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Abdelmegid MAKF, Bakr MM, Shams-Eddin H, Youssef AA, Abdel-Galeel A. Effect of reperfusion strategy on QT dispersion in patients with acute myocardial infarction: Impact on in-hospital arrhythmia. World J Cardiol 2023; 15:106-115. [PMID: 37033680 PMCID: PMC10074997 DOI: 10.4330/wjc.v15.i3.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Myocardial ischemia and ST-elevation myocardial infarction (STEMI) increase QT dispersion (QTD) and corrected QT dispersion (QTcD), and are also associated with ventricular arrhythmia. AIM To evaluate the effects of reperfusion strategy [primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy] on QTD and QTcD in STEMI patients and assess the impact of the chosen strategy on the occurrence of in-hospital arrhythmia. METHODS This prospective, observational, multicenter study included 240 patients admitted with STEMI who were treated with either PPCI (group I) or fibrinolytic therapy (group II). QTD and QTcD were measured on admission and 24 hr after reperfusion, and patients were observed to detect in-hospital arrhythmia. RESULTS There were significant reductions in QTD and QTcD from admission to 24 hr in both group I and group II patients. QTD and QTcD were found to be shorter in group I patients at 24 hr than those in group II (53 ± 19 msec vs 60 ± 18 msec, P = 0.005 and 60 ± 21 msec vs 69+22 msec, P = 0.003, respectively). The occurrence of in-hospital arrhythmia was significantly more frequent in group II than in group I (25 patients, 20.8% vs 8 patients, 6.7%, P = 0.001). Furthermore, QTD and QTcD were higher in patients with in-hospital arrhythmia than those without (P = 0.001 and P = 0.02, respectively). CONCLUSION In STEMI patients, PPCI and fibrinolytic therapy effectively reduced QTD and QTcD, with a higher observed reduction using PPCI. PPCI was associated with a lower incidence of in-hospital arrhythmia than fibrinolytic therapy. In addition, QTD and QTcD were shorter in patients not experiencing in-hospital arrhythmia than those with arrhythmia.
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Affiliation(s)
- Mohamed Aboel-Kassem F Abdelmegid
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
- Department of Cardiology, Sohag Heart and GIT Center, Sohag 85264, Egypt
| | - Mohamed M Bakr
- Department of Cardiology, Assiut Police Hospital, Assiut 71526, Egypt
| | - Hamdy Shams-Eddin
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
| | - Amr A Youssef
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
| | - Ahmed Abdel-Galeel
- Department of Cardiovascular Medicine, Assiut University Heart Hospital, Assiut University, Assiut 71526, Egypt
- Department of Cardiology, Qena General Hospital, Qena 92354, Egypt.
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Impact of cardiac rehabilitation on ventricular repolarization indices following coronary artery bypass grafting. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:143-149. [PMID: 34104507 PMCID: PMC8167467 DOI: 10.5606/tgkdc.dergisi.2021.20736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/01/2020] [Indexed: 11/21/2022]
Abstract
Background
The aim of this study was to evaluate the effect of cardiac rehabilitation on electrocardiographic changes in patients undergoing isolated coronary artery bypass grafting.
Methods
Between January 2016 and July 2019, a total of 625 patients (485 males, 140 females; mean age: 59.6 years; range, 50.6 to 68.6 years) who underwent isolated coronary artery bypass grafting and survived were retrospectively analyzed. The patients were divided into two groups according to the participation in the cardiac rehabilitation program as follows: the Rehab(+) group (n=363) and the Rehab(-) group (n=262). Electrocardiographic parameters of both groups were compared.
Results
There was a significant decrease in the electrocardiographic findings of heart rate (p<0.001), QTc (p<0.001), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001) in the Rehab(+) group before and after surgery. There was a significant decrease in the Rehab(+) group, compared to the Rehab(-) group, in terms of parameters of QT interval (p=0.001), QTc (p=0.017), Tpe duration (p<0.001), Tpe/QT ratio (p<0.001), and Tpe/QTc ratio (p<0.001).
Conclusion
Cardiac rehabilitation program after coronary artery bypass grafting decreases ventricular repolarization indices of electrocardiography. Based on these changes, postoperative cardiac rehabilitation program may reduce the risk of ventricular arrhythmia and sudden cardiac death during follow-up.
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Okayasu H, Shinozaki T, Takano Y, Sugawara N, Fujii K, Yasui-Furukori N, Ozeki Y, Shimoda K. Effects of Antipsychotics on Arrhythmogenic Parameters in Schizophrenia Patients: Beyond Corrected QT Interval. Neuropsychiatr Dis Treat 2021; 17:239-249. [PMID: 33542628 PMCID: PMC7851579 DOI: 10.2147/ndt.s287042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Antipsychotic drugs have been implicated as risk factors for QT prolongation, which is a predictor of sudden cardiac death. However, the QT interval is considered an imperfect marker for proarrhythmic risk. Recently, improved methods, namely, QT dispersion (QTD), QTD ratio (QTDR), T wave peak-to-end interval (Tp-e), Tp-e/QT ratio and Tp-e/QTc ratio, have been regarded as proarrhythmic risk markers. We attempted to reevaluate the risk of sudden cardiac death due to antipsychotics use by measuring these improved evaluation methods. PATIENTS AND METHODS We retrospectively evaluated QTc, QTD, QTDR, Tp-e, Tp-e/QT ratio and Tp-e/QTc ratio from the medical records of 410 patients with schizophrenia diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, or 5th Edition. Information on drugs administered was obtained from medical records. We investigated the correlation between each index on ECG and medication, such as antipsychotics, prescribed to participants with linear regression analysis. We also compared each index between 235 healthy controls and 235 patients matched for age and sex. RESULTS Positive correlations between QTc and levomepromazine and brexpiprazole were identified. Levomepromazine and lithium were positively correlated with QTD. Levomepromazine, quetiapine, asenapine, clozapine and carbamazepine were positively correlated with QTDR. Levomepromazine, olanzapine, brexpiprazole and lithium were positively correlated with Tp-e. Olanzapine, brexpiprazole and lithium were positively correlated with the Tp-e/QT ratio. Olanzapine, brexpiprazole and lithium were positively correlated with Tp-e/QTc ratio. Significant differences in all indexes were noted between the patients and healthy controls. CONCLUSION According to our results, the prediction of the risk of sudden cardiac death by each index was inconsistent. We should evaluate the predictive factor of ventricular arrhythmia according to various electrocardiogram indexes because QTc alone could not identify the risk of sudden cardiac death.
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Affiliation(s)
- Hiroaki Okayasu
- Department of Psychiatry, Dokkyo Medical University, Tochigi, Japan
| | | | - Yumiko Takano
- Department of Psychiatry, Dokkyo Medical University, Tochigi, Japan
| | - Norio Sugawara
- Department of Psychiatry, Dokkyo Medical University, Tochigi, Japan
| | - Kumiko Fujii
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | | | - Yuji Ozeki
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University, Tochigi, Japan
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Şahin AA, Yildirim C, Dogan Z, Demir AR, Panc C, Yalcin AA, Kalkan AK, Celik O. Evaluation of early electrocardiographic changes after successful percutaneous stent implantation to isolated coarctation of aorta. J Electrocardiol 2020; 63:124-128. [PMID: 33189064 DOI: 10.1016/j.jelectrocard.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coarctation of aorta (CoA) is a congenital obstructive lesion characterized by narrowing of the aorta in which concludes as increase in afterload. Percutaneous stent implantation to CoA is a treatment of choice in older children and adults. Pathology related to CoA mainly caused by increased afterload and left ventricular hypertrophy. Electrocardiographic (ECG) findings are also related to left ventricular hypertrophy (LVH). Evidence shows that, in variety of diseases, the correction of the pathology might normalize ECG findings and ventricular dysfunction related to increase in afterload. Therefore the aim of this study was to compare the pre- and postprocedural ECG findings of the patients who underwent percutaneous intervention for isolated CoA. METHODS After exclusion criterion was applied, 30 patients were included into study, retrospectively. ECG records before the procedure and 3 months after the procedure of the patients were evaluated. The parameters related to LVH, ventricular and atrial conduction were evaluated and compared between pre- and post-procedural ECG records. RESULTS The findings showed that parameters of atrial conduction including P wave maximum duration (p < 0.001) and p wave dispersion (p < 0.001) were significantly decreased after stent implantation. Additionally, ventricular repolarization parameters including QT duration (p = 0.039), Tpe interval (p < 0.001), Tpe / QT (p = 0.038) and Tpe / QTc (p = 0.003) were significantly decreased after stent implantation. Sokolow-Lyon criteria (p < 0.003) and voltage in selected leads were significantly decreased after intervention. CONCLUSION Percutaneous intervention to CoA might regress LVH parameters in ECG and improve atrial and ventricular repolarization in ECG, which might lead to decreased event of atrial and ventricular arrhythmias in patients with isolated CoA.
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Affiliation(s)
- Ahmet Anıl Şahin
- Department Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey; Department of Cardiology, Halic University, School of Medicine, Istanbul, Turkey.
| | - Ceren Yildirim
- Department Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zekeriya Dogan
- Department of Cardiology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ali Rıza Demir
- Department Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cafer Panc
- Department Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Arif Yalcin
- Department Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Kemal Kalkan
- Department Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Omer Celik
- Department Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Kosmopoulos M, Roukoz H, Sebastian P, Kalra R, Goslar T, Bartos JA, Yannopoulos D, Benditt DG. Increased QT Dispersion Is Linked to Worse Outcomes in Patients Hospitalized for Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2020; 9:e016485. [PMID: 32772765 PMCID: PMC7660793 DOI: 10.1161/jaha.120.016485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The incidence and mortality of out-of-hospital cardiac arrest (OHCA) remains high, but predicting outcomes is challenging. Being able to better assess prognosis of hospitalized patients after return of spontaneous circulation would enable improved management of survival expectations. In this study, we assessed the predictive value of ECG indexes in hospitalized patients with OHCA. Methods and Results PR interval and QT interval corrected by the Bazett formula (QTc) for all leads were calculated from standard 12-lead ECGs 24 hours after return of spontaneous circulation in 93 patients who were hospitalized following OHCA. PR interval and QT and QTc duration did not differentiate OHCA survivors and nonsurvivors. However, QT and QTc dispersion was significantly increased in patients who died during hospitalization compared with survivors discharged from the hospital (P<0.01). Logistic regression indicated a strong association between increased QT dispersion and in-hospital mortality (P<0.0001; area under the curve, 0.8918 for QT dispersion and 0.8673 for QTc dispersion). Multinomial logistic regression indicated that the increase of QTc dispersion correlated with worse Cerebral Performance Category scores at discharge (P<0.001; likelihood ratio, 51.42). There was also significant correlation between dispersion measures and serum potassium at the time of measurement and between dispersion measures and cumulative epinephrine administration. No difference existed regarding the number of measurable leads. Conclusions Lesser QT and QTc dispersion at 24 hours after return of spontaneous circulation was significantly associated with survival and neurologic status at discharge. Routine evaluation of QT and QTc dispersion during hospitalization following return of spontaneous circulation might improve outcome prognostication for patients hospitalized for OHCA.
