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Morgat C, Denjoy I, Fressart V, Badilini F, Vaglio M, Messali A, Maison-Blanche P, Leenhardt A, Extramiana F. ECG descriptors of ventricular repolarization are associated with cardiac events in a gene-specific manner in long QT syndrome patients. Europace 2022. [DOI: 10.1093/europace/euac053.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Assistance Publiques Hôpitaux de Paris (APHP)
Background
Congenital long QT syndrome (LQTS) is still associated with syncope and a risk of sudden cardiac death despite the dramatic reduction in mortality associated with beta-blocker therapy. Current risk stratification tools are imperfect.
Objective
To assess the contribution of automated scalar ECG descriptors of ventricular repolarization for arrrhythmic risk stratification in genotyped LQTS patients.
Methods
Patients with genotyped type 1, 2 or 3 LQTS with at least 1 digital ECG recording have been included in the study. History at diagnosis, and follow-up data were collected. Cardiac events included syncope, aborted cardiac arrest, appropriate implantable cardioverter-defibrillator therapy in VF zone, and sudden death.
ECG were analyzed using the BRAVO algorithm embedded in the CalECG software, version 4.1.0. QT interval duration was manually checked but ECG descriptors of Ventricular Repolarization were fully automatic.
Multivariate cox regression analysis were performed to identify parameters associated with cardiac events.
Results
467 patients (58% female, median age at diagnosis=25, LQT1,2,3 54%, 39%, 7%) were followed-up during 15.2±9.2 years. Rate of cardiac event was 1.2/100 patients-year before diagnosis and 0.9/100 patients-year during follow-up.
QTc duration was associated with the occurrence of cardiac events in the whole study population (HR=1.01 95%CI 1.0-1.01, p=0.03). Ventricular repolarization parameters associated with cardiac events were different according to LQTS type. Cardiac events were associated with increased time to accumulate 50% of T-wave energy (HR=1.53 95%CI 1.04-2.26, p=0.03) in LQT1 but with a decrease in T-wave slopes (ascending slope HR=0.63 95%CI 0.17-0.75, p<0.01) in type 2 LQTS patients. QTc duration was not independently associated with cardiac events in genotype specific multivariate models.
Conclusions
T-wave morphology parameters are associated with cardiac events in a gene-specific manner. Change in T-wave symmetry and T-wave flattening are associated with cardiac events in type 1 and type 2 LQTS respectively. The descriptors of ventricular repolarization are promising parameters or risk stratification beyond QTc duration in LQTS patients.
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Affiliation(s)
- C Morgat
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
| | - I Denjoy
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
| | - V Fressart
- Pitie Salpetriere APHP University Hospital, Paris, France
| | - F Badilini
- University of California San Francisco, San Francisco, United States of America
| | - M Vaglio
- University of Rochester, Rochester, United States of America
| | - A Messali
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
| | - P Maison-Blanche
- Clinique Medico-Chirurgicale Ambroise Pare, Neuilly sur Seine, France
| | - A Leenhardt
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
| | - F Extramiana
- Bichat APHP Site of Paris Nord University Hospital, Paris, France
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Barbic F, Minonzio M, Cairo B, Shiffer D, Cerina L, Verzeletti P, Badilini F, Vaglio M, Porta A, Santambrogio M, Gatti R, Rigo S, Bisoglio A, Furlan R. Effects of a cool classroom microclimate on cardiac autonomic control and cognitive performances in undergraduate students. Sci Total Environ 2022; 808:152005. [PMID: 34871696 DOI: 10.1016/j.scitotenv.2021.152005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/09/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
An inverted U-shape relationship between cognitive performance and indoor temperature with best performance peaking at 21.6 °C was previously described. Little is known on classroom temperature reduction effects on cognitive performances and cardiac autonomic profile, during the cold season. Fifteen students underwent electrocardiogram recording during a lecture in two days in December when classroom temperatures were set as neutral (NEUTRAL, 20-22 °C) and cool (COOL, 16-18 °C). Cognitive performance (memory, verbal ability, reasoning, overall cognitive C-score) was assessed by Cambridge Brain Science cognitive evaluation tool. Cardiac autonomic control was evaluated via the analysis of spontaneous fluctuations of heart period, as the temporal distance between two successive R-wave peaks (RR). Spectral analysis provided the power in the high frequency (HF, 0.15-0.40 Hz) and low frequency (LF, 0.04-0.15 Hz) bands of RR variability. Sympatho-vagal interaction was assessed by LF to HF ratio (LF/HF). Symbolic analysis provided the fraction of RR patterns composed by three heart periods with no variation (0 V%) and two variations (2 V%), taken as markers of cardiac sympathetic and vagal modulations, respectively. The students' thermal comfort was assessed during NEUTRAL and COOL trials. Classroom temperatures were 21.5 ± 0.8 °C and 18.4 ± 0.4 °C during NEUTRAL and COOL. Memory, verbal ability, C-Score were greater during COOL (13.01 ± 3.43, 12.32 ± 2.58, 14.29 ± 2.90) compared to NEUTRAL (9.98 ± 2.26, p = 0.002; 8.57 ± 1.07, p = 0.001 and 10.35 ± 3.20, p = 0.001). LF/HF (2.4 ± 1.7) and 0 V% (23.2 ± 11.1%) were lower during COOL compared to NEUTRAL (3.7 ± 2.8, p = 0.042; 28.1 ± 12.2.1%, p = 0.031). During COOL, 2 V% was greater (30.5 ± 10.9%) compared to NEUTRAL (26.2 ± 11.3, p = 0.047). The students' thermal comfort was slightly reduced during COOL compared to NEUTRAL trial. During cold season, a better cognitive performance was obtained in a cooler indoor setting enabling therefore energy saving too.
