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Benedikt M, Aziz F, Fröschl T, Strohhofer C, Kolesnik E, Tripolt N, Pferschy P, Wallner M, Bugger H, Zirlik A, Scherr D, Sourij H, von Lewinski D. Impact of baseline ECG characteristics on changes in cardiac biomarkers and echocardiographic metrices after acute myocardial infarction treated with Empagliflozin. Sci Rep 2024; 14:15083. [PMID: 38956086 PMCID: PMC11219811 DOI: 10.1038/s41598-024-64175-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
The EMMY trial was a multicentre, investigator-initiated, placebo-controlled, double-blind trial, which enrolled 476 patients immediately following AMI and the first study demonstrating a significant reduction in NT-proBNP-levels as well as significant improvements in cardiac structure and function in patients after acute myocardial infarction treated with empagliflozin vs. placebo. However, hardly any data are available investigating the prognostic role of baseline electrocardiogram metrics in SGLT2-inhibitor-treated patients. This post-hoc analysis investigated the association of baseline ECG metrics collected in one centre of the trial (181 patients) with changes in structural and functional cardiac parameters as well as cardiac biomarkers in response to Empagliflozin treatment. A total of 181 patients (146 men; mean age 58 ± 14 years) were included. Median PQ-interval was 156 (IQR 144-174) milliseconds (ms), QRS width 92 (84-98) ms, QTc interval 453 (428-478) ms, Q-wave duration 45 (40-60) ms, Q-wave amplitude 0.40 (0.30-0.70) millivolt (mV), and heart rate was 71 (64-85) bpm. For functional cardiac parameters (LVEF and E/e') of the entire cohort, a greater decrease of E/e' from baseline to week 26 was observed in shorter QRS width (P = 0.005).Structural cardiac endpoints were only found to have a significant positive correlation between LVEDD and Q wave duration (P = 0.037). Higher heart rate was significantly correlated with better response in LVEF (P = 0.001), E/e' (P = 0.021), and NT-proBNP (P = 0.005). Empagliflozin-treatment showed no interaction with the results. Baseline ECG characteristics post AMI are neither predictive for beneficial NTproBNP effects of Empagliflozin post AMI, nor for functional or structural changes within 26 weeks post AMI.
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Affiliation(s)
- Martin Benedikt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Faisal Aziz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Thomas Fröschl
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Christoph Strohhofer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Norbert Tripolt
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Peter Pferschy
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Heiko Bugger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Andreas Zirlik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria
- Interdisciplinary Metabolic Medicine Trials Unit, Medical University of Graz, Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, Austria.
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Allam LE, Abdelmotteleb AA, Eldamanhoury HM, Hassan HS. Unlocking the potential of sacubitril/valsartan therapy in improving ECG and echocardiographic parameters in heart failure patients with reduced ejection fraction (HErEF). Egypt Heart J 2024; 76:41. [PMID: 38546816 PMCID: PMC10978557 DOI: 10.1186/s43044-024-00468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Sacubitril/valsartan therapy has been found to reduce hospitalizations, improve echocardiogram parameters, and improve mortality in HFrEF. The objective is to assess S/V therapy effect on electrocardiogram indices and how those parameters related to echocardiographic parameters. RESULTS From June 2022 until June 2023, this prospective study enrolled 100 patients (mean age 56.1, 8.2, 78% male) with non-ischemic dilated cardiomyopathy (NIDCM) used PARADIGM-HF criteria: NYHA Class II, III, or IV HF; ejection fraction EF ≤ 40%; and hospitalization for HF within previous 12 months. Before starting S/V therapy, an echo and ECG were performed, as well as 6 months following the optimal dose and if LVEF was improved by more than 5%, they were termed notable S/V treatment responders. Aside from improving echo parameters, ECG parameters improved significantly. The QRS width was reduced from 123.7 ± 20.3 to 117.1 ± 18.8 ms (p 0.00), and QTc interval was reduced from 425.4 ± 32.8 to 421.4 ± 32.3 ms (p = 0.012). QRS width was significantly reduced in patients with LBBB, RBBB, and IVCD based on QRS morphology. QRS width (r = - 0.243, p = 0.016) and QTc (r = - 0.252, p = 0.012) had a negative connection with LVEF. CONCLUSION S/V therapy, in addition to improving echo parameters and NYHA class, improves QRS width and corrected QTc interval on ECG in HFrEF patients. This is an indication of reverse electrical LV remodeling and can be used as an auxiliary prediction for tracking therapy outcomes.
