and hospitalisation for heart failure). RESULTS The study population's mean age was 72.9±5.8years, 47.5% of whom were men. During the follow-up, 13.9% of the patients experienced a major cardiovascular event. These patients were older, more often smokers and engaged in less physical exercise, without presenting differences in the antihypertensive therapy or blood pressure control. The ventricular overload pattern (HR: 1.93; 95%CI: 1.160-3.196; P=.011) and the complete left bundle branch block (HR: 2.27; 95%CI: 1.040-4.956; P=.040) behaved as independent electrocardiographic predictors of major cardiovascular events; however, left ventricular hypertrophy using the Sokolow and/or Cornell index did not behave as such. CONCLUSIONS For patients with hypertension, the presence in the baseline electrocardiogram of complete left bundle branch block or a pattern of ventricular overload identifies a population at increased cardiovascular risk.
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Affiliation(s)
- P Guedes Ramallo
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España.
| | - P Morillas Blasco
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - M J Gómez Martínez
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - L Núñez Martínez
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - A Romero Valero
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - F Peris Castelló
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - F M Rodríguez Santiago
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - N Vicente Ibarra
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - M A Quintanilla Tello
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - E Castilla Cabanes
- Servicio de Cardiología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - L Fácila Rubio
- Servicio de Cardiología, Hospital General de Valencia, Valencia, España
| | - V Pallarés-Carratalá
- Unidad de Vigilancia de la Salud, Unión de Mutuas. Departamento de Medicina, Universitat Jaume I, Castellón, España
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Byrne C, Vaduganathan M, Pareek M. Electrocardiography and left ventricular function: looking beyond hypertrophy. Hypertens Res 2019; 42:580-582. [DOI: 10.1038/s41440-018-0200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 12/07/2018] [Accepted: 12/08/2018] [Indexed: 11/09/2022]
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Kowal J, Ahmad MI, Li Y, Soliman EZ. Prognostic significance of electrocardiographic right ventricular hypertrophy in the general population. J Electrocardiol 2019; 54:49-53. [PMID: 30901607 DOI: 10.1016/j.jelectrocard.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Echocardiographically detected right ventricular hypertrophy (RVH) is associated with cardiovascular disease (CVD) and mortality. However, the prognostic significance of electrocardiographic (ECG)RVH criteria as predictors of poor outcomes in the general population is unclear. METHODS This study included 7857 participants (59.8 ± 13.4 years, 52.6% women) from the Third National Health and Nutrition Examination Survey. Sixteen different ECG-RVH criteria were created from digitally recorded and centrally processed electrocardiograms. All-cause mortality was ascertained using the National Death Index. Cox proportional hazards analysis was used to examine the association between baseline ECG-RVH criteria and all-cause mortality. RESULTS The prevalence of RVH varied widely among the criteria. The lowest ECG-RVH prevalence was 0.09% (using S > R in I, II, III) while the highest prevalence was 20.7% (using (R I + S III) - (S I + R III) < 15 mm). During a median follow-up of 14 years, 2812 deaths occurred. The mortality rate was highest among participants with ECG-RVH defined as R:S ratio V5 < 0.75. In multivariable adjusted models, 9 out of the 16 ECG-RVH criteria were significantly associated with all-cause mortality. When ECG-RVH was defined as the presence of any ECG-RVH criteria, each additional ECG-RVH criteria was associated with 6% increased risk of all-cause mortality (HR (95% CI):1.06(1.03,1.10)). CONCLUSIONS There is a wide variation in the prevalence of ECG-RVH when different criteria are applied in the general population. However, the presence of ECG-RVH by most criteria regardless of prevalence was associated with poor prognosis suggesting that appropriate choice of criteria may enhance the utilization of these ECG markers in risk stratification.