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Affiliation(s)
- Marinos Kosmopoulos
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Henri Roukoz
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Pierre Sebastian
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Rajat Kalra
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Tomaz Goslar
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
- Department of Intensive Internal MedicineUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Jason A. Bartos
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Demetris Yannopoulos
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - David G. Benditt
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMNUSA
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Huang X, Hua N, Tang F, Zhang S. Effectiveness of magnetocardiography to identify patients in need of coronary artery revascularization: a cross-sectional study. Cardiovasc Diagn Ther 2020; 10:831-840. [PMID: 32968638 PMCID: PMC7487377 DOI: 10.21037/cdt-20-121] [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: 01/28/2020] [Accepted: 07/09/2020] [Indexed: 07/25/2023]
Abstract
BACKGROUND Patients with angina-like symptoms need invasive or non-invasive angiography to determine whether revascularization is necessary. For patients in need of revascularization, undergoing coronary computed tomography angiography (CCTA) may delay the treatment of revascularization and increase exposure to contrast agents and radiation. The aim of this cross-sectional study was to accessed the effectiveness of magnetocardiography (MCG) to identify patients who should undergo coronary revascularization. METHODS A total of 203 patients who were suffering from angina-like symptoms and underwent percutaneous coronary angiography (PCA) between July 27, 2015 and April 10, 2017 at the 8th Medical Center of Chinese PLA General Hospital, were enrolled in this cross-sectional study. In all patients, 12-lead electrocardiography (ECG) and MCG test were performed before PCA. For each subject. The value at every single sampling point was extracted from T wave of each MCG channel in time sequence. Pearson's correlation coefficients were calculated for each two T-waves. A binary logistic regression diagnosis model of these coefficients was established to identify patients in need of revascularization. RESULTS Ten pairings of coefficients were entered into diagnostic regression model as covariates. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.747 (95% CI: 0.680-0.815), and the asymptotic P value was less than 0.001. At the cut-off value of 0.55, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72.9%, 65.9%, 74.8%, 63.6% and 69.9%, and the positive and negative post-test probabilities were 65.9% and 25.7%. The accuracy, sensitivity, specificity, PPV and NPV for 12-lead ECG were 67.0%, 62.7%, 63.5%, 70.5% and 55.1%, respectively. However, when those acute myocardial infarction (AMI) patients were ruled out from both groups, the MCG model had an accuracy of 68.2%, a sensitivity of 70.1%, a specificity of 66.3%, a PPV of 68.5% and an NPV of 67.9%. But, the accuracy, sensitivity, specificity, PPV and NPV for 12-lead ECG were 60.0%, 55.2%, 65.1%, 62.3% and 58.1%, respectively. CONCLUSIONS Patients suffering from angina-like symptoms, with a logistic regression model value over 0.55, should be recommended for PCA.
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Affiliation(s)
- Xiao Huang
- Department of Cardiovascular, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ning Hua
- Department of Cardiovascular, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fakuan Tang
- Department of Cardiovascular, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shulin Zhang
- Institute of Microsystem and Information Technology, Chinese Academy of Science, Shanghai, China
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Hansen J, Johnsen J, Nielsen JM, Sørensen CB, Elkjær CC, Jespersen NR, Bøtker HE. Impact of Administration Time and Kv7 Subchannels on the Cardioprotective Efficacy of Kv7 Channel Inhibition. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:2549-2560. [PMID: 32669836 PMCID: PMC7337438 DOI: 10.2147/dddt.s226406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 04/15/2020] [Indexed: 01/12/2023]
Abstract
Purpose The mechanism of cardioprotection by Kv7.1-5 (KCNQ1-5) channels inhibition by XE991 is unclear. We examined the impact of administration time on the cardioprotective efficacy of XE991, the involvement of key pro-survival kinases, and the importance of the Kv7 subchannels. Methods Isolated perfused rat hearts were divided into five groups: 1) vehicle, 2) pre-, 3) post- or 4) pre- and post-ischemic administration of XE991 or 5) chromanol 293B (Kv7.1 inhibitor) followed by infarct size quantification. HL-1 cells undergoing simulated ischemia/reperfusion were exposed to either a) vehicle, b) pre-, c) per-, d) post-ischemic administration of XE991 or pre-, per- and post-ischemic administration of e) XE991, f) Chromanol 293B or g) HMR1556 (Kv7.1 inhibitor). HL-1 cell injury was evaluated by propidium iodide/Hoechst staining. Pro-survival kinase activation of Akt, Erk and STAT3 in XE991-mediated HL-1 cell protection was evaluated using phosphokinase inhibitors. Kv7 subtype expression was examined by RT-PCR and qPCR. Results XE991, but not Chromanol 293B, reduced infarct size and improved hemodynamic recovery in all isolated heart groups. XE991 protected HL-1 cells when administered during simulated ischemia. Minor activation of the survival kinases was observed in cells exposed to XE991 but pharmacological inhibition of kinase activation did not reduce XE991-mediated protection. Kv7 subchannels 1-5 were all present in rat hearts but predominately Kv7.1 and Kv7.4 were present in HL-1 cells and selective Kv7.1 did not reduce ischemia/reperfusion injury. Conclusion The cardioprotective efficacy of XE991 seems to depend on its presence during ischemia and early reperfusion and do not rely on RISK (p-Akt and p-Erk) and SAFE (p-STAT3) pathway activation. The protective effect of XE991 seems mainly mediated through the Kv7.4 subchannel.
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Affiliation(s)
- Jan Hansen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jacob Johnsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Møller Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Brandt Sørensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Casper Carlsen Elkjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nichlas Riise Jespersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Yamanaka E, Chino S, Takasusuki T, Hamaguchi S, Yamaguchi S. Effect of Methadone on Cardiac Repolarization in Japanese Cancer Patients: A Longitudinal Study. Cardiol Ther 2020; 9:119-126. [PMID: 31748937 PMCID: PMC7237557 DOI: 10.1007/s40119-019-00156-4] [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: 09/11/2019] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Methadone is known to prolong the QT interval, which could induce lethal arrhythmias such as torsades de pointes. To determine the risk of ventricular arrhythmias in cancer patients using methadone, we measured QT dispersion (QTD) and Tpeak-Tend (TpTe) before and after methadone administration and evaluated the correlations between methadone dosage and cardiac repolarization. METHODS We conducted a retrospective observational study with 19 patients undergoing follow-up for cancer pain with methadone. Electrocardiogram (ECG) recordings were obtained from the patients at methadone initiation and 1 week, 1 month, and 2 months later. The QT, corrected QT (QTc), QTD, QTc dispersion (QTcD), TpTe, TpTe/QT, and TpTe/QTc were measured manually via ECG records and analyzed using a repeated measures one-way ANOVA. The correlations between these ECG parameters and each methadone dosage were determined using Spearman's rank correlation coefficient. RESULTS The QTD, QTcD, TpTe/QT, and TpTe/QTc remained unchanged, while TpTe was prolonged significantly at 2 months (initiation: 82 ± 17 ms; 2 months: 106 ± 20 ms, p = 0.018). In addition, there was a positive correlation between TpTe and methadone dosage (rs = 0.4, p = 0.041). CONCLUSIONS The findings suggested that small or modest doses of methadone could exert dose-dependent effects on cardiac repolarization in cancer patients. TRIAL REGISTRATION UMIN Clinical Trials Registry, UMIN000034519.
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Affiliation(s)
- Eriko Yamanaka
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
| | - Satoru Chino
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
| | - Toshifumi Takasusuki
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan.
| | - Shinsuke Hamaguchi
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
| | - Shigeki Yamaguchi
- Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan
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Echocardiographic Parameters During and Beyond Onset of Kawasaki Disease Correlate with Onset Serum N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP). Pediatr Cardiol 2020; 41:947-954. [PMID: 32172336 DOI: 10.1007/s00246-020-02340-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/05/2020] [Indexed: 12/17/2022]
Abstract
The N-terminal proBNP (NT-proBNP), produced by cardiomyocytes, has several reported utilities and associations in acute Kawasaki disease (KD). The objective of this study is to examine the relationship between serum values of NT-proBNP at time of KD diagnosis with cardiac systolic, diastolic function and electrocardiographic changes, at onset of the disease and during the first year of follow-up. KD was diagnosed in 127 children between March 2007 and July 2014, mean diagnostic age 3.5 ± 2.9 years. Coronary artery maximum z score was 2.6 ± 2.8 (range - 0.6 to + 18.9), with giant aneurysm in 5/122 (4.1%). Age-adjusted NT-proBNP was 2.6 ± 1.6 z score, 78/122 (63.9%) > 2.0. There was a crescendo correlation between onset NT-proBNP z score and C-Reactive protein (CRP) serum levels (slope + 0.49, p < 0.001). There was a crescendo correlation between NT-proBNP z score and indexed left ventricular (LV) mass (slope + 1.86, p = 0.02), LV diastolic function parameter E/e' ratio (slope + 0.31, p = 0.04) and a decrescendo correlation with age-adjusted LV shortening fraction (SF) (- 0.63, p = 0.02). Lower SF z score, higher left ventricular mass index and E/e' ratio were associated with higher NT-proBNP z score, but without correlation with CRP levels. Within 2-3 months from the onset of the disease, there was a resolution of the systolic dysfunction. Electrocardiographic parameter changes were associated with decreased LV shortening fraction but not with NT-proBNP. KD patients with elevated NT-proBNP at onset have sub-clinical myocardial involvement and might benefit from follow-up and continued evaluation, even in the absence of coronary artery involvement.
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Abe M, Rastelli DD, Gomez AC, Cingolani E, Lee Y, Soni PR, Fishbein MC, Lehman TJA, Shimada K, Crother TR, Chen S, Noval Rivas M, Arditi M. IL-1-dependent electrophysiological changes and cardiac neural remodeling in a mouse model of Kawasaki disease vasculitis. Clin Exp Immunol 2020; 199:303-313. [PMID: 31758701 PMCID: PMC7008220 DOI: 10.1111/cei.13401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 02/06/2023] Open
Abstract
Kawasaki disease (KD) is the leading cause of acquired heart disease in children. In addition to coronary artery abnormalities, aneurysms and myocarditis, acute KD is also associated with echocardiogram (ECG) abnormalities in 40-80% of patients. Here, we show that these ECG changes are recapitulated in the Lactobacillus casei cell wall extract (LCWE)-induced KD vasculitis mouse model. LCWE-injected mice developed elevated heart rate and decreased R wave amplitude, with significant differences in prolonged ventricular repolarization. LCWE-injected mice developed cardiac ganglion inflammation, that may affect the impulse-conducting system in the myocardium. Furthermore, serum nerve growth factor (NGF) was significantly elevated in LCWE-injected mice, similar to children with KD vasculitis, associated with increased neural remodeling of the myocardium. ECG abnormalities were prevented by blocking interleukin (IL)-1 signaling with anakinra, and the increase in serum NGF and cardiac neural remodeling were similarly blocked in Il1r1-/- mice and in wild-type mice treated with anakinra. Thus, similar to clinical KD, the LCWE-induced KD vasculitis mouse model also exhibits electrophysiological abnormalities and cardiac neuronal remodeling, and these changes can be prevented by blocking IL-1 signaling. These data support the acceleration of anti-IL-1 therapy trials to benefit KD patients.
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Affiliation(s)
- M. Abe
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
| | - D. D. Rastelli
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Division of Gastroenterology and NutritionBoston Children’s HospitalBostonMAUSA
| | - A. C. Gomez
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
| | - E. Cingolani
- Cedars‐Sinai Medical CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCAUSA
| | - Y. Lee
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
| | - P. R. Soni
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
| | - M. C. Fishbein
- Department of PathologyDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - T. J. A. Lehman
- Division of RheumatologyDepartment of PediatricsWeill Cornell Medical SchoolNew YorkNYUSA
| | - K. Shimada
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - T. R. Crother
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - S. Chen
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - M. Noval Rivas
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
| | - M. Arditi
- Divisions of Infectious Diseases and ImmunologyDepartments of Biomedical Sciences and PediatricsCedars‐Sinai Medical CenterLos AngelesCAUSA
- Cedars‐Sinai Medical CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCAUSA
- Department of PediatricsDavid Geffen School of MedicineUCLALos AngelesCAUSA
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11
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Bazoukis G, Yeung C, Wui Hang Ho R, Varrias D, Papadatos S, Lee S, Ho Christien Li K, Sakellaropoulou A, Saplaouras A, Kitsoulis P, Vlachos K, Lampropoulos K, Thomopoulos C, Letsas KP, Liu T, Tse G. Association of QT dispersion with mortality and arrhythmic events-A meta-analysis of observational studies. J Arrhythm 2020; 36:105-115. [PMID: 32071628 PMCID: PMC7011802 DOI: 10.1002/joa3.12253] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The risk stratification of coronary heart disease (CHD) and/or heart failure (HF) patients with easily measured electrocardiographic markers is of clinical importance. The aim of this meta-analysis is to indicate whether increased QT dispersion (QTd) is associated with fatal and nonfatal outcomes in patients with CHD and/or HF. METHODS We systematically searched MEDLINE and Cochrane databases without restrictions until August 15, 2018 using the keyword "QT dispersion". Studies including data on the association between QTd and all-cause mortality, sudden cardiac death (SCD) or arrhythmic events in patients with HF and/or CHD were classified as eligible. RESULTS In the analysis including patients with CHD and/or HF, we found that QTd did not differ significantly in patients with SCD compared to no SCD patients while QTd was significantly greater in the group of all-cause mortality patients and in patients who experienced a sustained ventricular arrhythmia. Subgroup analysis showed that in myocardial infarction studies, QTd was significantly higher in patients with an arrhythmic event compared to arrhythmic event-free patients while a nonsignificant difference was found in QTd in patients who died from any cause compared to survivors. Similarly, in HF patients, the QTd was significantly greater in patients with an arrhythmic event while a nonsignificant difference was found regarding all-cause mortality and SCD outcomes. CONCLUSIONS QTd has a prognostic role for stratifying myocardial infarction or HF patients who are at higher risk of arrhythmic events. However, no prognostic role was found regarding all-cause mortality or SCD in this patient population.