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Affiliation(s)
- Lamyaa Elsayed Allam
- Department of Cardiology, Faculty of Medicine, Ain Shams University, 48 Mohammed Elnadi Street, 6th Zone, Nasr City, Cairo, 11371, Egypt.
| | - Ahmed Aly Abdelmotteleb
- Department of Cardiology, Faculty of Medicine, Ain Shams University, 48 Mohammed Elnadi Street, 6th Zone, Nasr City, Cairo, 11371, Egypt
| | - Hayam Mohamed Eldamanhoury
- Department of Cardiology, Faculty of Medicine, Ain Shams University, 48 Mohammed Elnadi Street, 6th Zone, Nasr City, Cairo, 11371, Egypt
| | - Hassan Shehata Hassan
- Department of Cardiology, Faculty of Medicine, Ain Shams University, 48 Mohammed Elnadi Street, 6th Zone, Nasr City, Cairo, 11371, Egypt
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Ahmadzadeh M, Rahimi M, Toufan-Tabrizi* M, Mohammadi K. Determining whether LV filling time contributes to HF symptoms in different widths of QRS in LBBB patients: A clinical study. Glob Cardiol Sci Pract 2024; 2024:e202408. [PMID: 38404659 PMCID: PMC10886770 DOI: 10.21542/gcsp.2024.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/11/2023] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVES Accurate assessment of left ventricular (LV) function is essential for managing patients with left bundle branch block (LBBB). This study aimed to evaluate the relationship between LV systolic function, left ventricular diastolic filling time (LVFT), QRS duration, and heart failure symptoms in patients with LBBB. METHODS This study was conducted between June 2021 and June 2022. Patients with LBBB and sinus rhythm who were referred to the echocardiography department were included in the study. All the patients underwent electrocardiogram-gated echocardiography using the same machine. In this study, the LVFT value was measured in absolute terms and as a ratio to the R-R interval (LVFT/RR). RESULTS A total of sixty-five patients were included, forty-two (64.6%) were women, and the mean age was 60.71 ± 8.72. We performed three one-way ANOVA tests that showed that LV filling time/RR ratio, QRS duration, and ejection fraction were significantly different between heart failure classes (p = 0.008, p = 0.001, and p < 0.001, respectively). A weak correlation was observed between LVEF and LVFT/RR (r = 0.349, p = 0.004). Additionally, QRS duration was negatively correlated with LVEF (r = - 0.395, p = 0.004) and LVFT/RR (r = - 0.350, p = 0.004), although these correlations were weak. CONCLUSION We showed that LVFT/RR ratio differed significantly between HF functional classes and was lower in patients with more severe HF symptoms. Additionally, QRS duration was negatively correlated with LVEF and LVFT/RR, and patients with more severe HF symptoms had longer QRS durations.
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Affiliation(s)
| | | | | | - Kamran Mohammadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Perry AS, Li S. Association of change in QRS duration with chronic heart failure outcomes. Am Heart J 2022; 254:77-80. [PMID: 36002049 DOI: 10.1016/j.ahj.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/26/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
QRS duration is an established risk factor among patients with heart failure. How change in QRS duration relates to heart failure outcomes has had limited study. In this post-hoc analysis of the Beta-Blocker Evaluation of Survival Trial, we demonstrated that QRS duration change from baseline to 3 months is independently associated with long-term survival and left ventricle ejection fraction.
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Affiliation(s)
- Andrew S Perry
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA
| | - Song Li
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA.
