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Kronberg FO, Behnes M, Reinhardt M, Abel N, Schmitt A, Lau F, Bertsch T, Steffen HJ, Weidner K, Abumayyaleh M, Kuschyk J, Akin I, Schupp T. Native QRS duration and outcomes in heart failure with mildly reduced ejection fraction: results from a large-scaled registry. Clin Res Cardiol 2025:10.1007/s00392-025-02667-8. [PMID: 40353874 DOI: 10.1007/s00392-025-02667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 04/27/2025] [Indexed: 05/14/2025]
Abstract
OBJECTIVE The study investigates the prognostic impact of the native QRS duration in patients with heart failure and mildly reduced ejection fraction (HFmrEF). BACKGROUND The prognostic impact of QRS duration in HFmrEF has rarely been investigated. METHODS Consecutive patients with HFmrEF and available 12-lead electrocardiogram were retrospectively included at one institution from 2016 to 2022. Patients with QRS duration ≥ 120 ms were compared to patients with QRS duration < 120 ms, further risk stratification was performed comparing patients with left and right bundle branch block (LBBB vs. RBBB). The primary endpoint was all-cause mortality at 30 months, secondary endpoints comprised the risk of HF-related rehospitalization. RESULTS In total, 1627 patients with HFmrEF were included with a median QRS duration of 90 ms (i.e., QRS duration ≥ 120 ms: 15%). Although the risk of long-term all-cause mortality was not affected by a prolonged QRS duration (35.1% vs. 28.7%; p = 0.057; HR = 1.254; 95% CI 0.993-1.583), patients with QRS duration ≥ 120 ms had a higher risk of HF-related rehospitalization (18.2% vs. 11.9%; p = 0.008; HR = 1.574; 95% CI 1.124-2.204). A QRS duration ≥ 120 ms was associated with long-term HF-related rehospitalization even after multivariable adjustment (HR 1.420, 95% CI 1.008-2.002, p = 0.045). Finally, the risks of long-term all-cause mortality and HF-related rehospitalization did not differ among patients with LBBB and RBBB. CONCLUSION A prolonged native QRS duration is independently associated with a higher risk of HF-related rehospitalization in HFmrEF, but not long-term all-cause mortality.
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Affiliation(s)
- Finn Ole Kronberg
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marielen Reinhardt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Noah Abel
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Felix Lau
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Henning Johann Steffen
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jürgen Kuschyk
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Sharafi M, Afrashteh S, Farjam M, Keshavarzian O, Annabi Toolgilani MA, Aboughadare H, Dastmanedh S, Moghaddam MT. Association between body composition components and electrocardiogram parameters: results from the Fasa Adults Cohort Study (FACS). Eur J Med Res 2025; 30:309. [PMID: 40251648 PMCID: PMC12008910 DOI: 10.1186/s40001-025-02569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 04/08/2025] [Indexed: 04/20/2025] Open
Abstract
OBJECTIVE Cardiovascular diseases as the leading cause of death and disability are increasing worldwide. The present study aimed to investigate the association between total body water, total fat percent, and trunk fat percent with electrocardiogram (ECG) parameters in the Persian Fasa Adult Cohort Study (FACS). METHODS This cross-sectional study was performed on the baseline information obtained from 3217 35-70-year-old participants of the FACS, southern Iran. Various ECG and body composition parameters were obtained from the FACS baseline database. Independent t-test, Chi-square test and linear regression were used for data analysis. RESULTS Total body water (TBW) was positively associated with QRS length in men and women, and with PD and PR interval in women, exclusively. Additionally, in participants without chronic diseases (healthy group), TBW was shown to be positively associated with QRS length and PD; however, it was associated with QRS length and S wave in V3 lead (SV3) among those with type two diabetes, hypertension or ischemic heart disease (defined as unhealthy group). Total body fat percent (TBFP) was linearly associated with SV3 in unhealthy group. None of the studied ECG parameters was associated with TBFP in men, women and healthy group. Moreover, trunk fat percent was shown to be positive associated with R wave in aVL lead in women and unhealthy groups. CONCLUSION Body fat percentage and fat distribution may affect ECG parameters, and subsequently associated with cardiovascular diseases, such as arrhythmias. Thus, these indicators may carry the potential for screening high-risk individuals.
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Affiliation(s)
- Mehdi Sharafi
- School of Nursing, Gerash University of Medical Sciences, Gerash, Iran
| | - Sima Afrashteh
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
| | - Omid Keshavarzian
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hanie Aboughadare
- Students Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanaz Dastmanedh
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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Stępień-Wroniecka A, Dziewięcka E, Graczyk K, Holcman K, Winiarczyk M, Przytuła N, Kostkiewicz M, Podolec P, Rubiś P. Gated myocardial perfusion SPECT for evaluating left ventricular dyssynchrony in cardiac resynchronization therapy candidates: a systematic review. Nucl Med Commun 2025; 46:285-303. [PMID: 39851177 DOI: 10.1097/mnm.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2025]
Abstract
OBJECTIVES Cardiac resynchronization therapy (CRT) is an intervention for heart failure patients with reduced ejection fraction who exhibit specific electrocardiographic indicators of electrical dyssynchrony. However, electrical dyssynchrony does not universally correspond to left ventricular mechanical dyssynchrony (LVMD). Gated single-photon emission computed tomography (SPECT) myocardial perfusion allows for the assessment of LVMD, yet its role in the CRT selection process remains debated. METHODS We conducted a systematic literature review to critically evaluate the evidence for the prediction and prognostic utility of SPECT for LVMD in assessing LVMD among CRT candidates. The review adhered to PRISMA 2020 Statement criteria and included articles from PubMed, Embase, and Cochrane databases. The quality of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation framework. RESULTS From an initial pool of 1055 records, 33 met the inclusion criteria and provided original data on the predictive value of myocardial perfusion SPECT for LVMD. Most of them measured LVMD according to established recommendations, focusing on phase histogram bandwidth (HBW) and phase histogram standard deviation (PSD). Out of 2066 patients from 27 studies, 62% ( n = 1214) were qualified as CRT responders. Five studies reported SPECT-based cutoffs for predicting CRT response (HBW ranging 55°-152° and for PSD 20°-54°). Only five studies assessed the prognostic implications of baseline SPECT-measured LVMD, indicating that elevated baseline HBW and PSD values are associated with poorer outcomes. CONCLUSION The objective and reproducible measurement of LVMD provided by SPECT underscores its potential as a valuable tool. Such assessment seems to be emerging as a promising adjunctive technique with potential to enhance CRT outcomes.
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Affiliation(s)
- Agnieszka Stępień-Wroniecka
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and
| | - Ewa Dziewięcka
- Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and
| | - Katarzyna Graczyk
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and
- Department of Nuclear Medicine, St.John Paul II Hospital, Krakow, Poland
| | - Mateusz Winiarczyk
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and
| | - Natalia Przytuła
- Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and
- Department of Nuclear Medicine, St.John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and
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Vurro D, Liboà A, D’Onofrio I, De Giorgio G, Scaravonati S, Crepaldi M, Barcellona A, Sciancalepore C, Galstyan V, Milanese D, Riccò M, D’Angelo P, Tarabella G. Sericin Electrodes with Self-Adhesive Properties for Biosignaling. ACS Biomater Sci Eng 2025; 11:1776-1791. [PMID: 39904518 PMCID: PMC12079639 DOI: 10.1021/acsbiomaterials.4c02234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 01/13/2025] [Accepted: 01/15/2025] [Indexed: 02/06/2025]
Abstract
The combination of green manufacturing approaches and bioinspired materials is growingly emerging in different scenarios, in particular in medicine, where widespread medical devices (MDs) as commercial electrodes for electrophysiology strongly increase the accumulation of solid waste after use. Electrocardiogram (ECG) electrodes exploit electrolytic gels to allow the high-quality recording of heart signals. Beyond their nonrecyclability/nonrecoverability, gel drying also affects the signal quality upon prolonged monitoring of biopotentials. Moreover, gel composition often causes skin reactions. This study aims to address the above limitation by presenting a composite based on the combination of silk sericin (SS) as a structural material, poly(vinyl alcohol) (PVA) as a robustness enhancer, and CaCl2 as a plasticizer. SS/PVA/CaCl2 formulations, optimized in terms of weight content (wt %) of single constituents, result in a biocompatible, biodegradable "green" material (free from potentially irritating cross-linking agents) that is, above all, self-adhesive on skin. The best formulation, i.e., SS(4 wt %)/PVA(4 wt %)/CaCl2(20 wt %), in terms of long-lasting skin adhesion (favored by calcium-ion coordination in the presence of environmental/skin humidity) and time-stability of electrode impedance, is used to assemble ECG electrodes showing quality trace recording over longer time scales (up to 6 h) than commercial electrodes. ECG recording is performed using customized electronics coupled to an app for data visualization.
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Affiliation(s)
- Davide Vurro
- Institute
of Materials for Electronics and Magnetism (IMEM-CNR), Parco Area delle Scienze 37/A, Parma 43124, Italy
| | - Aris Liboà
- Institute
of Materials for Electronics and Magnetism (IMEM-CNR), Parco Area delle Scienze 37/A, Parma 43124, Italy
- Department
of Chemistry Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 17/A, Parma 43124, Italy
| | - Ilenia D’Onofrio
- Institute
of Materials for Electronics and Magnetism (IMEM-CNR), Parco Area delle Scienze 37/A, Parma 43124, Italy
- Department
of Chemistry Life Sciences and Environmental Sustainability, University of Parma, Parco Area delle Scienze 17/A, Parma 43124, Italy
| | - Giuseppe De Giorgio
- Institute
of Materials for Electronics and Magnetism (IMEM-CNR), Parco Area delle Scienze 37/A, Parma 43124, Italy
| | - Silvio Scaravonati
- Department
of Mathematical, Physical and Computer Sciences, University of Parma, GISEL & INSTM, Parco Area delle Scienze 7/A, Parma 43124, Italy
| | - Marco Crepaldi
- Electronic
Design Laboratory, Fondazione Istituto Italiano
di Tecnologia, Via Enrico
Melen 83, Genova 16152, Italy
| | - Alessandro Barcellona
- Electronic
Design Laboratory, Fondazione Istituto Italiano
di Tecnologia, Via Enrico
Melen 83, Genova 16152, Italy
| | - Corrado Sciancalepore
- Department
of Engineering for Industrial Systems and Technologies, University of Parma, Parco Area delle Scienze 181/A, Parma 43124, Italy
| | - Vardan Galstyan
- Institute
of Materials for Electronics and Magnetism (IMEM-CNR), Parco Area delle Scienze 37/A, Parma 43124, Italy
| | - Daniel Milanese
- Department
of Engineering for Industrial Systems and Technologies, University of Parma, Parco Area delle Scienze 181/A, Parma 43124, Italy
| | - Mauro Riccò
- Electronic
Design Laboratory, Fondazione Istituto Italiano
di Tecnologia, Via Enrico
Melen 83, Genova 16152, Italy
| | - Pasquale D’Angelo
- Institute
of Materials for Electronics and Magnetism (IMEM-CNR), Parco Area delle Scienze 37/A, Parma 43124, Italy
| | - Giuseppe Tarabella
- Institute
of Materials for Electronics and Magnetism (IMEM-CNR), Parco Area delle Scienze 37/A, Parma 43124, Italy
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Karahan A, Oguz E. Addressing Functional Mitral Regurgitation in Dilated Cardiomyopathy: A Focus on Myocardial Segment Resynchronization Through Cardiac Resynchronization Therapy. Cureus 2024; 16:e74374. [PMID: 39723275 PMCID: PMC11668939 DOI: 10.7759/cureus.74374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2024] [Indexed: 12/28/2024] Open
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has emerged as a pivotal intervention in reducing functional mitral regurgitation (FMR), not only by enhancing global left ventricular (LV) systolic function but also by refining local myocardial synchronization. This study hypothesized that CRT-mediated synchronization of myocardial segments, particularly between papillary muscles, reduces FMR further, independent of the improvement of the LV systolic indices. METHODS Eighteen patients with dilated cardiomyopathy and biventricular pacing were evaluated. Measurements included the rate of rise in LV systolic pressure (LV dP/dt), asynchrony indices, transmitral pressure differences, mitral regurgitation quantification and diastolic filling times during pacing and with pacemaker interruption. As LV dP/dt decreased while the pacemaker was interrupted, dobutamine infusion was administered to restore LV dP/dt to pacing levels. All parameters were reassessed to evaluate the impact of myocardial resynchronization on FMR, independent of LV systolic performance. Results: LV dP/dt significantly decreased in 10 patients after pacemaker interruption (838±190 vs 444±72, p<0.01), with no significant change in eight patients (603±134 vs 592±156, p=0.679). Despite similar LV performance indices, biventricular pacing led to a statistically significant reduction in both effective regurgitant orifice area and regurgitant volume across all patients (p<0.001 and p=0.003, respectively). CONCLUSION CRT significantly reduces FMR in dilated cardiomyopathy patients with intraventricular delay independent of improvements in LV systolic performance indicators by resynchronization of the LV segments underlying the papillary muscles. Moreover, it may be the main determinant of the reduction in FMR in CRT, underscoring the need for further research into its mechanisms and therapeutic implications.
