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Dykiert IA, Kraik K, Jurczenko L, Gać P, Poręba R, Poręba M. The Effect of Obesity on Repolarization and Other ECG Parameters. J Clin Med 2024; 13:3587. [PMID: 38930116 PMCID: PMC11205044 DOI: 10.3390/jcm13123587] [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: 05/06/2024] [Revised: 06/02/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Overweight and obesity are important risk factors in the development of cardiovascular diseases. New repolarization markers, such as the Tpeak-Tend interval and JTpeak intervals, have not yet been profoundly studied in obese patients. The study aims to analyze whether, in patients with obesity and overweight, repolarization markers, including the Tpeak-Tend interval, are prolonged and simultaneously check the frequency of other ECG pathologies in a 12-lead ECG in this group of patients. Methods: A study group consisted of 181 adults (90 females and 91 males) with overweight and first-class obesity. The participants completed a questionnaire, and the ECG was performed and analyzed. Results: When analyzing the classic markers, only QT dispersion was significantly higher in obese people. The Tpeak-Tend parameter (97.08 ms ± 23.38 vs. 89.74 ms ± 12.88, respectively), its dispersion, and JTpeak-JTend parameters were statistically significantly longer in the obese group than in the controls. There were also substantial differences in P-wave, QRS duration, and P-wave dispersion, which were the highest in obese people. Tpeak-Tend was positively correlated with body mass and waist circumference, while JTpeak was with BMI, hip circumference, and WHR. Tpeak/JT was positively correlated with WHR and BMI. In backward stepwise multiple regression analysis for JTpeak-WHR, type 2 diabetes and smoking had the highest statistical significance. Conclusions: Only selected repolarization markers are significantly prolonged in patients with class 1 obesity and, additionally, in this group, we identified more pathologies of P wave as well as prolonged QRS duration.
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Affiliation(s)
- Irena A. Dykiert
- Department of Physiology and Pathophysiology, Division of Pathophysiology, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Krzysztof Kraik
- Students’ Scientific Association of Cardiovascular Diseases Prevention, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Lidia Jurczenko
- Students’ Scientific Association of Cardiovascular Diseases Prevention, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, 50-372 Wrocław, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland
| | - Małgorzata Poręba
- Department of Paralympic Sport, Wroclaw University of Health and Sport Sciences, 51-617 Wrocław, Poland
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Del Castillo MG, Hernando D, Orini M, Laguna P, Viik J, Bailón R, Pueyo E. QT variability unrelated to RR variability during stress testing for identification of coronary artery disease. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2021; 379:20200261. [PMID: 34689618 DOI: 10.1098/rsta.2020.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 06/13/2023]
Abstract
Stress test electrocardiogram (ECG) analysis is widely used for coronary artery disease (CAD) diagnosis despite its limited accuracy. Alterations in autonomic modulation of cardiac electrical activity have been reported in CAD patients during acute ischemia. We hypothesized that those alterations could be reflected in changes in ventricular repolarization dynamics during stress testing that could be measured through QT interval variability (QTV). However, QTV is largely dependent on RR interval variability (RRV), which might hinder intrinsic ventricular repolarization dynamics. In this study, we investigated whether different markers accounting for low-frequency (LF) oscillations of QTV unrelated to RRV during stress testing could be used to separate patients with and without CAD. Power spectral density of QTV unrelated to RRV was obtained based on time-frequency coherence estimation. Instantaneous LF power of QTV and QTV unrelated to RRV were obtained. LF power of QTV unrelated to RRV normalized by LF power of QTV was also studied. Stress test ECG of 100 patients were analysed. Patients referred to coronary angiography were classified into non-CAD or CAD group. LF oscillations in QTV did not show significant differences between CAD and non-CAD groups. However, LF oscillations in QTV unrelated to RRV were significantly higher in the CAD group as compared with the non-CAD group when measured during the first phases of exercise and last phases of recovery. ROC analysis of these indices revealed area under the curve values ranging from 61 to 73%. Binomial logistic regression analysis revealed LF power of QTV unrelated to RRV, both during the first phase of exercise and last phase of recovery, as independent predictors of CAD. In conclusion, this study highlights the importance of removing the influence of RRV when measuring QTV during stress testing for CAD identification and supports the added value of LF oscillations of QTV unrelated to RRV to diagnose CAD from the first minutes of exercise. This article is part of the theme issue 'Advanced computation in cardiovascular physiology: new challenges and opportunities'.