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Affiliation(s)
- Franca Barbic
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy.
| | - Maura Minonzio
- IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy
| | | | | | | | | | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marco Santambrogio
- Dipartimento di Informazione, Elettronica e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Roberto Gatti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy
| | - Stefano Rigo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Andrea Bisoglio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Internal Medicine, Rozzano, Milan, Italy
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Extramiana F, Laporte PL, Vaglio M, Denjoy I, Maison-Blanche P, Badilini F, Leenhardt A. Computerized automated algorithm-based analyses of digitized paper ECGs in Brugada syndrome. J Electrocardiol 2021; 69S:61-66. [PMID: 34563332 DOI: 10.1016/j.jelectrocard.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Brugada syndrome is a rare inherited arrhythmic syndrome with a coved type 1 ST-segment elevation on ECG and an increased risk of sudden death. Many studies have evaluated risk stratification performance based on ECG-derived parameters. However, since historical Brugada patient cohorts included mostly paper ECGs, most studies have been based on manual ECG parameter measurements. We hypothesized that it would be possible to run automated algorithm-based analysis of paper ECGs. We aimed: 1) to validate the digitization process for paper ECGs in Brugada patients; and 2) to quantify the acute class I antiarrhythmic drug effect on relevant ECG parameters in Brugada syndrome. METHODS A total of 176 patients (30% female, 43 ± 13 years old) with induced type 1 Brugada syndrome ECG were included in the study. All of the patients had paper ECGs before and during class I antiarrhythmic drug challenge. Twenty patients also had a digital ECG, in whom printouts were used to validate the digitization process. Paper ECGs were scanned and then digitized using ECGScan software, version 3.4.0 (AMPS, LLC, New York, NY, USA) to obtain FDA HL7 XML format ECGs. Measurements were automatically performed using the Bravo (AMPS, LLC, New York, NY, USA) and Glasgow algorithms. RESULTS ECG parameters obtained from digital and digitized ECGs were closely correlated (r = 0.96 ± 0.07, R2 = 0.93 ± 0.12). Class I antiarrhythmic drugs significantly increased the global QRS duration (from 113 ± 20 to 138 ± 23, p < 0.0001). On lead V2, class I antiarrhythmic drugs increased ST-segment elevation (from 110 ± 84 to 338 ± 227 μV, p < 0.0001), decreased the ST slope (from 14.9 ± 23.3 to -27.4 ± 28.5, p < 0.0001) and increased the TpTe interval (from 88 ± 18 to 104 ± 33, p < 0.0001). CONCLUSIONS Automated algorithm-based measurements of depolarization and repolarization parameters from digitized paper ECGs are reliable and could quantify the acute effects of class 1 antiarrhythmic drug challenge in Brugada patients. Our results support using computerized automated algorithm-based analyses from digitized paper ECGs to establish risk stratification decision trees in Brugada syndrome.
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Affiliation(s)
- Fabrice Extramiana
- Reference Center for Inherited Arrhythmic Syndromes, Hôpital Bichat, APHP, Université de Paris, Paris, France.
| | - Pierre-Léo Laporte
- Reference Center for Inherited Arrhythmic Syndromes, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | | | - Isabelle Denjoy
- Reference Center for Inherited Arrhythmic Syndromes, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | - Pierre Maison-Blanche
- Reference Center for Inherited Arrhythmic Syndromes, Hôpital Bichat, APHP, Université de Paris, Paris, France
| | | | - Antoine Leenhardt
- Reference Center for Inherited Arrhythmic Syndromes, Hôpital Bichat, APHP, Université de Paris, Paris, France
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Madhukar R, Jagadeesh AT, Moey MYY, Vaglio M, Badilini F, Leban M, Hartemann A, Dureau P, Funck-Brentano C, Bourron O, Salem JE. Association of thyroid-stimulating hormone with corrected QT interval variation: A prospective cohort study among patients with type 2 diabetes. Arch Cardiovasc Dis 2021; 114:656-666. [PMID: 34544648 DOI: 10.1016/j.acvd.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) have a prolonged QT interval and are at high risk of sudden cardiac death. A prolonged QT interval, indicative of impaired ventricular repolarization, is a risk factor for lethal ventricular arrhythmias, such as torsades-de-pointes (TdP). AIMS To identify key clinical and biochemical covariates associated with Fridericia's corrected QT interval (QTcF) among euthyroid patients with T2DM, and to describe the temporal relationship between these factors and QTcF. METHODS We performed prospective, clinical, biochemical and electrocardiographic measurements among patients with T2DM enrolled in the DIACART study at Pitié-Salpêtrière Hospital, at T1 (baseline) and T2 (follow-up), with a median interval of 2.55 years. RESULTS Mean age (63.9±8.5 years), sex (22.35% women), drugs with known risk of TdP according to the CredibleMeds website (Cred-drugsTdP) and serum thyroid-stimulating hormone (TSH) concentrations correlated with QTcF in univariate analysis at both T1 and T2. In multivariable analysis, all these covariates except age were significantly associated with QTcF at both T1 (women: standardized β=0.24±0.07, P=0.001; Cred-drugsTdP: β=0.19±0.07, P=0.007; TSH concentration: β=0.18±0.07, P=0.01) and T2 (women: β=0.25±0.08, P=0.002; Cred-drugsTdP: β=0.25±0.08, P=0.001; TSH concentration: β=0.19±0.08, P=0.01). Furthermore, variation in QTcF over the years was associated with variation in TSH concentration (r=0.24, P=0.007) and changes in use of Cred-drugsTdP (r=0.2, P=0.02). CONCLUSIONS Serum TSH concentration and its variation were associated with QTcF and its variation, even after correcting for the main determinants of QTcF. Interventional optimization of TSH concentration in T2DM warrants further investigation to establish its impact on the risk of TdP and sudden cardiac death.
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Affiliation(s)
- Rashmi Madhukar
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France
| | - Akshay T Jagadeesh
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France
| | - Melissa Yen Yen Moey
- Department of Cardiovascular Sciences, East Carolina University, Greenville; and Vidant Medical Center, Greenville, NC 27834, USA
| | | | | | - Monique Leban
- Department of Biology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 75013 Paris, France
| | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, inserm, 75013 Paris, France
| | - Pauline Dureau
- Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France
| | - Christian Funck-Brentano
- Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France
| | - Olivier Bourron
- Department of Diabetology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, inserm, 75013 Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France; Departments of Medicine and Pharmacology, Cardio-Oncology Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Extramiana F, Badilini F, Denjoy I, Vaglio M, Green CL, Kligfield P, Leenhardt A, Maison-Blanche P. Sex influences on ventricular repolarization duration in normal subjects and in type 1, 2 and 3 long QT syndrome patients: Different effect in acquired and congenital type 2 LQTS. J Electrocardiol 2020; 62:148-154. [PMID: 32905894 DOI: 10.1016/j.jelectrocard.2020.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/31/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the interaction between sex and rate corrected QT interval (QTc) duration in normal subjects after drug-induced QT prolongation and in LQTS patients. METHODS Semi-automated measurements were performed on 875 digital ECGs (200 normal subjects off drugs (100 females), 200 normal subjects on Moxifloxacin (100 females), 259 LQT1 patients (161 females), 183 LQT2 patients (100 females) and 33 LQT3 patients (15 females)). A sex specific coefficient was calculated in each group and was used to calculate group specific corrected QT intervals (QTci). RESULTS The mean sex difference (female minus male) in QTci interval duration was 17 ms 95%CI(12.7; 21.3) in normal subjects, 19 ms (14.5; 23.5) on Moxifloxacin, and 13 ms (4.8; 21.2) in LQT1 patients. The mean difference was 2 ms (-7.9; 11.9) in LQT2 and - 5 ms (-32.2; 22.2) in LQT3 patients (p = 0.0067 for the group and sex interaction). In the subgroup of patients above 15 years and without beta blocker treatment, the sex effect (female minus male) on QTci interval duration was 17 ms (4.1; 29.9) in LQT1 patients. QTc duration was not different between sex in LQT2 and in LQT3 patients (mean difference - 3 ms (-21.6; 15.6) and 12 ms (-28.4; 52.4), respectively) (p = 0.0191 for group and sex interaction). CONCLUSIONS The interaction between sex and QTc interval is preserved in type 1 LQTS and drug-induced QTc prolongation but blurred in type 2 LQTS. Further experimental studies are warranted to better understand the interaction of sexual hormones with malfunctioning KCNH2 encoded repolarizing potassium channel.