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Affiliation(s)
| | - Enis Oguz
- Department of Cardiology, Liv Hospital Ulus, Istanbul, TUR
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Sano T, Kiuchi S, Hisatake S, Ikeda T. Right Bundle Branch Block and Rehospitalization in Patients With Heart Failure. Cureus 2024; 16:e66238. [PMID: 39238703 PMCID: PMC11375113 DOI: 10.7759/cureus.66238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE The most important aspect of managing heart failure (HF) is preventing rehospitalization. Bundle branch block (BBB), particularly left BBB (LBBB), has been a known risk factor for worsening prognosis, whereas no such consideration has been made for right BBB (RBBB). However, recent research has shown that RBBB was associated with increased mortality. This study evaluated the effects of RBBB on prognosis, especially rehospitalization, in patients with HF. MATERIALS This study included 698 patients admitted for HF. Those who died in the hospital (n = 31) and dropped out during observation (n = 143) were excluded. After one year of observation, the patients were divided into a control group (n = 361) and a major adverse cardiovascular event (MACE) group (n = 163). After further excluding according to electrocardiography findings, patients were categorized as having no BBB (n = 307), pure RBBB (n = 37), and LBBB (n = 56), and then the characteristics, clinical data, and prognosis of the remaining patients were evaluated. RESULTS Patients were compared to no BBB, pure RBBB, and LBBB was associated with a risk for HF rehospitalization (p = 0.007). Furthermore, pure RBBB was independently associated with HF rehospitalization even after adjusting for confounders (hazard ratio: 2.40 (95% confidence interval: 1.26-4.58; p = 0.008). CONCLUSION Pure RBBB was independently associated with HF rehospitalization, highlighting the need for vigilance against the risk of HF rehospitalization among those with pure RBBB.
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Affiliation(s)
- Takahide Sano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, JPN
| | - Shunsuke Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, JPN
| | - Shinji Hisatake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, JPN
| | - Takanori Ikeda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, JPN
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Bak M, Youn J, Bae D, Lee J, Lee S, Cho D, Choi J, of PPCM registry investigators. Temporal Trends in Clinical Characteristics and Outcomes for Peripartum Cardiomyopathy: The Nationwide Multicenter Registry Over 20 Years. J Am Heart Assoc 2024; 13:e034055. [PMID: 38904229 PMCID: PMC11255681 DOI: 10.1161/jaha.123.034055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/23/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Although peripartum cardiomyopathy (PPCM) is a fatal disease affecting young patients and fetuses, little is known about its recent prognosis and risk factors. This study investigated temporal trends in clinical characteristics and outcomes for PPCM in a nationwide multicenter registry. METHODS AND RESULTS The study population comprised 340 patients (mean age, 33 years) who were diagnosed with PPCM between January 2000 and September 2022 in 26 tertiary hospitals in South Korea. PPCM was defined as heart failure with left ventricular ejection fraction ≤45% and no previously known cardiac disease. The main study outcomes included time to the first occurrence of all-cause death, heart transplantation, and cardiovascular hospitalization. The diagnosis of PPCM cases increased notably during the study period (P<0.001). However, clinical outcomes showed no significant improvement (all-cause death for 10 years: 0.9% [2000-2010] versus 2.3% [2011-2022], P=0.450; all-cause death and heart transplantation for 10 years: 3.6% [2000-2010] versus 3.0% [2011-2022] P=0.520; all-cause death, heart transplantation, and cardiovascular hospitalization for 10 years: 11.7% [2000-2010] versus 19.8% [2011-2022], P=0.240). High body mass index (hazard ratio [HR], 1.106 [95% CI, 1.024-1.196]; P=0.011), the presence of gestational diabetes (HR, 5.346 [95% CI, 1.778-16.07]; P=0.002), and increased baseline left ventricular end-diastolic dimension (HR, 1.078 [95% CI, 1.002-1.159]; P=0.044) were significant risk factors for poor prognosis. CONCLUSIONS While the incidence of PPCM has increased over the past 20 years, the prognosis has not improved significantly. Timely management and close follow-up are necessary for high-risk patients with PPCM with high body mass index, gestational diabetes, or large left ventricular end-diastolic dimension.
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Affiliation(s)
- Minjung Bak
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Jong‐Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Dae‐Hwan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University HospitalChungbuk National University College of MedicineChungbukRepublic of Korea
| | - Ju‐Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University HospitalChungbuk National University College of MedicineChungbukRepublic of Korea
| | - Sunki Lee
- Division of Cardiology, Department of Internal MedicineKorea University Guro Hospital, Korea UniversitySeoulRepublic of Korea
| | - Dong‐Hyuk Cho
- Division of Cardiology, Department of Internal MedicineKorea University Anam Hospital, Korea UniversitySeoulRepublic of Korea
| | - Jin‐Oh Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
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Al Younis SM, Hadjileontiadis LJ, Khandoker AH, Stefanini C, Soulaidopoulos S, Arsenos P, Doundoulakis I, Gatzoulis KA, Tsioufis K. Prediction of heart failure patients with distinct left ventricular ejection fraction levels using circadian ECG features and machine learning. PLoS One 2024; 19:e0302639. [PMID: 38739639 PMCID: PMC11090346 DOI: 10.1371/journal.pone.0302639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Heart failure (HF) encompasses a diverse clinical spectrum, including instances of transient HF or HF with recovered ejection fraction, alongside persistent cases. This dynamic condition exhibits a growing prevalence and entails substantial healthcare expenditures, with anticipated escalation in the future. It is essential to classify HF patients into three groups based on their ejection fraction: reduced (HFrEF), mid-range (HFmEF), and preserved (HFpEF), such as for diagnosis, risk assessment, treatment choice, and the ongoing monitoring of heart failure. Nevertheless, obtaining a definitive prediction poses challenges, requiring the reliance on echocardiography. On the contrary, an electrocardiogram (ECG) provides a straightforward, quick, continuous assessment of the patient's cardiac rhythm, serving as a cost-effective adjunct to echocardiography. In this research, we evaluate several machine learning (ML)-based classification models, such as K-nearest neighbors (KNN), neural networks (NN), support vector machines (SVM), and decision trees (TREE), to classify left ventricular ejection fraction (LVEF) for three categories of HF patients at hourly intervals, using 24-hour ECG recordings. Information from heterogeneous group of 303 heart failure patients, encompassing HFpEF, HFmEF, or HFrEF classes, was acquired from a multicenter dataset involving both American and Greek populations. Features extracted from ECG data were employed to train the aforementioned ML classification models, with the training occurring in one-hour intervals. To optimize the classification of LVEF levels in coronary artery disease (CAD) patients, a nested cross-validation approach was employed for hyperparameter tuning. HF patients were best classified using TREE and KNN models, with an overall accuracy of 91.2% and 90.9%, and average area under the curve of the receiver operating characteristics (AUROC) of 0.98, and 0.99, respectively. Furthermore, according to the experimental findings, the time periods of midnight-1 am, 8-9 am, and 10-11 pm were the ones that contributed to the highest classification accuracy. The results pave the way for creating an automated screening system tailored for patients with CAD, utilizing optimal measurement timings aligned with their circadian cycles.
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Affiliation(s)
- Sona M. Al Younis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Centre (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Leontios J. Hadjileontiadis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Centre (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ahsan H. Khandoker
- Department of Biomedical Engineering, Healthcare Engineering Innovation Centre (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Cesare Stefanini
- Creative Engineering Design Lab at the BioRobotics Institute, Applied Experimental Sciences Scuola Superiore Sant’Anna, Pontedera (Pisa), Italy
| | - Stergios Soulaidopoulos
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Arsenos
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Doundoulakis
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos A. Gatzoulis
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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9
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Al Younis SM, Hadjileontiadis LJ, Al Shehhi AM, Stefanini C, Alkhodari M, Soulaidopoulos S, Arsenos P, Doundoulakis I, Gatzoulis KA, Tsioufis K, Khandoker AH. Investigating automated regression models for estimating left ventricular ejection fraction levels in heart failure patients using circadian ECG features. PLoS One 2023; 18:e0295653. [PMID: 38079417 PMCID: PMC10712857 DOI: 10.1371/journal.pone.0295653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Heart Failure (HF) significantly impacts approximately 26 million people worldwide, causing disruptions in the normal functioning of their hearts. The estimation of left ventricular ejection fraction (LVEF) plays a crucial role in the diagnosis, risk stratification, treatment selection, and monitoring of heart failure. However, achieving a definitive assessment is challenging, necessitating the use of echocardiography. Electrocardiogram (ECG) is a relatively simple, quick to obtain, provides continuous monitoring of patient's cardiac rhythm, and cost-effective procedure compared to echocardiography. In this study, we compare several regression models (support vector machine (SVM), extreme gradient boosting (XGBOOST), gaussian process regression (GPR) and decision tree) for the estimation of LVEF for three groups of HF patients at hourly intervals using 24-hour ECG recordings. Data from 303 HF patients with preserved, mid-range, or reduced LVEF were obtained from a multicentre cohort (American and Greek). ECG extracted features were used to train the different regression models in one-hour intervals. To enhance the best possible LVEF level estimations, hyperparameters tuning in nested loop approach was implemented (the outer loop divides the data into training and testing sets, while the inner loop further divides the training set into smaller sets for cross-validation). LVEF levels were best estimated using rational quadratic GPR and fine decision tree regression models with an average root mean square error (RMSE) of 3.83% and 3.42%, and correlation coefficients of 0.92 (p<0.01) and 0.91 (p<0.01), respectively. Furthermore, according to the experimental findings, the time periods of midnight-1 am, 8-9 am, and 10-11 pm demonstrated to be the lowest RMSE values between the actual and predicted LVEF levels. The findings could potentially lead to the development of an automated screening system for patients with coronary artery disease (CAD) by using the best measurement timings during their circadian cycles.
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Affiliation(s)
- Sona M. Al Younis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Centre (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Leontios J. Hadjileontiadis
- Department of Biomedical Engineering, Healthcare Engineering Innovation Centre (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aamna M. Al Shehhi
- Department of Biomedical Engineering, Healthcare Engineering Innovation Centre (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Cesare Stefanini
- Creative Engineering Design Lab at the BioRobotics Institute, Applied Experimental Sciences Scuola Superiore Sant’Anna, Pontedera (Pisa), Italy
| | - Mohanad Alkhodari
- Department of Biomedical Engineering, Healthcare Engineering Innovation Centre (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
- Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stergios Soulaidopoulos
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Arsenos
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Doundoulakis
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos A. Gatzoulis
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Department, School of Medicine, “Hippokration” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ahsan H. Khandoker
- Department of Biomedical Engineering, Healthcare Engineering Innovation Centre (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
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10
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Feijen M, Egorova AD, Kuijken T, Bootsma M, Schalij MJ, van Erven L. One-Year Mortality in Patients Undergoing an Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy Pulse Generator Replacement: Identifying Patients at Risk. J Clin Med 2023; 12:5654. [PMID: 37685719 PMCID: PMC10489035 DOI: 10.3390/jcm12175654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Implantable cardioverter defibrillators (ICDs) significantly contribute to the prevention of sudden cardiac death in selected patients. However, it is essential to identify those who are likely to not have benefit from an ICD and to defer a pulse generator exchange. Easily implementable guidelines for individual risk stratification and decision making are lacking. This study investigates the 1-year mortality of patients who underwent an ICD or cardiac resynchronization therapy with defibrillator function (CRT-D) pulse generator replacement in a contemporary real-world tertiary hospital setting. The cause of death and patient- and procedure-related factors are stratified, and predictive values for 1-year mortality are evaluated. Patients with a follow-up of ≥365 days (or prior mortality) after an ICD or CRT-D exchange at the Leiden University Medical Center from 1 January 2018 until 31 December 2021 were eligible. In total, 588 patients were included (77% male, 69 [60-76] years old, 59% primary prevention, 46% ischemic cardiomyopathy and 37% mildly reduced left ventricular ejection fraction (LVEF)). Patients undergoing a CRT-D replacement or upgrade had a significantly higher 1-year all-cause mortality (10.7% and 11.9%, respectively) compared to patients undergoing ICD (2.8%) exchange (p = 0.002). LVEF ≤ 30%, New York Heart Association class ≥ 3, estimated glomerular filtration rate ≤ 30 mL/min/m2 and haemoglobin ≤ 7 mmol/L were independently associated with mortality within 1 year after pulse generator replacement. There is a growing need for prospectively validated risk scores to weight individualized risk of mortality with the expected ICD therapy benefit and to support a well-informed, shared decision-making process.
