Baseline Electrocardiogram Research Articles

Impact of Q wave in synthesized V7–9 lead on long-term outcomes after cardiac resynchronization therapy

BackgroundTo investigate the relationship between the Q wave in synthesized V7–9 leads of a baseline electrocardiogram and clinical outcomes in patients with heart failure after cardiac resynchronization therapy (CRT) device implantation. MethodsConsecutive patients with heart failure and a left ventricular (LV) ejection fraction <35 % were retrospectively analyzed. Patients with Q waves in the synthesized V7–9 lead were defined as the qV7–9 group and those without Q waves in the synthesized V7–9 lead were defined as the non-qV7–9 group. Multivariate analysis was performed to compare all-cause mortality and incidence of hospitalization for heart failure between the two groups. ResultsWe included 108 eligible patients. Twenty-nine patients were classified into the qV7–9 group and 79 patients were classified into the non-qV7–9 group. There were 22 patients (20 %) with ischemic etiology, 67 (62 %) with New York Heart Association functional class II or III heart failure, and 91 (84 %) with a defibrillator. The presence of Q waves in the synthesized V7–9 lead was significantly associated with worse outcomes, even with optimal medical treatment (adjusted hazard ratio, 2.1; 95 % confidence interval, 1.16–3.72; p = 0.03). ConclusionIn patients with heart failure and an LV ejection fraction of <35 %, the presence of Q waves in the synthetic V7–9 lead was associated with increased all-cause mortality and incidence of hospitalization after CRT device implantation.

The Spatial Ventricular Gradient Is an Independent Predictor of Anthracycline-Associated Cardiotoxicity

BackgroundAnthracyclines are effective chemotherapies that are limited by cardiotoxicity. The spatial ventricular gradient (SVG) is a marker of electrical heterogeneity linked to adverse cardiovascular outcomes, including sudden cardiac death and heart failure (HF). ObjectivesThe purpose of this study was to assess if SVG values before chemotherapy are associated with the risk of anthracycline-associated HF or cardiomyopathy (CM). MethodsWe analyzed 12-lead electrocardiograms obtained within 6 months before initiation of anthracyclines in a retrospective cohort treated for cancer between 1992 and 2019 at a single academic medical center. Incident HF and CM were defined by ICD-9/10 codes and confirmed by chart review. Vectorcardiograms were constructed from baseline electrocardiograms, and the SVG was calculated. The cumulative incidence of anthracycline-associated HF or CM was regressed on SVG vector orientation and magnitude with death as a competing risk. ResultsIn 889 patients (47% male; mean age 58 ± 16 years; 71% hematologic malignancies), larger SVG magnitude prechemotherapy was associated with decreased risk of HF or CM after multivariable adjustment, with a subhazard ratio of 0.76 per 1 SD increase (95% CI: 0.59-0.96; P = 0.024). SVG vector orientation, specifically a more leftward oriented VGx, was associated with decreased risk of HF or CM with a subhazard ratio of 0.77 per 1 SD increase (95% CI: 0.61-0.96; P = 0.023). ConclusionsLarger SVG magnitude and more leftward SVG orientation were associated with a decreased risk of anthracycline cardiotoxicity in a large retrospective cohort. Improved cardiac risk stratification algorithms incorporating the SVG could personalize both cancer and cardioprotective therapy.

A rapid wide complex tachycardia

A rapid wide complex tachycardia

Concentration QTc analysis of giredestrant: Overcoming QT/heart rate confounding in the presence of drug-induced heart rate changes.

Concentration-QTc (C-QTc) analysis has become a common approach for evaluating proarrhythmic risk and delayed cardiac repolarization of oncology drug candidates. Significant heart rate (HR) change has been associated with certain classes of oncology drugs and can result in over- or underestimation of the true QT prolongation risk. Because oncology early clinical trials typically lack a placebo control arm or time-matched, treatment-free baseline electrocardiogram collection, significant HR change brings additional challenges to C-QTc analysis in the oncology setting. In this work, a spline-based correction method (QTcSPL) was explored to mitigate the impact of HR changes in giredestrant C-QTc analysis. Giredestrant is a selective estrogen receptor degrader being developed for the treatment of patients with estrogen receptor-positive (ER+) breast cancer. A dose-related HR decrease has been observed in patients under giredestrant treatment, with significant reductions (>10bpm) observed at supratherapeutic doses. The QTcSPL method demonstrated superior functionality to reduce the correlation between QTc and HR as compared with the Fridericia correction (QTcF). The effect of giredestrant exposure on QTc was evaluated at the clinical dose of 30 mg and supratherapeutic dose of 100 mg based on a prespecified linear mixed effect model. The upper 90% confidence interval of ΔQTcSPL and ΔQTcF were below the 10ms at both clinical and supratherapeutic exposures, suggesting giredestrant has a low risk of QT prolongation at clinically relevant concentrations. This work demonstrated the use case of QTcSPL to address HR confounding challenges in the context of oncology drug development for the first time.

