Electrocardiogram Abnormalities In Patients Research Articles

Atrial depolarization abnormalities in pulmonary sarcoidosis

BackgroundCardiac sarcoidosis, often manifested as sudden death, can be the first manifestation of sarcoidosis. Since 12-lead electrocardiogram (ECG) is recommended as an initial screening tool for cardiac sarcoidosis, the recognition of subtle abnormalities assumes utmost significance. The objective of this study was to identify the electrocardiographic abnormalities in patients with pulmonary sarcoidosis.ResultsA detailed analysis of 12-lead ECGs obtained from sixty patients with histopathologically proven pulmonary sarcoidosis and no overt cardiac involvement was done. The findings were compared with those of an age-matched control group. Varying degrees of intraventricular conduction defects were common in the study group [67%], as well as the control group [57%] [P = 0.23]. There was a higher prevalence of biphasic P wave [P = 0.003] and bifid P wave [P = 0.029] in lead III and rsr’ in lead aVF [P = 0.03] in the study group as compared to the control group.ConclusionsOur study demonstrates a greater prevalence of subtle ECG abnormalities in patients with pulmonary sarcoidosis as compared to patients with other forms of pulmonary disease. Atrial depolarization abnormalities were commoner in patients with pulmonary sarcoidosis.

Prevalence and Associated Factors of Electrocardiogram Abnormalities in Patients With Systemic Lupus Erythematosus: A Machine Learning Study.

Electrocardiogram (EKG) abnormalities are predictive of subsequent cardiovascular events. Cardiac involvement is common in systemic lupus erythematosus (SLE). We aimed to determine the prevalence of EKG abnormalities in SLE patients and to examine the factors associated with EKG abnormalities with machine learning approaches. Consecutive SLE patients' records were retrieved from the database of the hospital for the cross-sectional study. Abnormal EKGs with clinical significance were grouped by the presence of tachyarrhythmias, atrioventricular block, nonspecific ST segment changes, T wave abnormalities, ventricular hypertrophy, axis deviation, bundle branch block, and QT interval prolongation. Associated factors of the most common EKG abnormalities were assessed by comparing logistic regression and 4 other machine learning approaches. In the present study, 299 patients were enrolled, with 128 showing clinically significant abnormalities on EKG. T wave changes (52.3%), nonspecific ST segment-T wave (ST-T) changes (26.6%), and prolonged QT interval (8.6%) were the most prevalent abnormalities among patients with abnormal findings on EKG. Random forests models had the best performance in the discovery of associated factors. Age, disease duration, antinuclear antibody titer, disease activity (as measured by the Systemic Lupus Erythematosus Disease Activity Index 2000) were associated with nonspecific ST-T changes, prolonged QT interval, and T wave changes. Hypertension, positivity for anti-SSA antibodies, and secondary Sjögren's syndrome were influential factors for nonspecific ST-T changes, prolonged QT interval, and T wave changes, specifically. ST-T and T wave changes were the most common abnormalities seen on EKGs of SLE patients. Our finding suggests that age, longer disease duration, higher disease activity, hypertension, anti-SSA antibody positivity, and secondary Sjögren's syndrome are important and influential factors in these EKG abnormalities.

A Novel Electrocardiography Model for the Diagnosis of Acute Pulmonary Embolism.