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Affiliation(s)
| | - David Hernando
- I3A, University of Zaragoza, IIS Aragón, Spain
- CIBER-BBN, Zaragoza, Spain
| | | | - Pablo Laguna
- I3A, University of Zaragoza, IIS Aragón, Spain
- CIBER-BBN, Zaragoza, Spain
| | - Jari Viik
- Tampere University of Technology, Tampere, Finland
| | - Raquel Bailón
- I3A, University of Zaragoza, IIS Aragón, Spain
- CIBER-BBN, Zaragoza, Spain
| | - Esther Pueyo
- I3A, University of Zaragoza, IIS Aragón, Spain
- CIBER-BBN, Zaragoza, Spain
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Enhanced adaptive matched filter for automated identification and measurement of electrocardiographic alternans. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Puljevic M, Danilowicz‐Szymanowicz L, Molon G, Puljevic D, Raczak G, Canali G, Velagic V, Pezo‐Nikolic B, Milicic D. TWARMI pilot trial: The value and optimal criteria of microvolt T-wave alternans in the diagnosis of reversible myocardial ischemia in patients without structural cardiac disease. Ann Noninvasive Electrocardiol 2019; 24:e12610. [PMID: 30383318 PMCID: PMC6931817 DOI: 10.1111/anec.12610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/19/2018] [Accepted: 10/08/2018] [Indexed: 12/13/2022] Open
Abstract
AIMS Microvolt T-wave alternans (MTWA) testing is a beat-to-beat fluctuation in the amplitude of T wave. We investigated whether: (a) MTWA can be new non-invasive tool for detection of reversible ischemia in patients with suspected CAD without structural heart disease, (b) MTWA can detect ischemia earlier and with greater test accuracy compared with exercise ECG ST-segment testing, and (c) threshold value of MTWA and heart rate at which the alternans is estimated can be different compared to standard values. METHODS A total of 101 patients with suspected stable coronary disease, but without structural heart disease, were included. Echocardiography, exercise ECG test, MTWA with classical and modified threshold alternans values, and coronary angiography were performed. RESULTS About 33.3% patients had a false-positive result on exercise ECG test. The sensitivity of exercise ECG ST-segment test in the detection of coronary artery disease was 97.8%, and the specificity was 42.5% (DOR 33.89). In a group of angiographically positive patients, standard MTWA accurately identified 60% of patients, while 40% had a false-negative result. About 91.8% patients with negative angiography result were accurately identified with 8.2% false positives. The sensitivity of MTWA was 59.61% and specificity 91.83%. Best ratio of sensitivity and specificity (86.53% and 95.91%, DOR 151.06) had modified criteria for positive MTWA (MTWA >1.5 µV at heart rate 115-125/min). CONCLUSIONS This study showed that MTWA can be the new non-invasive tool for the detection of reversible ischemia in patients with suspected CAD without structural heart disease. Also, MTWA can detect ischemia earlier and with greater accuracy compared with exercise ECG testing.