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Affiliation(s)
- Fabrice Extramiana
- Université de Paris, CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, INSERMU1166, 75018 Paris, France.
| | | | - Isabelle Denjoy
- Université de Paris, CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, INSERMU1166, 75018 Paris, France
| | | | - Cynthia L Green
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America
| | - Paul Kligfield
- Division of Cardiology, Weill Cornell Medical College, New York, NY, United States of America
| | - Antoine Leenhardt
- Université de Paris, CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, INSERMU1166, 75018 Paris, France
| | - Pierre Maison-Blanche
- Université de Paris, CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, INSERMU1166, 75018 Paris, France
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Salvetti M, Paini A, Di Castelnuovo A, Assanelli D, Costanzo S, Gianfagna F, Badilini F, Vaglio M, Donati MB, de Gaetano G, Lorenza Muiesan M, Iacoviello L. Correction of QRS voltage for body mass index does not improve the prediction of fatal and nonfatal cardiovascular events. The Moli-sani study. Nutr Metab Cardiovasc Dis 2020; 30:426-433. [PMID: 31791640 DOI: 10.1016/j.numecd.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The diagnosis of LVH by ECG may particularly difficult in obese individuals. The aim of this study was to prospectively investigate whether the correction for body mass index (BMI) might improve the prognostic significance for cerebro and cardiovascular events of two electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in a large cohort of Italian adults. METHODS AND RESULTS In 18,330 adults (54 ± 11 years, 55% women) from the Moli-sani cohort, obesity was defined using the ATPIII criteria. The Sokolow-Lyon (SL) and Cornell Voltage (CV) criteria were used for ECG-LVH. In overweight and obese subjects, as compared with normal weight, the prevalence of ECG-LVH by the SL index was lower. During follow-up (median 4.3 yrs), 503 cerebro and cardiovascular events occurred. One standard deviation (1-SD) increment in uncorrected and in BMI-corrected SL index and CV was associated with an increased risk of events (HR 1.12, 95% CI 1.02-1.22 and HR 1.16, 95% CI 1.06-1.26 and HR 1.12, 95% CI 1.03-1.23 and HR 1.17, 95% CI 1.07-1.27, respectively for SL and CV). In obese subjects, 1-SD increment in uncorrected CV and in BMI-corrected CV was not associated to a significant risk of events (HR 1.05, 95% CI 0.910-1.22 and HR 1.08, 95% CI 0.95-1.23 respectively). Uncorrected SL index showed a significant association with events, which was marginally stronger with BMI-corrected SL voltage (HR 1.18, 95% CI 1.02-1.37 and HR 1.17, 95% CI 1.04-1.33 respectively, Akaike information criterion change from 3220 to 3218). CONCLUSIONS BMI correction of ECG LVH voltage criteria does not significantly improve the prediction of cerebro and cardiovascular events in obese patients in a large cohort at low cardiovascular risk.
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Affiliation(s)
- Massimo Salvetti
- Department of Clinical & Experimental Sciences, University of Brescia & Department of Internal Medicine, ASST Spedali Civili di Brescia, Italy
| | - Anna Paini
- Department of Clinical & Experimental Sciences, University of Brescia & Department of Internal Medicine, ASST Spedali Civili di Brescia, Italy
| | | | - Deodato Assanelli
- Department of Clinical & Experimental Sciences, University of Brescia & Department of Internal Medicine, ASST Spedali Civili di Brescia, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Francesco Gianfagna
- Mediterranea Cardiocentro, Napoli, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Varese, 100, Varese, Italy
| | | | | | - Maria B Donati
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical & Experimental Sciences, University of Brescia & Department of Internal Medicine, ASST Spedali Civili di Brescia, Italy.
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, IS, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Varese, 100, Varese, Italy
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Barbic F, Minonzio M, Cairo B, Shiffer D, Dipasquale A, Cerina L, Vatteroni A, Urechie V, Verzeletti P, Badilini F, Vaglio M, Iatrino R, Porta A, Santambrogio M, Gatti R, Furlan R. Effects of different classroom temperatures on cardiac autonomic control and cognitive performances in undergraduate students. Physiol Meas 2019; 40:054005. [DOI: 10.1088/1361-6579/ab1816] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Magodoro IM, Albano AJ, Muthalaly R, Koplan B, North CM, Vořechovská D, Downey J, Kraemer J, Vaglio M, Badilini F, Kakuhire B, Tsai AC, Siedner MJ. Population Prevalence and Correlates of Prolonged QT Interval: Cross-Sectional, Population-Based Study From Rural Uganda. Glob Heart 2019; 14:17-25.e4. [PMID: 30584028 PMCID: PMC6737252 DOI: 10.1016/j.gheart.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/11/2018] [Accepted: 11/20/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES We aimed to estimate the prevalence and correlates of QT interval prolongation in rural Uganda. BACKGROUND Major electrocardiographic abnormalities, including prolonged QT interval, have been shown to be independently predictive of adverse cardiovascular events among Western populations. Cardiovascular diseases are on the rise in sub-Saharan Africa with poorly characterized context-specific risk factors. An important question is whether ECG screening might have value in cardiovascular disease risk stratification in SSA. METHODS We conducted a cross-sectional survey in a sample of adults participating in an ongoing whole-population cohort in Mbarara, Uganda, in 2015. Of 1,814 subjects enrolled in the parent whole-population cohort, 856 (47%) participated in the study. Participants completed 12-lead electrocardiography and cardiovascular disease risk factors assessment. We summarized sex-specific, heart rate variation-adjusted QT (QTa) defining prolonged QTa as >460 ms in women and >450 ms in men. We fit linear and logistic regression models to estimate correlates of (continuous) QTa interval length and (dichotomous) prolonged QTa. Models included inverse probability of sampling weights to generate population-level estimates accounting for study nonparticipation. RESULTS We assessed data from 828 participants with electrocardiograms. The weighted population mean age was 38.4 years (95% confidence interval: 36.3-40.4). The weighted population was 50.4% female, 11.5% had elevated blood pressure, and 57.6% had a high-sensitivity C-reactive protein >1 mg/dl. The population mean QTa was 409.1 ms (95% confidence interval: 405.1-413.1), and 10.3% (95% confidence interval: 7.8-13.5) met criteria for prolonged QTa. Women had a higher mean QTa (421.6 ms vs. 396.3 ms; p < 0.001), and a higher proportion of women had a prolonged QTa (14.0% vs. 9.3%; p = 0.122) than did men. In multivariable-adjusted regression models, female sex and hypertension correlated with higher mean QTa and meeting criteria for prolonged QTa, respectively. CONCLUSIONS QT interval prolongation is highly prevalent in rural Uganda and may be more common than in high-income settings. Female sex, age, and high blood pressure correlated with QT interval prolongation. Future work should assess whether genetic predisposition or environmental factors in sub-Saharan African populations contribute to prolonged QT and clarify consequences.