Acute pulmonary embolism (acPE) is a severe disease that is often misdiagnosed as it is difficult to detect quickly and accurately. In this study, a novel electrocardiogram (ECG) model was used to estimate the probability of acPE rapidly via analysis of ECG characteristics. A total of 327 patients with acPE who were diagnosed at the Sichuan Provincial People's Hospital (SPPH) between 2018 and 2021 were retrospectively studied. A total of 331 patients were randomly selected as the control group, which included patients hospitalized during the same time period. The control group included patients who presented with characteristic symptoms of acPE, but this diagnosis was ruled out following further diagnostic testing. This study compared the diagnostic value of the ECG model with those of another ECG scoring model (Daniel-ECG score) and the most common prediction models (Wells score and Geneva score). This study established an ECG-predictive model using analysis of the ECG abnormalities in patients with acPE. The final ECG model included certain novel ECG signs that had not been incorporated in the previous ECG score of the patients, and thus, compared to the previous ECG score, exhibited a more favorable area under the receiver operating characteristic curve (AUC) value (0.8741). The model developed in this study was named the SPPH-ECG model. Furthermore, this study compared the SPPH-ECG model with Daniel-ECG score, Wells score, and Geneva score, and the SPPH-ECG model was demonstrated to exhibit a superior AUC value (0.8741), sensitivity (79.08%), negative predictive value (79.52%), and test accuracy (79.42%), while the Geneva score presented superior specificity (100%) and positive predictive value (100%) compared with the SPPH-ECG model. In conclusion, the SPPH-ECG model may play a role in ruling out acPE in patients during diagnostic testing and diagnose acPE rapidly and accurately in combination with the Geneva scoring system.

Population prevalence of atrial fibrillation and QRS prolongation and mortality in people with suspected heart failure

Abstract Background The 12-lead electrocardiogram (ECG) is an essential tool for the diagnosis and management of heart failure (HF). There are few population-based studies on the prevalence and prognostic implications of ECG abnormalities in patients with HF. There are also no robust diagnostic criteria for HF. We explored these issues in a large administrative database. Methods The National Health Service Greater Glasgow and Clyde Health Board serves a population of ∼1.1 million. We obtained de-identified administrative data, including investigations, diagnosis and prescriptions, linked to hospital admissions and deaths, for anyone with a diagnosis of vascular disease or HF or prescribed loop diuretics (LD) or neuro-endocrine antagonists between 1st January 2012 and 1st April 2018. People were classified into 5 exclusive groups: a) prevalent HF; b) incident (or latent) HF with onset during follow-up; c) people taking LDs but with no diagnosis of HF at any time; d) new prescription of LDs during follow-up but with no diagnosis of HF at any time and d) people to whom none of the above applied. ECGs were classified according to heart rhythm (sinus, AF or flutter or pacemaker/CRT/ICD) and QRS duration <100ms, 100–130ms or >130ms. Follow-up for each group started on 1st of January 2012 (prior to the onset of the classifying event for incident groups). Results During the observation period, of 316,350 people included, 158,421 had a recorded ECG (mean of 3.2 per person with an ECG), including 8,768 prevalent and 13,195 incident cases of HF. Of those who never got a diagnosis of heart failure, 11,508 were receiving and a further 14,633 were newly prescribed LD during follow-up. There were 110,317 people who did not fall into the above groups, of whom 51,089 were aged ≥60 years. A higher proportion of those who were prescribed loop diuretics without a diagnosis of heart failure were women. A similar proportion of those with heart failure and those prescribed diuretics alone had, lung disease and renal dysfunction but patients with heart failure had more ischaemic heart disease, more often had a heart rhythm other than sinus and had longer QRS duration. By three years, 8,816 people (11%) had died, of whom 2,919 (33%) had a diagnosis of heart failure and 2,694 (31%) had been prescribed LD without a diagnosis of HF, together accounting for 64% of all deaths. Patients with a rhythm other than sinus had a worse prognosis in all 5 groups of patients. QRS duration >130ms was associated with a worse prognosis in patients with HF or taking LD. Conclusions Most people with cardiovascular disease who die will first develop HF or be prescribed a LD (indicating possible undiagnosed HF). Patient characteristics of those prescribed LD suggest that many might have HF with preserved left ventricular ejection fraction (HFpEF). Baseline characteristics and HR Funding Acknowledgement Type of funding source: None

Electrocardiographic abnormalities in severe anaemia and its reversibility after correction of anaemia