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Affiliation(s)
- Jamie Kowal
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Yabing Li
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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25
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Al‐Shafei AIM, El‐Gendy OAA. Regular consumption of green tea improves pulse pressure and induces regression of left ventricular hypertrophy in hypertensive patients. Physiol Rep 2019; 7:e14030. [PMID: 30912296 PMCID: PMC6434072 DOI: 10.14814/phy2.14030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/14/2019] [Accepted: 02/17/2019] [Indexed: 12/21/2022] Open
Abstract
This study characterized the effects of regular green tea (GT) and hot water (HW) ingestion on systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and left ventricular hypertrophy (LVH) in two equal, sex- and age-matched groups; Grp1 and Grp2 (n = 100 each; age 53 ± 4 years) of hypertensive patients. Grp1 had regular GT treatment, followed by HW ingestion, whereas Grp2 had HW ingestion followed by GT treatment for periods of 4 months each. Electrocardiographic (ECG) and echocardiographic assessments of LVH were made before and at the end of both periods. SBP was lowered significantly by 6.6%; DBP by 5.1%, and PP by 9.1% by the end of month 4 of GT treatment in Grp1. Upon GT cessation and HW ingestion, SBP, DBP, and PP returned to pretreatment levels over 4 months. In Grp2, SBP, DBP, and PP were reduced insignificantly by 1.5%, 1.0%, and 2.3% by the end of the 4th month of HW ingestion. Conversely, over 4 months of GT treatment, SBP, DBP, and PP were significantly lowered by 5.4%, 4.1%, and 7.7% from the baseline values, respectively. ECG and echocardiographic evidence of LVH was shown in 20% of Grp1 and 24% of Grp2 patients before intervention. This was significantly lowered to 8% and 10% in Grp1 and Grp2 by GT treatment. However, this increased to 16% following HW ingestion in Grp1. HW ingestion did mot induce regression of LVH in Grp2. Thus, regular GT ingestion has cardiovascular protective effects.
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Affiliation(s)
- Ahmad I. M. Al‐Shafei
- Istanbul Medipol UniversityIstanbulTurkey
- Bahrain UniversitySouthern GovernorateBahrain
- Qassim UniversityQassimSaudi Arabia
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26
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Jiang X, Quan X, Yang J, Zhou X, Hu A, Zhang Y. Electrocardiographic criteria for the diagnosis of abnormal hypertensive cardiac phenotypes. J Clin Hypertens (Greenwich) 2019; 21:372-378. [PMID: 30706989 PMCID: PMC8030302 DOI: 10.1111/jch.13486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/24/2018] [Accepted: 12/11/2018] [Indexed: 11/27/2022]
Abstract
This article compared the performance of 18 electrocardiographic (ECG) left ventricular hypertrophic (LVH) criteria and four P-wave indices for the diagnosis of echocardiographic (ECHO) LVH and left atrial enlargement (LAE), including the deepest S-wave amplitude added to the S-wave amplitude of lead V4 (SD +SV4 ) and P-wave terminal force in lead V1 (PTFV1 ). A total of 152 middle-aged hypertensive patients without evident cardiovascular diseases (CVDs) were enrolled. The gold standard for the diagnosis of LVH and LAE was ECHO left ventricular mass index (LVMI) and largest left atrial volume index (LAVI). For the detection of LVH, Sokolow-Lyon voltage, Cornell voltage, Cornell product, SD +SV4 , Manning, and R+S in any precordial lead had relatively higher sensitivity, especially SD +SV4 criteria. Their combination could further increase sensitivity (43% vs 29% [SD +SV4 ], P = 0.016). PTFV1 was the only criterion that had significant diagnostic value for ECHO LAE (AUC, 0.68; 95% CI: 0.54-0.73, P = 0.008). For middle-aged hypertensive patients without evident cardiovascular diseases, SD +SV4 had the highest sensitivity for the diagnosis of LVH and the combination of several ECG LVH criteria might further increase sensitivity. PTFV1 had significant diagnostic value for ECHO LAE.
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Affiliation(s)
- Xueli Jiang
- Cardiovascular Department, Chinese Academy of Medical Sciences, Peking Union Medical CollegeFuwai HospitalBeijingChina
| | - Xin Quan
- Ultrasound Imaging Center, Chinese Academy of Medical Sciences, Peking Union Medical CollegeFuwai HospitalBeijingChina
| | - Jun Yang
- Department of MedicineMonash UniversityClaytonAustralia
| | - Xianliang Zhou
- Cardiovascular Department, Chinese Academy of Medical Sciences, Peking Union Medical CollegeFuwai HospitalBeijingChina
| | - Aihua Hu
- Beijing Hypertension AssociationBeijingChina
| | - Yuqing Zhang
- Cardiovascular Department, Chinese Academy of Medical Sciences, Peking Union Medical CollegeFuwai HospitalBeijingChina