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Affiliation(s)
- Mislav Puljevic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
| | | | - Giulio Molon
- Cardiology DepartmentS. Cuore HospitalVeronaItaly
| | - Davor Puljevic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
| | - Grzegorz Raczak
- Department of Cardiology and ElectrotherapyMedical University of GdanskGdanskPoland
| | - Guido Canali
- Cardiology DepartmentS. Cuore HospitalVeronaItaly
| | - Vedran Velagic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
| | - Borka Pezo‐Nikolic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
| | - Davor Milicic
- University of Zagreb, School of Medicine, University Hospital Center ZagrebZagrebCroatia
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Floré V, Claus P, Vos MA, Vandenberk B, Van Soest S, Sipido KR, Adriaenssens T, Bogaert J, Desmet W, Willems R. T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial Infarction. J Cardiovasc Transl Res 2015; 8:484-92. [PMID: 26350221 DOI: 10.1007/s12265-015-9649-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/21/2015] [Indexed: 12/01/2022]
Abstract
The purpose of this study is to investigate the relationship between T-wave alternans (TWA), infarct size and microvascular obstruction (MVO) and recurrent cardiac morbidity after ST elevation myocardial infarction (STEMI). One hundred six patients underwent TWA testing 1-12 months and 57 patients underwent cardiac magnetic resonance imaging (MRI) in the first 2-4 days after STEMI. During follow-up (3.5 ± 0.5 years), death (n = 2), ventricular tachycardia (n = 3), supraventricular tachycardia (n = 4), heart failure (n = 3) and recurrent coronary ischemia (n = 25) were observed. After multivariate analysis, positive TWA (HR2.59, CI1.10-6.11, p0.024) and larger MVO (HR1.08, CI1.01-1.16, p0.034) were associated with recurrent angina or ACS. Presence of MVO was correlated with TWA (Spearman rho 0.404, p0.002) and the impairment of LVEF (-0.524, p < 0.001). Patients after STEMI remain at a high risk of symptoms of coronary ischemia. The presence of MVO and TWA 1-12 months after STEMI is related to each other and to recurrent angina or ACS.
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Affiliation(s)
- V Floré
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium. .,Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - P Claus
- Division of Imaging and Cardiovascular Dynamics, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - M A Vos
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - B Vandenberk
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - S Van Soest
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - K R Sipido
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - T Adriaenssens
- Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - J Bogaert
- Department of Imaging and Pathology, University of Leuven, Leuven, Belgium
| | - W Desmet
- Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - R Willems
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.,Division of Clinical Cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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Kenttä T, Tulppo MP, Nearing BD, Karjalainen JJ, Hautala AJ, Kiviniemi AM, Huikuri HV, Verrier RL. Effects of exercise rehabilitation on cardiac electrical instability assessed by T-wave alternans during ambulatory electrocardiogram monitoring in coronary artery disease patients without and with diabetes mellitus. Am J Cardiol 2014; 114:832-7. [PMID: 25107578 DOI: 10.1016/j.amjcard.2014.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 10/25/2022]
Abstract
Effects of exercise rehabilitation on electrocardiographic markers of risk for sudden cardiac death have not been adequately studied. We examined effects of controlled exercise training on T-wave alternans (TWA) in 24-hour ambulatory electrocardiogram recordings in patients with stable coronary artery disease (CAD) without and with type 2 diabetes mellitus (DM). Consecutive patients with angiographically confirmed CAD were recruited to join the ARTEMIS (Innovation to Reduce Cardiovascular Complications of Diabetes at the Intersection) study. Exercise (n = 65) and control groups (n = 65) were matched on age, sex, DM, and previous myocardial infarction. Ambulatory electrocardiograms were recorded before and after a 2-year training period. TWA was assessed using time domain-modified moving average method by an investigator blinded to patients' clinical status. Average TWA values decreased in the rehabilitation group but not in control patients (rehabilitation [mean ± SEM]: 52.8 ± 1.7 μV vs 48.7 ± 1.5 μV, p <0.001; control: 53.7 ± 1.7 μV vs 54.3 ± 1.6 μV, p = 0.746). Changes in TWA differed between the groups (rehabilitation: -4.1 ± 1.2 μV vs controls: +0.6 ± 1.1 μV, p = 0.005). In CAD + DM patients, 50% (n = 9) of the 18 positive TWA cases were converted with exercise versus 10% (n = 2 of 20) of controls (p = 0.020). In CAD patients, 30% (n = 8 of 27) of positive TWA cases were converted with exercise versus 4% (n = 1 of 28) of controls (p = 0.012). In conclusion, this is the first report of the effectiveness of exercise rehabilitation to reduce TWA, a marker of sudden cardiac death risk, in patients with stable CAD.
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