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Affiliation(s)
- George Bazoukis
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Cynthia Yeung
- Department of MedicineQueen's UniversityKingstonONCanada
| | - Ryan Wui Hang Ho
- Li Ka Shing Faculty of MedicineUniversity of Hong KongHong KongP.R. China
| | | | - Stamatis Papadatos
- 3rd Department of Internal MedicineSotiria General HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Sharen Lee
- Laboratory of Cardiovascular PhysiologyLi Ka Shing Institute of Health SciencesHong Kong S.A.R.P.R. China
| | | | - Antigoni Sakellaropoulou
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Athanasios Saplaouras
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Panagiotis Kitsoulis
- Laboratory of Anatomy‐Histology‐Embryology School of MedicineUniversity of IoanninaIoanninaGreece
| | - Konstantinos Vlachos
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Konstantinos Lampropoulos
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | | | - Konstantinos P. Letsas
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of AthensAthensGreece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Gary Tse
- Laboratory of Cardiovascular PhysiologyLi Ka Shing Institute of Health SciencesHong Kong S.A.R.P.R. China
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12
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Moghadam EA, Hamzehlou L, Moazzami B, Mehri M, Ziaee V. Increased QT Interval Dispersion is Associated with Coronary Artery Involvement in Children with
Kawasaki Disease. Oman Med J 2020; 35:e88. [PMID: 31993226 PMCID: PMC6975257 DOI: 10.5001/omj.2020.06] [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] [Received: 01/14/2019] [Accepted: 04/01/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives Coronary artery (CA) involvement is the most well known complication of Kawasaki disease (KD). Previous studies have suggested that QT dispersion has a predictive value in diagnosing cardiac ischemia, ventricular arrhythmia, and sudden cardiac death. However, limited data exits regarding the application of QT dispersion in KD. Therefore, we sought to determine whether there is a relationship between QT dispersion and CA involvement in patients with KD. Methods We performed a cross-sectional study of all consecutive patients with KD who were followed-up at the Pediatric Rheumatology Department (Pediatrics Center of Excellence affiliated to Tehran University of Medical Sciences, Tehran, Iran) from September 2013 to November 2015. Patients who met the criteria for KD, based on the American Heart Association guideline, were enrolled in the study. We collected data regarding patients' demographics, clinical manifestations, laboratory, and echocardiographic findings. Results A total of 70 KD patients were identified, including 43 males (61.4%) and 27 females (38.6%). The median age of patients was 21.0 (11.0-48.0) months. We found statistically significant differences between age, gender, and platelet count among patients with and without CA involvement (p < 0.050). Median corrected QT dispersion in patients with CA involvement calculated from 12 leads in the acute phase was significantly higher compared to the non-CA involvement group (108.0 (89.5-138.5) ms vs. 63.0 (54.0-74.5) ms, respectively (p < 0.001)). Conclusions Prolonged QT dispersion (corrected or non-corrected) during the acute and convalescence phases in patients with KD is associated with coronary involvement.
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Affiliation(s)
- Ehsan Aghaei Moghadam
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.,Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Leila Hamzehlou
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Bobak Moazzami
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Mina Mehri
- Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran
| | - Vahid Ziaee
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.,Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran.,Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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13
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Komatsuzaki M, Takasusuki T, Yamaguchi S. Impact of thoracic epidural sympathetic block on cardiac repolarization. Local Reg Anesth 2018; 11. [PMID: 30410391 PMCID: PMC6200079 DOI: 10.2147/lra.si82402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The interval from the peak to the end of the T wave (Tp-Te) on electrocardiography is considered a marker of ventricular arrhythmias. A previous study suggested that right stellate ganglion block prolonged QT and QT dispersion (QTD). We investigated the effect of thoracic epidural sympathetic block with 1% mepivacaine on QT, QTD, Tp-Te, and Tp-Te/QT by using computerized measurement. PATIENTS AND METHODS After obtaining the approval of the ethics committee of Dokkyo Medical University Hospital, 23 patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo thoracic surgery were enrolled. An epidural catheter was inserted at the Th4-5 or 5-6 level and then used for injection of 7 mL of 1% mepivacaine. Changes in RR interval, QT, corrected QT (QTc), QTD, QTc dispersion (QTcD), Tp-Te, Tp-Te/QT, and Tp-Te/QTc before and after epidural injection were assessed by computerized measurement. Statistical analysis was performed by one-way ANOVA. RESULTS Systolic blood pressure was consistently suppressed 10-15 minutes after injection (baseline: 136±10 mmHg, 11 minutes: 113±12 mmHg, 12 minutes: 112±13 mmHg, 13 minutes: 112±12 mmHg, 14 minutes: 108±17 mmHg, 15 minutes: 111±14 mmHg; P<0.05). However, RR interval, QT, QTc, QTD, QTcD, Tp-Te, Tp-Te/QT, and Tp-Te/QTc were not changed after epidural block. CONCLUSION Thoracic epidural injection of 1% mepivacaine did not alter QT, QTc, QTD, QTcD, Tp-Te, Tp-Te/QT, or Tp-Te/QTc. These results emphasize the safety of thoracic epidural sympathetic block with 1% mepivacaine for patients compared with right stellate ganglion block, in terms of cardiac repolarization.
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Affiliation(s)
- Makoto Komatsuzaki
- Department of Anesthesiology, Dokkyo Medical University, school of Medicine, Mibu, Tochigi 321–0293, Japan,
| | - Toshifumi Takasusuki
- Department of Anesthesiology, Dokkyo Medical University, school of Medicine, Mibu, Tochigi 321–0293, Japan, ,Correspondence: Toshifumi Takasusuki, Department of Anesthesiology, Dokkyo Medical University, school of Medicine, Kitakobayashi 880, Mibu, Tochigi 321-0293, Japan, Tel +81 282 86 0788, Fax +81 282 86 0478, Email
| | - Shigeki Yamaguchi
- Department of Anesthesiology, Dokkyo Medical University, school of Medicine, Mibu, Tochigi 321–0293, Japan,
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14
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Yamashita Y, Takasusuki T, Kimura Y, Komatsuzaki M, Yamaguchi S. Effects of Neostigmine and Sugammadex for Reversal of Neuromuscular Blockade on QT Dispersion Under Propofol Anesthesia: A Randomized Controlled Trial. Cardiol Ther 2018; 7:163-172. [PMID: 30218410 PMCID: PMC6251823 DOI: 10.1007/s40119-018-0119-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction Reversal of non-depolarizing neuromuscular blocking agent neostigmine is associated with QT prolongation under general anesthesia. To clarify the effects of neostigmine and sugammadex on hemodynamic status, the QT interval and QT dispersion after reversal of neuromuscular blockade were evaluated with a 12-lead electrocardiogram. To exclude QT prolongation due to sevoflurane, the present study was performed under propofol anesthesia. Methods After receiving approval from the ethics committee of Dokkyo Medical University Hospital, 40 patients with American Society of Anesthesiologists physical status I or II were randomly allocated to group N (n = 20) or group S (n = 20). Group N was administered neostigmine (40 μg/kg) and atropine (20 μg/kg), while Group S was administered sugammadex (4 mg/kg) for reversal of neuromuscular blockade after surgery. The changes in RR interval, QT interval (QT), corrected QT interval (QTc), QT dispersion (QTD), and corrected QT dispersion (QTcD) before and after administration of reversal agents were recorded using computerized measurements. Statistical analysis was performed using two-way analysis of variance. Results The RR interval significantly decreased after reversal of the neuromuscular blockade in group N, compared with group S (p < 0.05). Compared with group S, the QT decreased, whereas QTc and QTcD increased, in group N (p < 0.05). Sugammadex was not found to alter QT, QTc, QTD, or QTcD throughout the study. Conclusion In the present study, a mixture of neostigmine and atropine, but not sugammadex, increased QTc and QTcD under propofol anesthesia. Thus, neostigmine may cause electrocardiogram abnormalities that could precede the development of fatal arrhythmias.
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Affiliation(s)
- Yusuke Yamashita
- Department of Anesthesiology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi, Japan
| | - Toshifumi Takasusuki
- Department of Anesthesiology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi, Japan.
| | - Yoshiyuki Kimura
- Department of Anesthesiology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi, Japan
| | - Makoto Komatsuzaki
- Department of Anesthesiology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi, Japan
| | - Shigeki Yamaguchi
- Department of Anesthesiology, Dokkyo Medical University, School of Medicine, Mibu, Tochigi, Japan
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15
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Conlon R, Tanner R, David S, Szeplaki G, Galvin J, Keaney J, Keelan E, Boles U. Evaluation of the Tp-Te Interval, QTc and P-Wave Dispersion in Patients With Coronary Artery Ectasia. Cardiol Res 2018; 8:280-285. [PMID: 29317970 PMCID: PMC5755659 DOI: 10.14740/cr631w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Coronary artery ectasia (CAE) is defined as a diffuse dilatation of the diameter of the ectatic segment of the coronary artery, 1.5 times greater than that of the adjacent segment. The Tp-Te interval, P-wave and QTc dispersions are relatively new electrocardiographic markers associated with an increased risk of developing arrhythmias. Despite CAE increasing in prevalence in recent years, there is a sparsity of data available about its arrhythmogenic effect. The aim of the study was to evaluate QTc, P-wave dispersion and Tp-Te and Tp-Te/QT ratio in patients with CAE. Methods A retrospective comparative study was designed for consecutive age- and sex-matched patients. Twenty patients with isolated CAE (group 1) and 20 control subjects (group 2), with normal coronary arteries, were included. All patients presented with chest pain and coronary angiogram was indicated. Outcome measures included Tp-Te interval, Tp-Te/QT ratio, QTc dispersion and P-wave dispersion. Measurement of electrocardiogram (ECG) parameters was conducted using standardized digital online software. Descriptive and inferential statistics were performed. Results Mean Tp-Te (95.5 ± 9.01 ms) and Tp-Te/QT ratio (0.22 ± 0.02) were significantly prolonged in CAE group (Tp-Te: 84 ± 5.62 ms, P = 0.00009; Tp-Te/QT ratio: 0.20 ± 0.01, P = 0.00004). In addition, QTc (31.2 ± 3.71 ms) and P-wave dispersion (31.9 ± 5.46 ms) were significantly increased in comparison to the control group (QTc: 27.6 ± 2.82 ms, P = 0.00532 and 20 ± 3.77 ms, P = 0.00003 respectively). However, there was no difference in ventricular activation time (VAT) between groups. Conclusions CAE ECGs were found to be associated with increased Tp-Te, Tp-Te/QT ratio, QTc intervals and P-wave dispersions. This may suggest that CAE existence has a pro-arrhythmogenic nature.