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Valentine D, Lord AS, Torres J, Frontera J, Ishida K, Czeisler BM, Lee F, Rosenthal J, Calahan T, Lewis A. How Does Preexisting Hypertension Affect Patients with Intracerebral Hemorrhage? J Stroke Cerebrovasc Dis 2018; 28:782-788. [PMID: 30553645 DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with intracerebral hemorrhage (ICH) frequently present with hypertension, but it is unclear if this is due to pre-existing hypertension (prHTN) or to the bleed itself or associated pain. We sought to assess the relationship between prHTN and admission systolic blood pressure (aBP) and bleed severity. METHODS We retrospectively assessed the relationship between prHTN and aBP and NIHSS in patients with ICH at 3 institutions. RESULTS Of 251 patients, 170 (68%) had prHTN based on history of hypertension/antihypertensive use. Median aBP was significantly higher in those with prHTN (155 mm Hg (IQR 135-181) versus 139 mm Hg (IQR 124-158), P < .001). Patients with left ventricular hypertrophy (LVH) on electrocardiogram (ECG) or transthoracic echocardiogram (TTE) had significantly higher aBP than those without LVH (median aBP 195 mm Hg (IQR 155-216) for patients with LVH on ECG versus 147 mm Hg (IQR 129-163) for patients with no LVH on ECG, P < .001; median aBP 181 mm Hg (IQR 153-214) for patients with LVH on TTE versus 152 mm Hg (IQR 137-169) for patients with no LVH on TTE, P = .01). prHTN was associated with a higher median NIHSS (11 (IQR 3-20) for patients with history of hypertension/antihypertensive use versus 6 (IQR 1-14) for patients without this history (P = .02); 9 (IQR 3-19) versus 5 (IQR 2-13) for patients with/without LVH on ECG (P = .085); and 10 (IQR 5-18) versus 5 (IQR 1-13) for patients with/without LVH on TTE (P = .046). CONCLUSIONS Patients with ICH who have prHTN have higher aBP and NIHSS, suggesting that prHTN may worsen reactive hypertension in the setting of ICH.
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Affiliation(s)
- David Valentine
- Department of Neurology, New York University School of Medicine, New York, New York.
| | - Aaron S Lord
- Department of Neurology, New York University School of Medicine, New York, New York; Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Jose Torres
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Jennifer Frontera
- Department of Neurology, New York University School of Medicine, New York, New York; Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Koto Ishida
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Barry M Czeisler
- Department of Neurology, New York University School of Medicine, New York, New York; Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Fred Lee
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Jonathan Rosenthal
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Thomas Calahan
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Ariane Lewis
- Department of Neurology, New York University School of Medicine, New York, New York; Department of Neurosurgery, New York University School of Medicine, New York, New York
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Ioannou A, Papageorgiou N, Singer D, Missouris CG. Registry report of the prevalence of ECG abnormalities and their relation to patient characteristics in an asymptomatic population. QJM 2018; 111:875-879. [PMID: 30239921 DOI: 10.1093/qjmed/hcy212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality in developed countries. Many patients do not experience symptoms before a first major cardiovascular event. Resting electrocardiogram (ECG) may help identify asymptomatic individuals with a high risk of cardiovascular disease. OBJECTIVE We sought to determine the prevalence of ECG abnormalities in an apparently symptom-free adult population within a prospective registry. METHODS The registry consisted of 4739 consecutive apparently healthy individuals [age 62.8 ± 6.2 (SD) years; 54% female], referred by their General Practitioners between 2009 and 2013. Patient demographics, and clinical data were obtained, alongside blood tests and a resting ECG. RESULTS ECG abnormalities were present in 1509 (31.8%) subjects and were commoner with increasing age (F = 0.161, p = 0.01), systolic (F = 0.134, p = 0.01) and diastolic (F = 0.44, p = 0.01) blood pressure and waist circumference (F = 0.53, p = 0.01). Left ventricular hypertrophy (LVH) was the most common abnormality (n = 281) and was positively associated with systolic (F = 0.12, p = 0.01) and diastolic blood pressure (F = 0.99, p = 0.01) and male gender (X2 = 60.5, p < 0.01). All ECG abnormalities (except for LVH) were associated with an increasing age, while right bundle branch block (F = 0.041, p = 0.01) and atrial fibrillation (n = 29; F = 0.036, p = 0.05) were associated with the presence of diabetes mellitus (n = 211). Only left bundle branch block (n = 50) was associated with angina (F = 0.05, p = 0.01). CONCLUSIONS Unrecognized cardiac abnormalities are common in middle-aged men and women with no overt symptoms. ECG offers the potential to identify these abnormalities and provide earlier intervention and treatment, and possibly improve cardiovascular outcome.
