Criteria For Ventricular Hypertrophy Research Articles

Electrocardiographic features and need for pacemaker in cardiac amyloidosis: Analysis of 58 cases

AimAmyloidosis is a disease in which amyloid fibrils can be deposited in different cardiac structures, and several electrocardiographic abnormalities can be produced by this phenomenon. The objective of this study was to describe the most common basal electrocardiographic alterations in patients diagnosed with cardiac amyloidosis (CA) and to determine if these abnormalities have an impact on the need of pacemaker. MethodsThis retrospective study included patients who had an established diagnosis of CA [light-chain cardiac amyloidosis (LA-CA) or transthyretin cardiac amyloidosis (TTR-CA)] between January 2013 and March 2021. The baseline heart rate, the percentage of patients with a pseudo-infarct pattern, low-voltage pattern or cardiac conduction disturbances, and the impact of these factors on the need of pacemaker were analysed. ResultsFifty-eight patients with CA (20 with LA-CA and 38 with TTR-CA) were included, and the majority were male (69.0%). Twenty-one patients had atrial fibrillation (AF) at diagnosis. Thirty-five patients had a pseudo-infarct pattern, 35% had a low-voltage pattern, and 22% had criteria for ventricular hypertrophy. Two hirds had a conduction disorder: 18 patients with first degree atrioventricular block, 12 right bundle branch block, 3 left bundle branch block and 25 with a branch hemiblock. There were no differences between LA-CA and TTR-CA. Patients with TTR-CA had a greater need for pacemakers in the follow-up (39 ± 40 meses). Bundle branch block was a predictor of the need for a permanent pacemaker (HR 23.43, 4.09–134.09, IC 95%, p = 0.01). ConclusionsElectrocardiographic abnormalities in patients diagnosed wich CA are heterogeneus. Most frecuent is the presence of conduction disorders, the pseudoinfarction pattern, followed by the low voltage pattern. Patients with any bundle branch block at the baseline electrocardiogram need more frecuent to require a pacemaker during follow-up, especially in TTR-CA.

Alteraciones electrocardiográficas y necesidad de marcapasos en amiloidosis cardiaca: análisis de 58 casos

AimAmyloidosis is a disease in which amyloid fibrils can be deposited in different cardiac structures, and several electrocardiographic abnormalities can be produced by this phenomenon. The objective of this study was to describe the most common basal electrocardiographic alterations in patients diagnosed with cardiac amyloidosis (CA) and to determine if these abnormalities have an impact on the need of pacemaker. MethodsThis retrospective study included patients who had an established diagnosis of CA [light-chain cardiac amyloidosis (LA-CA) or transthyretin cardiac amyloidosis (TTR-CA)] between January 2013 and March 2021. The baseline heart rate, the percentage of patients with a pseudo-infarct pattern, low-voltage pattern or cardiac conductions disturbances, and the impact of these factors on the need of pacemaker were analysed. ResultsFifty-eight patients with CA (20 with LA-CA and 38 with TTR-CA) were included, and the majority were male (69.0%). Twenty-one patients had atrial fibrillation (AF) at diagnosis. Thirty-five patients had a pseudo-infarct pattern, 35% had a low-voltage pattern, and 22% had criteria for ventricular hypertrophy. Two hirds had a conduction disorder: 18 patients with first degree atrioventricular block, 12 right bundle branch block, 3 left bundle branch block and 25 with a branch hemiblock. There were no differences between LA-CA and TTR-CA. Patients with TTR-CA had a greater need for pacemakers in the folow-up (39±40 meses). Bundle branch block was a predictor of the need for a permanent pacemaker (HR: 23.43; CI 95%: 4.09.134.09; P=.01). ConclusionsElectrocardiographic abnormalities in patients diagnosed wich CA are heterogeneus. Most frecuent is the presence of conduction disorders, the pseudoinfarction pattern, followed by the low voltage pattern. Patients with any bundle branch block at the baseline electrocardiogram need more frecuent to require a pacemaker during follow-up, especially in TTR-CA.

Is derived vectorcardiography a potential screening tool for pulmonary hypertension?