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Affiliation(s)
| | - Anastasia D. Egorova
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (M.F.); (L.v.E.)
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11
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Zhang Q, Zhou D. Machine Learning Electrocardiogram for Mobile Cardiac Pattern Extraction. SENSORS (BASEL, SWITZERLAND) 2023; 23:5723. [PMID: 37420885 DOI: 10.3390/s23125723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Internet-of-things technologies are reshaping healthcare applications. We take a special interest in long-term, out-of-clinic, electrocardiogram (ECG)-based heart health management and propose a machine learning framework to extract crucial patterns from noisy mobile ECG signals. METHODS A three-stage hybrid machine learning framework is proposed for estimating heart-disease-related ECG QRS duration. First, raw heartbeats are recognized from the mobile ECG using a support vector machine (SVM). Then, the QRS boundaries are located using a novel pattern recognition approach, multiview dynamic time warping (MV-DTW). To enhance robustness with motion artifacts in the signal, the MV-DTW path distance is also used to quantize heartbeat-specific distortion conditions. Finally, a regression model is trained to transform the mobile ECG QRS duration into the commonly used standard chest ECG QRS durations. RESULTS With the proposed framework, the performance of ECG QRS duration estimation is very encouraging, and the correlation coefficient, mean error/standard deviation, mean absolute error, and root mean absolute error are 91.2%, 0.4 ± 2.6, 1.7, and 2.6 ms, respectively, compared with the traditional chest ECG-based measurements. CONCLUSIONS Promising experimental results are demonstrated to indicate the effectiveness of the framework. This study will greatly advance machine-learning-enabled ECG data mining towards smart medical decision support.
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Affiliation(s)
- Qingxue Zhang
- Department of Electrical and Computer Engineering, Department of Biomedical Engineering, Purdue School of Engineering and Technology, 723 W. Michigan St., Indianapolis, IN 46202, USA
| | - Dian Zhou
- Department of Electrical and Computer Engineering, University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX 75080, USA
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12
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Ballantyne BA, Chew DS, Vandenberk B. Paradigm Shifts in Cardiac Pacing: Where Have We Been and What Lies Ahead? J Clin Med 2023; 12:jcm12082938. [PMID: 37109274 PMCID: PMC10146747 DOI: 10.3390/jcm12082938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
The history of cardiac pacing dates back to the 1930s with externalized pacing and has evolved to incorporate transvenous, multi-lead, or even leadless devices. Annual implantation rates of cardiac implantable electronic devices have increased since the introduction of the implantable system, likely related to expanding indications, and increasing global life expectancy and aging demographics. Here, we summarize the relevant literature on cardiac pacing to demonstrate the enormous impact it has had within the field of cardiology. Further, we look forward to the future of cardiac pacing, including conduction system pacing and leadless pacing strategies.
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Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
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13
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Berger M, Kumowski N, Straw S, Verket M, Marx N, Witte KK, Schütt K. Clinical implications and risk factors for QRS prolongation over time in heart failure patients. Clin Res Cardiol 2023; 112:312-322. [PMID: 36378295 PMCID: PMC9898415 DOI: 10.1007/s00392-022-02122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND QRS prolongation is an established prognostic marker in heart failure (HF). In contrast, the role of QRS width progression over time has been incompletely explored. The current study investigates the role of QRS width progression over time on clinical status and identifies underlying predictors. METHODS Datasets of ≥ 2 consecutive visits from 100 attendees to our HF clinic between April and August 2021 were analysed for changes in QRS complex duration. RESULTS In total 240 datasets were stratified into tertiles based on change in QRS duration (mm/month) (1st tertile: - 1.65 [1.50] 'regression'; 2nd tertile 0.03 [0.19] 'stable', 3rd tertile 3.57 [10.11] 'progression'). The incidence of the combined endpoint HF hospitalisation and worsening of symptomatic heart failure was significantly higher in the group with QRS width progression (3rd tertile) compared with the stable group (2nd tertile; log-rank test: p = 0.013). These patients were characterised by higher plasma NT-pro-BNP levels (p = 0.008) and higher heart rate (p = 0.007). A spline-based prediction model identified patients at risk of QRS width progression when NT-pro-BNP and heartrate were > 837 pg/ml and > 83/bpm, respectively. These markers were independent of guideline-directed medical HF therapy. Patients beyond both thresholds had a 14-fold increased risk of QRS width progression compared to those with neither or either alone (HR: 14.2 [95% 6.9 - 53.6]; p < 0.0001, p for interaction = 0.016). CONCLUSIONS This pilot study demonstrates that QRS width progression is associated with clinical deterioration of HF. NTproBNP plasma levels and heart rate indicate patients at risk QRS width progression, independently of HF therapy.
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Affiliation(s)
- Martin Berger
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Nina Kumowski
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Sam Straw
- grid.9909.90000 0004 1936 8403Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Marlo Verket
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Klaus K. Witte
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Katharina Schütt
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
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14
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Bortolan G, Christov I, Simova I. Modifications in Electrocardiographic and Vectordardiographic Morphological Parameters in Elderly Males as Result of Cardiovascular Diseases and Diabetes Mellitus. Diagnostics (Basel) 2022; 12:diagnostics12122911. [PMID: 36552917 PMCID: PMC9776814 DOI: 10.3390/diagnostics12122911] [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: 10/11/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Morphological electrocardiographic and vectorcardiographic features have been used in the detection of cardiovascular diseases and prediction of the risk of cardiac death for a long time. The objective of the current study was to investigate the morphological electrocardiographic modifications in the presence of cardiovascular diseases and diabetes mellitus in an elderly male population, most of them with multiple comorbidities. METHODS A database of ECG recordings from the Italian Longitudinal Study on Aging (ILSA-CNR), created to evaluate physiological and pathological modifications related to aging, was considered. The study examined a group of 1109 males with full clinical documentation aged 65-84 years. A healthy control group (219 individuals) was compared to the groups of diabetes mellitus (130), angina pectoris (99), hypertension (607), myocardial infarction (160), arrhythmia (386), congestive heart failure (73), and peripheral artery disease (95). Twenty-one electrocardiographic features were explored, and the effects of cardiovascular diseases and diabetes on these parameters were analyzed. The three-years mortality index was derived and analyzed. RESULTS AND CONCLUSIONS Myocardial infarction and arrhythmia were the diagnostic groups that showed a significant deviation of 11 electrocardiographic parameters compared to the healthy group, followed by hypertension and congestive heart failure (10), angina pectoris (9), and diabetes mellitus and peripheral artery disease (8). In particular, a set of three parameters (QRS and T roundness and principal component analysis of T wave) increased significantly, whereas four parameters (T amplitude, T maximal vector, T vector ratio, and T wave area dispersion) decreased significantly in all cardiovascular diseases and diabetes mellitus with respect to healthy group. The QRS parameters show a more specific discrimination with a single disease or a group of diseases, whereas the T-wave features seems to be influenced by all the pathological conditions. The present investigation of disease-related electrocardiographic parameters changes can be used in assessing the risk analysis of cardiac death, and gender medicine.
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Affiliation(s)
- Giovanni Bortolan
- Institute of Neuroscience-National Research Council, IN-CNR, 35127 Padova, Italy
- Correspondence:
| | - Ivaylo Christov
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Iana Simova
- Heart and Brain Center of Excellence, University Hospital Pleven, 5804 Pleven, Bulgaria
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15
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Huang J, Guo L, Zhang W, Li R, He B. Left bundle branch potential predicts better electrical synchrony in bradycardia patients receiving left bundle branch pacing. BMC Cardiovasc Disord 2022; 22:376. [PMID: 35986250 PMCID: PMC9389707 DOI: 10.1186/s12872-022-02812-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Left bundle branch pacing (LBBP) is a novel physiological pacing technology. We aim to explore the relation between LBB potential (LBB Po) and left ventricular (LV) electrical/mechanical synchrony in bradycardia patients without heart failure (HF) receiving LBBP. Methods A total of 62 patients undergoing LBBP were categorized by LBB Po: the LBB Po positive (+) group and the LBB Po negative (−) group. The perioperative electrocardiographic and echocardiography parameters related to cardiac synchrony were analyzed. Results There were 42 (67.74%) patients in the LBB Po (+) group and 20 patients in the LBB Po (−) group. Paced QRS duration (113.50 ± 17.65 ms vs. 123.40 ± 13.18 ms, P = 0.031) and stimulus left ventricular activation time (71.76 ± 3.53 ms vs. 74.45 ± 3.12 ms, P = 0.005) were shorter in the LBB Po (+) group than in the LBB Po (−) group. No significant differences in the LV mechanical synchrony (Ts-SD-12, 36.55 ± 19.76 vs. 39.95 ± 16.04, P = 0.505; PSD, 51.14 ± 17.69 vs. 45.65 ± 10.55, P = 0.205) between the two groups. There was not statistically difference in ventricular lead parameters measured intraoperative between the two groups. Compared with the LBB Po (−) group, the LBB Po (+) group showed a dramatically higher total procedure duration time (93.52 ± 9.18 min vs. 86.25 ± 10.54 min, p = 0.007) and fluoroscopy time for ventricle lead implantation (18.95 ± 3.43 min vs. 14.00 ± 3.16 min, p < 0.001). Conclusions The appearance of LBB Po may suggest better electrical synchrony during LBBP, but similar in LV mechanical synchrony. However, the total operation duration and fluoroscopy time of ventricular lead implantation in the LBB Po (+) group were longer. Therefore, it may be unnecessary to deliberately recognize the LBB Po when it is difficult to detect LBB Po and meet the LBBP criterion.
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16
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Gassanov N, Mutallimov M, Caglayan E, Erdmann E, Er F. ECG as a risk stratification tool in patients with wearable cardioverter-defibrillator. J Cardiol 2022; 80:573-577. [PMID: 35985868 DOI: 10.1016/j.jjcc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The wearable cardioverter defibrillator (WCD) is increasingly used in patients at elevated risk for ventricular arrhythmias but not fulfilling the indications for an implantable cardioverter defibrillator (ICD). Currently, there is an insufficient risk prediction of fatal arrhythmias in patients at risk. In this study, we assessed the prognostic role of baseline electrocardiogram (ECG) in WCD patients. METHODS WCD patients from diverse clinical institutions in Germany (n = 227) were retrospectively enrolled and investigated for the incidences of death or ventricular arrhythmias during WCD wearing. In addition, the widely accepted ECG predictors of adverse outcome were analyzed in patients with arrhythmic events. RESULTS Life-threatening arrhythmias occurred in 22 (9.7 %) patients, mostly in subjects with ischemic heart disease (15 of 22). There was no difference in baseline left ventricular ejection fraction (LVEF) in subjects with and without arrhythmic events (31.3 ± 7.9 % vs. 32.6 ± 8.3 %; p = 0,24). Patients with arrhythmia exhibited significantly longer QRS duration (109.5 ± 23.1 ms vs. 100.6 ± 22.3 ms, p = 0,04), Tpeak-Tend (Tp-e) (103.1 ± 15.6 ms vs. 93.2 ± 19.2 ms, p = 0,01) and QTc (475.0 ± 60.0 ms vs. 429.6 ± 59.4 ms, p < 0,001) intervals. In contrast, no significant differences were found for incidences of fragmented QRS (27.3 % vs. 24 %, p = 0.79) and inverted/biphasic T-waves (16.6 % vs. 22.7 %, p = 0,55). In multivariate regression analysis both Tp-e (HR 1.03; 95 % CI 1.001-1.057; p = 0.02) and QTc (HR 1.02; 95 % CI 1.006-1.026; p < 0.001) were identified as independent predictors of ventricular arrhythmias. After WCD use, the prophylactic ICD was indicated in 76 patients (33 %) with uneventful clinical course but persistent LVEF ≤35 %. The ECG analysis in these subjects did not reveal any relevant changes in arrhythmogenesis markers. CONCLUSIONS ECG repolarization markers Tp-e and QTc are associated with malignant arrhythmias in WCD patients and may be used - in addition to other established risk markers - to identify appropriate patients for ICD implantation.