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Affiliation(s)
- Ronan Conlon
- Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
| | - Richard Tanner
- Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
| | - Santhosh David
- Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
| | - Gabor Szeplaki
- Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
| | - Joseph Galvin
- Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
| | - John Keaney
- Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
| | - Edward Keelan
- Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
| | - Usama Boles
- Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland.,Heart and Vascular Center, Mater Private Hospital, Dublin 2, Ireland
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16
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Suleimani HF, Eshraghi A, Daloee MH, Hoseini S, Nakhaee N. Effect of nicorandil on QT dispersion in patients with stable angina pectoris undergoing elective angioplasty: A triple-blind, randomized, placebo-controlled study. Electron Physician 2017; 9:4934-4941. [PMID: 28979725 PMCID: PMC5614275 DOI: 10.19082/4934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/12/2017] [Indexed: 11/25/2022] Open
Abstract
Background Nicorandil leads to the relaxation of fine vascular smooth muscle, and thus causes vasodilatation of major epicardial. Also, it has anti-arrhythmic and cardio-protective effects by improving reperfusion, and ultimately leads to a reduction in microvascular damage caused by percutaneous coronary intervention (PCI). Objective The aim of this study was to determine the effect of nicorandil on QT interval dispersion (QTd) in patients with stable angina pectoris during elective angioplasty. Methods This triple-blind and randomized clinical trial was performed on patients with stable angina pectoris, candidates for elective angiography referred to Imam Reza and Ghaem hospitals in Mashhad, Iran, between January and October 2016. The patients were randomly assigned to one of two groups receiving nicorandil (60 mg as 20 mg before and 40 mg after PCI) and placebo. All the patients underwent electrocardiography 12 hours before and 12 hours after PCI. The values of maximal corrected QT interval (QTc max) and QTd in these intervals, and the levels of changes in the QTd (QTd difference before angiography and after PCI) were compared between the two groups. Data were analyzed statistically using SPSS version 18 software via Chi-square and Independent-samples t-test. Results This study was performed on 90 patients (55 males and 35 females) with a mean age of 58.6±10.8 years, on two groups of 45 people. The two groups were matched for age, body mass index, cardiovascular risk factors and baseline testing. The QTd before angiography had no statistically significant difference between the patients of both groups (control: 77.7±17.1 vs. nicorandil: 80.7±14.2 ms; p=0.371). The QTd after PCI in the nicorandil group was lower than the control group (48.1±14.2 vs. 59.2±15.6 ms; p=0.000). The decrease rate in QTd had a statistically significant difference between the two groups (control: 18.9±11.0 vs. nicorandil: 33.5±9.5 ms; p=0.000). Conclusions The results of this study showed that oral administration of nicorandil around the PCI could further reduce QTd following PCI, compared to the control group. Trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2016120631159N1 Funding The authors received no financial support for the research, authorship, and/or publication of this article.
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Affiliation(s)
- Homa Fal Suleimani
- M.D., Assistant Professor, Department of Cardiology, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Eshraghi
- M.D., Assistant Professor, Department of Cardiology, Atherosclerosis Prevention Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Hasanzadeh Daloee
- M.D., Professor, Department of Cardiology, Atherosclerosis Prevention Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Hoseini
- M.D., Resident of Cardiology, Department of Cardiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nima Nakhaee
- M.D., Resident of Cardiology, Department of Cardiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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17
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Motoki N, Akazawa Y, Yamazaki S, Hachiya A, Motoki H, Matsuzaki S, Koike K. Prognostic Significance of QT Interval Dispersion in the Response to Intravenous Immunoglobulin Therapy in Kawasaki Disease. Circ J 2017; 81:537-542. [PMID: 28154289 DOI: 10.1253/circj.cj-16-0864] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is classified as a systemic vasculitis syndrome and QT interval dispersion (QTD) has been associated with cardiac involvement and disease activity in patients with cardiovasculitis. We examined whether baseline QTD could predict a response to intravenous immunoglobulin (IVIG) in KD. METHODS AND RESULTS QTD was recorded in 86 patients with KD before IVIG, who were separated into IVIG responders (R group; n=62) and nonresponders (N group; n=24). The association between baseline QTD and response to IVIG was investigated, and the predictive response value was compared with conventional risk scores from Gunma and Kurume universities. Baseline-corrected QTDs with Bazett's (QTbcD) and Fridericia's (QTfcD) formulae were significantly increased in the N group (R group vs. N group: 31.6 [28.3, 44.0] ms vs. 66.6 [50.5, 76.3] ms and 27.4 [25.2, 39.1] ms vs. 55.2 [42.4, 66.3] ms, respectively, both P<0.001). Multiple logistic regression analysis revealed QTfcD as an independent predictor of a response to IVIG after adjustment for conventional scores (odds ratio: 1.133, 95% confidence interval: 1.061-1.210, P<0.001). Moreover, QTfcD provided incremental predictive value for IVIG nonresponders over Gunma score (increment in global χ2=25.46, P<0.001). CONCLUSIONS QTD was significantly associated with a response to IVIG in KD patients and may represent a useful identifier of IVIG nonresponders with high risk of coronary aneurysm.
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Affiliation(s)
- Noriko Motoki
- Department of Pediatrics, Shinshu University School of Medicine
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18
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Davis IC, Ahmadizadeh I, Randell J, Younk L, Davis SN. Understanding the impact of hypoglycemia on the cardiovascular system. Expert Rev Endocrinol Metab 2017; 12:21-33. [PMID: 29109754 PMCID: PMC5669378 DOI: 10.1080/17446651.2017.1275960] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Hypoglycemia occurs commonly in insulin requiring individuals with either Type 1 or Type 2 Diabetes. AREAS COVERED This article will review recent information on the pro-inflammatory and pro-atherothrombotic effects of hypoglycemia. Additionally, effects of hypoglycemia on arrhythmogenic potential and arterial endothelial dysfunction will be discussed. Effects of hypoglycemia on cardiovascular morbidity and mortality from large clinical studies in Type 1 and Type 2 DM will also be reviewed. EXPERT COMMENTARY The relative and absolute risk of severe hypoglycemia leading to death and serious adverse events in both cardiovascular and other organ systems has been highlighted following the publication of recent large clinical trials focused on glucose control and outcomes. It would be helpful if future studies could develop broader end points to include minor and moderate hypoglycemia as well as more robust methods for capturing hypoglycemia contemporaneously with adverse events. In addition, perhaps consideration of including hypoglycemia as a primary outcome, may help identify the possible cause and effect of hypoglycemia on cardiovascular morbidity and mortality.
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Affiliation(s)
- Ian Charles Davis
- University of Maryland School of Medicine, Baltimore, Maryland 21201-1544, United States
| | - Ida Ahmadizadeh
- University of Maryland School of Medicine, Baltimore, Maryland 21201-1544, United States
| | | | - Lisa Younk
- University of Maryland School of Medicine, Baltimore, Maryland 21201-1544, United States
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19
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Hurtado-de-Mendoza D, Corona-Villalobos CP, Pozios I, Gonzales J, Soleimanifard Y, Sivalokanathan S, Montoya-Cerrillo D, Vakrou S, Kamel I, Mormontoy-Laurel W, Dolores-Cerna K, Suarez J, Perez-Melo S, Bluemke DA, Abraham TP, Zimmerman SL, Abraham MR. Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy. J Arrhythm 2016; 33:201-207. [PMID: 28607615 PMCID: PMC5459419 DOI: 10.1016/j.joa.2016.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/02/2016] [Accepted: 10/06/2016] [Indexed: 11/18/2022] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. Methods ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look–Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1–V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. Results All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63%) patients; the median T1 relaxation time was 411±38 ms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1–V4 (p<0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1–V4 (odds ratio, 1.011 [1.004–1.0178, p=0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. Conclusion Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1–V4.
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Affiliation(s)
- David Hurtado-de-Mendoza
- Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA.,Cayetano Heredia University School of Medicine, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
| | - Celia P Corona-Villalobos
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 110B, Baltimore, MD 21287, USA
| | - Iraklis Pozios
- Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
| | - Jorge Gonzales
- Cayetano Heredia University School of Medicine, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
| | - Yalda Soleimanifard
- Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
| | - Sanjay Sivalokanathan
- Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
| | - Diego Montoya-Cerrillo
- Cayetano Heredia University School of Medicine, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
| | - Styliani Vakrou
- Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
| | - Ihab Kamel
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 110B, Baltimore, MD 21287, USA
| | - Wilfredo Mormontoy-Laurel
- Faculty of Sciences, Department of Statistics, Demography, Humanities and Social Sciences, Cayetano Heredia University, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
| | - Ketty Dolores-Cerna
- Faculty of Sciences, Department of Statistics, Demography, Humanities and Social Sciences, Cayetano Heredia University, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
| | - Jacsel Suarez
- Cayetano Heredia University School of Medicine, 430 Honorio Delgado Ave, Lima, LIMA 31, Peru
| | - Sergio Perez-Melo
- Department of Mathematics and Statistics, Florida International University, S.W. 8th Street, DM 430, Miami, FL 33199, USA
| | - David A Bluemke
- Department of Radiology and Imaging Sciences, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, 10 Center Drive, Rm 10/1C355, Bethesda, MD 20892, USA
| | - Theodore P Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
| | - Stefan L Zimmerman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, 600 North Wolfe Street, MRI 110B, Baltimore, MD 21287, USA
| | - M Roselle Abraham
- Hypertrophic Cardiomyopathy Center of Excellence, Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross 871, Baltimore, MD 21205, USA
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Eshraghi A, Ebdali RT, Sajjadi SS, Golnezhad R. Diagnostic Value of Electrocardiogram in Predicting Exaggerated Blood Pressure Response to Exercise Stress Testing. Electron Physician 2016; 8:2765-2771. [PMID: 27757187 PMCID: PMC5053458 DOI: 10.19082/2765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/18/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION It is believed that an exaggerated blood pressure response (EBPR) to exercise stress test is associated with a higher risk of cardiovascular events. It is also assumed that QT dispersion (QT-d), which was originally proposed to measure the spatial dispersion of ventricular recovery times, may have a relationship to cardiovascular events. The objective of this study was to examine the difference of changes in QT-d, Maxi-QT, Mini-QT, and QT-c (corrected QT interval) of the electrocardiogram in two groups of patients with exaggerated blood pressure responses (EBPR group) and normal responses (control group) to exercise testing. Also, the diagnostic value of each of these criteria in the prediction of EBPR was studied. METHODS This cross-sectional study was conducted from May 2015 to February 2016 on patients suspected of coronary artery disease (CAD) undergoing exercise testing who had been referred to Ghaem and Imam Reza hospitals in Mashhad (Iran). All patients underwent a treadmill exercise test with the 12-lead ECG, which was optically scanned and digitized for analysis of QT-d, QT max, and QT min. Patients were divided into two groups of normal and EBPR to exercise testing. QT changes of ECG were compared between the two groups, and the diagnostic accuracy of QT variables for prediction of EBPR to exercise testing was studied. A multiple linear regression analysis (MLR), Pearson Chi-qquare, independent samples t-test, and receiver operating characteristic (ROC) curve were used as statistical methods in IBM SPSS version 19. RESULTS Sixty patients (55% male) with a mean age of 50.48 ± 10.89 years were studied in two groups of normal (n=30) and exaggerated blood pressure response (n=30) to exercise testing. Maximum QT and QT dispersion were statistically different in individuals' exaggerated blood pressure response to exercise stress test (p < 0.05). The logistic regression analysis revealed that none of our parameters predicted the EBPR. The ROC curve showed that 50 and 345 milliseconds for QT dispersion and Maxi-QT were the optimal cut-off points for the prediction of EBPR. CONCLUSION It seems that Maxi-QT and QT-d may be predictors of EBPR during exercise testing. Also, a significant difference in maxi-QT and QT-d was observed between two groups of patients with normal and EBPR during the exercise testing.