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Affiliation(s)
- Itai M Magodoro
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; University of Cape Town, Cape Town, South Africa.
| | - Alfred J Albano
- Michigan State University School of Medicine, East Lansing, MI, USA
| | - Rahul Muthalaly
- Harvard Medical School, Boston, MA, USA; Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Bruce Koplan
- Harvard Medical School, Boston, MA, USA; Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Crystal M North
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA
| | | | - Jordan Downey
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Kraemer
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Martino Vaglio
- Analyzing Medical Parameters for Solutions, LLC, New York, NY, USA
| | - Fabio Badilini
- Analyzing Medical Parameters for Solutions, LLC, New York, NY, USA
| | | | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Analyzing Medical Parameters for Solutions, LLC, New York, NY, USA
| | - Mark J Siedner
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Mbarara University of Science and Technology, Mbarara, Uganda; Africa Health Research Institute, KwaZulu-Natal, South Africa
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Badilini F, Young B, Brown B, Vaglio M. Archiving and exchange of digital ECGs: A review of existing data formats. J Electrocardiol 2018; 51:S113-S115. [PMID: 30078672 DOI: 10.1016/j.jelectrocard.2018.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/26/2018] [Accepted: 07/29/2018] [Indexed: 11/29/2022]
Abstract
Digital ECG is today a common practice but a universal format for its storage and exchange has never been widely implemented. The reason is linked on one side to the need of the manufacturing industry to (rightly) protect intellectual propriety and technology, but on the other to an inadequate effort of the research community to sufficiently enforce the use of digital ECG data. To some degree, and at least from a practical point of view, the problem is also linked to other factors, such as the need in some instances to protect patient-sensitive information, and whether digital exchanged data should also include annotations and measurements from an algorithm or by human intervention. As a result, after more than 30 years it is still common that the full ECG acquired information is not preserved, but only partially stored or saved as a PDF report. Paradoxically, the modern era of hospital information technology and the advent and large diffusion of electronic health record systems did not bring expected improvements: the process of digital ECG retrieval and management remains extremely complicated and cumbersome. The ultimate risk is that the ECG may end up being considered "just" an image rather than a voltage-versus-time signal as it has always been. A critical review of the most commonly used formats for digital ECG will be given, focusing in particular to those linked with DICOM, HL7 and SCP-ECG standards, and highlighting the respective advantages and limitations with special emphasis to the needs typically encountered by the research community. The goal is to provide a snapshot of the present, and to discuss mid- and long-term potential directions and changes, emphasizing what digital ECG organizations could do to "save" ECG information and facilitate its widespread exchange.
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Hoden L, Dureau P, Funck-Brentano C, Badilini F, Vaglio M, Hartemann A, Bourron O, Salem J. Complex influence of endocrine and neuro-vegetative disorders on ventricular repolarization in diabetic patients. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Couderc JP, Ma S, Page A, Besaw C, Xia J, Chiu WB, de Bie J, Vicente J, Vaglio M, Badilini F, Babaeizadeh S, Chien CHS, Baumert M. An evaluation of multiple algorithms for the measurement of the heart rate corrected JTpeak interval. J Electrocardiol 2017; 50:769-775. [PMID: 29021091 DOI: 10.1016/j.jelectrocard.2017.08.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Indexed: 10/18/2022]
Abstract
Interest in the effects of drugs on the heart rate-corrected JTpeak (JTpc) interval from the body-surface ECG has spawned an increasing number of scientific investigations in the field of regulatory sciences, and more specifically in the context of the Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative. We conducted a novel initiative to evaluate the role of automatic JTpc measurement technologies by comparing their ability to distinguish multi- from single-channel blocking drugs. A set of 5232 ECGs was shared by the FDA (through the Telemetric and Holter ECG Warehouse) with 3 ECG device companies (AMPS, Mortara, and Philips). We evaluated the differences in drug-concentration effects on these measurements between the commercial and the FDA technologies. We provide a description of the drug-induced placebo-corrected changes from baseline for dofetilide, quinidine, ranolazine, and verapamil, and discuss the various differences across all technologies. The results revealed only small differences between measurement technologies evaluated in this study. It also confirms that, in this dataset, the JTpc interval distinguishes between multi- and single-channel (hERG) blocking drugs when evaluating the effects of dofetilide, quinidine, ranolazine, and verapamil. However, in the case of quinidine and dofetilide, we noticed a poor consistency across technologies because of the lack of standard definitions for the location of the peak of the T-wave (T-apex) when the T-wave morphology is abnormal.
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Affiliation(s)
- Jean-Philippe Couderc
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY 14618, USA.