BackgroundPatients with atrial septal defects and pulmonary hypertension would benefit from early identification and treatment of pulmonary hypertension prior to closure. Noninvasive screening tools for pulmonary hypertension are inadequate. Electrocardiography, though readily available, has so far been of limited screening utility in patients with pulmonary hypertension. We hypothesize that derived vectorcardiographic parameters will aid in identifying increased right ventricular afterload and thus provide an additional screening tool for pulmonary hypertension in patients with secundum atrial septal defects. ObjectiveEstablish whether vectorcardiography can be used to screen for pulmonary hypertension. MethodsA retrospective review of patients with secundum atrial septal defects (ASD) who underwent cardiac catheterization at the University of Minnesota from 2012 to 2020 was performed. We excluded patients with other congenital heart diagnoses, insufficient hemodynamic data, or lacking sinus rhythm electrocardiogram at time of cardiac catheterization. Parameters analyzed included: Sokolow-Lion right ventricular hypertrophy criteria, PR duration, QRS duration, corrected QT intervals, QRS and T wave frontal plane axes, rSR', R' amplitude, as well as vectorcardiographic parameters (Kors regression-related method), the QRS vector magnitude, T wave vector magnitude, and the spatial QRS-T angle. These were compared to measures of pulmonary hypertension obtained at cardiac catheterization. ResultsThe spatial QRS-T angle significantly differentiated ASD patients with pulmonary hypertension (median 104 degrees, interquartile range 55–137 degrees) from ASD patients without pulmonary hypertension (median 37 degrees, interquartile range 21–63 degrees, p-value of 0.002). At a cut-off of 124 degrees, the positive and negative predictive values for identification of pulmonary hypertension were 36.4% and 96.4%, respectively, with an odds ratio of 13.4 (95% confidence interval of 2.9 to 63.7). The positive predictive value was significantly improved when combined with echocardiographic data to screen for pulmonary hypertension. ConclusionThe spatial QRS-T angle is associated with pulmonary hypertension in patients with secundum atrial septal defects.

The use of vector electrocardiography for pulmonary hypertension screening in patients with atrial septal defects

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with unrepaired atrial septal defects accumulate yearly risk of developing pulmonary arterial hypertension due to vascular remodeling in response to chronically increased pulmonary circulation. Electrocardiography, though readily available, has so far been of limited screening utility in this population. We hypothesize that vectorcardiographic parameters will aid in identifying increased ventricular afterload and thus provide an additional screening tool for pulmonary hypertension in this patient population. Purpose To establish whether vector electrocardiography can be used as a non-invasive screening tool for pulmonary hypertension screening in patients with atrial septal defects. Methods Retrospective chart review of patients with the diagnosis of secundum atrial septal defect who underwent cardiac catheterization at the University of Minnesota from January 2012 to September 2020. We excluded patients with other congenital heart diagnoses, insufficient hemodynamic data, or no sinus rhythm electrocardiogram. An electrocardiogram prior to or on the day of the intervention was assessed. Parameters analyzed include: Sokolow-Lion right ventricular hypertrophy criteria, PR duration, QRS duration, corrected QT intervals, QRS and Twave frontal plane axes, rSR’, rSR’ with the R’ of 5mm or more, as well as vectorcardiographic parameters (Kohr’s regression-related method) the QRS vector magnitude, T wave vector magnitude, and spatial QRS-T angle. These results were then used to compare those with and without pulmonary hypertension (diagnosed by mean pulmonary artery pressure of 25mmHg or more along with body surface area-indexed pulmonary vascular resistance of 3 Woods units/meter squared with normal left atrial/pulmonary vein wedge pressure). Mann-Whitney U-testing was used for non-parametric testing for significance within the dataset. Results Three hundred and five patients were identified with secundum atrial septal defects, but after exclusion, there were a total of 122 patients meeting criteria for assessment. Eight ASD patients had pulmonary hypertension (37% male, median age 7.5 years, interquartile range 0.4 to 23 years) while 114 patients did not (31% male, median age 5 years, interquartile range 3 to 13 years, p-value 0.68). Only the spatial QRS-T angle significantly differentiated pulmonary hypertension (median 104 degrees, interquartile range 55 to 137 degrees) from those ASD patients without pulmonary hypertension (median 37 degrees, interquartile range 21 to 63 degrees) with a p-value of 0.002. At a cut-off of 124 degrees, the positive and negative predictive values for identification of pulmonary hypertension was 36.4% and 96.4%, respectively, with an odds ratio of 13.4 (95% confidence interval of 2.9 to 63.7). Conclusions The spatial QRS-T angle may be a useful, non-invasive screening tool for pulmonary hypertension in patients with secundum atrial septal defects.