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Affiliation(s)
- Ali Eshraghi
- M.D., Assistant Professor, Department of Cardiology, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reyhaneh Takalloo Ebdali
- M.D., Resident of Cardiology, Department of Cardiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Sajed Sajjadi
- M.D., Resident of Cardiology, Department of Cardiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Golnezhad
- M.D., Resident of Cardiology, Department of Cardiology, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Lutfi MF. QT Interval Derived Measurements in Patients with Cardiac Syndrome X Compared to Coronary Artery Disease. Front Physiol 2016; 7:422. [PMID: 27708590 PMCID: PMC5030246 DOI: 10.3389/fphys.2016.00422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022] Open
Abstract
Previous studies assessing effect of ischemia on ventricular repolarization are mostly directed toward patients with coronary artery disease (CAD); however, similar reports on cardiac syndrome X (CSX) are scarce. Whether microvascular dysfunction of CSX and ischemia induced by CAD produce comparable effect on ventricular repolarization is unclear and deserve further studies. In the present study, ECG measures of ventricular repolarization were compared between CAD and CSX patients (40 subjects in each group). Following evaluation of sociodemographic characteristics, medical and past medical history, a resting ECG was used to assess measurements of ventricular repolarization in each patient, namely, QT interval (QT), corrected QT interval (QTc), QT dispersion (QTd), corrected QT dispersion (QTcd), adjacent QT dispersion (AdQTd), QT dispersion ratio (QTdR), JT dispersion (JTd), and Corrected JT dispersion (JTcd). Results showed comparable QT intervals and QTd in CAD and CSX patients even after adjustment for the possible variations in gender, age and body mass index of the studied groups. Although JTd was increased in CSX subjects (26.6 ± 7.2 ms) compared with CAD patients (22.7 ± 6.5 ms, p = 0.019), statistical significance disappeared after correcting JT for variations in heart rate. QT and QTc were significantly below 440 ms in CAD as well as CSX patients (p < 0.001). In contrast, maximum QTd, maximum QTcd and AdQTd of CAD and CSX patients were significantly above 440 ms (p < 0.001). The means of JTd and JTcd were significantly above 22 ms and 24 ms respectively (p < 0.001, p = 0.001) in CSX but not CAD patients (p = 0.529, p = 0.281). The present findings clearly demonstrate comparable measures of ventricular repolarization in CAD and CSX patients and consequently an equal risk of cardiac events in both groups.
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Affiliation(s)
- Mohamed F Lutfi
- Department of Physiology, Faculty of Medicine and Health Sciences, Al-Neelain University Khartoum, Sudan
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22
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Şahin BD, Yıldırım E, Ipek E, Cengiz M, Aslan K, Poyraz E, Demirelli S, Bayantemur M, Ermis E, Ciftci C. The Relationship between P & QT Dispersions and Presence & Severity of Stable Coronary Artery Disease. Korean Circ J 2016; 46:522-9. [PMID: 27482261 PMCID: PMC4965431 DOI: 10.4070/kcj.2016.46.4.522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/04/2015] [Accepted: 12/01/2015] [Indexed: 01/17/2023] Open
Abstract
Background and Objectives The study aimed to evaluate the correlation between electrocardiographic (ECG) parameters and presence and extent of coronary artery disease (CAD) to indicate the usefulness of these parameters as predictors of severity in patients with stable CAD. Subjects and Methods Two hundred fifty patients, without a history of any cardiovascular event were included in the study. The ECG parameters were measured manually by a cardiologist before coronary angiography. The patients were allocated into five groups: those with normal coronary arteries (Group 1), non-critical coronary lesions (Group 2), one, two and three vessel disease (Group 3, Group 4 and Group 5, respectively. Results Group 1 had the lowest P wave dispersion (PWD) and P wave (Pmax), QT interval (QTmax), QT dispersion (QTd), corrected QT dispersion (QTcd) and QT dispersion ratio (QTdR), while the patients in group 5 had the highest values of these parameters. Gensini score and QTmax, QTd, QTcmax, QTcd, QTdR, Pmax, and PWD were positively correlated. QTdR was the best ECG parameter to differentiate group 1 and 2 from groups with significant stenosis (groups 3, 4, and 5) (area under curve [AUC] 0.846). QTdR was the best ECG parameter to detect coronary arterial narrowing lesser than 50% and greater than 50%, respectively (AUC 0.858). Conclusion Presence and severity of CAD can be determined by using ECG in patients with stable CAD and normal left ventricular function.
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Affiliation(s)
- Bingül Dilekci Şahin
- Department of Cardiology, Erzurum Region Training and Research Hospital, Erzurum, Turkey
| | - Erkan Yıldırım
- Department of Cardiology, Erzurum Region Training and Research Hospital, Erzurum, Turkey
| | - Emrah Ipek
- Department of Cardiology, Erzurum Region Training and Research Hospital, Erzurum, Turkey
| | - Mahir Cengiz
- Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Kursat Aslan
- Department of Cardiology, Erzurum Region Training and Research Hospital, Erzurum, Turkey
| | - Esra Poyraz
- Department of Cardiology, Istanbul Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Selami Demirelli
- Department of Cardiology, Erzurum Region Training and Research Hospital, Erzurum, Turkey
| | - Murat Bayantemur
- Department of Cardiology, Erzurum Region Training and Research Hospital, Erzurum, Turkey
| | - Emrah Ermis
- Department of Cardiology, Erzurum Region Training and Research Hospital, Erzurum, Turkey
| | - Cavlan Ciftci
- Department of Cardiology, Istanbul Bilim University, Istanbul, Turkey
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Karahan Z, Ugurlu M, Ucaman B, Veysel Ulug A, Kaya I, Cevik K, Sahin Adiyaman M, Oztürk O, Iyem H, Ozdemir F. Association Between ACE Gene Polymorphism and QT Dispersion in Patients with Acute Myocardial Infarction. Open Cardiovasc Med J 2016; 10:117-21. [PMID: 27347229 PMCID: PMC4897009 DOI: 10.2174/1874192401610010117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/02/2016] [Accepted: 02/10/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Angiotensin converting enzyme (ACE) gene polymorphism is associated with high renin-angiotensin system causing myocardial fibrosis and ventricular repolarization abnormality. Based on these findings, this study was designed to determine the association between ACE gene insertion/deletion (I/D) polymorphism and QT dispersion after acute myocardial infarction (MI). Objective and Methods: The study included 108 patients with acute MI. Blood samples were obtained from all the patients for genomic DNA analysis. ECGs were recorded at baseline and at the end of a 6-month follow up. The OT dispersion was manually calculated. Results: The mean age of the patients was 57.5 ±9.9 years (ranging from 36 to 70). The
patients with DD genotype showed longer QT dispersion than patients with II or
DI genotype at the baseline, while at the end of the six-month follow up the
patients with DI genotype showed longer QT dispersion than patients with DD or
II genotypes. However, the magnitude of the QT dispersion prolongation was
higher in patients carrying the ACE D allele than patients who were not carrying
it, at baseline and at the end of six-month follow up (52.5 ±2.6 msn vs.
47.5±2.1 msn at baseline, 57±3.2 msn vs. 53±2.6 msn in months, P: 0.428 and
P: 0.613, respectively). Conclusion: Carriers of the D allele of ACE gene I/D polymorphism may be associated with QT dispersion prolongation in patients with MI.An interaction of QT dispersion and ACE gene polymorphism may be associated with an elevation of serum type I-C terminal pro-collagen concentration, possibly leading to myocardial fibrosis, and increased action potential duration.
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Affiliation(s)
- Zulkuf Karahan
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Murat Ugurlu
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Berzal Ucaman
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Ali Veysel Ulug
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Ilyas Kaya
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Kemal Cevik
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | | | - Onder Oztürk
- Gazi Yasargil Education and Research Hospital, Cardiology, Diyarbakir, Turkey
| | - Hikmet Iyem
- Gazi Yasargil Education and Research Hospital, Cardiovascular Surgery, Diyarbakir, Turkey
| | - Ferit Ozdemir
- Gazi Yasargil Education and Research Hospital, Cardiovascular Surgery, Diyarbakir, Turkey
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Rivera-Fernández R, Arias-Verdú MD, García-Paredes T, Delgado-Rodríguez M, Arboleda-Sánchez JA, Aguilar-Alonso E, Quesada-García G, Vera-Almazán A. Prolonged QT interval in ST-elevation myocardial infarction and mortality. J Cardiovasc Med (Hagerstown) 2016; 17:11-9. [DOI: 10.2459/jcm.0000000000000015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sara JD, Lennon RJ, Ackerman MJ, Friedman PA, Noseworthy PA, Lerman A. Coronary microvascular dysfunction is associated with baseline QTc prolongation amongst patients with chest pain and non-obstructive coronary artery disease. J Electrocardiol 2015; 49:87-93. [PMID: 26620729 DOI: 10.1016/j.jelectrocard.2015.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) causes ischemia and is linked to adverse cardiovascular events. Acute transmural ischemia is associated with QT prolongation, but whether CMD affects repolarization is unknown. The aim of this study was to determine if CMD is associated with prolongation of resting heart rate corrected QT interval (QTc). METHODS In patients presenting to the catheterization laboratory with chest pain and non-obstructive coronary artery disease (CAD) at angiography, coronary flow reserve (CFR) in response to intracoronary adenosine was measured and compared to baseline to give a CFR ratio. The Bazett's-derived QTc was manually derived from patients' 12-lead ECG obtained prior to the procedure. QTc was compared between patients with normal and abnormal (CFR ratio≤2.5) coronary microvascular function. RESULTS Of the 926 patients included in this study, 281 patients (30%) had CMD (mean age 53.2 years [SD 12.7], 25% male). QTc was significantly longer in those with an abnormal CFR response to adenosine (median [Q1, Q3] ms: 420 [409, 438] vs. 416 [405, 432]; p value<0.001) and patients in the lowest quartile of CFR had a significantly longer QTc compared to those in the highest quartile (median [Q1, Q3] ms: 420 [409, 439] vs. 413 [402, 426]; p<0.001). In a linear regression model adjusting for age and sex, CMD was associated with an increase in QTc of 3.09 ms (p=0.055). CONCLUSION Our data suggest that CMD may be associated with an increase in baseline QTc, however the precise clinical relevance of this finding needs to be better investigated in larger clinical studies.
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Affiliation(s)
- Jaskanwal D Sara
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, MN, USA
| | - Michael J Ackerman
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA
| | - Peter A Noseworthy
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, MN, USA.
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Jensen CJ, Lusebrink S, Wolf A, Schlosser T, Nassenstein K, Naber CK, Sabin GV, Bruder O. Reduction of QTD--A Novel Marker of Successful Reperfusion in NSTEMI. Pathophysiologic Insights by CMR. Int J Med Sci 2015; 12:378-86. [PMID: 26005372 PMCID: PMC4441062 DOI: 10.7150/ijms.11224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/07/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND/OBJECTIVES Non-ST segment elevation myocardial infarction (MI) poses similar detrimental long-term prognosis as ST-segment elevation MI. No marker on ECG is established to predict successful reperfusion in NSTEMI. QT dispersion is increased by myocardial ischemia and reduced by successful restoration of epicardial blood flow by PCI. Whether QT dispersion reduction translates to smaller infarcts and thus indicates successful reperfusion is unknown. We hypothesized that the relative reduction of QT dispersion (QTD-Rrel ) on a standard ECG in acutely reperfused NSTEMI is related to infarct size and infarct transmurality as assessed by delayed enhancement CMR (DE-CMR). METHODS AND RESULTS 69 patients with a first acute NSTEMI were included. QTD-Rrel was stratified according to LV function and volumes, infarct transmurality and size as assessed by DE-CMR. Extensive myocardial infarction was defined as above median infarct size. LV function and end-systolic volume were only mildly related to QTD-Rrel . QTD-Rrel was inversely related to infarct size (r=-0.506,p=0.001) and infarct transmurality (r=-0.415, p=0.001). QTD-Rrel was associated with extensive myocardial infarction in univariate analysis (odds ratio (OR) 0.958, CI 0.935-0.982; p=0.001). Compared to clinical and angiographic data QTD-Rrel remained the only independent predictor of non-transmural infarcts (OR 1.110, CI 1.055-1.167; p=0.049). CONCLUSION In patients with acute Non-ST-Segment Myocardial infarction QTd-Rrel calculated on a surface ECG prior and post PCI for restoration of epicardial blood flow detects small, non-transmural infarcts as assessed by delayed enhancement CMR. Thus, QTd-Rrel can indicate successful reperfusion therapy.