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Affiliation(s)
- Natig Gassanov
- Department of Internal Medicine II, Klinikum Idar-Oberstein, Idar-Oberstein, Germany.
| | - Mirza Mutallimov
- Department of Internal Medicine II, Klinikum Idar-Oberstein, Idar-Oberstein, Germany
| | - Evren Caglayan
- Department of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Erland Erdmann
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Fikret Er
- Department of Internal Medicine I, Klinikum Gütersloh, Gütersloh, Germany
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17
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Association between Empagliflozin Use and Electrocardiographic Changes. Clin Pract 2022; 12:557-564. [PMID: 35892445 PMCID: PMC9326746 DOI: 10.3390/clinpract12040059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/29/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Empagliflozin, a sodium-glucose transporter 2 inhibitor, has been shown to bind to late sodium channels in mice cardiomyocytes. We sought to investigate the electrocardiographic (ECG) features associated with empagliflozin use in patients with diabetes mellitus. We compared ECG features of 101 patients before and after initiation of empagliflozin and found that empagliflozin was associated with a significant increase in QRS duration among diabetes patients with heart failure.
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18
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Leikas AJ, Hassinen I, Kivelä A, Hedman A, Mussalo H, Ylä-Herttuala S, Hartikainen JEK. Intramyocardial adenoviral vascular endothelial growth factor-D ∆N∆C gene therapy does not induce ventricular arrhythmias. J Gene Med 2022; 24:e3437. [PMID: 35750637 DOI: 10.1002/jgm.3437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/13/2022] [Accepted: 06/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Phase I KAT301 trial investigated the use of intramyocardial adenoviral vascular endothelial growth factor -DΔNΔC (AdVEGF-D) gene therapy (GT) to alleviate symptoms in refractory angina (RA) patients. In KAT301, 30 patients with RA were randomized to AdVEGF-D or control group in 4:1 ratio. The treatment was found feasible, increased myocardial perfusion, and reduced angina symptoms at 1-year follow-up. However, there is some evidence suggesting that intramyocardial delivery route and overexpression of VEGFs might induce ventricular arrhythmias. Thus, we investigated whether intramyocardial AdVEGF-D GT increases the risk of ventricular arrhythmias in patients treated for RA. METHODS We analyzed non-invasive risk predictors of ventricular arrhythmias from 12-lead electrocardiography (ECG) as well as heart rate variability (HRV) and the incidence of arrhythmias from 24 h ambulatory ECG at baseline and 3 and 12 months after the GT. In addition, we analyzed the incidence of new-onset arrhythmias and pacemaker implantations during 8.2-year (range 6.3 - 10.4 years) follow-up. RESULTS We found no significant increase in arrhythmias, including supraventricular and ventricular ectopic beats, atrial fibrillation, non-sustained ventricular tachycardias, and life-threatening tachycardias, nor changes in the non-invasive risk predictors of ventricular arrhythmias in the AdVEGF-D treated patients. Instead, we found a significant improvement in the very low and high-frequency bands of HRV suggestive of improved cardiac autonomic regulation after GT. CONCLUSIONS In conclusion, our results suggest that AdVEGF-D GT does not predispose to arrhythmias and might improve HRV metrics.
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Affiliation(s)
- Aleksi J Leikas
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Iiro Hassinen
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,Mikkeli Central Hospital, Mikkeli, Finland
| | - Antti Kivelä
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Hedman
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Mussalo
- Center of Diagnostic Imaging, Kuopio University Hospital, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Juha E K Hartikainen
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
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19
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Rueda C, Fernández I, Larriba Y, Rodríguez-Collado A, Canedo C. Compelling new electrocardiographic markers for automatic diagnosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106807. [PMID: 35525215 DOI: 10.1016/j.cmpb.2022.106807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE The automatic diagnosis of heart diseases from the electrocardiogram (ECG) signal is crucial in clinical decision-making. However, the use of computer-based decision rules in clinical practice is still deficient, mainly due to their complexity and a lack of medical interpretation. The objetive of this research is to address these issues by providing valuable diagnostic rules that can be easily implemented in clinical practice. In this research, efficient diagnostic rules friendly in clinical practice are provided. METHODS In this paper, interesting parameters obtained from the ECG signals analysis are presented and two simple rules for automatic diagnosis of Bundle Branch Blocks are defined using new markers derived from the so-called FMMecg delineator. The main advantages of these markers are the good statistical properties and their clear interpretation in clinically meaningful terms. RESULTS High sensitivity and specificity values have been obtained using the proposed rules with data from more than 35,000 patients from well known benchmarking databases. In particular, to identify Complete Left Bundle Branch Blocks and differentiate this condition from subjects without heart diseases, sensitivity and specificity values ranging from 93% to 99% and from 96% to 99%, respectively. The new markers and the automatic diagnosis are easily available at https://fmmmodel.shinyapps.io/fmmEcg/, an app specifically developed for any given ECG signal. CONCLUSIONS The proposal is different from others in the literature and it is compelling for three main reasons. On the one hand, the markers have a concise electrocardiographic interpretation. On the other hand, the diagnosis rules have a very high accuracy. Finally, the markers can be provided by any device that registers the ECG signal and the automatic diagnosis is made straightforwardly, in contrast to the black-box and deep learning algorithms.
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Affiliation(s)
- Cristina Rueda
- Department of Statistics and Operations Research, Universidad de Valladolid, Paseo de Belén 7, Valladolid 47011, Spain.
| | - Itziar Fernández
- Department of Statistics and Operations Research, Universidad de Valladolid, Paseo de Belén 7, Valladolid 47011, Spain
| | - Yolanda Larriba
- Department of Statistics and Operations Research, Universidad de Valladolid, Paseo de Belén 7, Valladolid 47011, Spain
| | - Alejandro Rodríguez-Collado
- Department of Statistics and Operations Research, Universidad de Valladolid, Paseo de Belén 7, Valladolid 47011, Spain
| | - Christian Canedo
- Department of Statistics and Operations Research, Universidad de Valladolid, Paseo de Belén 7, Valladolid 47011, Spain
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The effects of combined hydroxychloroquine and azithromycin therapy on QRS wave in COVID-19 patients. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.985876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Abstract
The role of electromechanical dyssynchrony in heart failure gained prominence in literature with the results of trials of cardiac resynchronization therapy (CRT). CRT has shown to significantly decrease heart failure hospitalization and mortality in heart failure patients with dyssynchrony. Current guidelines recommend the use of electrical dyssynchrony based on a QRS > 150 ms and a left bundle branch block pattern on surface electrocardiogram to identify dyssynchrony in patients who will benefit from CRT implantation. However, predicting response to CRT remains a challenge with nearly one-third of patients gaining no benefit from the device. Multiple echocardiographic measures of mechanical dyssynchrony have been studied over the past two decade. However, trials where mechanical dyssynchrony used as an additional or lone criteria for CRT failed to show any benefit in the response to CRT. This shows that a deeper understanding of cardiac mechanics should be applied in the assessment of dyssynchrony. This review discusses the evolving role of imaging techniques in assessing cardiac dyssynchrony and their application in patients considered for device therapy.
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22
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Shah K, Karpe V, K Turagam M, Shah M, Natale A, Gopinathannair R, Lakkireddy D, Garg J. Cardiac Resynchronization Therapy in continuous flow Left Ventricular Assist Device Recipients: A Systematic Review and Meta-analysis from ELECTRAM Investigators. J Atr Fibrillation 2021; 13:2441. [PMID: 34950326 DOI: 10.4022/jafib.2441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/05/2020] [Accepted: 08/15/2020] [Indexed: 11/10/2022]
Abstract
Introduction Whether cardiac resynchronization therapy (CRT) continues to augment left ventricular remodeling in patients with the continuous-flow left ventricular assist device (cf-LVAD) remains unclear. Methods We performed a systematic review and meta-analysis of all clinical studies examining the role of continued CRT in end-stage heart failure patients with cf-LVAD reporting all-cause mortality, ventricular arrhythmias, and ICD shocks. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data. Results Eight studies (7 retrospective and 1 randomized) with a total of 1,208 unique patients met inclusion criteria. There was no difference in all-cause mortality (RR 1.08, 95% CI 0.86 - 1.35, p = 0.51, I2=0%), all-cause hospitalization (RR 1.01, 95% CI 0.76-1.34, p = 0.95, I2=11%), ventricular arrhythmias (RR 1.08, 95% CI 0.83 - 1.39, p = 0.58, I2 =50%) and ICD shocks (RR 0.87, 95% CI 0.57 - 1.33, p = 0.52, I2 =65%) comparing CRT versus non-CRT. Subgroup analysis demonstrated significant reduction in ventricular arrhythmias (RR 0.76, 95% CI 0.64 - 0.90, p = 0.001) and ICD shocks (RR 0.65, 95% CI 0.44 - 0.97, p = 0.04) in "CRT on" group versus "CRT off" group. Conclusions CRT was not associated with a reduction in all-cause mortality or increased risk of ventricular arrhythmias and ICD shocks compared to non-CRT in cf-LVAD patients. It remains to be determined which subgroup of cf-LVAD patients benefit from CRT. The findings of our study are intriguing, and therefore, larger studies in a randomized prospective manner should be undertaken to address this specifically.
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Affiliation(s)
- Kuldeep Shah
- Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Vallabh Karpe
- Department of Medicine, Allegheny General Hospital, Pittsburgh, PA
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mahek Shah
- Division of Cardiology, Section of Heart Failure and Transplantation Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
| | | | | | - Jalaj Garg
- Cardiac Arrhythmia Service, Medical College of Wisconsin, Milwaukee, WI
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23
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Mueller‐Leisse J, Brunn J, Zormpas C, Hohmann S, Hillmann HAK, Eiringhaus J, Bauersachs J, Veltmann C, Duncker D. Extended follow-up after wearable cardioverter-defibrillator period: the PROLONG-II study. ESC Heart Fail 2021; 8:5142-5148. [PMID: 34480414 PMCID: PMC8712878 DOI: 10.1002/ehf2.13586] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 11/05/2022] Open
Abstract
AIM The wearable cardioverter-defibrillator (WCD) is used for temporary protection from sudden cardiac death (SCD) in patients with newly diagnosed heart failure with reduced ejection fraction before considering an implantable cardioverter-defibrillator (ICD). However, the prognostic significance of the WCD remains controversial due to conflicting evidence. The aim of the present study was to evaluate prognosis of patients receiving life-saving WCD shocks. METHODS AND RESULTS All patients receiving a WCD at Hannover Medical School for heart failure with reduced ejection fraction between 2012 and 2017 were included. Data were acquired at baseline, at 3 months and at last available follow-up (FU). Three hundred and fifty-three patients were included (69% male; age 56 ± 15 years; left ventricular ejection fraction 25 ± 8%). FU after the WCD was 2.8 ± 1.5 years with a maximum of 6.8 years. Daily WCD wear time was 22 ± 4 h. Fourteen patients (4%) received appropriate WCD shocks. Two patients (0.6%) died during the WCD period. Thirty patients (9%) died during extended FU. Mean estimated survival after the WCD was similar between patients with and without WCD shocks. Patients without an ICD recommendation after WCD prescription did not experience SCD during FU. CONCLUSIONS Patients with WCD shocks showed a favourable survival. Patients without an ICD recommendation after WCD prescription had no SCD during FU. These findings support the practice of careful risk stratification before considering an ICD and the use of the WCD for temporary protection from SCD.
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Affiliation(s)
- Johanna Mueller‐Leisse
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Johanna Brunn
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Christos Zormpas
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Henrike Aenne Katrin Hillmann
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Jörg Eiringhaus
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Johann Bauersachs
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
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Fabiszak T, Kasprzak M, Koziński M, Kubica J. Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction. J Clin Med 2021; 10:5445. [PMID: 34830726 PMCID: PMC8619668 DOI: 10.3390/jcm10225445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). METHODS We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. RESULTS Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45-48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22-2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04-0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke's pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). CONCLUSIONS According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.
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Affiliation(s)
- Tomasz Fabiszak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Marek Koziński
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, ul. Powstania Styczniowego 9B, 81-519 Gdynia, Poland;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
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25
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Qu Q, Sun JY, Zhang ZY, Kan JY, Wu LD, Li F, Wang RX. His-Purkinje conduction system pacing: A systematic review and network meta-analysis in bradycardia and conduction disorders. J Cardiovasc Electrophysiol 2021; 32:3245-3258. [PMID: 34664764 DOI: 10.1111/jce.15269] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND His-Purkinje conduction system pacing (HPCSP) has emerged as an effective alternative to overcome the limitations of right ventricular pacing (RVP) via physiological left ventricular activation, but there remains a paucity of comparative information for His bundle pacing (HBP) and left bundle branch pacing (LBBP). METHODS A Bayesian random-effects network analysis was conducted to compare the relative effects of HBP, LBBP, and RVP in patients with bradycardia and conduction disorders. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from database inception until September 21, 2021. RESULTS Twenty-eight studies involving 4160 patients were included in this meta-analysis. LBBP significantly improved success rate, pacing threshold, pacing impedance, and R-wave amplitude compared with HBP. LBBP also demonstrated a nonsignificant trend towards superior outcomes of lead complications, heart failure hospitalization, atrial fibrillation, and all-cause death. However, HBP was associated with significantly shorter paced QRS duration relative to LBBP. Despite higher success rates, shorter procedure/fluoroscopy duration, and fewer lead complications, patients receiving RVP were more likely to experience reduced left ventricular ejection fraction, longer paced QRS duration, and higher rates of heart failure hospitalization than those receiving HPCSP. No statistical differences were observed in the remaining outcome measures. CONCLUSIONS This network meta-analysis demonstrates the efficacy and safety of HPCSP for the treatment of bradycardia and conduction disorders, with differences in pacing parameters, electrophysiology characteristics, and clinical outcomes between HBP and LBBP. Larger-scale, long-term comparative studies are warranted for further verification.