Analysis of the Early Repolarization in Competitive Athletes: Comparison Between the Notch and The Slur

Early repolarization is currently defined by the presence of notch or slur, at the end of QRS complex, greater ≥ than 0.1 mV in two contiguous leads, and the ST-segment elevation is not necessary for diagnosis. Several studies have confirmed that early repolarization on the electrocardiogram has been associated with an increased risk of sudden arrhythmic death either in the general population or in athletes. However, no study has evaluated the prevalence of this anomaly, using the current definition of early repolarization, in the population of Algerian or North African athletes, no study analyzed notches and slurs separately, and no study compared them. The main objective of our study is to determine the prevalence of ER in an Algerian population of competitive athletes. The secondary objective was to compare the end-QRS Notching and Slurring, and to determine the influence on this prevalence of certain clinical and electrocardiographic parameters, to establish an epidemiological profile of this anomaly. Methods: In our study, we used the current definition of early repolarization. The study population is represented by 621 athletes participating in the various sports competitions organized in the region of Sétif, having undergone a cardiological examination, at the level of the cardiology service of Setif university hospital center, as part of the establishment of a medical certificate of no contraindication to the practice of the sport. Athletes also benefited from a clinical examination (weight, height, cardiac auscultation, functional signs (angina, palpitation, loss of awareness and dyspnea), palpation of the pulse, and measurement of the blood pressure). The electrocardiograms were collected at rest and away from any sporting activity. And in addition to the analysis of ER (prevalence, notch, slur, amplitude, and topography), criteria for ventricular hypertrophy (Sokolow-Lyon index and Cornell index), heart rate, and right bundle branch block were sought and analyzed. Results: The ECG was normal in 29.3% of the athletes, while the majority of athletes (66.3%) had adaptative electrocardiographic abnormalities to regular physical training (minimum of 4 h per week) and competition, 4.3% of athletes had abnormal electrocardiographic patterns suggesting underlying heart disease. The prevalence of ER in our athletes according to the new diagnostic criteria is 26.1%, with a clear male predominance. This prevalence increases with age, peaking in the third decade and then declines. The prevalence of ER is higher in bradycardic athletes and those with a Sokolow-Lyon index greater than 35 mm; for the Cornell index, no relationship was found. Moreover, ER is significantly lower in athletes with incomplete right Branch Block. In our series, ER is predominant in the inferior leads (40.7%) than lateral ones (34.6%), and the double location is found in 24.7%. This distribution of topographies is not influenced by age and gender. 31.8% of ER has an amplitude ≥ of 2 mm. 30.9% of ER is associated with ST-segment elevation. Notch is the predominant pattern whatever the topography of ER is (notch, 57.4%; slur, 18.5%; notch+slur, 24.1%); notch predominates in lateral leads (52.3%) while slur is predominant in inferior leads (68.0%).1%); only the notch has a significant relationship with male sex (23.8% vs 5.7%, p<0.001) with bradycardia (41.4% vs 16%, P<0.001) and with physical training. The prevalence of notches and slurs is significantly higher in athletes with a Sokolow-Lyon index greater than 35 mm. Conclusion: The pattern of ER is frequent in athletes; its prevalence is influenced by age, sex, heart rate, left ventricular hypertrophy, and incomplete right bundle branch block, type of sport, and intensity of the dynamic and static component of sports activity. The inferior topography (considered as a criterion of the high risk of ER) is found the most in our athletes; the notch is the most frequent pattern. It has been found that the two patterns "notch" and "slur", which are the basis of the definition of ER, are not influenced in the same way by the other clinical and electrocardiographic parameters.

Standard Values and Characteristics of Electrocardiographic Findings in Children and Adolescents.