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Association between electrical and mechanical remodeling after cardiac resynchronization therapy: systematic review and meta-analysis of observational studies. Heart Fail Rev 2022; 27:2165-2176. [DOI: 10.1007/s10741-022-10234-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
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Lin PL, Lee YH, Liu LYM, Tsai CT, Yang TF, Chiou WR, Hsieh MY, Chang HY, Huang CC. Duration of Heart Failure With Reduced Ejection Fraction Associated With Electrocardiographic Outcomes Before and After Sacubitril/Valsartan. J Cardiovasc Pharmacol Ther 2022; 27:10742484221107799. [PMID: 35713466 DOI: 10.1177/10742484221107799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Changes in QRS duration in patients with heart failure with reduced ejection fraction (HFrEF) after sacubitril/valsartan therapy is not fully understood. This study aimed to assess the association of duration of HFrEF diagnosis with electrocardiographic and echocardiographic outcomes between before and after sacubitril/valsartan. METHODS We included HFrEF patients who received naïve sacubitril/valsartan therapy for ≥3 months, between January 2016 and March 2018. All patients were divided into 2 groups based on their duration of HFrEF. Generalized linear models were analyzed the cardiac outcomes after sacubitril/valsartan therapy by HFrEF duration. RESULTS Among these, 42 patients were HFrEF duration of <1 year and 47 patients were ≥1 year. The mean difference of QRS duration was lesser in the <1-year group than in the ≥1-year group (-2.3 msec vs 6.3 msec; P = .029). However, the mean difference of left ventricular ejection fraction (LVEF) was higher in the ≥1-year group (13.8% vs 5.8%; P = .008). After adjusting for patient demographics and clinical characteristics, the ≥1-year group had a significantly prolonged QRS duration (coefficient = 11; 95% confidence interval [CI], 0.3-21.7) and an unfavorable LVEF recovery (coefficient = -10.3; 95% CI -14.5 to -6.1) compared with the <1-year group. CONCLUSION Prolonged QRS durations and unfavorable LVEF recoveries after sacubitril/valsartan therapy were observed in patients with HFrEF duration of ≥1 year. Earlier diagnosis of HFrEF and appropriate medication treatment may be beneficial in the improvement of QRS duration and LVEF recovery.
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Affiliation(s)
- Po-Lin Lin
- Division of Cardiology, 156934Hsinchu MacKay Memorial Hospital, Hsinchu.,Department of Biological Science and Technology, 34914National Yang Ming Chiao-Tung University, Hsinchu
| | - Ying-Hsiang Lee
- Cardiovascular Center, 117127MacKay Memorial Hospital, Taipei.,Department of Medicine, 117127Mackay Medical College, New Taipei.,Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing, and Management, Taipei
| | - Lawrence Yu-Min Liu
- Division of Cardiology, 156934Hsinchu MacKay Memorial Hospital, Hsinchu.,Department of Medicine, 117127Mackay Medical College, New Taipei
| | - Cheng-Ting Tsai
- Cardiovascular Center, 117127MacKay Memorial Hospital, Taipei.,Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, Taipei
| | - Ten-Fang Yang
- Department of Biological Science and Technology, 34914National Yang Ming Chiao-Tung University, Hsinchu.,Graduate Institute of Medical Informatics, Taipei Medical University and Hospital, Taipei
| | - Wei-Ru Chiou
- Department of Medicine, 117127Mackay Medical College, New Taipei.,Division of Cardiology, 117127Taitung MacKay Memorial Hospital, Taitung
| | - Mu-Yang Hsieh
- Department of Biological Science and Technology, 34914National Yang Ming Chiao-Tung University, Hsinchu.,Department of Internal Medicine, 63423National Taiwan University Hospital Hsin-Chu Branch, Hsinchu.,Department of Internal Medicine, College of Medicine, 63423National Taiwan University, Taipei
| | - Hung-Yu Chang
- Division of Cardiology, Heart Centre, 38007Cheng Hsin General Hospital, Taipei
| | - Chun-Che Huang
- Department of Healthcare Administration, 145713I-Shou University, Kaohsiung
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Kang MK. ECG Monitoring of Reactions to Sacubitril-valsartan in Heart Failure with Reduced Ejection Fraction. J Cardiovasc Imaging 2020; 28:254-256. [PMID: 33086440 PMCID: PMC7572258 DOI: 10.4250/jcvi.2020.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Min-Kyung Kang
- Division of Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
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