Accuracy of Peguero-Lo Presti ECG Criteria for Left Ventricular Hypertrophy Diagnosis in Elderly Thai Patients Using Cardiovascular Magnetic Resonance as a Gold Standard

Background: The conventional electrocardiogram (ECG) criteria have shown low sensitivity for LVH detection in the elderly. Objective: To evaluate the diagnosis accuracy of the new ECG criteria proposed by Peguero-Lo Presti in this population using cardiovascular magnetic resonance (CMR) as a gold standard. Materials and Methods: Patients older than 60 years that underwent CMR (1.5 T and 3 T, Philips) between 2012 and 2019 were included. Exclusion criteria were abnormal CMR findings and abnormal baseline ECG. Left ventricular mass index (LVMI) was calculated from short-axis slices covering the entire left ventricle. LVH was defined as LVMI of 63 g/m² or more in male patients and 48 g/m² or more in female patients. LVH by new ECG criteria was defined by the deepest S + SV4 of 2.8 or more in males and 2.3 or more in females. Sensitivity, specificity, and accuracy between the new criteria and the Cornell voltage criteria were compared. Results: Five hundred fifty-nine patients were included with a mean age of 71±7 years old, and with 63.69% of female, 71.56% had hypertension, and 16.46% were octogenarian. Eighty patients (14.3%) had LVH detected by CMR. The new ECG criteria showed higher sensitivity compared with the Cornell voltage criteria especially in the octogenarian with a sensitivity of 15% versus 10% in overall and 31.25% versus 18.75% in octogenarian, but the AUC did not show significant difference at AUC of 0.56 versus 0.54 (p=0.67). Conclusion: Using CMR as the gold standard, the new ECG criteria showed higher sensitivity than the Cornell voltage criteria, especially in the octogenarian, without significant different accuracy. Keywords: Electrocardiography; Elderly population; Left ventricular hypertrophy; Cardiac magnetic resonance; Peguero-Lo Presti Criteria

A predictive model of response to metoprolol in children and adolescents with postural tachycardia syndrome

BackgroundThe present work was designed to explore whether electrocardiogram (ECG) index-based models could predict the effectiveness of metoprolol therapy in pediatric patients with postural tachycardia syndrome (POTS).MethodsThis study consisted of a training set and an external validation set. Children and adolescents with POTS who were given metoprolol treatment were enrolled, and after follow-up, they were grouped into non-responders and responders depending on the efficacy of metoprolol. The difference in pre-treatment baseline ECG indicators was analyzed between the two groups in the training set. Binary logistic regression analysis was further conducted on the association between significantly different baseline variables and therapeutic efficacy. Nomogram models were established to predict therapeutic response to metoprolol. The receiver-operating characteristic curve (ROC), calibration, and internal validation were used to evaluate the prediction model. The predictive ability of the model was validated in the external validation set.ResultsOf the 95 enrolled patients, 65 responded to metoprolol treatment, and 30 failed to respond. In the responders, the maximum value of the P wave after correction (Pcmax), P wave dispersion (Pd), Pd after correction (Pcd), QT interval dispersion (QTd), QTd after correction (QTcd), maximum T-peak-to-T-end interval (Tpemax), and T-peak-to-T-end interval dispersion (Tped) were prolonged (all P < 0.01), and the P wave amplitude was increased (P < 0.05) compared with those of the non-responders. In contrast, the minimum value of the P wave duration after correction (Pcmin), the minimum value of the QT interval after correction (QTcmin), and the minimum T-peak-to-T-end interval (Tpemin) in the responders were shorter (P < 0.01, < 0.01 and < 0.01, respectively) than those in the non-responders. The above indicators were screened based on the clinical significance and multicollinearity analysis to construct a binary logistic regression. As a result, pre-treatment Pcmax, QTcmin, and Tped were identified as significantly associated factors that could be combined to provide an accurate prediction of the therapeutic response to metoprolol among the study subjects, yielding good discrimination [area under curve (AUC) = 0.970, 95% confidence interval (CI) 0.942–0.998] with a predictive sensitivity of 93.8%, specificity of 90.0%, good calibration, and corrected C-index of 0.961. In addition, the calibration curve and standard curve had a good fit. The accuracy of internal validation with bootstrap repeated sampling was 0.902. In contrast, the kappa value was 0.769, indicating satisfactory agreement between the predictive model and the results from the actual observations. In the external validation set, the AUC for the prediction model was 0.895, and the sensitivity and specificity were 90.9% and 95.0%, respectively.ConclusionsA high-precision predictive model was successfully developed and externally validated. It had an excellent predictive value of the therapeutic effect of metoprolol on POTS among children and adolescents.