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Affiliation(s)
- Christoph J Jensen
- 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany
| | - Sarah Lusebrink
- 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany
| | - Alexander Wolf
- 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany
| | - Thomas Schlosser
- 2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen, Germany
| | - Kai Nassenstein
- 2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen, Germany
| | - Christoph K Naber
- 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany
| | - Georg V Sabin
- 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany
| | - Oliver Bruder
- 1. Contilia Heart and Vascular Center, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Germany
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Antonakis V, Tsioufis C, Tsiachris D, Andrikou I, Fantaki M, Dagres N, Vrachnis N, Stefanadis C. Associations of Hemodynamic Load and Ventricular Repolarization in Patients With Newly Diagnosed Essential Hypertension: A Long-Term Follow-Up Study. J Clin Hypertens (Greenwich) 2014; 16:219-24. [DOI: 10.1111/jch.12275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Velissaris Antonakis
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Costas Tsioufis
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Dimitris Tsiachris
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Ioannis Andrikou
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Maria Fantaki
- Second Cardiology Department; University of Athens; Attikon University Hospital; Athens Greece
| | - Nikos Dagres
- Second Cardiology Department; University of Athens; Attikon University Hospital; Athens Greece
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Nigro G, Russo V, Rago A, Papa AA, Cioppa ND, Scarpati C, Palladino T, Corcione A, Sarubbi B, Caianiello G, Russo MG. The effect of aortic coarctation surgical repair on QTc and JTc dispersion in severe aortic coarctation newborns: a short-term follow-up study. Physiol Res 2013; 63:27-33. [PMID: 24182342 DOI: 10.33549/physiolres.932491] [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: 11/25/2022] Open
Abstract
Sudden death is a possible occurrence for newborns younger than 1 year with severe aortic coarctation (CoA) before surgical correction. In our previous study, we showed a significant increase of QTc-D and JTc-D in newborns with isolated severe aortic coarctation, electrocardiographic parameters that clinical and experimental studies have suggested could reflect the physiological variability of regional and ventricular repolarization and could provide a substrate for life-threatening ventricular arrhythmias. The aim of the current study was to evaluate the effect of surgical repair of CoA on QTc-d, JTc-d in severe aortic coarctation newborns with no associated congenital cardiac malformations. The study included 30 newborns (18M; 70+/-12 h old) affected by severe congenital aortic coarctation, without associated cardiac malformations. All newborns underwent to classic extended end-to-end repair. Echocardiographic and electrocardiographic measurements were performed in each patient 24 h before and 24 h after the interventional procedure and at the end of the follow-up period, 1 month after the surgical correction. All patients at baseline, 24 h and one month after CoA surgical repair did not significantly differ in terms of heart rate, weight, height, and echocardiographic parameters. There were no statistically significant differences in QTc-D (111.7+/-47.4 vs 111.9+/-63.8 ms vs 108.5+/-55.4 ms; P=0.4) and JTc-D (98.1+/-41.3 vs 111.4+/-47.5 vs 105.1+/-33.4 ms; P=0.3) before, 24 h and 1 month after CoA surgical correction. In conclusions, our study did not show a statistically significant decrease in QTc-D and JTc-D, suggesting the hypothesis that the acute left ventricular afterload reduction, related to successful CoA surgical correction, may not reduce the ventricular electrical instability in the short-term follow-up.
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Affiliation(s)
- G Nigro
- Chair of Cardiology, Second University of Naples, Naples,
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29
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Amoozgar H, Ahmadipour M, Amirhakimi A. QT Dispersion and T Wave Peak-to-end Interval Dispersion in Children with Kawasaki Disease. Int Cardiovasc Res J 2013; 7:99-103. [PMID: 24757631 PMCID: PMC3987441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/08/2013] [Accepted: 07/13/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The main complication of Kawasaki disease is the Coronary Artery (CA) involvement and long term follow up of patients depends on the severity of coronary arterial aneurysms, ischemia, and thrombosis. Early diagnosis of these complications can lead to a more desirable outcome for patients. Myocardial ischemia can prolong QT dispersion and increase the risk of cardiac arrhythmias as well as sudden cardiac arrests. Also, T wave peak-to-end (Tp-Te) interval dispersion, which provides a valuable index of transmural dispersion of repolarization, can trigger the arrhythmia. MATERIALS AND METHODS We evaluated the non-corrected QT interval dispersion (QTD) and the corrected QT (QTc) dispersion and measured Tp-Te interval dispersion in 49 Iranian children (28 males and 21 females) with the diagnosis of Kawasaki disease (KD) in the acute phase and 49 age-matched controls in a prospective study from 2009 to 2012. Student's t-test and Pearson correlation were used to analyze the data. All the statistical analyses were performed through the SPSS 16. Besides, P<0.05 was considered as statistically significant. RESULTS Patients with KD had significantly longer QTc dispersion (0.099±0.055 s versus. 0.040±0.018 s; P<0.001), non-corrected QT dispersion (0.075±0.046 versus 0.042±0.019; P<0.001), and Tp-Te dispersion (0.047±0.054 versus 0.022±0.011; P=0.015). The patients with elevation in white blood cell count (above 15000) had a statistically significant increased in QTD (P=0.011). No significant correlation was found between coronary involvement and repolarization indexes. CONCLUSIONS In conclusion, the QT interval (corrected or non-corrected) and the Tp-Te dispersion significantly increased in the patients with KD which shows repolarization changes during the acute phase of KD. However, there is no correlation between the QT interval and the coronary involvement.
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Affiliation(s)
- Hamid Amoozgar
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Maryam Ahmadipour
- Division of Pediatric Cardiology, Department of Pediatric, Shiraz University of Medical Sciences, Shiraz, IR Iran,Corresponding author: Maryam Ahmadipour, Department of Pediatrics, Nemazee Hospital, Shiraz, IR Iran. Post code: 7193711351, Tel/Fax: +98-7116474298, E-mail:
| | - Anis Amirhakimi
- Division of Pediatric Cardiology, Department of Pediatric, Shiraz University of Medical Sciences, Shiraz, IR Iran
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31
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Drigny J, Gremeaux V, Guiraud T, Gayda M, Juneau M, Nigam A. Long-term high-intensity interval training associated with lifestyle modifications improves QT dispersion parameters in metabolic syndrome patients. Ann Phys Rehabil Med 2013; 56:356-70. [PMID: 23669144 DOI: 10.1016/j.rehab.2013.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 03/15/2013] [Accepted: 03/18/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND QT dispersion (QTd) is a marker of myocardial electrical instability, and is increased in metabolic syndrome (MetS). Moderate intensity continuous exercise (MICE) training was shown to improve QTd in MetS patients. OBJECTIVES To describe long-term effects of MICE and high-intensity interval exercise training (HIIT) on QTd parameters in MetS. METHODS Sixty-five MetS patients (53 ± 9 years) were assigned to either a MICE (60% of peak power output [PPO]), or a HIIT program (alternating phases of 15-30 s at 80% of PPO interspersed by passive recovery phases of equal duration), twice weekly during 9 months. Ventricular repolarization indices (QT dispersion=QTd, standard deviation of QT = sdQT, relative dispersion of QT = rdQT, QT corrected dispersion = QTcd), metabolic, anthropometric and exercise parameters were measured before and after the intervention. RESULTS No adverse events were noted during exercise. QTd decreased significantly in both groups (51 vs 56 ms in MICE, P < 0.05; 34 vs 38 ms in HIIT, P < 0.05). Changes in QTd were correlated with changes in maximal heart rate (r = -0.69, P < 0.0001) and in heart rate recovery (r = -0.49, P < 0.01) in the HIIT group only. When compared to MICE, HIIT training induced a greater decrease in weight, BMI and waist circumference. Exercise capacity significantly improved by 0.82 and 1.25 METs in MICE and HIIT groups respectively (P < 0.0001). Lipid parameters also improved to the same degree in both groups. CONCLUSION In MetS, long-term HIIT and MICE training led to comparable effects on ventricular repolarization indices, and HIIT might be associated with greater improvements in certain cardiometabolic risk factors.
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Affiliation(s)
- J Drigny
- Montreal Heart Institute Cardiovascular and Prevention Center (ÉPIC) and Université de Montréal, 5055, St-Zotique Street East, Montreal, Quebec H1T 1N6, Canada
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Russo V, Rago A, Politano L, Papa AA, Di Meo F, Russo MG, Golino P, Calabrò R, Nigro G. Increased dispersion of ventricular repolarization in Emery Dreifuss muscular dystrophy patients. Med Sci Monit 2012; 18:CR643-CR647. [PMID: 23111739 PMCID: PMC3560603 DOI: 10.12659/msm.883541] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/28/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Sudden cardiac death (SCD) is common in patients with Emery-Dreifuss muscular dystrophy (EDMD) and is attributed to the development of life-threatening arrhythmias that occur in the presence of normal left ventricular systolic function. Heterogeneity of ventricular repolarization is considered to provide an electrophysiological substrate for malignant arrhythmias. QTc dispersion (QTc-D) and JTc dispersion (JTc-D) are electrocardiographic parameters indicative of heterogeneity of ventricular repolarization. The aim of our study was to evaluate the heterogeneity of ventricular repolarization in patients with Emery-Dreifuss muscular dystrophy with preserved systolic and diastolic cardiac function. MATERIAL/METHODS The study involved 36 EDMD patients (age 20 ± 12, 26 M) and 36 healthy subjects used as controls, matched for age and sex. Heart rate, QRS duration, maximum and minimum QT and JT interval, QTc-D and JTc-D measurements were performed. RESULTS Compared to the healthy control group, the EDMD group presented increased values of QTc-D (82.7 ± 44.2 vs. 53.1 ± 13.7; P=0,003) and JTc-D (73.6 ± 32.3 vs. 60.4 ± 11.1 ms; P=0.001). No correlation between QTc dispersion and ejection fraction (R=0.2, P=0.3) was found. CONCLUSIONS Our study showed a significant increase of QTc-D and JTc-D in Emery-Dreifuss muscular dystrophy patients with preserved systolic and diastolic cardiac function.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, 2 University of Naples, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, 2 University of Naples, Naples, Italy
| | - Luisa Politano
- Cardiomyology and Genetic Section, Department of Internal and Experimental Medicine, 2 University of Naples, Naples, Italy
| | | | | | | | - Paolo Golino
- Chair of Cardiology, 2 University of Naples, Naples, Italy
| | | | - Gerardo Nigro
- Chair of Cardiology, 2 University of Naples, Naples, Italy
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Choice of an alternative lead for QT interval measurement in serial ECGs when Lead II is not suitable for analysis. Indian Heart J 2012; 64:535-40. [PMID: 23253403 DOI: 10.1016/j.ihj.2012.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 05/08/2012] [Accepted: 07/17/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Conventionally, QT interval is measured in lead II. There are no data to select an alternative lead for QT measurement when it cannot be measured in Lead II for any reason. METHODS AND RESULTS We retrospectively analyzed ECGs from 1906 healthy volunteers from 41 phase I studies. QT interval was measured on the median beat in all 12 leads. The mean difference in QT interval between lead aVR and in Lead II was the least, followed by aVF, V5, V6 and V4; lead aVL had maximum difference. The T wave was flat (<0.1 mV) in Lead II in 6.9% of ECGs; it was also flat in 20% of these ECGs (1.4% of all ECGs) in Leads aVR, aVF and V5. CONCLUSIONS When QT interval cannot be measured in Lead II, the best alternative leads are aVR, aVF, V5, V6 and V4 in that sequence. It differs maximally from that in Lead II in Lead aVL.
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Nigro G, Russo V, Rago A, Papa AA, Cioppa ND, Di Meo F, Corcione A, Caianiello G, Russo MG, Calabrò R. Heterogeneity of ventricular repolarization in newborns with severe aortic coarctation. Pediatr Cardiol 2012; 33:302-306. [PMID: 21968578 DOI: 10.1007/s00246-011-0132-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 09/13/2011] [Indexed: 10/17/2022]
Abstract
Sudden death is a possible occurrence for newborns younger than 1 year with severe aortic coarctation (CoA) before surgical correction. Basic research and animal experiments have shown electrophysiologic changes during mechanical ventricular pressure overload. The current study aimed to evaluate the effect of severe CoA on the heterogeneity of ventricular repolarization by examining corrected QT and JT interval dispersion (respectively, QTc-D and JTc-D) and electrocardiographic parameters of spatial heterogeneity of ventricular repolarization in newborns with no associated congenital cardiac malformations. The study enrolled 30 isolated severe CoA neonates (age, 45 ± 15 days; 17 males) with normal size and wall thickness of the left ventricle before surgical correction and 30 age- and sex-matched healthy newborns used as control subjects. Heart rate, QRS duration, maximum and minimum QT and JT intervals, and QTc-D and JTc-D measurements were performed. The healthy control group did not significantly differ from the CoA group in terms of heart rate, weight, height, and echocardiographic parameters. Compared with the healthy control group, the CoA group presented significantly increased values of QTc-D (109.7 ± 43.4 vs. 23 ± 15 ms; P = 0.03) and JTc-D (99.1 ± 43.3 vs. 65.8 ± 24.1 ms; P = 0.04). A statistically significant correlation was found between the Doppler peak pressure gradient across the coarctation site and the values of QTc-D (r = 0.48; P = 0.03) and JTc-D (r = 0.42; P = 0.04). Our study showed significantly increased QTc-D and JTc-D in isolated CoA newborns with normal left ventricular geometry.