Background: Anaemia is one of the commonest clinical problems in our country. It affects various organs including the heart. Clinical manifestations of anaemia referable to cardiovascular system may closely simulate symptoms and signs of organic heart disease. It includes some electrocardiogram (ECG) changes also. ECG changes in anaemia show correlation to haemoglobin (Hb) concentration and the changes are reversible after correction of anaemia. In this study, the main objective was to study electrocardiographic changes in patients with severe anaemia and ECG reversibility after treatment of anaemia.Methods: 50 patients admitted in medicine wards of Shri B. M. Patil Medical College, Hospital and Research Center, Vijayapura for severe anaemia (Hb concentration less than or equal to 7 gm %) were studied for ECG changes. All patients were reassessed for reversibility of changes after treatment.Results: Out of 50 patients with severe anaemia, 20 patients were having Hb % of 3 to 5 gm %. Of which 16 patients were having ECG changes (10 were females and 6 were males). All ECG changes were reverted to normal after correction of anaemia, except one patient (showed pre-treatment T wave inversion and post-treatment flat T waves).Conclusions: ECG abnormalities in patients with severe anaemia are more common in females. ECG abnormalities in patients with severe anaemia (Hb 5 gm %) can get reverted to normal after correction of anaemia.

Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study.

The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2. Retrospective review of adult inpatients' charts, comparing those with billing codes for "Hemodialysis" vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded. One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study

ABSTRACTBackground: The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2.Methods: Retrospective review of adult inpatients’ charts, comparing those with billing codes for “Hemodialysis” vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded.Results: One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). Conclusion: To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

Abstract TP572: Electrocardiogram T Wave Abnormalities are Associated With the Total Burden of Cerebral Small Vessel Disease in Patients With Acute Ischemic Stroke or Transient Ischemic Attack

Introduction: Electrocardiogram (ECG) abnormalities are commonly seen in patients with acute ischemic stroke (AIS). We aimed to determine the influence of the underlying brain state as measured by the total cerebral small vessel disease (CSVD) burden on ECG abnormalities in patients with AIS or Transient Ischemic Attack (TIA). Methods: Patients with AIS and TIA were prospectively enrolled in a hospital-based stroke registry. Total CSVD burden was measured according to Staals et al on the first brain MRI obtained within 48 hours from hospital admission. Stroke volume was measured on the DWI sequences using ABC/2 formula according to Sims et al. ECG abnormalities were noted on the first ECG obtained in the Emergency Department. Additionally, PR and QTC intervals and QRS complex duration were measured. Univariate analysis was used to test the relationships between total CSVD burden and ECG abnormalities. Linear regression and binary logistic regression models were used for the variables that were significant in univariate analysis to adjust for age, sex, race, current smoking, history of atrial fibrillation, coronary artery disease, valvular disease, myocardial infarction, hypertension, diabetes, hyperlipidemia, antihypertensive medications, stroke volume and involvement of the insula by the stroke. Results: 141 patients (age 64.5±15.3, 49% females, total CSVD burden was 1.6±1.4, stroke volume 21±40.6, heart rate 79.6±16.5, PR interval 168.4±27 ms, QRS complex 94.1±19.2 ms, QTC interval 450±37.1 ms, abnormalities of ST, T wave, right ventricular hypertrophy, left ventricular hypertrophy, bundle branch block and myocardial infarction were seen in 19.8%, 26.5%, 1.7%, 9.2%, 6.7% and 24.2%). Rhythm was sinus in 72.7% and atrial fibrillation in 8.6%. In univariate analysis, there was significant relationship of total CSVD score with QTC interval and T wave abnormalities (P values: 0.01 and 0.0036 respectively). The relationship of T wave abnormality with total CSVD burden remained significant in logistic regression analysis (OR: 2.2, 95% CI: 1-4.8, P: 0.05). Conclusions: Total CSVD burden is associated with ECG T wave abnormalities in TIA and AIS patients. Further research is required to identify the underlying pathophysiological mechanisms.