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Affiliation(s)
- Qiang Qu
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Yu Sun
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen-Ye Zhang
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Jun-Yan Kan
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Li-Da Wu
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Feng Li
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Ru-Xing Wang
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
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26
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Recapitulation of dyssynchrony-associated contractile impairment in asymmetrically paced engineered heart tissue. J Mol Cell Cardiol 2021; 163:97-105. [PMID: 34634355 PMCID: PMC8828044 DOI: 10.1016/j.yjmcc.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND One third of heart failure patients exhibit dyssynchronized electromechanical activity of the heart (evidenced by a broad QRS-complex). Cardiac resynchronization therapy (CRT) in the form of biventricular pacing improves cardiac output and clinical outcome of responding patients. Technically demanding and laborious large animal models have been developed to better predict responders of CRT and to investigate molecular mechanisms of dyssynchrony and CRT. The aim of this study was to establish a first humanized in vitro model of dyssynchrony and CRT. METHODS Cardiomyocytes were differentiated from human induced pluripotent stem cells and cast into a fibrin matrix to produce engineered heart tissue (EHT). EHTs were either field stimulated in their entirety (symmetrically) or excited locally from one end (asymmetrically) or they were allowed to beat spontaneously. RESULTS Asymmetrical pacing led to a depolarization wave from one end to the other end, which was visualized in human EHT transduced with a fast genetic Ca2+-sensor (GCaMP6f) arguing for dyssynchronous excitation. Symmetrical pacing in contrast led to an instantaneous (synchronized) Ca2+-signal throughout the EHT. To investigate acute and long-term functional effects, spontaneously beating human EHTs (0.5-0.8 Hz) were divided into a non-paced control group, a symmetrically and an asymmetrically paced group, each stimulated at 1 Hz. Symmetrical pacing was clearly superior to asymmetrical pacing or no pacing regarding contractile force both acutely and even more pronounced after weeks of continuous stimulation. Contractile dysfunction that can be evoked by an increased afterload was aggravated in the asymmetrically paced group. Consistent with reports from paced dogs, p38MAPK and CaMKII-abundance was higher under asymmetrical than under symmetrical pacing while pAKT was considerably lower. CONCLUSIONS This model allows for long-term pacing experiments mimicking electrical dyssynchrony vs. synchrony in vitro. Combined with force measurement and afterload stimulus manipulation, it provides a robust new tool to gain insight into the biology of dyssynchrony and CRT.
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27
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Mantri N, Lu M, Zaroff JG, Risch N, Hoffmann T, Oni-Orisan A, Lee C, Jorgenson E, Iribarren C. QT Interval Dynamics and Cardiovascular Outcomes: A Cohort Study in an Integrated Health Care Delivery System. J Am Heart Assoc 2021; 10:e018513. [PMID: 34581201 PMCID: PMC8649135 DOI: 10.1161/jaha.120.018513] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Long QT has been associated with ventricular dysrhythmias, cardiovascular disease (CVD) mortality, and sudden cardiac death. However, no studies to date have investigated the dynamics of within‐person QT change over time in relation to risk of incident CVD and all‐cause mortality in a real‐world setting. Methods and Results A cohort study among members of an integrated health care delivery system in Northern California including 61 455 people (mean age, 62 years; 60% women, 42% non‐White) with 3 or more ECGs (baseline in 2005–2009; mean±SD follow‐up time, 7.6±2.6 years). In fully adjusted models, tertile 3 versus tertile 1 of average QT corrected (using the Fridericia correction) was associated with cardiac arrest (hazard ratio [HR], 1.66), heart failure (HR, 1.62), ventricular dysrhythmias (HR, 1.56), all CVD (HR, 1.31), ischemic heart disease (HR, 1.28), total stroke (HR, 1.18), and all‐cause mortality (HR, 1.24). Tertile 3 versus tertile 2 of the QT corrected linear slope was associated with cardiac arrest (HR, 1.22), ventricular dysrhythmias (HR, 1.12), and all‐cause mortality (HR, 1.09). Tertile 3 versus tertile 1 of the QT corrected root mean squared error was associated with ventricular dysrhythmias (HR, 1.34), heart failure (HR, 1.28), all‐cause mortality (HR, 1.20), all CVD (HR, 1.14), total stroke (HR, 1.08), and ischemic heart disease (HR, 1.07). Conclusions Our results demonstrate improved predictive ability for CVD outcomes using longitudinal information from serial ECGs. Long‐term average QT corrected was more strongly associated with CVD outcomes than the linear slope or the root mean squared error. This new evidence is clinically relevant because ECGs are frequently used, noninvasive, and inexpensive.
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Affiliation(s)
- Neha Mantri
- Department of Cardiology Kaiser Permanente San Francisco Medical Center San Francisco CA
| | - Meng Lu
- Division of Research Kaiser Permanente Oakland CA
| | - Jonathan G Zaroff
- Department of Cardiology Kaiser Permanente San Francisco Medical Center San Francisco CA
| | - Neil Risch
- Institute for Human Genetics University of California, San Francisco CA
| | - Thomas Hoffmann
- Institute for Human Genetics University of California, San Francisco CA
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Arnold AD, Shun-Shin MJ, Ali N, Keene D, Howard JP, Chow JJ, Qureshi NA, Koa-Wing M, Tanner M, Lefroy DC, Linton NW, Ng FS, Lim PB, Peters NS, Kanagaratnam P, Francis DP, Whinnett ZI. Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing. Heart Rhythm O2 2021; 2:439-445. [PMID: 34667958 PMCID: PMC8505200 DOI: 10.1016/j.hroo.2021.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND His bundle pacing (HBP) can be achieved in 2 ways: selective HBP (S-HBP), where the His bundle is captured alone, and nonselective HBP (NS-HBP), where local myocardium is also captured, resulting a pre-excited electrocardiogram appearance. OBJECTIVE We assessed the impact of this ventricular pre-excitation on left and right ventricular dyssynchrony. METHODS We recruited patients who displayed both S-HBP and NS-HBP. We performed noninvasive epicardial electrical mapping for left and right ventricular activation time (LVAT and RVAT) and pattern. RESULTS Twenty patients were recruited. In the primary analysis, the mean within-patient change in LVAT from S-HBP to NS-HBP was -5.5 ms (95% confidence interval: -0.6 to -10.4, noninferiority P < .0001). NS-HBP did not prolong RVAT (4.3 ms, -4.0 to 12.8, P = .296) but did prolong QRS duration (QRSd, 22.1 ms, 11.8 to 32.4, P = .0003). In patients with narrow intrinsic QRS (n = 6), NS-HBP preserved LVAT (-2.9 ms, -9.7 to 4.0, P = .331) but prolonged QRS duration (31.4 ms, 22.0 to 40.7, P = .0003) and mean RVAT (16.8 ms, -5.3 to 38.9, P = .108) compared to S-HBP. Activation pattern of the left ventricular surface was unchanged between S-HBP and NS-HBP, but NS-HBP produced early basal right ventricular activation that was not seen in S-HBP. CONCLUSION Compared to S-HBP, local myocardial capture during NS-HBP produces pre-excitation of the basal right ventricle resulting in QRS duration prolongation. However, NS-HBP preserves the left ventricular activation time and pattern of S-HBP. Left ventricular dyssynchrony is not an important factor when choosing between S-HBP and NS-HBP in most patients.
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Affiliation(s)
- Ahran D. Arnold
- Address reprint requests and correspondence: Dr Ahran D. Arnold, NHLI, Hammersmith Hospital, Du Cane Rd, London W120HS, UK.
| | | | - Nadine Ali
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - James P. Howard
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Ji-Jian Chow
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Norman A. Qureshi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Michael Koa-Wing
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mark Tanner
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - David C. Lefroy
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nick W.F. Linton
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nicholas S. Peters
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Darrel P. Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Zachary I. Whinnett
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Safiullina AA, Uskach TM, Sharapova YS, Kochetov AG, Sapelnikov OV, Tereshchenko SN. Dynamics of Holter electrocardiogram monitoring in patients with chronic heart failure and atrial fibrillation on the background of cardiac contractility modulation. TERAPEVT ARKH 2021; 93:1044-1051. [DOI: 10.26442/00403660.2021.09.201034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/09/2021] [Indexed: 11/22/2022]
Abstract
Aim. To evaluate the dynamics of cardiac arrhythmias on the background of cardiac contractility modulation (MCC) in patients with chronic heart failure (CHF) and various forms of atrial fibrillation (AF) on the basis of daily electrocardiogram (ECG) monitoring.
Materials and methods. In 100 patients with CHF and AF, the following studies were performed before implantation of the MCC device and after 12 months of follow-up: 12-channel ECG with an estimate of the width of the QRS complex, transthoracic echocardiography (EchoCG), and Holter ECG monitoring. All patients received long-term optimal drug therapy for CHF before surgery.
Results. The results obtained indicate that there is no effect of MCC on the development and progression of ventricular arrhythmias in patients with CHF and AF during the year of follow-up, both extrasystole and tachyarrhythmias, regardless of the etiology and LVEF (less than 35% or more than 35%), and a decrease in the frequency of AF paroxysms in patients with CHF during treatment. These results are due to the reverse remodeling of the LV myocardium under the influence of the MCC device.
Conclusion. The use of MСС in patients with CHF and AF is a safe method of therapy that does not induce cardiac arrhythmias, including ventricular extrasystole. Large-scale comparative studies are required to evaluate these results.
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30
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Nikhanj A, Yogasundaram H, Kimber S, Siddiqi ZA, Oudit GY. Clinical utility of 12-lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy. Ann Noninvasive Electrocardiol 2021; 26:e12876. [PMID: 34250701 PMCID: PMC8588368 DOI: 10.1111/anec.12876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/29/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction Heart disease remains a leading cause of mortality in patients with muscular dystrophy (MD), and cardiac assessment by standard imaging modalities is challenging due to the prominence of physical limitations. Methods In this prospective cohort study of 169 MD patients and 34 negative control patients, we demonstrate the clinical utility of a 12‐lead electrocardiogram (ECG) as an effective modality for the assessment of cardiac status in patients with MD. We assessed the utility of conventional criteria for electrocardiogram‐indicated left ventricular hypertrophy (ECG‐LVH) as well as ECG morphologies. Results Cornell voltage, Cornell voltage‐duration, Sokolow–Lyon voltage, and Romhilt‐Estes point score criteria demonstrated low sensitivity and minimal positive predictive value for ECG‐LVH when compared with cardiac imaging. Patients with LBBB had a high probability of a cardiomyopathy (relative risk [RR], 2.75; 95% confidence interval [CI], 2.14–3.53; p < .001), and patients with QRS fragmentation (fQRS) had a high probability of a cardiomyopathy (RR, 1.76; 95% CI, 1.20–2.59; p = .004), requiring cardiac medication and device intervention. We found that an R/S ratio >1 in V1 and V2 is highly specific (specificity, 0.89; negative predictive value [NPV], 0.89 and specificity, 0.82; NPV, 0.89, respectively) for patients with dystrophinopathies compared with other types of MD. Conclusion The identification of LBBB and fQRS was linked to cardiomyopathy in patients with MD, while ECG‐LVH was of limited utility. Importantly, these findings can be applied to effectively screen a broad cohort of MD patients for structural heart disease and prompt further evaluation and therapeutic intervention.