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Affiliation(s)
- Gerardo Nigro
- Second University of Naples, Monaldi Hospital, Naples, Italy
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QT dispersion before and after coronary artery angioplasty: a case study from Iran. Ann Cardiol Angeiol (Paris) 2011; 61:27-31. [PMID: 21917237 DOI: 10.1016/j.ancard.2011.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 07/24/2011] [Indexed: 11/21/2022]
Abstract
AIM In this study, we investigated the changes in QT dispersion (QTd) after successful coronary artery revascularization. BACKGROUND QTd, as a marker of regional variability of myocardial repolarization, increases following impaired myocardial perfusion and is associated with increased risk of ischemia-induced arrhythmia. METHODS In 45 consecutive patients (mean age 54.39±11.49 years) undergoing elective percutaneous coronary intervention (PCI), QTd was measured from a 12-lead electrocardiogram 6-12 hours before and 6 hours after the procedure. QTd was defined as the difference between maximum and minimum QT interval in the 12 leads. QT changes were analyzed regarding preoperative ejection fraction (EF), type and number of involved vessels, type and number of revascularized coronary arteries and history of Q-wave MI using SPSS software. RESULTS QTd significantly decreased postoperatively from 55.48±20.03 to 42.00±19.96 in the study population (P=0.001). Subgroup analyses showed that QTd did not decrease significantly in patients with two-vessel disease and those with low EF (<50%); however, the reduction was significant for other subgroups. CONCLUSION Successful PCI results in improved regional heterogeneity of myocardial repolarization, evidenced as decreased QTd after the procedure.
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Correll CU, Lops JD, Figen V, Malhotra AK, Kane JM, Manu P. QT interval duration and dispersion in children and adolescents treated with ziprasidone. J Clin Psychiatry 2011; 72:854-60. [PMID: 21457682 PMCID: PMC3319445 DOI: 10.4088/jcp.10m05990yel] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 06/03/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the incidence of symptoms (palpitations, syncope) and electrocardiographic signs (increased QT duration and dispersion) of an increased risk of torsades de pointes in youth treated with ziprasidone. METHOD Data for this study were collected as part of a prospective, observational, mixed inpatient and outpatient cohort study of youth who were administered antipsychotic treatment for the first time. For this study, we focus on 29 patients (mean ± SD age 15.3 ± 2.9 years) receiving ziprasidone (112.8 ± 50.6 mg/d; range, 20-240) for 99.3 ± 108.7 days. All patients had normal electrocardiograms (ECGs) and no serious medical illness at baseline. Patients had a mean of 2.7 ± 1.3 (median = 3; range, 1-7; total = 49) follow-up ECGs performed monthly for 3 months and every 3 months thereafter, with concurrent blood ziprasidone level measurements. Heart rate-corrected QT interval (QTc) duration and dispersion were measured manually in ≥ 6 ECG leads. QTc > 450-millisecond or ≥ 60-millisecond increase and QTc dispersion > 100 milliseconds were considered abnormal. The study was conducted from December 2001 to September 2007. RESULTS No patient reported syncope or symptomatic arrhythmias. Seven patients (24.1%) developed ECG abnormalities; 5 had peak QTc durations > 450 milliseconds, and 2 had peak QTc dispersion > 100 milliseconds. The baseline-to-peak QTc duration increased by 22.9 ± 21 milliseconds (P < .0001). The baseline-to-peak QTc dispersion increased by 6.1 ± 31.4 milliseconds (P = .30). The peak QTc duration and dispersion occurred after 47.6 ± 46.0 and 60.4 ± 73.2 treatment days, respectively. Baseline-to-peak QTc duration and dispersion changes were not correlated with ziprasidone dose (P = .65) or plasma levels (P = .50). CONCLUSIONS Ziprasidone was associated with a dose- and level-independent, significant prolongation of QTc duration in one-quarter of youth. However, prolongation of QTc dispersion was nonsignificant, and no patient experienced concomitant abnormal prolongation of both QTc duration and QTc dispersion. The dissociation between prolonged QTc duration and dispersion suggests low arrhythmogenic potential in youth with normal baseline ECGs.
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Affiliation(s)
- Christoph U. Correll
- The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System, Glen Oaks, NY,Albert Einstein College of Medicine, Bronx, NY,The Feinstein Institute for Medical Research, Manhasset, NY
| | - Johnny D. Lops
- The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System, Glen Oaks, NY
| | - Vicki Figen
- The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System, Glen Oaks, NY
| | - Anil K. Malhotra
- The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System, Glen Oaks, NY,Albert Einstein College of Medicine, Bronx, NY,The Feinstein Institute for Medical Research, Manhasset, NY
| | - John M. Kane
- The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System, Glen Oaks, NY,Albert Einstein College of Medicine, Bronx, NY,The Feinstein Institute for Medical Research, Manhasset, NY
| | - Peter Manu
- The Zucker Hillside Hospital, North Shore – Long Island Jewish Health System, Glen Oaks, NY,Albert Einstein College of Medicine, Bronx, NY
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Prediction of life-threatening arrhythmias: Multifactorial risk stratification following acute myocardial infarction. Int J Angiol 2011. [DOI: 10.1007/bf01616221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Ghelani SJ, Singh S, Manojkumar R. QT interval dispersion in North Indian children with Kawasaki disease without overt coronary artery abnormalities. Rheumatol Int 2011; 31:301-305. [PMID: 20012870 DOI: 10.1007/s00296-009-1252-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 11/28/2009] [Indexed: 01/28/2023]
Abstract
Increased QT interval dispersion has been associated with an increased risk for ventricular arrhythmias and sudden cardiac events. We examined the QT interval dispersion in 20 North Indian children with Kawasaki disease (KD) with no coronary artery abnormalities on echocardiography compared the same with matched controls. The study population consisted of 20 children in convalescent phase of KD and 20 age and sex-matched healthy controls. Intervals were measured with the use of a digital caliper with least count of 0.01 mm by a single blinded observer. The QTc dispersion was calculated as the difference between the maximum and minimum corrected QT intervals in 12 and 8 leads (i.e. the 6 precordial leads, the shortest extremity lead, and the median of the 5 other extremity leads). Of the 480 leads obtained (12 per subject), 36 were excluded from analysis (15 because of poor T wave formation and 11 because of presence of U waves). Children with KD had significantly higher QTc dispersion in 12 lead (67.08 ± 17.72 ms compared to 47.63 ± 16.48 ms in controls P ≤ 0.001) as well as 8 lead (60.51 ± 18.54 ms compared to 42.92 ± 18.03 ms in controls P ≤ 0.001) analysis. There was no correlation between delay in IVIG therapy and QT interval dispersion. In conclusion, QT interval dispersion is significantly increased in North Indian children with KD. The dispersion is indicative of inhomogenous ventricular repolarization and may represent increased risk for developing ventricular arrhythmia in this population.
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Affiliation(s)
- Sunil J Ghelani
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Pan KL, Hsu JT, Chang ST, Chung CM, Chen MC. Prognostic value of QT dispersion change following primary percutaneous coronary intervention in acute ST elevation myocardial infarction. Int Heart J 2011; 52:207-211. [PMID: 21828945 DOI: 10.1536/ihj.52.207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
This study analyzed the corrected QT dispersion (cQTd) before and at 24 hours after successful primary percutaneous coronary intervention (PCI) in 81 patients with single coronary artery disease and acute ST elevation myocardial infarction. Major cardiovascular events (MACE) at 1 year were defined as death, nonfatal myocardial infarction, life-threatening arrhythmias, and heart failure hospitalization. The cQTd before primary PCI was significantly longer in patients without MACE than in patients with MACE (73.1 ± 29.3 versus 56.3 ± 25.2 msec, P = 0.026). The cQTd at 24 hours after primary PCI was significantly shorter in patients without MACE than in patients with MACE (38.4 ± 20.8 versus 50.8 ± 28.7 msec, P = 0.045). Thus, the absolute cQTd change was significantly higher in patients without MACE compared to patients with MACE (P = 0.001). By multivariate analysis, absolute cQTd change was an independent predictor for the development of MACE, with an odds ratio of 1.498 for each 10-msec decrement in absolute cQTd change (95 percent confidence interval, 1.157 to 1.939, P = 0.002). In conclusion, the absolute cQTd change after primary PCI was an independent predictor of the development of MACE in patients with single vessel disease and acute ST elevation myocardial infarction.
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Affiliation(s)
- Kuo-Li Pan
- Division of Cardiology, Chiayi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Kaohsiung, Taiwan, Republic of China
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HIV Protease Inhibitors Induced Prolongation of the QT Interval: Electrophysiology and Clinical Implications. Am J Ther 2010; 17:e193-201. [DOI: 10.1097/mjt.0b013e3181ad3437] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shirafuji S, Liu J, Okamura N, Hamada K, Fujimiya T. QT Interval Dispersion and Cardiac Sympathovagal Balance Shift in Rats With Acute Ethanol Withdrawal. Alcohol Clin Exp Res 2010; 34:223-30. [DOI: 10.1111/j.1530-0277.2009.01085.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Guiraud T, Gayda M, Curnier D, Juneau M, Talajic M, Fortier A, Nigam A. Long-Term Exercise-Training Improves QT Dispersion in the Metabolic Syndrome. Int Heart J 2010; 51:41-6. [DOI: 10.1536/ihj.51.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Thibaut Guiraud
- Cardiovascular Prevention Centre, Montreal Heart Institute
- Clinique de Réadaptation Cardiovasculaire et Pulmonaire de Saint Orens
| | - Mathieu Gayda
- Cardiovascular Prevention Centre, Montreal Heart Institute
| | | | - Martin Juneau
- Cardiovascular Prevention Centre, Montreal Heart Institute
- Department of Medicine, Université de Montréal
- Research Center, Université de Montréal
| | - Mario Talajic
- Department of Medicine, Université de Montréal
- Research Center, Université de Montréal
| | - Annik Fortier
- Montreal Heart Institute Coordinating Center, Université de Montréal
| | - Anil Nigam
- Cardiovascular Prevention Centre, Montreal Heart Institute
- Department of Medicine, Université de Montréal
- Research Center, Université de Montréal
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Nussinovitch U, Katz U, Nussinovitch M, Nussinovitch N. Late ventricular potentials and QT dispersion in familial dysautonomia. Pediatr Cardiol 2009; 30:747-51. [PMID: 19340477 DOI: 10.1007/s00246-009-9419-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 01/12/2009] [Accepted: 03/11/2009] [Indexed: 11/30/2022]
Abstract
Familial dysautonomia is a worldwide disorder characterized by maldevelopment and dysfunction of the autonomic and sensory systems. Despite major improvements in disease management in recent years, sudden death remains the cause of death in up to 43% of patients. The aim of this study was to evaluate electrocardiographic markers of sudden death in familial dysautonomia. A comparative case series design was used. Electrocardiographic measurements were performed in 13 patients with familial dysautonomia, 7 male and 6 female, aged 9-46 years. QT was measured from all leads and corrected QT (QTc) was calculated with the Bazett formula. QT dispersion (QTd), a marker of arrhythmogenicity, was calculated and corrected for heart rate. Late ventricular potential parameters, predictive of arrhythmias, were calculated as well. Findings were compared to a matched control group using the Mann-Whitney-Wilcoxon test. A prolonged QT interval was noted in 30.7% of patients. Several QT dispersion parameters were significantly abnormal in the study group compared to the controls. All late potential parameters were within normal range in both groups. In conclusion, patients with familial dysautonomia commonly have electrocardiographic abnormalities and may be at a higher risk for adverse cardiac events.