Correlation of Mean Heart Dose and Cardiac Biomarkers with Electrocardiographic Changes in Patients Receiving Thoracic Radiation Therapy.

Cardiotoxicity is a well-recognized, serious adverse effect of thoracic radiation therapy. This study aimed to evaluate longitudinal electrocardiogram (ECG) changes in patients receiving thoracic radiation therapy and identify correlating factors that can predict the risk of cardiotoxicity. This retrospective study included 202 patients treated with thoracic radiation therapy, and chemotherapy and targeted therapy were allowed. Mean heart dose (MHD) was evaluated on dose-volume histograms. ECG, high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal B-type natriuretic peptide (NT-proBNP) analyses were conducted before irradiation and during the follow-up period of 6-12 months (average 8 months). Chi square test and logistic regression analysis were applied to identify risk factors associated with ECG changes. At a median time of 3 months postirradiation, 46.5% of patients showed ECG changes, and 33.0% of patients achieved baseline ECG levels during the follow-up period at a median of 5 months postirradiation. Logistic regression analysis identified MHD, hs-cTnT and NT-pro BNP as significant factors associated with ECG changes (P < 0.05). Hs-cTnT and NT-proBNP were increased significantly after radiation therapy compared with baseline levels (P < 0.05), and these increases were observed as a median time of 2 months postirradiation, which was earlier than ECG changes. Higher MHD and elevated hs-cTnT and NT-proBNP levels correlated with an increased risk of ECG changes in patients receiving thoracic radiation therapy. Early identification of patients at high risk of cardiotoxicity and timely intervention might reduce the incidence of radiation-induced cardiac toxicity.

Cardiovascular profile and electrocardiographic findings of hospitalized adult patients during the surge of delta and omicron variants of COVID-19 in a COVID-19 tertiary referral center

Abstract Funding Acknowledgements Type of funding sources: None. Background COVID-19 has been reported to cause cardiac injury. It can be detected by an electrocardiogram (ECG), which may show markers that may predict clinical outcome. Robust data on the ECG abnormalities among COVID-19 patients affected by the alpha, beta, and gamma variants have been reported, but there is paucity of data among patients affected by the delta and omicron variants. Purpose This study aims to describe the cardiovascular profile, ECG findings, and clinical course of adult patients with COVID-19, and to determine the association between certain ECG findings and clinical outcomes among these patients. Methods We evaluated 547 COVID-19 patients admitted from June 2021 to June 2022. Clinical profiles were extracted from electronic records. Admission ECGs were independently read and adjudicated by three cardiologists. Logistic regression analysis was done to determine the association between ECG abnormalities and adverse outcomes, including in-hospital mortality, ICU admission, need for mechanical ventilation, acute respiratory distress syndrome (ARDS), shock, acute kidney injury (AKI), myocardial infarction (MI), myocarditis, venous thromboembolism (VTE), and stroke. Results A Total of 547 COVID-19 patients (mean age 54; men 51.2%) were included. The most common comorbidities were hypertension, diabetes, and dyslipidemia. Majority of patients had severe COVID-19 infection (36%). On admission, 6.4% needed intubation and 14.6% died. The most common ECG abnormalities were non-specific ST-T wave changes (41.1%) and sinus tachycardia (25.6%). Other findings were ST segment depression (3.3%), T wave inversion (1.6%), and ST segment elevation (1.3%). On logistic regression analysis, intraventricular conduction delay (IVCD), T wave inversion, and poor R wave progression were significantly associated with mortality; sinus tachycardia, atrioventricular (AV) block, ST segment elevation, and T wave inversion were significantly associated with the development of VTE; left axis deviation, ST segment elevation, and T wave inversion were significantly associated with the development of ARDS; sinus tachycardia, ST segment depression, and T wave inversion were significantly associated with the development of shock; and sinus tachycardia, ST segment elevation, and early repolarization changes were significantly associated with ICU admission. No associations were established for AKI, MI, myocarditis, and need for mechanical ventilation due to the low prevalence of these outcomes. Conclusion A baseline ECG in patients with COVID-19 may help predict patients who may warrant hospitalization or even intensive care monitoring. In our cohort, certain ECG abnormalities, especially sinus tachycardia, left axis deviation, ST segment elevation, ST segment depression, T wave inversion, AV block, IVCD, poor R wave progression, and early repolarization changes, were associated with adverse clinical outcomes, including in-hospital mortality.