Reference values and the characteristics of the electrocardiographic (ECG) findings using a large number of subjects are lacking for children and adolescents.Methods and Results:A total of 56,753 digitally stored ECGs of participants in a school-based ECG screening system were obtained between 2006 and 2009 in Kagoshima, Japan. Each ECG was manually reviewed by 2 pediatric cardiologists and only ECGs with sinus rhythm were included. A final total of 48,401 ECGs from 16,773 1st (6 years old, 50% girls), 18,126 7th (12 years old, 51% girls), and 13,502 10th graders (15 years old, 52% girls) were selected. ECG variables showed differences in age and sex. However, the effects of age and sex on ECG variables such as the PQ interval, QRS voltage, and STJ segment were also different. The 98th percentile values of well-known surrogate parameters for ventricular hypertrophy in the present study were much higher than the conventional criteria. The present study of a large number of pediatric subjects showed that the effects of age and sex on ECG parameters are different, and that criteria for ventricular hypertrophy should be newly determined by age and sex. We have developed reference data for STJ segment elevation for children and adolescents. These findings are useful for creating guidelines and recommendations for interpretation of pediatric ECG.

Deeper S Wave in Lead V5 and Broader Extent of T Wave Inversions in the Precordial Leads are Clinically Useful Electrocardiographic Parameters for Predicting Pulmonary Hypertension.

Electrocardiography (ECG) is used to screen for pulmonary hypertension (PH). However, it is unclear which parameters of ECG are the most useful for screening.ECG parameters related to right ventricular hypertrophy criteria were examined in 145 ECGs of subjects who were suspected to have PH and underwent right heart catheterization (RHC) (age 58.4 ± 17.5 years, 112 women, mean pulmonary arterial pressure [MPAP] 35.4 ± 13.3 mmHg). Based on the results of RHC, 108 subjects had PH (56 pulmonary arterial hypertension [PAH] and 52 chronic thromboembolic pulmonary hypertension [CTEPH]).Fourteen of 17 ECG parameters in the present study were significantly associated with PH on univariate analysis. On multivariable logistic regression analysis, S wave depth in lead V5 (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.10-1.47) and depth of T wave inversion in lead V4 (OR 1.21, 95% CI 1.03-1.46) were independent predictors of MPAP ≥ 25 mmHg, and the cut-off values determined by receiver operating characteristic curve analyses were 0.42 mV and -0.28 mV, respectively.In conclusion, a deeper S wave in lead V5 and the presence of a wider extent of negative T waves in the precordial leads may be clinically simple and useful ECG parameters for screening for PH.

Clinical Use of Electrocardiography in Adults With Congenital Heart Disease

The prevalence of adult congenital heart disease (ACHD) has risen markedly over the past 2 decades, with the number of adults now rivaling the number of children with severe defects.1 This is, perhaps, not surprising given that current care allows nearly 90% of infants born with heart defects to thrive into their adult years.1,2 This remarkable triumph is tempered, however, by the realization that early interventions were reparative and not curative. Numerous complications may surface years after uneventful childhood courses, justifying vigilant clinical follow-up throughout adulthood. The 12-lead ECG remains an invaluable cornerstone in the clinical appraisal of adults with congenital heart disease that, in certain circumstances, provides diagnostic and/or prognostic information. The present review imparts a clinical perspective to ECG interpretation in ACHD, emphasizing practical and pathogenomonic findings in the more frequently encountered congenital defects in adults. Anatomic features of the conduction system relevant to ECG findings in ACHD are summarized, including variations in the location of the sinus node, atrioventricular (AV) node, and His-Purkinje system. Thereafter, pertinent ECG features are highlighted for common subtypes of ACHD (Table). Examples are provided throughout for illustration. View this table: Table. Typical ECG Features in Common Forms of ACHD ### Sinus Node In the morphologically normal heart, a crescent-shaped sinus node is characteristically located epicardially along the lateral aspect of the superior cavoatrial junction. It generates a P-wave axis typically between 15° and 75°. Most patients with ACHD have normally positioned atrial chambers, called atrial situs solitus, with normal sinus node location. The position of the sinus node may, however, vary with the atrial chambers and their appendages. #### Juxtaposition of the Atrial Appendages In juxtaposition of the atrial appendages, both appendages are on the same side of the arterial pedicle rather than each being ipsilateral to its respective atrium. Left juxtaposition, with left-sided atrial appendages, frequently accompanies tricuspid atresia and has …