Electrocardiographic abnormalities in patients with pulmonary sarcoidosis (RCD code: III)

Sarcoidosis is a systemic inflammatory disease characterized by the presence of noncaseating granulomas. Etiology of the disease remains unknown. From 3.7% to 54.9% patients with extra‑cardiac sarcoidosis have asymptomatic heart involvement. Conduction abnormalities, arrhythmias and congestive heart failure are the most common clinical manifestations of cardiac sarcoidosis (CS). The aim of the study was to evaluate the type and frequency of electrocardiographic abnormalities in patients with pulmonary sarcoidosis and to compare differences in the occurrence of electrocardiographic changes between patients diagnosed with CS and patients without confirmation of CS. Materials and methods : 49 patients (18 women, 31 men), mean age 45.6 ±12.2 years with biopsy‑proven pulmonary sarcoidosis were enrolled in the study. The patients were divided into two groups. Group 1 consisted of 12 patients diagnosed with CS, and Group 2 of 37 patients without diagnosis of CS. 12‑lead baseline electrocardiogram (ECG) was recorded for all participants. Results : 89.8% patients with pulmonary sarcoidosis had abnormal ECG. The most common ECG abnormalities were ST‑T changes observed in 79.6%. Conduction abnormalities were present in 26.5% of patients. 22.45% patients had left axis deviation. Rhythm abnormalities were recorded in 20.4% of all analyzed ECGs. ECGs of 8.16% of patients met criteria of hypertrophy. There was a trend towards more frequent prevalence of some ECG changes in patients with CS than patients without CS. However, these differences were not statistically significant. Conclusions : We observed a trend towards more frequent prevalence of some ECG abnormalities in a group of patients with CS than in patients without CS. However, these differences were not statistically significant. ECG abnormalities in patients with pulmonary sarcoidosis require further diagnostics. JRCD 2017; 3 (3): 81–85

Prospective Exploratory Analysis of Cardiac Biomarkers and Electrocardiogram Abnormalities in Patients Receiving Thoracic Radiation Therapy with High-Dose Heart Exposure

Acute effects of incidental cardiac irradiation in patients treated for thoracic cancer are not well characterized. We evaluated longitudinal changes in cardiac biomarkers for patients undergoing conformal radiation therapy (RT) with thoracic malignancies with high-dose cardiac exposure. Twenty-five patients enrolled in a prospective trial (February 2009-December 2012) received more than or equal to 45 Gy to the thorax, with pretreatment estimates of more than or equal to 20 Gy to the heart. Chemotherapy was allowed except for doxorubicin or fluorouracil. Electrocardiographic (ECG), troponin-I (TnI), and brain natriuretic peptide (BNP) measurements were obtained before RT, within 24 hours of the first fraction, at the end of RT, and at first follow-up (1-2 months). These biomarkers were quantified at specific times and changes from baseline were evaluated with paired t tests. The median heart dose was 25.9 Gy (range 10.1-35.1 Gy). After the first RT fraction, no changes were noted in ECG or median TnI or BNP levels; at the end of RT, two patients had elevated TnI and BNP, but neither difference was statistically significant. At first follow-up, TnI had returned to normal but the median BNP remained elevated (p = 0.042). BNP did not increase over time in the 18 patients who received only RT. Twelve patients experienced acute ECG changes during RT, which resolved in seven patients by the next measurement. No patients experienced clinically significant RT-related events. Increases in BNP and ECG changes were observed during high doses of radiation to the heart. The findings of this pilot study warrant further investigation and validation.