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Affiliation(s)
- Anish Nikhanj
- Division of Cardiology.,Mazankowski Alberta Heart Institute
| | | | - Shane Kimber
- Division of Cardiology.,Mazankowski Alberta Heart Institute
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gavin Y Oudit
- Division of Cardiology.,Mazankowski Alberta Heart Institute
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31
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Chen X, Hansson PO, Thunström E, Mandalenakis Z, Caidahl K, Fu M. Incremental changes in QRS duration as predictor for cardiovascular disease: a 21-year follow-up of a randomly selected general population. Sci Rep 2021; 11:13652. [PMID: 34211015 PMCID: PMC8249416 DOI: 10.1038/s41598-021-93024-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/27/2021] [Indexed: 02/08/2023] Open
Abstract
The QRS complex has been shown to be a prognostic marker in coronary artery disease. However, the changes in QRS duration over time, and its predictive value for cardiovascular disease in the general population is poorly studied. So we aimed to explore if increased QRS duration from the age of 50–60 is associated with increased risk of major cardiovascular events during a further follow-up to age 71. A random population sample of 798 men born in 1943 were examined in 1993 at 50 years of age, and re-examined in 2003 at age 60 and 2014 at age 71. Participants who developed cardiovascular disease before the re-examination in 2003 (n = 86) or missing value of QRS duration in 2003 (n = 127) were excluded. ΔQRS was defined as increase in QRS duration from age 50 to 60. Participants were divided into three groups: group 1: ΔQRS < 4 ms, group 2: 4 ms ≤ ΔQRS < 8 ms, group 3: ΔQRS ≥ 8 ms. Endpoints were major cardiovascular events. And we found compared with men in group 1 (ΔQRS < 4 ms), men with ΔQRS ≥ 8 ms had a 56% increased risk of MACE during follow-up to 71 years of age after adjusted for BMI, systolic blood pressure, smoking, hyperlipidemia, diabetes and heart rate in a multivariable Cox regression analysis (HR 1.56, 95% CI:1.07–2.27, P = 0.022). In conclusion, in this longitudinal follow-up over a decade QRS duration increased in almost two out of three men between age 50 and 60 and the increased QRS duration in middle age is an independent predictor of major cardiovascular events.
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Affiliation(s)
- Xiaojing Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. .,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Kenneth Caidahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska Universtity Hospital, Stockholm, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
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Tokavanich N, Prasitlumkum N, Mongkonsritragoon W, Cheungpasitporn W, Thongprayoon C, Vallabhajosyula S, Chokesuwattanaskul R. A network meta-analysis and systematic review of change in QRS duration after left bundle branch pacing, His bundle pacing, biventricular pacing, or right ventricular pacing in patients requiring permanent pacemaker. Sci Rep 2021; 11:12200. [PMID: 34108548 PMCID: PMC8190182 DOI: 10.1038/s41598-021-91610-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/28/2021] [Indexed: 12/20/2022] Open
Abstract
Cardiac dyssynchrony is the proposed mechanism for pacemaker-induced cardiomyopathy, which can be prevented by biventricular pacing. Left bundle branch pacing and His bundle pacing are novel interventions that imitate the natural conduction of the heart with, theoretically, less interventricular dyssynchrony. One of the surrogate markers of interventricular synchrony is QRS duration. Our study aimed to compare the change of QRS duration before and after implantation between types of cardiac implantable electronic devices (CIEDs): left bundle branch pacing versus His bundle pacing versus biventricular pacing and conventional right ventricular pacing. A literature search for studies that reported an interval change of QRS duration after CIED implantation was conducted utilizing the MEDLINE, EMBASE, and Cochrane databases. All relevant works from database inception through November 2020 were included in this analysis. A random-effects model, Bayesian network meta-analysis was used to analyze QRS duration changes (eg, electrical cardiac synchronization) across different CIED implantations. The mean study sample size, from 14 included studies, was 185 subjects. The search found 707 articles. After exclusions, 14 articles remained with 2,054 patients. The His bundle pacing intervention resulted in the most dramatic decline in QRS duration (mean difference, - 53 ms; 95% CI - 67, - 39), followed by left bundle branch pacing (mean difference, - 46 ms; 95% CI - 60, - 33), and biventricular pacing (mean difference, - 19 ms; 95% CI - 37, - 1.8), when compared to conventional right ventricle apical pacing. When compared between LBBP and HBP, showed no statistically significant wider QRS duration in LBBP with mean different 6.5 ms. (95% CI - 6.7, 21). Our network meta-analysis found that physiologic pacing has the greatest effect on QRS duration after implantation. Thus, HBP and LBBP showed no significant difference between QRS duration after implantation. Physiologic pacing interventions result in improved electrocardiography markers of cardiac synchrony, narrower QRS duration, and might lower electromechanical dyssynchrony.
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Affiliation(s)
- Nithi Tokavanich
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, CA, USA
| | - Wimwipa Mongkonsritragoon
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | | | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ronpichai Chokesuwattanaskul
- Division of Cardiovascular Medicine, Department of Medicine, Cardiac Center, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
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Structural heart disease, not the right ventricular pacing site, determines the QRS duration during right ventricular pacing. Heart Vessels 2021; 36:1870-1878. [PMID: 34047815 DOI: 10.1007/s00380-021-01881-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
Right ventricular (RV) pacing causes changes in the heart's electrical and mechanical activation patterns. The QRS duration is a useful surrogate marker of electrical dyssynchrony; a longer QRS duration during RV pacing indicates poor prognosis. However, the mechanisms underlying a longer QRS duration during RV pacing remain unclear; hence, we investigated factors predicting QRS prolongation during RV pacing. We enrolled 211 patients who underwent catheter ablation for supraventricular tachyarrhythmia and showed no bundle branch block. Three-dimensional mapping for the QRS duration during RV pacing from the RV outflow to RV apex was performed, and differences in the QRS duration were analyzed. The predisposing factors causing QRS > 160 ms during RV apical pacing were also analyzed. The QRS durations at baseline and during RV pacing from the RV outflow and at the RV apex were 85.0 ± 7.5 ms, 163.7 ± 17.1 ms, and 156.2 ± 16.1 ms, respectively. With respect to the QRS duration, there was a significant correlation between RV outflow and RV apical pacing (r = 0.658, p < 0.001). Difference in the QRS duration between the RV outflow and RV apex in each patient was only 12.5 ± 10.4 ms. Logistic multivariable regression analysis identified baseline QRS duration [odds ratio (OR) 1.24, 95% confidence interval (CI) 1.15-1.33, p < 0.01], interventricular septum thickness (OR 1.20, 95% CI 1.02-1.40, p = 0.025), left atrial diameter (OR 1.08, 95% CI 1.01-1.16, p = 0.024), and E/e' (OR 1.23, 95% CI 1.12-1.35, p < 0.01) as significant predictors of QRS prolongation during RV apical pacing. The QRS duration during RV pacing largely depends not on the pacing site, but on the underlying structural heart diseases.
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Hua T, Vlahos A, Shariat MH, Payne D, Redfearn D. Predicting adverse cardiovascular outcomes in post-coronary artery bypass grafting patients using novel ECG frequency analysis of the QRS complex. Ann Noninvasive Electrocardiol 2021; 26:e12822. [PMID: 33754404 PMCID: PMC8293601 DOI: 10.1111/anec.12822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background A novel metric called Layered Symbolic Decomposition frequency (LSDf) has been shown to be an independent predictor of ventricular arrhythmia and mortality in patients receiving implantable cardioverter‐defibrillator (ICD) devices. This novel index studies the fragmentation of the QRS complex. However, its generalizability to predict cardiovascular events for other cardiac procedures is unknown. Herein, we investigated the applicability of LSDf as a predictive measure for major adverse cardiovascular events (MACE) in patients receiving coronary artery bypass grafting (CABG). Methods and Results One hundred ninety‐five patients had high‐resolution ECG recorded prior to CABG surgery in 2012/2013 and were followed for a mean duration of 7.32 ± 0.32 years for postoperative cardiovascular outcomes. These outcomes were described as a modified composite of MACE defined as hospitalization for heart failure, ventricular tachycardia, ventricular fibrillation, and cardiovascular death including stroke and cardiac arrest. One hundred seventy‐two patients were included for analysis and 18 patients experienced a postoperative cardiovascular outcome. These patients had significantly increased age (71.3 vs. 64.6 years, p = .007), prolonged QRS duration (113.22 vs. 97.35 ms, p = .003), reduced left ventricular ejection fraction (42.7% vs. 56.5%, p < .001), and lower LSDf percent (13.5% vs. 16.9%, p = .002). Patients with an LSDf below 13.25% were 4.8 (OR 1.7–13.5, p < .001) times more likely to experience a MACE and up to 19.4 (OR 4.2–90.3, p < .001) times more likely to experience a MACE when older than 70 years and an ejection fraction below 50%. Conclusion Layered Symbolic Decomposition frequency may be an applicable metric to predict long‐term cardiovascular outcomes in patients with ischemic heart disease.
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Affiliation(s)
- Thalia Hua
- Queen's University, Kingston, ON, Canada
| | | | | | - Darrin Payne
- Queen's University, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Damian Redfearn
- Queen's University, Kingston, ON, Canada.,Kingston Health Sciences Centre, Kingston, ON, Canada
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Chyou JY, Tay WT, Anand IS, Teng THK, Yap JJL, MacDonald MR, Chopra V, Loh SY, Shimizu W, Abidin IZ, Richards AM, Butler J, Lam CSP. Electroanatomic Ratios and Mortality in Patients With Heart Failure: Insights from the ASIAN-HF Registry. J Am Heart Assoc 2021; 10:e017932. [PMID: 33719492 PMCID: PMC8174226 DOI: 10.1161/jaha.120.017932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background QRS duration (QRSd) is a marker of electrical remodeling in heart failure. Anthropometrics and left ventricular size may influence QRSd and, in turn, may influence the association between QRSd and heart failure outcomes. Methods and Results Using the prospective, multicenter, multinational ASIAN‐HF (Asian Sudden Cardiac Death in Heart Failure) registry, this study evaluated whether electroanatomic ratios (QRSd indexed for height or left ventricular end‐diastole volume) are associated with 1‐year mortality in individuals with heart failure with reduced ejection fraction. The study included 4899 individuals (aged 60±19 years, 78% male, mean left ventricular ejection fraction: 27.3±7.1%). In the overall cohort, QRSd was not associated with all‐cause mortality (hazard ratio [HR], 1.003; 95% CI, 0.999–1.006, P=0.142) or sudden cardiac death (HR, 1.006; 95% CI, 1.000–1.013, P=0.059). QRS/height was associated with all‐cause mortality (HR, 1.165; 95% CI, 1.046–1.296, P=0.005 with interaction by sex pinteraction=0.020) and sudden cardiac death (HR, 1.270; 95% CI, 1.021–1.580, P=0.032). QRS/left ventricular end‐diastole volume was associated with all‐cause mortality (HR, 1.22; 95% CI, 1.05–1.43, P=0.011) and sudden cardiac death (HR, 1.461; 95% CI, 1.090–1.957, P=0.011) in patients with nonischemic cardiomyopathy but not in patients with ischemic cardiomyopathy (all‐cause mortality: HR, 0.94; 95% CI, 0.79–1.11, P=0.467; sudden cardiac death: HR, 0.734; 95% CI, 0.477–1.132, P=0.162). Conclusions Electroanatomic ratios of QRSd indexed for body size or left ventricular size are associated with mortality in individuals with heart failure with reduced ejection fraction. In particular, increased QRS/height may be a marker of high risk in individuals with heart failure with reduced ejection fraction, and QRS/left ventricular end‐diastole volume may further risk stratify individuals with nonischemic heart failure with reduced ejection fraction. Registration URL: https://Clinicaltrials.gov. Unique identifier: NCT01633398.
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Affiliation(s)
- Janice Y Chyou
- Division of Cardiology Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System New York NY
| | - Wan Ting Tay
- National Heart Centre Singapore Singapore Singapore
| | - Inder S Anand
- Department of Medicine University of Minnesota Medical School and VA Medical Center Minneapolis MN
| | | | | | | | - Vijay Chopra
- Heart Institute Medanta-The Medicity Gurugram India
| | - Seet Yoong Loh
- Department of Cardiology Tan Tock Seng Hospital Singapore Singapore
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical School Tokyo Japan
| | | | | | - Arthur Mark Richards
- Cardiovascular Research InstituteNational University of Singapore Singapore Singapore
| | - Javed Butler
- Department of Medicine University of Mississippi Medical Center Jackson MI
| | - Carolyn S P Lam
- National Heart Centre SingaporeDuke-NUS Medical School Singapore Singapore
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Leiter RE, Santus E, Jin Z, Lee KC, Yusufov M, Chien I, Ramaswamy A, Moseley ET, Qian Y, Schrag D, Lindvall C. Deep Natural Language Processing to Identify Symptom Documentation in Clinical Notes for Patients With Heart Failure Undergoing Cardiac Resynchronization Therapy. J Pain Symptom Manage 2020; 60:948-958.e3. [PMID: 32585181 DOI: 10.1016/j.jpainsymman.2020.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 11/26/2022]
Abstract
CONTEXT Clinicians lack reliable methods to predict which patients with congestive heart failure (CHF) will benefit from cardiac resynchronization therapy (CRT). Symptom burden may help to predict response, but this information is buried in free-text clinical notes. Natural language processing (NLP) may identify symptoms recorded in the electronic health record and thereby enable this information to inform clinical decisions about the appropriateness of CRT. OBJECTIVES To develop, train, and test a deep NLP model that identifies documented symptoms in patients with CHF receiving CRT. METHODS We identified a random sample of clinical notes from a cohort of patients with CHF who later received CRT. Investigators labeled documented symptoms as present, absent, and context dependent (pathologic depending on the clinical situation). The algorithm was trained on 80% and fine-tuned parameters on 10% of the notes. We tested the model on the remaining 10%. We compared the model's performance to investigators' annotations using accuracy, precision (positive predictive value), recall (sensitivity), and F1 score (a combined measure of precision and recall). RESULTS Investigators annotated 154 notes (352,157 words) and identified 1340 present, 1300 absent, and 221 context-dependent symptoms. In the test set of 15 notes (35,467 words), the model's accuracy was 99.4% and recall was 66.8%. Precision was 77.6%, and overall F1 score was 71.8. F1 scores for present (70.8) and absent (74.7) symptoms were higher than that for context-dependent symptoms (48.3). CONCLUSION A deep NLP algorithm can be trained to capture symptoms in patients with CHF who received CRT with promising precision and recall.