ASSESSMENT OF LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH ESSENTIAL ARTERIAL HYPERTENSION IN A GENERAL PRACTICE

Background. The heart is a target organ in arterial hypertension. Echocardiography is the most valuable noninvasive method to assess the left ventricular hypertrophy. Patients with left ventricular hypertrophy constitute a group with high cardiovascular risk. Unfortunately, it is not affordable to all hypertensive patients treated in general practice. ECG still remains the basic method to evaluate the left ventricular hypertrophy. A selection of the most sensitive ECG criteria to evaluate left ventricular hypertrophy might improve the sensitivity of the method and thus recognize a sufficient proportion of the hypertensive patients with left ventricular hypertrophy, confirmed by echocardiography. Patients and methods. We included 62 consecutive patients (31 male and 31 female) with essential arterial hypertension, treated in a single general practice. We made anamnesis, a complete clinical examination with eye fundi examination, usual laboratory examinations, 12-lead ECG and echocardiography. We applied the ECG criteria to evaluate left ventricular hypertrophy (Sokolow-Lyon index > 38 mm, Cornell product > 2440 mm*ms) and echocardiographic criteria (left ventricular mass for men at least 125 g/m2 and for women at least 110 g/m2). Results. We found left ventricular hypertrophy in 13 (21.0%) patients by using the combination of both ECG criteria and in 39 (62.9%) by echocardiography. The sensitivity of the combined ECG criteria was 25.6%, the sensitivity of SokolowLyon index was 12.8% and the sensitivity of Cornell product was 17.9%. The specificity of Sokolow-Lyon index was 83%, Cornell product had 78% specificity and the combination of both criteria had specificity of 100%. The left ventricular hypertrophy confirmed by echocardiography was more prevalent in female patients (p = 0.035) and it showed statistically significant correlation with higher values of Sokolow-Lyon index and Cornell product (p < 0.0005). Conclusions. The combination of Sokolow-Lyon index and Cornell product yields higher sensitivity than each of them alone and enables us to recognize a higher percentage of hypertensive patients with actual left ventricular hypertrophy. Values of applied ECG criteria which are closer to the limit values signify a higher possibility for the left ventricular hypertrophy.

Heart Disease in Infants, Children and Adolescents

The editors of this book have selected 74 contributors from 33 centers to encompass the topics in pediatric cardiology. Each chapter includes an extensive selection of references. The first chapter, written by James Nora, is concerned with the etiologic aspects of congenital heart disease. His tables of autosomal dominant, recessive, and sex-linked syndromes will be helpful in investigating causes of heart disease when associated with other malformations. Forrest Adams describes fetal circulation and the alterations that occur after birth. Jerome Liebman and Robert Plonsey present electrocardiography along with tables of normal values for heart rate, PR interval, and amplitude of R and S waves in the precordial leads. Criteria for ventricular hypertrophy are designated. The intricacies of vectorcardiography are related by Samuel Sapin, with illustrations and tables of normal values for age. Richard Meyer, a pioneer in the field of pediatric echocardiography, amply covers the subject and provides superb echocardiograms

Electrocardiogram of the Athlete

Routine medical evaluations of well-trained endurance athletes frequently disclose electrocardiographic abnormalities suggestive of organic heart disease. First- and second-degree atrioventricular (AV) block, altered ventricular conduction, criteria for atrial enlargement or ventricular hypertrophy, and repolarization abnormalities are commonly found. On the basis of such abnormal tracings, the athlete may be advised to refrain from his customary strenuous exertion, even though the results of physical examination are normal and there is no history suggesting cardiovascular disease. In fact, such athletes are usually quite fit for the activity for which they train so vigorously. The electrocardiographic findings probably reflect the anatomic and electrophysiologic effects of training on the cardiovascular system. It is important for physicians to recognize these changes as normal variants when seen in well-trained athletes.