| | - Shiyang Ma
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14618, USA
| | - Alex Page
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY 14618, USA
| | - Connor Besaw
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY 14618, USA
| | - Jean Xia
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY 14618, USA
| | - W Brian Chiu
- Mortara Instrument Europe s.r.l., Via Cimarosa 103, 40033 Casalecchio di Reno, BO, Italy
| | - Johan de Bie
- Mortara Instrument Europe s.r.l., Via Cimarosa 103, 40033 Casalecchio di Reno, BO, Italy
| | - Jose Vicente
- Division of Cardiovascular and Renal Products, Office of Drug Evaluation I, Office of New Drugs Center for Drug Evaluation and Research, U.S. Food and Drug Administration, USA
| | - Martino Vaglio
- AMPS LLC, 418 Central Park W, Suite 21C, 10025 New York, NY, USA
| | - Fabio Badilini
- AMPS LLC, 418 Central Park W, Suite 21C, 10025 New York, NY, USA
| | - Saeed Babaeizadeh
- Advanced Algorithm Research Center, Philips Healthcare, Andover, MA, USA
| | | | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, SA 5005, Australia
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Iacoviello L, Bonaccio M, Di Castelnuovo A, Costanzo S, Rago L, De Curtis A, Assanelli D, Badilini F, Vaglio M, Persichillo M, Macfarlane PW, Cerletti C, Donati MB, de Gaetano G. Frontal plane T-wave axis orientation predicts coronary events: Findings from the Moli-sani study. Atherosclerosis 2017; 264:51-57. [PMID: 28772106 DOI: 10.1016/j.atherosclerosis.2017.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS The orientation of the frontal plane T-wave axis (T axis) is a reliable measure of ventricular repolarisation. We investigated the association between T-axis and the risk of coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), stroke and cardiovascular (CVD) mortality. METHODS A sample of 21,287 Moli-sani participants randomly recruited from the general adult (≥35 y) Italian population, free of CVD disease, were followed for a median of 4.4 years. T-axis was measured from a standard 12-lead resting ECG. RESULTS After adjusting for CVD risk factors, subjects with abnormal T-axis showed an increase in the risk of both CHD (Hazard Ratio (HR) = 2.65; 95% CI = 1.67-4.21), HF (HR = 2.56; 1.80-3.63), AF (HR = 2.48; 1.56-3.94) and CVD mortality (HR = 2.83; 1.50-5.32). The association with CHD and HF, but not with AF or CVD death, remained significant after further adjustment for ECG abnormalities. Subjects with abnormal T-axis showed higher levels of subclinical inflammation, hs-troponin I and hs-NT-proBNP (p < 0.001 for all). However, further adjustment for troponin I and/or NT-proBNP determined a reduction of HRs ranging from 12.1 to 24.0% for CHD, while additional adjustment for inflammation markers did not change any association. CONCLUSIONS An abnormal T-axis orientation is associated with an increased risk of both CHD and HF, independently of common CVD risk factors and other ECG abnormalities. This association was partially explained by increased hs-troponin I and hs-NT-proBNP levels.
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Affiliation(s)
- Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Augusto Di Castelnuovo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Livia Rago
- EPICOMED Research, SRL, Campobasso, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | | | | | | | - Mariarosaria Persichillo
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | | | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Isernia, Italy
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Abstract
Using BRAVO algorithm (AMPS-LLC, NY, v4.4.0), 5223 ECGs from a publicly available annotated dataset from a randomized clinical trial on four different compounds and placebo were analyzed. ECGs were automatically processed and JTp interval was computed on: 12 standard ECG leads, Vector Magnitude (VM), and root mean square (RMS) leads. On VM and RMS, JTp intervals were nearly identical (228 ± 29 vs. 227 ± 30 ms respectively, with correlation of 0.99, p < 0.0001). On lead II, JTp interval was about 10 ms longer, but highly correlated with that measured on VM (0.94, p < 0.0001). Similarly, on lead V5, JTp was about 8 ms longer than on VM, with a correlation of 0.95, p < 0.0001. When compared to the public available annotations, JTp by BRAVO generated longer (about 8 ms) measurement and evidenced outliers conducible to both the T-wave peak (in few ECGs presenting notched shapes) and, to a lesser degree, to the J point, due to variability of the two algorithms. Differences on the drug-induced effect from the four compounds were negligible.
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Bonaccio M, Di Castelnuovo A, Rago L, de Curtis A, Assanelli D, Badilini F, Vaglio M, Costanzo S, Persichillo M, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. T-wave axis deviation is associated with biomarkers of low-grade inflammation. Findings from the MOLI-SANI study. Thromb Haemost 2015; 114:1199-206. [PMID: 26155907 DOI: 10.1160/th15-02-0177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/26/2015] [Indexed: 11/05/2022]
Abstract
T-wave axis deviation (TDev) may help identifying subjects at risk for major cardiac events and mortality, but the pathogenesis of TDev is not well established; in particular, the possible association between TDev and inflammation is unexplored and unknown. We aimed at investigating the association between low-grade inflammation and TDev abnormalities by conducting a cross-sectional analysis on 17,507 subjects apparently free from coronary heart and haematological diseases enrolled in the MOLI-SANI study. TDev was measured from a standard 12-lead resting electrocardiogram. High sensitivity (Hs) C-reactive protein (CRP), leukocyte (WBC) and platelet counts, neutrophil or granulocyte to lymphocyte ratios were used as markers of inflammation. In multivariable model subjects reporting high CRP levels had higher odds of having borderline and abnormal TDev (OR=1.70; 95 %CI: 1.53-1.90 and OR=1.72; 95 %CI: 1.23-2.41, respectively); the association was still significant, although reduced, after controlling for body mass index (OR=1.17; 95 %CI: 1.05-1.32, for borderline and OR=1.46; 95 %CI: 1.03-2.08, for abnormal). Similarly, higher neutrophil or granulocyte to lymphocyte ratios were associated with increased odds of having abnormal TDev. Neither platelet nor leukocyte counts were associated with abnormal TDev. The relationship between CRP with TDev abnormalities was significantly stronger in men, in non- obese or normotensive individuals, and in those without metabolic syndrome. In conclusion, C-reactive protein and some cellular biomarkers of inflammation such as granulocyte or neutrophil to lymphocyte ratios were independently associated with abnormal TDev, especially in subjects at low CVD risk. These results suggest that a low-grade inflammation likely contributes to the pathogenesis of T- wave axis deviation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Licia Iacoviello
- Licia Iacoviello, Laboratory of Molecular and Nutritional Epidemiology, Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy, Tel.: +39 0865929664, Fax:+39 0865927575, E-mail:
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Rivolta MW, Badilini F, Mainardi LT, Vaglio M, Sassi R. Quantification of ventricular repolarization heterogeneity during sotalol administration using the V-index. J Electrocardiol 2013. [DOI: 10.1016/j.jelectrocard.2013.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Assanelli D, Rago L, Di Castelnuovo A, Badilini F, Vaglio M, Gianfagna F, Salvetti M, Zito F, Donati MB, de Gaetano G, Iacoviello L. T-wave axis deviation and left ventricular hypertrophy interaction in diabetes and hypertension (MOLI-SANI project). J Electrocardiol 2013. [DOI: 10.1016/j.jelectrocard.2013.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Assanelli D, Rago L, Di Castelnuovo A, Badilini F, Vaglio M, Gianfagna F, Salvetti M, Zito F, Donati MB, de Gaetano G, Iacoviello L. T-wave axis deviation and left ventricular hypertrophy interaction in the MOLI-SANI project. J Electrocardiol 2013. [DOI: 10.1016/j.jelectrocard.2013.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Vaglio M, Rago L, Di Castelnuovo A, Assanelli D, Badilini F, Salvetti M, Donati MB, de Gaetano G, Iacoviello L. C-reactive protein level is linked to T-wave axis deviation in a healthy Italian population: results from the MOLI-SANI project. J Electrocardiol 2012. [DOI: 10.1016/j.jelectrocard.2012.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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De Ferrari GM, Greco A, Sanzo A, Raineri C, Turco A, Bonardi M, Badilini F, Vaglio M. NEGATIVE T WAVES AFTER REPERFUSED MYOCARDIAL INFARCTION ARE A MARKER OF MYOCARDIAL STUNNING AND PREDICT REGIONAL RECOVERY OF CONTRACTILE FUNCTION. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61069-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Extramiana F, Dubois R, Roussel P, Vaglio M, Dreyfus G, Badilini F, Leenhardt A, Maison-Blanche P. 206 The time course of new T-wave ECG descriptors following single and double dose administration of Sotalol in healthy subjects. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Extramiana F, Dubois R, Vaglio M, Roussel P, Dreyfus G, Badilini F, Leenhardt A, Maison-Blanche P. The time course of new T-wave ECG descriptors following single- and double-dose administration of sotalol in healthy subjects. Ann Noninvasive Electrocardiol 2010; 15:26-35. [PMID: 20146779 PMCID: PMC6932454 DOI: 10.1111/j.1542-474x.2009.00336.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The aim of the study was to assess the time course effect of IKr blockade on ECG biomarkers of ventricular repolarization and to evaluate the accuracy of a fully automatic approach for QT duration evaluation. METHODS Twelve-lead digital ECG Holter was recorded in 38 healthy subjects (27 males, mean age = 27.4 + or - 8.0 years) on baseline conditions (day 0) and after administration of 160 mg (day 1) and 320 mg (day 2) of d-l sotalol. For each 24-hour period and each subject, ECGs were extracted every 10 minutes during the 4-hour period following drug dosage. Ventricular repolarization was characterized using three biomarker categories: conventional ECG time intervals, principal component analysis (PCA) analysis on the T wave, and fully automatic biomarkers computed from a mathematical model of the T wave. RESULTS QT interval was significantly prolonged starting 1 hour 20 minutes after drug dosing with 160 mg and 1 hour 10 minutes after drug dosing with 320 mg. PCA ventricular repolarization parameters sotalol-induced changes were delayed (>3 hours). After sotalol dosing, the early phase of the T wave changed earlier than the late phase prolongation. Globally, the modeled surrogate QT paralleled manual QT changes. The duration of manual QT and automatic surrogate QT were strongly correlated (R(2) = 0.92, P < 0.001). The Bland and Altman plot revealed a nonstationary systematic bias (bias = 26.5 ms + or - 1.96*SD = 16 ms). CONCLUSIONS Changes in different ECG biomarkers of ventricular repolarization display different kinetics after administration of a potent potassium channel blocker. These differences need to be taken into account when designing ventricular repolarization ECG studies.
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Affiliation(s)
- Fabrice Extramiana
- Lariboisière Hospital, APHP, Paris 7 University, INSERM U942, Paris, France.
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Badilini F, Vaglio M, Sarapa N. Automatic extraction of ECG strips from continuous 12-lead holter recordings for QT analysis at prescheduled versus optimized time points. Ann Noninvasive Electrocardiol 2009; 14 Suppl 1:S22-9. [PMID: 19143738 DOI: 10.1111/j.1542-474x.2008.00260.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Continuous 12-lead ECG monitoring (Holter) in early-phase pharmaceutical studies is today widely used as an ideal platform to extract discrete ECGs for analysis. The extraction process is typically performed manually by trained readers using commercial Holter processing systems. METHODS Antares, a novel method for automatic 12-lead extraction from continuous Holter recordings applying minimal noise criteria and heart-rate stability conditions is presented. A set of 12-lead Holter recordings from healthy subjects administered with sotalol is used to compare ECG extractions at fixed time points with ECG extractions generated by Antares optimizing noise and heart rate inside 5 minute windows centered around each expected time point of interest. RESULTS Global, low- and high-frequency noise content of extracted ECGs was significantly reduced via optimized approach by Antares. Heart rate was also slightly reduced (from 69 +/- 13 to 64 +/- 13 bpm, P < 0.05). Similarly, the corrected QT interval from optimized extractions was significantly reduced (QTcB from 414 +/- 32 to 402 +/- 30 ms, P < 0.05). Using only baseline data, and after adjusting for intersubject variability, the standard deviation (SD) of QT intervals was highly reduced with optimized extraction (SD of QTcF from 11 +/- 8 to 7 +/- 2 ms, P < 0.05). CONCLUSIONS Extraction of discrete 12-lead ECG strips from continuous Holter generates less noisy and more stable ECGs leading to more robust QTc data, thereby potentially facilitating the assessment of ECG effects on clinical trials.
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Couderc JP, Vaglio M, Xia X, McNitt S, Wicker P, Sarapa N, J Moss A, Zareba W. Impaired T-amplitude adaptation to heart rate changes identifies IKr inhibition in the congenital and acquired form of the long QT syndrome. J Electrocardiol 2007. [DOI: 10.1016/j.jelectrocard.2007.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Couderc JP, Vaglio M, Xia X, McNitt S, Wicker P, Sarapa N, Moss AJ, Zareba W. Impaired T-amplitude adaptation to heart rate characterizes I(Kr) inhibition in the congenital and acquired forms of the long QT syndrome. J Cardiovasc Electrophysiol 2007; 18:1299-305. [PMID: 17916157 DOI: 10.1111/j.1540-8167.2007.00960.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The QTc interval prolongation is not a perfect surrogate marker of the presence of an increased risk for arrhythmic events. In the search for alternative markers, we investigated the T-amplitude and QT interval adaptation to heart rate (HR) in patients with the congenital long QT syndrome (LQTS) and individuals with sotalol-induced QT prolongation. METHODS AND RESULTS Our investigation is based on the analysis of continuous 12-lead digital Holter recordings in: 49 LQT1 carriers, 25 LQT2 carriers, 37 healthy individuals off drugs and on 160 mg of sotalol, and 21 of them also on 320 mg of sotalol. The Holter recordings were used to investigate repolarization parameters and their HR dependency. A loss of HR dependency of the T-amplitude was found as a common feature in individuals with impaired I(kr) kinetics: LQT2 carriers and subjects on sotalol. The T-amplitude/RR slope was significantly (P < 0.05) flatter in LQT2 (0.31 +/- 0.27 microV/ms) than in both LQT1 (0.62 +/- 0.40 microV/ms) and healthy individuals (0.55 +/- 0.29 microV/ms). A dose-dependent reduction of the T-amplitude/RR slope was also observed in subjects on sotalol (160 mg dose: 0.26 +/- 0.19 microV/ms; 320 mg dose: 0.21 +/- 0.14 microV/ms). The QT/RR slope was less effective than T-amplitude/RR slope in differentiating between congenital and drug-induced repolarization delay. CONCLUSIONS Impaired adaptation of T-amplitude to changing HR is a common electrocardiographic feature associated with KCNH2 mutation and I(kr) blockade by sotalol. This ECG marker may play an important role in the future of the assessment of the penetrance of KCNH2 mutation and the identification of a drug effect on the I(kr) kinetics.