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Affiliation(s)
- A Ioannou
- Department of Cardiology, Royal Free Hospital, London, UK
| | - N Papageorgiou
- Department of Cardiology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - D Singer
- Department of Internal Medicine, Office of Global Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | - C G Missouris
- Department of Cardiology, Wexham Park Hospital, Frimley Health NHS Trust, Slough, UK
- Medical School, University of Cyprus, Nicosia, Cyprus
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29
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Duncan JR, MacDonald EJ, Dorsett KM, Nayyar M, Bursac Z, Schenone MH. Does left ventricular hypertrophy by electrocardiogram predict adverse outcomes in pregnancies with chronic hypertension? J Matern Fetal Neonatal Med 2018; 33:1638-1642. [PMID: 30227767 DOI: 10.1080/14767058.2018.1524457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: The American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy recommends assessing left ventricular function with echocardiogram or electrocardiogram (ECG) in women with severe hypertension of long duration. We aim to compare the rates of superimposed preeclampsia (SIP) and other obstetrical outcomes in pregnancies with chronic hypertension (CHTN) and left ventricular hypertrophy (LVH) by ECG criteria with mothers without LVH.Study design: After IRB approval, we performed a retrospective chart review from January 2015 to December 2016. Singleton pregnancies with CHTN who carried the pregnancy beyond 20 weeks and planned to deliver at our institution were included for analysis. Patients with insufficient data, multiple gestations, and those with systemic lupus erythematosus were excluded from this study. Rates of SIP and other obstetrical outcomes were compared among those with LVH and those without LVH. Univariate parametric and nonparametric statistical models were applied as appropriate. Associations were considered statistically significant at an alpha level of 0.05.Results: We included 218 pregnancies. Nineteen (8.7%) had LVH. The rate of SIP was higher in pregnancies with LVH than in those without it (68 versus 41%; OR = 3.01; 95% CI 1.1-8.5; p = .022). The birthweight was lower in the LVH group (2432 g [2120-2990] versus 2870 g [2430-3440]; p = .016). Other obstetrical outcomes were not significantly different between those patients with LVH and those without.Conclusions: LVH by ECG criteria may be associated with higher rates of SIP and with lower birthweight in pregnancies with CHTN. ECG may be a cost-effective tool to identify patients with CHTN at risk of adverse outcomes. Larger trials are necessary to corroborate our findings.
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Affiliation(s)
- Jose R Duncan
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis,TN, USA.,Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
| | - Erin J MacDonald
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis,TN, USA.,Christ Community Women's Health Services, Memphis, TN, USA
| | - Katherine M Dorsett
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis,TN, USA
| | - Mannu Nayyar
- Division of Cardiology, University of Tennessee Health Science, Memphis,TN, USA
| | - Zoran Bursac
- Division of Biostatistics, University of Tennessee Health Science Center, Memphis,TN, USA
| | - Mauro H Schenone
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis,TN, USA
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30
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Shao Q, Meng L, Tse G, Sawant AC, Zhuo Yi Chan C, Bazoukis G, Baranchuk A, Li G, Liu T. Newly proposed electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in a Chinese population. Ann Noninvasive Electrocardiol 2018; 24:e12602. [PMID: 30281188 DOI: 10.1111/anec.12602] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/20/2018] [Accepted: 08/28/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The electrocardiographic criteria currently available for the diagnosis of left ventricular hypertrophy (LVH) are low in sensitivity. Thus, we compared the diagnostic performance of newly proposed electrocardiographic criteria to the existing criteria in a Chinese population. METHODS A total of 235 consecutive hypertensive patients, hospitalized in our department between May 2017 and April 2018, were included. They were divided into two groups based on the gold standard echocardiogram: those with (n = 116) and without LVH (n = 119). The newly proposed ECG criteria were calculated by summating the amplitude of the deepest S wave (SD ) in any single lead and the S-wave amplitude of lead V4 (SV4 ). The area under the curve was calculated and compared against the sex-specific Cornell limb lead and Sokolow-Lyon criteria. RESULTS ECG analysis of the cohort showed that the newly proposed criteria had the highest sensitivity in diagnosing LVH (male: 65.5%; female: 81%), followed by the Cornell limb lead criteria (male: 55.2%; female: 56.9%). The specificities of both sets of criteria were higher than 70%, with no significant differences between them. Receiver operator curve analysis showed an optimal cutoff of ≥2.1 mV for females (AUC: 0.832; 95% CI: 0.757-0.906) and ≥2.6 mV for males (AUC: 0.772; 95% CI: 0.687-0.856). CONCLUSION The newly proposed SD + SV4 criteria provide an improved sensitivity for the ECG diagnosis of LVH compared to existing criteria, but its routine use will require further validation in larger populations.
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Affiliation(s)
- Qingmiao Shao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lei Meng
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Abhishek C Sawant
- Division of Cardiology, Department of Internal Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Calista Zhuo Yi Chan
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - George Bazoukis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Adrian Baranchuk
- Division of Cardiology, Electrophysiology and Pacing, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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