Frequency and type of arrhythmia in Holter electrocardiogram in patients undergoing hemodialysis

Background/Aim: It is known that approximately 40% of chronic hemodialysis patients die due to cardiac arrhythmia and cardiovascular reasons. Determining whether the hemodialysis procedure poses a risk for arrhythmia is important in terms of prognostic follow-up of the patients. Therefore, we aimed to determine the underlying arrhythmia frequency and types with 24-hour Holter electrocardiogram (ECG) in patients receiving hemodialysis with normal baseline electrocardiography between the hemodialysis periods. Methods: Between January 2018 and January 2022, 91 consecutive patients who received hemodialysis for chronic renal failure (CRF) and applied to the cardiology outpatient clinic with complaints of palpitation and sinus rhythm on ECG and evaluated with 24-hour rhythm Holter ECG were included in the study. Our study was designed as a retrospective cohort study. Results: The mean age of the patient population was 65.78 (11.92) years, the mean systolic blood pressure was 143.71 (24.88) mmHg, and the mean heart rate was 83.43 (15.85) beats/min. Hypertension (HT) (n=44, 48%) and coronary artery disease (n=34, 37%) were the most common comorbid diseases. The most common arrhythmias detected on Holter ECG were ventricular extrasystole (VES) (n=18, 19.8%) and paroxysmal AF (n=8, 8.8%). Non-sustained ventricular tachycardia was detected in two patients. Conclusion: Detecting arrhythmia in the interdialytic periods in patients receiving hemodialysis due to CRF is important for follow-up and treatment. Even if the baseline ECG is normal in hemodialysis patients with CRF, the frequency of the underlying arrhythmia that needs to be treated is high.

A Holistic Approach to Identify and Classify COVID-19 from Chest Radiographs, ECG, and CT-Scan Images Using ShuffleNet Convolutional Neural Network.

Early and precise COVID-19 identification and analysis are pivotal in reducing the spread of COVID-19. Medical imaging techniques, such as chest X-ray or chest radiographs, computed tomography (CT) scan, and electrocardiogram (ECG) trace images are the most widely known for early discovery and analysis of the coronavirus disease (COVID-19). Deep learning (DL) frameworks for identifying COVID-19 positive patients in the literature are limited to one data format, either ECG or chest radiograph images. Moreover, using several data types to recover abnormal patterns caused by COVID-19 could potentially provide more information and restrict the spread of the virus. This study presents an effective COVID-19 detection and classification approach using the Shufflenet CNN by employing three types of images, i.e., chest radiograph, CT-scan, and ECG-trace images. For this purpose, we performed extensive classification experiments with the proposed approach using each type of image. With the chest radiograph dataset, we performed three classification experiments at different levels of granularity, i.e., binary, three-class, and four-class classifications. In addition, we performed a binary classification experiment with the proposed approach by classifying CT-scan images into COVID-positive and normal. Finally, utilizing the ECG-trace images, we conducted three experiments at different levels of granularity, i.e., binary, three-class, and five-class classifications. We evaluated the proposed approach with the baseline COVID-19 Radiography Database, SARS-CoV-2 CT-scan, and ECG images dataset of cardiac and COVID-19 patients. The average accuracy of 99.98% for COVID-19 detection in the three-class classification scheme using chest radiographs, optimal accuracy of 100% for COVID-19 detection using CT scans, and average accuracy of 99.37% for five-class classification scheme using ECG trace images have proved the efficacy of our proposed method over the contemporary methods. The optimal accuracy of 100% for COVID-19 detection using CT scans and the accuracy gain of 1.54% (in the case of five-class classification using ECG trace images) from the previous approach, which utilized ECG images for the first time, has a major contribution to improving the COVID-19 prediction rate in early stages. Experimental findings demonstrate that the proposed framework outperforms contemporary models. For example, the proposed approach outperforms state-of-the-art DL approaches, such as Squeezenet, Alexnet, and Darknet19, by achieving the accuracy of 99.98 (proposed method), 98.29, 98.50, and 99.67, respectively.