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Affiliation(s)
- Jean-Philippe Couderc
- Heart Research Follow-Up Program, Cardiology Department, University of Rochester Medical Center, Rochester, New York, USA.
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Vaglio M, Couderc JP, McNitt S, Xia X, Moss AJ, Zareba W. A quantitative assessment of T-wave morphology in LQT1, LQT2, and healthy individuals based on Holter recording technology. Heart Rhythm 2007; 5:11-8. [PMID: 18180017 DOI: 10.1016/j.hrthm.2007.08.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 08/16/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical course and the precipitating risk factors in the congenital long QT syndrome (LQTS) are genotype specific. OBJECTIVES The goal of this study was to develop a computer algorithm allowing for electrocardiogram (ECG)-based identification and differentiation of LQT1 and LQT2 carriers. METHODS Twelve-lead ECG Holter monitor recordings were acquired in 49 LQT1 carriers, 25 LQT2 carriers, and 38 healthy subjects as controls. The cardiac beats were clustered based on heart-rate bin method. Scalar and vectorial repolarization parameters were compared for similar heart rates among study groups. The Q to Tpeak (QTpeak), the Tpeak to Tend interval, T-wave magnitude and T-loop morphology were automatically quantified using custom-made algorithms. RESULTS QTpeak from lead II and the right slope of the T-wave were the most discriminant parameters for differentiating the 3 groups using prespecified heart rate bin (75.0 to 77.5 beats/min). The predictive model utilizing these scalar parameters was validated using the entire spectrum of heart rates. Both scalar and vectorcardiographic models provided very effective identification of tested subjects in heart rates between 60 and 100 beats/min, whereas they had limited performance during tachycardia and slightly better discrimination in bradycardia. In the 60 to 100 beats/min heart rate range, the best 2-variable model identified correctly 89% of healthy subjects, 84% of LQT1 carriers, and 92% of LQT2 carriers. A model including 3 parameters based purely on scalar ECG parameters could correctly identify 90% of the population (89% of healthy subjects, 90% of LQT1 carriers, and 92% of LQT2 carriers). CONCLUSION Automatic algorithm quantifying T-wave morphology discriminates LQT1 and LQT2 carriers and healthy subjects with high accuracy. Such computerized ECG methodology could assist physicians evaluating subjects suspected for LQTS.
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Affiliation(s)
- Martino Vaglio
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York, USA
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Abstract
A novel mechatronic body weight support (BWS) system has been developed to provide precise body weight unloading for patients with neurological or other impairments during treadmill training. The system is composed of a passive elastic spring element to take over the main unloading force and an active closed-loop controlled electric drive to generate the exact desired force. Both force generating units, the passive spring and the active electric drive, act on the patient via a polyester rope connected to a harness worn by the patient. The length of the rope can be adjusted with an electric winch to adapt the system to different patient sizes. The system is fully computer controlled. At unloading loads of up to 60 kg and walking speeds of up to 3.2 km/h, the mean unloading error and the maximum unloading error of the presented BWS system was less than 1 and 3 kg, respectively. The performance was compared with those of two purely passive BWS systems currently being used by most other rehabilitation groups. This comprised counterweight systems and static BWS systems with fixed rope lengths. Counterweight systems reached mean and maximum unloading errors of up to 5.34 and 16.22 kg, respectively. The values for the static BWS were 11.02 kg and 27.67 kg, respectively. The novel mechatronic BWS system presented in this study adjusts desired unloading changes of up to 20 kg within less than 100 ms. Thus, not only constant BWS, but also gait cycle dependent or time variant oscillations of the desired force can be realized with high accuracy. Precise and constant unloading force is believed to be an important prerequisite for BWS gait therapy, where it is important to generate physiologically correct segmental dynamics and ground reaction forces. Thus, the novel BWS system presented in this paper is an important contribution to maximize the therapeutic outcome of human gait rehabilitation.
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Affiliation(s)
- Martin Frey
- Swiss Federal Institute of Technology, CH-8092 Zurich, Switzerland.
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Couderc JP, Vaglio M, Xia X, McNitt S, Hyrien O. Electrocardiographic method for identifying drug-induced repolarization abnormalities associated with a reduction of the rapidly activating delayed rectifier potassium current. Conf Proc IEEE Eng Med Biol Soc 2006; 2006:4010-4015. [PMID: 17946595 DOI: 10.1109/iembs.2006.260492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Several important non-cardiac drugs have been removed from the market after revealing harmful effect that was not identified during prior safety-assessment studies. We developed a new technique for the measurements of repolarization abnormalities from surface ECGs; this method improves sensitivity and specificity of the current technique used to identify the presence of abnormal ion current kinetics in the myocardial cells namely a prolongation of the QT interval on the surface ECG signal. We described in this paper the method and preliminary results, revealing the superiority of our technique that may play a role in the future of drug-safety assessment.