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Affiliation(s)
- Richard E Leiter
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Enrico Santus
- Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Zhijing Jin
- Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Katherine C Lee
- Department of Surgery, University of California San Diego Health, San Diego, California, USA
| | - Miryam Yusufov
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Isabel Chien
- Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Ashwin Ramaswamy
- Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Edward T Moseley
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Yujie Qian
- Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Deborah Schrag
- Harvard Medical School, Boston, Massachusetts, USA; Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Harvard Medical School, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Stone E, Zhou Y, Jelinek H, Mclachlan CS. Baseline Framingham risk score does not predict future ECG-derived QRS duration over an average of 3.3 years. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2020. [DOI: 10.1186/s42444-020-00024-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Prolonged electrocardiogram (ECG) QRS duration has been associated with increased cardiovascular risk. It is unclear whether the main predictor of cardiovascular risk, the Framingham risk score also predicts short-term changes in ECG QRS duration. Our aim is to determine whether baseline Framingham risk score is associated with baseline or changes in QRS duration.
Methods
A retrospective cross-sectional analysis was performed using observational data obtained from two hundred two participants. Framingham risk score was calculated using an online risk calculator. QRS duration was obtained using a 10 s trace from a Welch Allyn PC-based 12-lead ECG system.
Results
Average follow-up duration was 3.3 ± 1.1 years. Mean QRS change was 1.8 ± 11.4 ms. Specifically, among two hundred two participants, there are 104 subjects with a greater QRS duration at follow-up, while 98 subjects had the same or a shorter follow-up QRS duration. Baseline Framingham risk score did not significantly predict an increase in QRSd with an odds ratio of 1.04 (P = 0.230). Regression analysis of QRS duration at baseline and Framingham risk at baseline had a weak association (R2 = 0.020; P = 0.043). The Framingham risk score at follow-up was likewise has a weak association with follow-up QRS duration (R2 = 0.045; P = 0.002).
Conclusions
Our results do not demonstrate a statistically significant association between Framingham risk parameters and future QRS duration changes over longitudinal time. QRS duration had variable changes between baseline and follow-up. This might suggest that a longer period of follow-up is required to document more stable increases in QRS duration associated with ventricular pathology. A larger population study is needed to confirm our observations.
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Prolonged QRS independently predicts long-term all-cause mortality in patients with narrow QRS complex undergoing coronary artery bypass grafting surgery (9-year follow-up results). POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:117-122. [PMID: 33014085 PMCID: PMC7526483 DOI: 10.5114/kitp.2020.99073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/28/2020] [Indexed: 11/17/2022]
Abstract
Aim We investigated the association of intermediate QRS prolongation with the long-term all-cause mortality in coronary artery bypass grafting (CABG) surgery patients with a narrow QRS complex in the preoperative electrocardiography (ECG). Material and methods A total of 221 consecutive patients with narrow QRS (< 120 ms) sinus rhythm who underwent CABG surgery were included in the study. The patients were followed up for 9.2 years postoperatively in terms of mortality outcomes. Results Follow-up data were obtained from 211 (173 men, 38 women) of 221 patients. Death occurred in 57 of them. We examined patients in the two groups according to survival outcomes. In multivariate COX regression analysis EuroSCORE (OR = 1.342, 95% CI: 1.167-1.544, p < 0.001), extent of coronary artery disease (OR = 1.768, 95% CI: 1.034-3.020, p = 0.037), QRS duration (OR = 1.029, 95% CI: 1.002-1.058, p = 0.035) and fasting glucose levels (OR = 0.992, 95% CI: 0.984-0.999, p = 0.029) were independent predictors of all-cause mortality. QRS duration > 89.5 ms determined all-cause mortality with a sensitivity of 73.7% and a specificity of 52% (OR = 2.07) due to ROC analysis. All-cause mortality was significantly higher in patients with preop QRS duration > 90 ms from the first year (c2 = 6.724, p = 0.010). Conclusions In CABG patients with a narrow QRS complex, preoperative intermediate prolonged QRS is an independent predictor of all-cause mortality in long-term follow-up.
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40
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Kristensen SL, Castagno D, Shen L, Jhund PS, Docherty KF, Rørth R, Abraham WT, Desai AS, Dickstein K, Rouleau JL, Zile MR, Swedberg K, Packer M, Solomon SD, Køber L, McMurray JJV. Prevalence and incidence of intra-ventricular conduction delays and outcomes in patients with heart failure and reduced ejection fraction: insights from PARADIGM-HF and ATMOSPHERE. Eur J Heart Fail 2020; 22:2370-2379. [PMID: 32720404 DOI: 10.1002/ejhf.1972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/08/2022] Open
Abstract
AIMS The importance of intra-ventricular conduction delay (IVCD), the incidence of new IVCD and its relationship to outcomes in heart failure and reduced ejection fraction (HFrEF) are not well studied. We addressed these questions in the PARADIGM-HF and ATMOSPHERE trials. METHODS AND RESULTS The risk of the primary composite outcome of cardiovascular death or heart failure hospitalization and all-cause mortality were estimated by use of Cox regression according to baseline QRS duration and morphology in 11 861 patients without an intracardiac device. At baseline, 1789 (15.1%) patients had left bundle branch block (LBBB), 524 (4.4%) right bundle branch block (RBBB), 454 (3.8%) non-specific IVCD, 2588 (21.8%) 'mildly abnormal' QRS (110-129 ms) and 6506 (54.9%) QRS <110 ms. During a median follow-up of 2.5 years, the risk of the primary composite endpoint was higher among those with a wide QRS, irrespective of morphology: hazard ratios (95% confidence interval) LBBB 1.36 (1.23-1.50), RBBB 1.54 (1.31-1.79), non-specific IVCD 1.65 (1.40-1.94) and QRS 110-129 ms 1.35 (1.23-1.47), compared with QRS duration <110 ms. A total of 1234 (15.6%) patients developed new-onset QRS widening ≥130 ms (6.1 per 100 patient-years). Incident LBBB occurred in 495 (6.3%) patients (2.4 per 100 patient-years) and was associated with a higher risk of the primary composite outcome [hazard ratio 1.42 (1.12-1.82)]. CONCLUSION In patients with HFrEF, a wide QRS was associated with worse clinical outcomes irrespective of morphology. The annual incidence of new-onset LBBB was around 2.5%, and associated with a higher risk of adverse outcomes, highlighting the importance of repeat electrocardiogram review. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT0083658 (ATMOSPHERE) and NCT01035255 (PARADIGM-HF).
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Affiliation(s)
- Søren Lund Kristensen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Davide Castagno
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Li Shen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Rasmus Rørth
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - William T Abraham
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Ohio State University, Columbus, OH, USA
| | - Akshay S Desai
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA, USA
| | - Kenneth Dickstein
- Stavanger University Hospital, Stavanger, and the Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Jean L Rouleau
- Institut de Cardiologie, Université de Montréal, Montréal, Canada
| | - Michael R Zile
- Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, SC, USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA and National Heart and Lung Institute, Imperial College, London
| | - Scott D Solomon
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA, USA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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Soylu K, Cerik IB, Aksan G, Nar G, Meric M. Evaluation of ivabradine in left ventricular dyssynchrony and reverse remodeling in patients with chronic heart failure. J Arrhythm 2020; 36:762-767. [PMID: 32782651 PMCID: PMC7411195 DOI: 10.1002/joa3.12398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/13/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Ivabradine is a pharmacological agent used in patients with heart failure and sinus rhythm. Its only known pharmacological effect is to slow the heart rate. In this study, we investigated the impact of ivabradine on dyssynchrony parameters in heart failure patients. METHODS In this study, we assigned 55 patients taking medication for heart failure to receive ivabradine in addition (Group I). Twenty healthy volunteers comprised Group II. Echocardiographic measurements (dyssynchrony, left ventricular volumes and left ventricular ejection fraction) were taken at baseline, 1 month, and 3 months. RESULTS A total of 32 heart failure patients in Group I completed the study. There was significant improvement in dyssynchrony parameters after ivabradine treatment in Group I. Interventricular dyssynchrony (IVD) decreased from 42.0 ± 24.4 milliseconds at baseline to 33.6 ± 20.7 milliseconds at 1 month (P = .001) and to 30.7 ± 19.4 milliseconds at 3 months (P < .001). Septal to posterior wall motion delay decreased from 90.3 ± 21.4 milliseconds to 83.9 ± 26.9 milliseconds (P = .011) at 1 month and to 81.5 ± 27.3 milliseconds at 3 months (P = .001). Septal to lateral Ts delay (Ts-SL) decreased from 42.7 ± 24.5 milliseconds to 35.8 ± 22.6 milliseconds at 1 month (P < .001) and to 34.8 ± 22.4 milliseconds at 3 months (P = .002). Left ventricular end-systolic volume (LVESV) decreased from 139.4 ± 42.2 mL to 135.3 ± 39.6 mL at 1 month (P = .006) and to 123.3 ± 39.5 mL at 3 months (P < .001). CONCLUSION The addition of ivabradine to heart failure treatment improves cardiac dyssynchrony parameters in chronic systolic heart failure patients with sinus rhythm.
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Affiliation(s)
- Korhan Soylu
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
| | - Idris Bugra Cerik
- Department of CardiologyFaculty of MedicineCumhuriyet UniversitySivasTurkey
| | - Gokhan Aksan
- Department of CardiologySamsun Education and Research HospitalSamsunTurkey
| | - Gokay Nar
- Department of CardiologyFaculty of MedicinePamukkale UniversityDenizliTurkey
| | - Murat Meric
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
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Held EP, Reinier K, Uy-Evanado A, Nakamura K, Chugh HS, Jui J, Chugh SS. Remodeling of the 12-lead electrocardiogram in immediate survivors of sudden cardiac arrest. Resuscitation 2020; 153:169-175. [PMID: 32574652 DOI: 10.1016/j.resuscitation.2020.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The ECG is a critical diagnostic tool for the management of immediate sudden cardiac arrest (SCA) survivors, but can be altered as a consequence of the SCA event. A limited number of studies report that electrical remodeling post SCA is due to prolonged myocardial repolarization, but a better understanding of this phenomenon is needed. AIM To identify specific ECG abnormalities that follow SCA in immediate survivors. METHODS SCA survivors with a pre-arrest ECG and an ECG obtained within 48 h post-SCA were prospectively collected in the Oregon Sudden Unexpected Death Study (Portland metro region) from 2002-2015. Ventricular depolarization and repolarization measurements were compared between pre-arrest and post-arrest ECGs using paired t-tests and assessed for association with survival using unpaired t-tests and Pearson's chi-square tests. RESULTS A pre-arrest ECG and post-arrest ECG were available for 297 SCA cases (67.8 ± 13.4 years; 65.3% male). From the pre- to post-arrest setting, there was a significant mean increase in QRS (21 ms, p < 0.001) and QTc (35 ms, p < 0.001) in each SCA case, while there was no significant change in the JTc (4 ms, p = 0.361). Post-arrest QRS duration was significantly shorter in cases who survived to hospital discharge compared with those who did not survive (mean QRSD 115 ± 29 ms vs 127 ± 34 ms; p = 0.006). CONCLUSIONS Contrary to expectations, electrical remodeling of the ECG due to SCA occurs due to prolongation of ventricular depolarization (QRSD), and not repolarization (JTc). Prolonged QRSD may also assist with prognostication and warrants further evaluation.