QTc Interval of Healthcare Workers from India: Baseline and Effect of Hydroxychloroquine Prophylaxis during the COVID-19 Pandemic.

The aim of this study was to access the incidence of prolonged QTc interval and changes, if any, among Indian healthcare workers (HCWs) taking hydroxychloroquine (HCQ) prophylaxis while managing coronavirus disease 2019 (COVID-19) cases. At the beginning of the COVID-19 pandemic, as per the Indian Council of Medical Research (ICMR) policy, HCWs were advised to take HCQ as prophylaxis after getting an electrocardiogram (ECG) while being posted to look after COVID-19 patients. A follow-up ECG was repeated for those who took HCQ. The normal upper limit for QTc interval of 460 milliseconds (ms) for females and 450 ms for males was considered. A baseline ECG was analyzed for 250 HCWs with a median age of 35 (30-43) years. The median QTc was 410 (395-421) ms with the prevalence of prolonged QTc of 1.8% in females and 0% in males. A follow-up ECG after HCQ intake for 43 HCWs was further analyzed. They had a median age of 35 (31-39) years and took an average dose of HCQ of 2372 ± 839 mg. Pre- and post-HCQ chemoprophylaxis QTc interval (ms) was as follows: 408 (386-419) and 405 (387-417), with P = 0.434, respectively. Among Indian HCWs, the prevalence of prolonged QTc is 1.8% and 0% in females and males, respectively. HCQ intake as chemoprophylaxis for COVID-19 did not affect their QTc interval.

320 THE POTENTIAL ROLE OF ECHOCARDIOGRAPHY IN THE PRE-PARTICIPATION SCREENING: RESULTS OF AN OBSERVATIONAL RETROSPECTIVE STUDY

Abstract Introduction Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of hidden cardiac diseases. Commonly used protocols include history collection, physical examination and baseline electrocardiogram. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. Aim of the Study The aim of the present paper was to evaluate the potential role of echocardiogram in identifying life-threatening cardiovascular abnormalities that might be undetected by commonly used PPS. Methods We retrospectively reviewed a corporate wellness program - database and analyzed data recorded from 2017 to 2022 to compare two medical models: a “standard” PPS including medical history, physical examination, electrocardiogram (ECG) and exercise stress test (EST); an “advanced” PPS comprising history, physical examination, ECG, EST and echocardiography. The primary outcome of the study was to assess the efficacy of the advanced PPS in detecting CV abnormalities compared to the “standard” PPS. Results We analyzed data from 500 subjects (420 male, 33.69 ± 7.9 mean aged) enrolled for the first time in the corporate wellness program between 2017 and 2022. 339 (67.8%) subjects had no pathological findings at “standard” PPS and, even if would have not required further evaluation including echocardiogram, performed the ultrasound exam anyway (“advanced” PPS): 31 (9.1%) showed some abnormal findings at echocardiography. Conclusions Even if with some limitations, performing a screening echocardiogram could help to detect subjects with some form of cardiovascular morpho-functional abnormalities, otherwise difficult to diagnose with “standard” PPS protocol.