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Vaglio M, Couderc JP, Xia J, Zareba W. Fractionated repolarization velocity induced by sotalol in healthy subjects. J Electrocardiol 2005. [DOI: 10.1016/j.jelectrocard.2005.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vaglio M, Couderc JP, Xia X, Zareba W. Fractionated repolarization velocity induced by sotalol in healthy subjects. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baechtold F, Scott JA, Markert M, Mehta S, McCormack DG, Anglada F, Galaud D, Vaglio M, Waeber B, Feihl F. Does the activation of poly (ADP-ribose) synthetase mediate tissue injury in the sepsis induced by cecal ligation and puncture? Shock 2001; 16:137-42. [PMID: 11508866 DOI: 10.1097/00024382-200116020-00009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Poly (ADP-ribose) synthetase (PARS) is a DNA protective enzyme activated by single-strand breakage. It is suspected that exaggerated PARS activation related to biochemical stress by reactive oxygen and nitrogen species contributes to cellular injury in sepsis. The main hypothesis is that PARS activation leads to massive ATP and NAD consumption and consequent cellular energy depletion. The PARS inhibitor 3-amino-benzamide (3AB) is protective in rodents challenged with either endotoxin or intraperitoneal zymozan. The present experiment was designed to test the effect of 3AB in a more clinically relevant model of sepsis, namely polymicrobial sepsis induced by cecal ligature and puncture (CLP). Adult male Wistar rats were anesthetized, instrumented with catheters in the jugular vein and in the carotid artery, and then randomized into three groups: Sham (no laparotomy, n = 13), CLP (n = 15), and CLP/3AB (n = 18). All animals were allowed to recover and they received a continuous intravenous infusion of saline (20 mL/kg/h) and fentanyl (20 microg/kg/h). 3AB was administered to the CLP/3AB group as an intravenous bolus (10 mg/kg) followed by a continuous intravenous infusion (10 mg/kg/h). After 24 h, blood was drawn for the determination of biological indicators of organ injury. Rats were then anesthetized and biopsies of the liver were quickly frozen into liquid nitrogen for the subsequent determination of NAD and ATP levels. Further organ samples were collected for the assay of myeloperoxidase (MPO) to indicate tissue infiltration by leukocytes, and nitrotyrosine to indicate the level of biochemical stress by reactive nitrogen species. Twenty-four-hour mortality was 0/13 (Sham), 1/15 (CLP), and 5/18 (CLP/3AB; p = NS). In the surviving rats, CLP induced a clear elevation of liver enzymes, bilirubin, and pancreatic lipase, but not creatinine in the plasma, as well as a marked increase of MPO activity in liver, jejunum, and lung, but not kidney or heart. None of these variables was affected by treatment with 3AB. Furthermore, CLP did not cause depletion of NAD or ATP in the liver, nor any change in the nitrotyrosine content of any organ. These data argue against a general role of PARS activation in the pathogenesis of sepsis-induced tissue injury.
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Affiliation(s)
- F Baechtold
- Division of Clinical Pathophysiology, University Hospital, Lausanne, Switzerland
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Mooser V, Tinguely F, Fontana P, Lenain V, Vaglio M, Ruchat P, von Segesser LK, Marcovina SM, Markert M, Darioli R, Nicod P. Effect of cardiopulmonary bypass and heparin on plasma levels of Lp(a) and Apo(a) fragments. Arterioscler Thromb Vasc Biol 1999; 19:1060-5. [PMID: 10195936 DOI: 10.1161/01.atv.19.4.1060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fragments of apolipoprotein(a) [apo(a)], the distinctive glycoprotein of lipoprotein(a) [Lp(a)], are present in human plasma and urine and have been implicated in the development of atherosclerosis. The mechanism responsible for the generation of apo(a) fragments in vivo is poorly understood. In this study, we examined the plasma levels of Lp(a) and apo(a) fragments [or free apo(a)] and urinary apo(a) in 15 subjects who underwent cardiac surgery necessitating cardiopulmonary bypass. We also measured the plasma concentration and activity of polymorphonuclear elastase, an Lp(a)-cleaving enzyme in vitro, and plasma levels of C-reactive protein. Despite a marked activation of polymorphonuclear cells and a pronounced inflammatory response, as documented by an 8-fold and a 35-fold increase in plasma levels of polymorphonuclear elastase and C-reactive protein, respectively, the proportion of plasma free apo(a) to Lp(a) and urinary excretion of apo(a) remained unchanged over a 7-day period after surgery, and polymorphonuclear elastase activity remained undetectable in plasma. No fragmentation of apo(a) was observed ex vivo in plasma samples collected before and after surgery. These data indicate that in this model, apo(a) is not fragmented in plasma and are consistent with the hypothesis that apo(a) fragments result from a constitutively active tissue mechanism that is not modified by cardiac surgery with cardiopulmonary bypass.
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Affiliation(s)
- V Mooser
- Departments of Internal Medicine Central Laboratory of Clinical Chemistry, University of California, Irvine, USA.
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Lemarchand P, Vaglio M, Mauël J, Markert M. Translocation of a small cytosolic calcium-binding protein (MRP-8) to plasma membrane correlates with human neutrophil activation. J Biol Chem 1992; 267:19379-82. [PMID: 1326551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To further understand the mechanisms involved in phagocyte activation in general and in NADPH oxidase activation in particular, a polyclonal antibody was raised in rabbit against a partially purified oxidase preparation. The enzyme was solubilized from zymosan-activated human neutrophils and resting cells and separated by preparative isoelectric focusing electrophoresis. A polyclonal antibody was raised in rabbit against the pI 5.0 fraction, which had the maximum superoxide-producing capacity. Analysis of the polyclonal antibody revealed marked differences between activated and resting neutrophils. The antibody recognized in particular an 8-kDa protein (p8) in resting human neutrophil cytosol and in the membrane of zymosan-activated cells. A polyclonal antibody (anti-p8) was raised against the pure cytosolic p8 protein. This anti-p8 reacted not only with p8, but also with cytosolic proteins of 14 kDa and 6 kDa. N-terminal amino acid sequence analysis of p8 revealed homology with the calcium-binding myeloid related protein (MRP-8). Upon neutrophil activation, translocation of the 8- and 14-kDa proteins to the membrane was observed with stimuli known to depend on extracellular calcium. In calcium-depleted medium, the absence of translocation correlated with a depression of superoxide production, supporting a role for the calcium-binding protein in cellular activation.
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Affiliation(s)
- P Lemarchand
- Central Laboratory of Clinical Chemistry, CHUV, Lausanne, Switzerland
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Markert M, Vaglio M, Frei J. Activation of the human neutrophil respiratory burst by an anion channel blocker. J Lab Clin Med 1988; 111:577-83. [PMID: 2452224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We found that 4,4'-diisothiocyano-2,2'-disulfonic acid (DIDS), an anion channel blocker in erythrocytes, caused a concentration-related stimulation of oxygen radicals in human neutrophils, as measured by luminol- and lucigenin-amplified chemiluminescence. The DIDS-elicited oxygen radical burst followed the kinetic pattern of other stimuli with a lag period of 20 seconds, reaching a maximum after 12 to 15 minutes. Washing neutrophils that had been pretreated with DIDS did not reverse neutrophil activation. DIDS was found to strongly stimulate lactate production and did not block the efflux of this anion. Cytochalasin B completely abolished the chemiluminescence responses when added before DIDS stimulation. It also inhibited lactate production, however, only in a glucose-containing medium. Modulation of oxygen radical production by DIDS may reveal an additional transductional pathway for neutrophil activation.
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Affiliation(s)
- M Markert
- Central Laboratory of Clinical Chemistry, CHUV, Lausanne, Switzerland
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