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Affiliation(s)
- Elizabeth P Held
- Center for Cardiac Arrest Prevention, Cedars-Sinai Smidt Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd., Los Angeles, CA 90048, US
| | - Kyndaron Reinier
- Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, US
| | - Audrey Uy-Evanado
- Center for Cardiac Arrest Prevention, Cedars-Sinai Smidt Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd., Los Angeles, CA 90048, US
| | - Kotoka Nakamura
- Center for Cardiac Arrest Prevention, Cedars-Sinai Smidt Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd., Los Angeles, CA 90048, US
| | - Harpriya S Chugh
- Center for Cardiac Arrest Prevention, Cedars-Sinai Smidt Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd., Los Angeles, CA 90048, US
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, US
| | - Sumeet S Chugh
- Center for Cardiac Arrest Prevention, Cedars-Sinai Smidt Heart Institute, Advanced Health Sciences Pavilion, 127 S. San Vicente Blvd., Los Angeles, CA 90048, US.
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Lucero CM, Andrade DC, Toledo C, Díaz HS, Pereyra KV, Diaz-Jara E, Schwarz KG, Marcus NJ, Retamal MA, Quintanilla RA, Del Rio R. Cardiac remodeling and arrhythmogenesis are ameliorated by administration of Cx43 mimetic peptide Gap27 in heart failure rats. Sci Rep 2020; 10:6878. [PMID: 32327677 PMCID: PMC7181683 DOI: 10.1038/s41598-020-63336-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Abstract
Alterations in connexins and specifically in 43 isoform (Cx43) in the heart have been associated with a high incidence of arrhythmogenesis and sudden death in several cardiac diseases. We propose to determine salutary effect of Cx43 mimetic peptide Gap27 in the progression of heart failure. High-output heart failure was induced by volume overload using the arterio-venous fistula model (AV-Shunt) in adult male rats. Four weeks after AV-Shunt surgery, the Cx43 mimetic peptide Gap27 or scrambled peptide, were administered via osmotic minipumps (AV-ShuntGap27 or AV-ShuntScr) for 4 weeks. Cardiac volumes, arrhythmias, function and remodeling were determined at 8 weeks after AV-Shunt surgeries. At 8th week, AV-ShuntGap27 showed a marked decrease in the progression of cardiac deterioration and showed a significant improvement in cardiac functions measured by intraventricular pressure-volume loops. Furthermore, AV-ShuntGap27 showed less cardiac arrhythmogenesis and cardiac hypertrophy index compared to AV-ShuntScr. Gap27 treatment results in no change Cx43 expression in the heart of AV-Shunt rats. Our results strongly suggest that Cx43 play a pivotal role in the progression of cardiac dysfunction and arrhythmogenesis in high-output heart failure; furthermore, support the use of Cx43 mimetic peptide Gap27 as an effective therapeutic tool to reduce the progression of cardiac dysfunction in high-output heart failure.
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Affiliation(s)
- Claudia M Lucero
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.,Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - David C Andrade
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.,Centro de Investigación en Fisiología del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - Camilo Toledo
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hugo S Díaz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katherin V Pereyra
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Esteban Diaz-Jara
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karla G Schwarz
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Noah J Marcus
- Department of Physiology and Pharmacology, Des Moines University, Des Moines, IA, USA
| | - Mauricio A Retamal
- Universidad del Desarrollo, Centro de Fisiología Celular e Integrativa, Clínica Alemana Facultad de Medicina, Santiago, Chile
| | | | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Envejecimiento y Regeneración (CARE-UC), Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centro de Excelencia de Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile.
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Chubb H, Rosenthal DN, Almond CS, Ceresnak SR, Motonaga KS, Arunamata AA, Long J, Trela AV, Hanisch D, McElhinney DB, Dubin AM. Impact of Cardiac Resynchronization Therapy on Heart Transplant-Free Survival in Pediatric and Congenital Heart Disease Patients. Circ Arrhythm Electrophysiol 2020; 13:e007925. [PMID: 32202126 DOI: 10.1161/circep.119.007925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) studies in pediatric or congenital heart disease patients have shown an improvement in ejection fraction and heart failure symptoms. However, a survival benefit of CRT in this population has not been established. This study aimed to evaluate the impact of CRT upon heart transplant-free survival in pediatric and congenital heart disease patients, using a propensity score-matched (PSM) analysis. METHODS This single-center study compared CRT patients (implant date, 2004-2017) and controls, matched by 1:1 PSM using 21 comprehensive baseline indices for risk stratification. CRT patients were <21 years of age or had congenital heart disease, had systemic ventricular ejection fraction <45%, symptomatic heart failure, and had significant electrical dyssynchrony, all before CRT implant. Controls were screened from nonselective imaging and ECG databases. Controls were retrospectively enrolled when they achieved the same inclusion criteria at an outpatient clinical encounter, within the same time period. RESULTS Of 133 patients who received CRT during the study period, 84 met all study inclusion criteria. One hundred thirty-three controls met all criteria at an outpatient encounter. Following PSM, 63 matched CRT-control pairs were identified with no significant difference between groups across all baseline indices. Heart transplant or death occurred in 12 (19%) PSM-CRT subjects and 37 (59%) PSM-controls with a median follow-up of 2.7 years (quartiles, 0.8-6.1 years). CRT was associated with markedly reduced risk of heart transplant or death (hazard ratio, 0.24 [95% CI, 0.12-0.46]; P<0.001). There was no CRT procedural mortality and 1 system infection at 54 months post-implant. CONCLUSIONS In pediatric and congenital heart disease patients with symptomatic systolic heart failure and electrical dyssynchrony, CRT was associated with improved heart transplant-free survival. Visual Overview: A visual overview is available for this article.
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Affiliation(s)
- Henry Chubb
- Division of Pediatric Cardiology, Department of Pediatrics (H.C., D.N.R., C.S.A., S.R.C., K.S.M., A.A.A., J.L., D.B.M., A.M.D.), Stanford University, CA.,Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery (H.C., D.B.M.), Stanford University, CA
| | - David N Rosenthal
- Division of Pediatric Cardiology, Department of Pediatrics (H.C., D.N.R., C.S.A., S.R.C., K.S.M., A.A.A., J.L., D.B.M., A.M.D.), Stanford University, CA
| | - Christopher S Almond
- Division of Pediatric Cardiology, Department of Pediatrics (H.C., D.N.R., C.S.A., S.R.C., K.S.M., A.A.A., J.L., D.B.M., A.M.D.), Stanford University, CA
| | - Scott R Ceresnak
- Division of Pediatric Cardiology, Department of Pediatrics (H.C., D.N.R., C.S.A., S.R.C., K.S.M., A.A.A., J.L., D.B.M., A.M.D.), Stanford University, CA
| | - Kara S Motonaga
- Division of Pediatric Cardiology, Department of Pediatrics (H.C., D.N.R., C.S.A., S.R.C., K.S.M., A.A.A., J.L., D.B.M., A.M.D.), Stanford University, CA
| | - Alisa A Arunamata
- Division of Pediatric Cardiology, Department of Pediatrics (H.C., D.N.R., C.S.A., S.R.C., K.S.M., A.A.A., J.L., D.B.M., A.M.D.), Stanford University, CA
| | - Jin Long
- Division of Pediatric Cardiology, Department of Pediatrics (H.C., D.N.R., C.S.A., S.R.C., K.S.M., A.A.A., J.L., D.B.M., A.M.D.), Stanford University, CA
| | - Anthony V Trela
- Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford, Palo Alto, CA (A.V.T., D.H.)
| | - Debra Hanisch
- Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford, Palo Alto, CA (A.V.T., D.H.)
| | - Doff B McElhinney
- Division of Pediatric Cardiology, Department of Pediatrics (H.C., D.N.R., C.S.A., S.R.C., K.S.M., A.A.A., J.L., D.B.M., A.M.D.), Stanford University, CA.,Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery (H.C., D.B.M.), Stanford University, CA
| | - Anne M Dubin
- Division of Pediatric Cardiology, Department of Pediatrics (H.C., D.N.R., C.S.A., S.R.C., K.S.M., A.A.A., J.L., D.B.M., A.M.D.), Stanford University, CA
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Association of patient-reported outcomes and heart rate trends in heart failure: a report from the Chiron project. Sci Rep 2020; 10:576. [PMID: 31953477 PMCID: PMC6969136 DOI: 10.1038/s41598-019-57239-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 12/27/2019] [Indexed: 02/07/2023] Open
Abstract
Patient-reported outcomes (PROs) have been previously considered "soft" end-points because of the lack of association of the reported outcome to measurable biological parameters. The present study aimed to assess whether electrocardiographic measures are associated to PROs changes. We evaluated the association between heart rate (HR), QRS and QT/QTc durations and PROs, classified as "good" or "bad" according to the patients' overall feeling of health, in patients from the Chiron project. Twenty-four chronic heart failure (HF) patients were enrolled in the study (71% male, mean age 62.9 ± 9.4 years, 42% ischemic etiology, 15 NYHA class II and 9 class III) providing 1086 days of usable physiological recordings (4 hours/day). The mean HR was significantly higher in the "bad" than in the "good" PROs class (74.0 ± 6.4 bpm vs 68.0 ± 7.2 bpm; p < 0.001). Conversely, the ratio between movement and rest activities showed significantly higher values in "good" compared to "bad" PROs. We also found significantly longer QTc and QRS durations in patients with "bad" PROs compared to patients with "good" PROs. That in patients with mild to moderate HF, higher HR, wider QRS and longer QTc, as well as a reduced HR ratio between movement and rest, were associated with "bad" PROs is clinically noteworthy because the association of worse PROs with measurable variations of biological parameters may help physicians in evaluating PROs reliability itself and in their clinical decisions. Whether a timely intervention on these biological parameters may prevent adverse outcomes is important and deserves to be investigated in further studies.
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47
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Singleton MJ, German C, Hari KJ, Saylor G, Herrington DM, Soliman EZ, Freedman BI, Bowden DW, Bhave PD, Yeboah J. QRS duration is associated with all-cause mortality in type 2 diabetes: The diabetes heart study. J Electrocardiol 2020; 58:150-154. [DOI: 10.1016/j.jelectrocard.2019.11.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/09/2019] [Accepted: 11/27/2019] [Indexed: 01/12/2023]
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48
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Pozzi A, Gori M, Iorio A, Iacovoni A, Carobbio A, Cioffi G, De Maria R, Grosu A, Fontana A, Canova PA, Calabrese A, Ferrari P, Parati G, Lorini FL, Senni M, Gavazzi A. Prolonged QRS associated with left bundle branch conduction defect is a prognostic red flag in asymptomatic patients at risk for heart failure (ACCF/AHA stages A and B): Insights from the DAVID-Berg study. Eur J Prev Cardiol 2019; 27:2326-2329. [PMID: 31847560 DOI: 10.1177/2047487319896431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrea Pozzi
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Italy
| | - Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Italy
| | - Annamaria Iorio
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Italy
| | - Attilio Iacovoni
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Italy
| | | | - Giovanni Cioffi
- Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Italy
| | - Renata De Maria
- CNR Institute of Clinical Physiology, CardioThoracic and Vascular Department, Niguarda Ca' Granda Hospital, Italy
| | - Aurelia Grosu
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Italy
| | | | | | - Alice Calabrese
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Italy
| | - Paola Ferrari
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Istituto Auxologico Italiano, IRCCS, Italy.,Department of Health Sciences, University of Milano-Bicocca, Italy
| | | | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Italy
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Kawasaki M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, Kikuchi A, Kawai T, Seo M, Hirota Kida, Sakata Y, Fukunami M. Prognostic value of cardiac metaiodobenzylguanidine imaging and QRS duration in implantable cardioverter defibrillator patients with and without heart failure. Int J Cardiol 2019; 296:164-171. [DOI: 10.1016/j.ijcard.2019.07.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/16/2019] [Accepted: 07/22/2019] [Indexed: 01/08/2023]
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50
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Sugita J, Fujiu K. Emerging Function of Cardiac Macrophages Ushers in a New Era for the Electrophysiology of the Heart. Circ Rep 2019; 1:558-563. [PMID: 33693101 PMCID: PMC7897688 DOI: 10.1253/circrep.cr-19-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Maintaining a coordinated heart rhythm is essential for maintaining the heart’s pumping function and blood circulation. Every heartbeat is generated by electrical impulse propagation that is passing through gap junctions, which are composed of connexin proteins. In mammalian hearts, Cx43, Cx40, Cx45, and Cx30.2 are expressed and regulated by post-translational modification. Cardiac macrophages account for only a small number of total heart cells, but they reside all around the heart. They are primarily established prenatally, and they arise from embryonic yolk sac progenitors. Recently, increasing attention has been directed toward novel roles for cardiac resident macrophages, especially in the heart’s electrical impulse conduction. Here, we provide an overview of the recent findings on connexins, with a focus on the emerging function of cardiac macrophages, and we discuss the future directions of treatment for heart disease.
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Affiliation(s)
- Junichi Sugita
- Department of Cardiovascular Medicine, the University of Tokyo Tokyo Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, the University of Tokyo Tokyo Japan.,Department of Advanced Cardiology, the University of Tokyo Tokyo Japan
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