477. Evaluation of Electrocardiogram (ECG) Monitoring Practice in Newly Initiated Azole Antifungal Therapy

Abstract Background Azole antifungals are first-line options in the management of many fungal infections, but most are known to cause corrected Q-T interval (QTc) prolongation. There is a lack of guidance on which patients on azoles warrant ECG monitoring, potentially leading to discordant clinical practices. We aimed to determine factors associated with ECG monitoring of patients on systemic azole therapy. Methods We performed a retrospective cohort study of hospitalized adult patients who received at least five days of inpatient azole therapy. Pregnant patients, those on azoles prior to admission or with a gap in azole therapy &amp;gt; 3 days were excluded. Only the first admission with azole use per patient over the study period was included. The primary outcome was any ECG measurement within 5 days of starting azole therapy. We calculated adjusted odds ratios (aOR) for the association between patient and treatment characteristics and likelihood of ECG measurement using multivariable logistic regression. Figure 1.Study Flow Diagram Results 4,126 patients met inclusion criteria over 9 years (Figure 1). Most were admitted to the Hematology/Oncology service (49%), followed by Transplant (20.4%). Azole therapy was initiated for medical prophylaxis in 61.7% and for treatment in 27.9%. Fluconazole (FLU) was the most utilized azole (75.2%), followed by voriconazole (VOR) (18%). Overall, 1,454 patients (35.24%) had at least one ECG measured within 5 days of starting azole therapy. Patients were more likely to have an ECG monitored if they received VOR (48.1%) compared to FLU (31.1%), or were on the transplant service (53.9%) vs medicine (37%). On multivariate analysis (Figure 2), likelihood of having an ECG measured was greater among patients (1) receiving posaconazole (POS, aOR 1.75, 95% CI 1.31-2.34) or VOR (aOR 1.34, 95% CI 1.10-1.63) versus FLU, (2) with a baseline ECG (aOR 2.07 (1.76-2.43), and (3) who received concomitant QT-prolonging medications (aOR 1.22, 95% CI 1.01-1.48) or diuretics (aOR 1.38 95% CI 1.16-1.63). Figure 2.Odds Ratio for Primary Outcome QT-prolonging medication use during azole therapy: Antibiotics (ciprofloxacin, levofloxacin, moxifloxacin, clarithromycin, azithromycin), HIV meds (protease inhibitors), CV meds (amiodarone, disopyramide, dofetilide, procainamide, quinidine, sotalol), anti-emetics (chlorpromazine, metoclopramide, ondansetron), chemotherapy (nilotinib, sunitinib), psychiatric meds (haloperidol, risperidone, ziprasidone), miscellaneous (methadone); Diuretics/electrolyte disturbing agents used during azole therapy: Furosemide, bumetanide, torsemide, sulfamethoxazole-trimethoprim, amphotericin Conclusion Use of POS or VOR, baseline ECG monitoring, concomitant QT-prolonging medications, and electrolyte abnormalities, were associated with greater likelihood of ECG monitoring. These results can help target guidance for ECG monitoring in patients on azoles. Disclosures Conan MacDougall, PharmD, MAS, Merck: Advisor/Consultant Sarah B. Doernberg, MD, MAS, Basilea: Clincal events committee|Genentech: Advisor/Consultant|Gilead: Grant/Research Support|Regeneron: Grant/Research Support|Shinogi: Clincal events committee.

300. Trends in electrocardiographic and cardiovascular manifestations of patients hospitalized with COVID-19

Abstract Background Early in the coronavirus disease 2019 (COVID-19) pandemic, a low incidence of cardiovascular complications was reported amongst hospitalised patients with COVID-19 in Singapore. Little was known about the trend of cardiovascular complications as the pandemic progressed. As such, we sought to examine the evolving trends in electrocardiographic and cardiovascular manifestations in patients hospitalised for COVID-19 infection. Methods We examined the first 1781 consecutive hospitalised patients with polymerase chain reaction (PCR) confirmed COVID-19 in a tertiary academic centre. We divided the population based on those who had an abnormal electrocardiogram (ECG) and those who had a normal ECG, comparing the baseline characteristics and outcomes between the 2 groups. Cardiovascular complications such as acute myocardial infarction, stroke, pulmonary embolism, myocarditis and mortality were also examined over time. Results Of the 261 (14.7%) patients presenting with abnormal ECG, they were more likely to be symptomatic with complaints of breathlessness, palpitations and chest pain. Sinus tachycardia was the most common arrhythmia. Troponin I levels (41.6±264.3 vs 97.0±482.9, p=0.047) and C-reactive protein levels (20.1±50.7 vs 13.9±24.1 µmol/L, p=0.003) were significantly higher amongst those with abnormal ECGs at presentation, with a higher prevalence of myocarditis (1.9% vs 0.5%, p=0.021), pulmonary embolism (1.9% vs 0.3%, p=0.009) and acute myocardial infarction (1.1% vs 0.1%, p=0.025). Over time, there was a trend towards a higher proportion of hospitalised patients with cardiovascular complications. Baseline characteristics of hospitalised patients with COVID-19, with or without abnormal ECG at presentation Changes in percentage of hospitalised patients with COVID-19, experiencing cardiovascular events (acute myocardial infarction, stroke, myocarditis, pulmonary embolism and death) over time Conclusion A baseline ECG at presentation is a simple test that provides valuable information on potential cardiovascular complications in the context of COVID-19. Although the prevalence of abnormal ECGs is relatively low, it appears to be increasing over time amongst hospitalised patients with COVID-19. Disclosures All Authors: No reported disclosures.