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Affiliation(s)
- Udi Nussinovitch
- Department of Internal Medicine B, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Ekici Y, Bozbas H, Karakayali F, Salman E, Moray G, Karakayali H, Haberal M. Effect of different intra-abdominal pressure levels on QT dispersion in patients undergoing laparoscopic cholecystectomy. Surg Endosc 2009; 23:2543-9. [DOI: 10.1007/s00464-009-0388-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 01/08/2009] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
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Kumar A, Narasimhan C, Sankari A, Ranginani A, Lennon C, Bekerman C, Clark W, Denes P. Changes in QT dispersion during adenosine infusion. Clin Cardiol 2009; 23:760-2. [PMID: 11061054 PMCID: PMC6655080 DOI: 10.1002/clc.4960231013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND QT dispersion (QTd) measurement during treadmill stress testing has been to shown to improve the accuracy of exercise electrocardiogram (ECG) in the detection of significant coronary artery disease (CAD). HYPOTHESIS The aim of this study was to determine whether adenosine-induced changes in QTd could predict significant CAD and to assess its efficacy as a diagnostic index in patients undergoing adenosine stress test. METHODS QT interval measurements were made in 57 consecutive patients undergoing adenosine sestamibi stress test. Patients with an abnormal stress test underwent coronary angiography. Patients with significant disease by coronary angiography (> 70% stenosis) were classified as having CAD (Group 1), and those with normal stress images and/or normal coronaries by angiography were classified as having no CAD (Group 2). RESULTS QT dispersion increased from 28.2 +/- 4.5 to 43.8 +/- 4.5 ms with a delta QTd of 15.53 +/- 3.68 in Group 1 (p = 0.001) and from 28.4 +/- 2.6 to 34.8 +/- 2.8 ms with a delta QTd of 6.58 +/- 2.21 ms in Group 2 (p = 0.006). Patients in Group 1 had a significantly higher increase in QTd (delta QTd) than the patients in Group 2 (p < 0.03). Addition of delta QTd (> 10 ms) to the ST depression during adenosine infusion would increase the sensitivity of the ECG from 23 to 65% and decrease the specificity from 91 to 70% for diagnosis of significant CAD. CONCLUSIONS delta QTd is significantly more prolonged in patients with CAD during adenosine infusion. It increases the sensitivity of the stress ECG in diagnosis of CAD during adenosine infusion when used as an adjuvant index.
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Affiliation(s)
- A Kumar
- Dept. of Cardiology, Michael Reese Hospital, Chicago, IL 60616, USA
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Abstract
BACKGROUND QT dispersion has been shown to be associated with fatal arrhythmias and sudden death in coronary artery disease. A recent study indicated that marked QT dispersion in electrocardiograms (ECGs) obtained during acute ischemia demonstrated a significant correlation with ventricular fibrillation. HYPOTHESIS This study investigated the ECG parameters for repolarization (QT dispersion, corrected QT, corrected QT dispersion, and QT dispersion ratio) and their interrelation with acute ischemia. METHODS QT parameters as well as a newly developed repolarization index, QT dispersion ratio [(QT dispersion/RR interval) x 100] were calculated digitally during rest and ischemia in 32 patients with coronary artery disease (rest angina, Braunwald class III). Results were correlated with clinical consequences, mainly arrhythmias, within a follow-up period of 5 +/- 2 days. RESULTS While most patients had an increase in all four parameters, only the QT dispersion ratio showed a significant difference when correlated with ventricular arrhythmias (p < 0.001, F ratio = 38). CONCLUSION QT dispersion ratio appears to be a new and promising parameter in predicting ventricular arrhythmias in patients with acute ischemia.
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Affiliation(s)
- V G Cin
- Selçuk University, School of Medicine, Cardiac Department, Konya, Turkey
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Hailer B, Van Leeuwen P, Sallner D, Lange S, Wehr M. Changes of QT dispersion in patients with coronary artery disease dependent on different methods of stress induction. Clin Cardiol 2009; 23:181-6. [PMID: 10761806 PMCID: PMC6654857 DOI: 10.1002/clc.4960230310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Episodes of stress-induced myocardial ischemia in patients with coronary artery disease (CAD) may cause increases of QT dispersion (QTd). HYPOTHESIS Aim of this study was to analyze the effect of increasing heart rates on QTd and to compare the effect of different methods of stress induction in patients with varying degrees of CAD when estimating QTd. METHODS We studied 58 patients, 22 with prior myocardial infarction (MI), 25 without MI or wall motion disturbances at rest, and 11 patients without evidence of CAD. Prior to coronary angiography, standard 12-lead ECGs were obtained at rest as well as during dynamic exercise and pharmacologic stress using arbutamine simultaneously with echocardiography. QTd was determined at each stress level by subtracting minimal from maximal QT interval duration. RESULTS QTd values at rest were not consistently higher in the patients with CAD. At maximal heart rate, QTd was statistically significantly higher in patients with CAD with a better discrimination between groups for pharmacologic stress (p < 0.005 for exercise, p < 0.0001 for arbutamine). Patients after MI had higher QTd values under all conditions than did the groups without MI. As in patients with CAD, the values of this group changed more radically as a result of pharmacologic stress. CONCLUSION Patients with CAD can be identified on the basis of QTd under stress. These changes were not as marked in patients with MI as their rest values were already increased. Overall, drug-induced stress produced greater differences than dynamic exercise, suggesting that the ischemic threshold might be lower in the former.
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Affiliation(s)
- B Hailer
- Department of Medicine, Philippusstift, Essen, Germany
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Soliman EZ, Abdel-Salam M, Dardir MD. A simple ECG marker for the detection of coronary restenosis after successful coronary angioplasty. Intern Med 2009; 48:1793-8. [PMID: 19834270 DOI: 10.2169/internalmedicine.48.2463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The dynamic nature of QT dispersion (QTd) and the absence of an acceptable normal value suggest that the relative change not the absolute value of QTd would be a better predicator of coronary restenosis. We sought to examine the usefulness of the relative change in QTd, compared to the absolute value, as a predictor for coronary restenosis after previously successful percutaneous transluminal coronary angioplasty (PTCA). METHODS Ninety-two patients with a history of successful PTCA who were referred for coronary angiography (CA) for exclusion of coronary restenosis were included in this analysis. QTd was calculated as the difference in milliseconds between the maximum and minimum QT interval in the 12-lead ECG. Relative change in QTd was measured as [QTd at the time of angiography (current) - QTd after the successful PTCA (baseline)]/QTd (baseline) %. Receiver operating characteristics (ROC) analysis was used to detect the best cut-off point and also to compare the diagnostic accuracy of the relative change in QTd vs. the absolute QTd for prediction of coronary restenosis. RESULTS The relative change in QTd showed a significantly larger ROC area under curve (AUC) compared to the absolute QTd [AUC (95% CI): 0.79 (0.698, 0.872) and 0.61 (0.498, 0.703) respectively; p=0.011 for AUCs comparison]. The best cut-off point for the relative QTd was 40%, and for the absolute QTd this was 50 ms. The sensitivity and specificity of > or =40% increase in QTd to detect coronary restenosis was 71% and 83%, with positive and negative predictive values of 90% and 57%, respectively. The diagnostic accuracy of the absolute value of QTd was much less than this; the sensitivity and specificity of QTd > or =50 ms were 48% and 58%, with positive and negative predictive values of 71% and 34%, respectively. CONCLUSIONS Compared to the absolute value, the relative change in QTd is a better predictor of coronary restenosis after a previously successful PTCA. These findings may open the door for rethinking the use of QTd as a simple ECG predictor for cardiovascular outcomes.
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Affiliation(s)
- Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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Batchu SN, Law E, Brocks DR, Falck JR, Seubert JM. Epoxyeicosatrienoic acid prevents postischemic electrocardiogram abnormalities in an isolated heart model. J Mol Cell Cardiol 2008; 46:67-74. [PMID: 18973759 DOI: 10.1016/j.yjmcc.2008.09.711] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 09/22/2008] [Accepted: 09/26/2008] [Indexed: 10/21/2022]
Abstract
Cytochrome P450 epoxygenases metabolize arachidonic acid (AA) to epoxyeicosatrienoic acids (EETs) which are in turn converted to dihydroxyeicosatrienoic acids (DHETs) by soluble epoxide hydrolase (sEH). The main objective of this study was to investigate the protective effects of EETs following ischemic injury using an ex vivo electrocardiogram (EKG) model. Hearts from C57Bl/6, transgenic mice with cardiomyocyte-specific overexpression of CYP2J2 (Tr) and wildtype (WT) littermates were excised and perfused with constant pressure in a Langendorff apparatus. Electrodes were placed superficially at the right atrium and left ventricle to assess EKG waveforms. In ischemic reperfusion experiments hearts were subjected to 20 min of global no-flow ischemia followed by 20 min of reperfusion (R20). The EKG from C57Bl/6 hearts perfused with 1 microM 14,15-EET showed less QT prolongation (QTc) and ST elevation (STE) (QTc=41+/-3, STE=2.3+/-0.3; R20: QTc=42+/-2 ms, STE=1.2+/-0.2mv) than control hearts (QTc=36+/-2, STE=2.3+/-0.2; R20: QTc=53+/-3 ms; STE=3.6+/-0.4mv). Similar results of reduced QT prolongation and ST elevation were observed in EKG recording from CYP2J2 Tr mice (QTc=35+/-1, STE=1.9+/-0.1; R20: QTc=38+/-4 ms, STE=1.3+/-0.2mv) compared to WT hearts. The putative epoxygenase inhibitor MS-PPOH (50 microM) and EET antagonist 14,15-EEZE (10 microM) both abolished the cardioprotective response, implicating EETs in this process. In addition, separate exposure to the K(ATP) channel blockers glibenclamide (1 microM) and HMR1098 (10 microM), or the PKA protein inhibitor H89 (50 nM) during reperfusion abolished the improved repolarization in both the models. Consistent with a role of PKA, CYP2J2 Tr mice had an enhanced activation of the PKAalpha regulatory II subunit in plasma membrane following IR injury. The present data demonstrate that EETs can enhance the recovery of ventricular repolarization following ischemia, potentially by facilitating activation of K(+) channels and PKA-dependent signaling.
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Affiliation(s)
- S N Batchu
- Faculty of Pharmacy and Pharmaceutical Sciences, 3126 Dentistry/Pharmacy Centre, University of Alberta, Edmonton, AB, Canada
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Gadaleta FL, Llois SC, Sinisi VA, Quiles J, Avanzas P, Kaski JC. [Corrected QT interval prolongation: a new predictor of cardiovascular risk in patients with non-ST-elevation acute coronary syndrome]. Rev Esp Cardiol 2008. [PMID: 18570777 DOI: 10.1157/13123062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES Recently we reported that prolongation of the corrected QT (CTc) interval is an independent risk factor in patients with unstable angina and acute ischemic changes. The aim of this study was to determine the prognostic value of this variable in patients with non-ST-segment elevation acute coronary syndrome who do not exhibit acute ischemic changes on admission ECG. METHODS The study included 55 patients with this syndrome. On admission, a standard 12-lead ECG was recorded, the cardiac troponin-T was measured and a TIMI (Thrombolysis in Myocardial Infarction) risk score was calculated. The primary endpoint was the combination of nonfatal acute myocardial infarction, percutaneous or surgical revascularization, and cardiac death up to 30 days after discharge. Two independent investigators measured the QT interval manually and the corrected value was derived using Bazett's formula. In the statistical analysis, the following cut-off points were used: the median TIMI risk score, a cardiac troponin-T level of 0.04 ng/mL, and a QTc of 0.458 s. RESULTS Of the 21 patients (38%) who reached the primary endpoint, 17 (81%) had QTc prolongation. Binary logistic regression analysis showed that QTc prolongation was an independent predictor of the combined endpoint. CONCLUSIONS This study shows that QTc prolongation is an independent predictor of cardiovascular risk in patients with non-ST-segment elevation acute coronary syndrome but without acute ischemic changes on admission ECG.
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