Horticultural Therapy May Reduce Psychological and Physiological Stress in Adolescents with Anorexia Nervosa: A Pilot Study.

Studies in psychiatric populations have found a positive effect of Horticultural therapy (HCT) on reductions in stress levels. The main objective of the present pilot study was to evaluate the impact of the addition of HCT to conventional clinical treatment (Treatment as Usual, TaU) in a sample of six female adolescents with anorexia nervosa restricting type (AN-R), as compared to six AN-R patients, matched for sex and age, under TaU only. This is a prospective, non-profit, pilot study on patients with a previous diagnosis of AN-R and BMI < 16, recruited in 2020 in clinical settings. At enrolment (T0) and after treatment completion (TF), psychiatric assessment was performed. At T0, all the patients underwent: baseline electrocardiogram acquisition with a wearable chest strap for recording heart rate and its variability; skin conductance registration and thermal mapping of the individual’s face. An olfactory identification test was administered both to evaluate the olfactory sensoriality and to assess the induced stress. One-way analyses of variance (ANOVAs) were performed to analyze modifications in clinical and physiological variables, considering time (T0, TF) as a within-subjects factor and group (experimental vs. control) as between-subjects factors. When the ANOVA was significant, post hoc analysis was performed by Paired Sample T-tests. Only in the HCT group, stress response levels, as measured by the biological parameters, improved over time. The body uneasiness level and the affective problem measures displayed a significant improvement in the HCT subjects. HCT seems to have a positive influence on stress levels in AN-R.

Accidental coronary artery kinking by leadless pacemaker fixation tine.

We present a case of a 59-year-old woman who presented with a coronary syndrome soon after an uneventful leadless pacemaker (MicraVR™, Medtronic) implantation. A routine postoperative electrocardiogram (ECG) revealed alteration of the baseline ECG (Panel A, left) with appearance of a complete right bundle branch block (RBBB) and ST-segment elevation in V3 (Panel A, middle). She reported intermittent moderate chest pain which worsened in left lateral position. An emergency transthoracic echocardiogram showed minimal pericardial effusion (<0.5 mm) with a normal systolic left ventricular function. A coronary computed tomography angiogram suggested that the septal anchor of the pacemaker partially occluded the distal segment of the left anterior descending (LAD) artery (Panel B). This was associated with enhancement defects on septo-apical and apical segments, consistent with ischaemia. The coronary angiography confirmed the partial LAD kinking in relation to the device anchor which was considered extravascular (Panel C). After patient consent, pacemaker retrieval was successfully performed using a 26Fr Gore DrySeal™ introducer sheath, a 12Fr Cook Performer™ guiding sheath holding an EV3 Amplatz gooseneck Snare of 15 mm. Once the pacemaker was trapped and before applying traction, a 0.14 Asahi FielderXT™ coronary wire was inserted through the lesion, to protect the vessel in case of injury. The coronary integrity was confirmed after device removal (Panel D). The RBBB disappeared 48 h later, leaving a Q wave in lead V3 (Panel A, right). Systematic postoperative ECG is warranted after leadless pacemaker implantation.

Computerized electrocardiogram data transformation enables effective algorithmic differentiation of wide QRS complex tachycardias.

Accurate automated wide QRS complex tachycardia (WCT) differentiation into ventricular tachycardia (VT) and supraventricular wide complex tachycardia (SWCT) can be accomplished using calculations derived from computerized electrocardiogram (ECG) data of paired WCT and baseline ECGs. Develop and trial novel WCT differentiation approaches for patients with and without a corresponding baseline ECG. We developed and trialed WCT differentiation models comprised of novel and previously described parameters derived from WCT and baseline ECG data. In Part 1, a derivation cohort was used to evaluate five different classification models: logistic regression (LR), artificial neural network (ANN), Random Forests [RF], support vector machine (SVM), and ensemble learning (EL). In Part 2, a separate validation cohort was used to prospectively evaluate the performance of two LR models using parameters generated from the WCT ECG alone (Solo Model) and paired WCT and baseline ECGs (Paired Model). Of the 421 patients of the derivation cohort (Part 1), a favorable area under the receiver operating characteristic curve (AUC) by all modeling subtypes: LR (0.96), ANN (0.96), RF (0.96), SVM (0.96), and EL (0.97). Of the 235 patients of the validation cohort (Part 2), the Solo Model and Paired Model achieved a favorable AUC for 103 patients with (Solo Model 0.87; Paired Model 0.95) and 132 patients without (Solo Model 0.84; Paired Model 0.95) a corroborating electrophysiology procedure or intracardiac device recording. Accurate WCT differentiation may be accomplished using computerized data of (i) the WCT ECG alone and (ii) paired WCT and baseline ECGs.

Abstract 12154: Relationship Between Caffeine Consumption and Young Athletes' Comorbidities, Exercise-Related Symptoms, and Baseline Electrocardiogram

Introduction: Studies on adult athletes have found that caffeine consumption has both positive and negative effects on physical performance and cardiovascular physiology. While roughly 3 in 4 children older than 5 years old consume caffeinated beverages, the effects of caffeine on children and adolescent athletes are less studied. Methods: The HeartBytes National Youth Database produced by Simon’s Heart, a nonprofit organization that organizes pre-participation examinations (PPEs) of adolescents, was utilized for this study. This database contains demographic, exercise-related symptom (chest pain or dyspnea), and electrocardiogram data obtained during Simon’s Heart PPEs. Logistic regression models were adjusted for age, BMI, race, and gender except for the model assessing BMI as an outcome, which adjusted only for age, race, and gender. Results: Of the 7425 patients in the HeartBytes database, the majority were male (60.6%) and White (83.9%). The median age was 15.0 years old (interquartile range 13.5 - 16.5). Those who consumed caffeine were more likely to have a history of ADHD (adjusted odds ratio [aOR] 1.43 [CI: 1.15 - 1.76]; p = 0.001) and a BMI ≥ 30 (aOR 1.69 [CI: 1.27 - 2.25]; p &lt; 0.001) when compared to non-caffeine drinkers. Caffeine drinkers overall were at no higher risk for exercise-related symptoms. However, when type of beverage was assessed, soda drinkers were more likely to have symptoms during exercise (aOR 1.33 [CI: 1.02 - 1.73]; p = 0.032) and coffee drinkers were more likely to have syncope with exercise (aOR 2.13 [CI: 1.20 - 3.60]; p = 0.006) compared to those who do not consume caffeinated beverages. No association was present between caffeine consumption or beverage type and ECG changes. Conclusions: In this dataset from a national registry of PPEs, caffeine consumption was independently associated with obesity and ADHD. While caffeine consumption itself did not increase risk of exercise-related symptoms, soda drinkers were at higher risk for symptoms during exercise, and coffee drinkers were at higher risk of syncope with exercise. The study shows that caffeine consumption may have significant impact on youth health. Future studies are needed to further confirm our findings.

The diagnostic value of serum YKL-40 for myocardial involvement in idiopathic inflammatory myopathy

ObjectiveTo investigate the diagnostic value of serum chitinase-3-like-1 protein (YKL-40) levels for myocardial involvement in idiopathic inflammatory myopathies (IIM). MethodsA total of 74 patients with definite IIM who visited Jiangsu Province People's Hospital between May 2018 and January 2022 were enrolled in this retrospective study. Baseline clinical evaluation, laboratory index, electrocardiogram (ECG), echocardiography (ECHO) and cardiac magnetic resonance (CMR) parameters were collected. Serum YKL-40 of all participants was determined by ELISA. Receiver-operating characteristic (ROC) curve was used to assess the diagnostic value of YKL-40 in assessing myocardial involvement in IIM patients. Results1. YKL-40 concentration was significantly higher in IIM patients with myocardial injury than without myocardial injury.2. Multivariate logistic regression analysis demonstrated that serum YKL-40 was an independent risk factor for myocardial involvement in IIM.3. YKL-40 > 66.4 ng/ml (AUC = 0.85, 95 % CI 0.75–0.95) predicted myocardial injury in IIM with a sensitivity of 0.75 and specificity of 0.95. ConclusionSerum YKL-40 could serve as a potential biomarker to predict myocardial injury in IIM patients.

An unusual cause of a relatively narrow, wide complex tachycardia.

An 11-year-old boy presented with palpitations but no evidence of any cardiac disease. The baseline electrocardiogram (ECG) recorded during sinus rhythm is shown in Figure 1A and the tachycardia in Figure 1B. What are the differential diagnoses of this arrhythmia?