A Prospective Analysis of Cardiac Biomarkers and Electrocardiogram Abnormalities in Patients Receiving Thoracic Radiation Therapy With High-Dose Heart Exposure

A Prospective Analysis of Cardiac Biomarkers and Electrocardiogram Abnormalities in Patients Receiving Thoracic Radiation Therapy With High-Dose Heart Exposure

Frequent electrocardiographic abnormalities and associated conditions in Chagas disease patients

Purpose: Chagas disease (ChD) is endemic in Latin American countries, but has become a worldwide problem due to migration of infected individuals to developed countries, mostly in Europe and North America. Electrocardiography has been considered an essential exam to evaluate ChD patients. The objective of this study was to identify prevalent abnormalities in the electrocardiogram (ECG) and common associated conditions in patients with ChD. Methods: In this observational and retrospective study, all 12-lead standard digital electrocardiograms (ECGs) analyzed by cardiologists of a public telemedicine service in Brazil, from January to December 2011 were assessed. This service attends primary care of 658 cities in Minas Gerais province. ECGs were sent by remote professionals through internet to be analyzed by cardiologists who are trained and experienced in the analysis and interpretation of ECG. The prevalence of ECG abnormalities in patients who declared to have ChD was assessed. Results: During the study period, 264,324 patients were evaluated; 7590 were ChD patients (mean age 57.0±13.7 years, 64.1% women. Hypertension was the most frequent comorbidity, present in 61.3% of the ChD patients, followed by diabetes (9.1%) and dyslipidemia (6.9%). Family history of coronary disease was reported by 32.6% of the patients, and 10.7% referred smoking. Only 30.1% of the patients had normal ECGs. Regarding the rhythm, 86.9% of them had a normal sinus rhythm, 5.3% atrial fibrillation or flutter, 5.4% ventricular premature beats, 2.5% supraventricular premature beats and 3.5% were pacemaker users. Right bundle branch block (RBBB) was observed in 22.7% of the ECGs, left bundle block in 3.1% and left anterior hemiblock (LAH) in 22.5%.The presence of first degree atrioventricular block was found in 4.9%, second and third degrees in 0.2% each. There was electrocardiographic evidence of left ventricular and atrial hypertrophy in 3.6% and 2.5% of patients, respectively. Conclusion: In this large sample of primary care patients with ChD, there was a high prevalence of ECG abnormalities. As expected, the most common abnormalities were RBBB and LAH.

Frequent electrocardiographic abnormalities and associated conditions in Chagas disease patients

Introduction: Chagas disease (ChD) is endemic in Latin American countries, but has become a worldwide problem due to migration of infected individuals to developed countries. Electrocardiography has been considered an essential exam to evaluate ChD patients. The objective of this study is to identify prevalent abnormalities in the electrocardiogram (ECG) and common associated conditions in patients with ChD. Methods: In this observational and retrospective study, all 12-lead standard digital ECGs analyzed by cardiologists of a public telemedicine service in Brazil, from January to December 2011 were assessed. This service attends primary care of 660 cities in Minas Gerais province. ECGs were sent by IT professionals in remote sites over the internet to be analyzed centrally by cardiologists who were trained and experienced in the analysis and interpretation of ECGs. The prevalence of ECG abnormalities in patients known to have ChD was assessed. Results: During the study period, 264,324 patients were assessed; 7590 were ChD patients (mean age 57.0 ± 13.7 years, 64.1% women). Hypertension was the most frequent comorbidity (61.3% of the ChD patients), followed by diabetes (9.1%) and dyslipidemia (6.9%). Family history of coronary disease was reported by 32.6% of the patients, and 10.7% were smokers. Only 30.1% of them had normal ECGs. Regarding the rhythm, 86.9% had normal sinus rhythm, 5.3% atrial fibrillation or flutter, 5.4% ventricular premature beats, 2.5% supraventricular premature beats and 3.5% were pacemaker users. Right bundle branch block (RBBB) was observed in 22.7% of the ECGs, left bundle block in 3.1% and left anterior hemiblock (LAH) in 22.5%.The presence of first degree atrioventricular block was found in 4.9%, second and third degrees in 0.2% each. There was electrocardiographic evidence of left ventricular and atrial hypertrophy in 3.6% and 2.5% of patients, respectively. Conclusion: In this large sample of primary care patients with ChD, there was a high prevalence of ECG abnormalities. As expected, the most common abnormalities were RBBB and LAH.

Atrial fibrillation: prevalence in primary care patients in Brazil

Introduction: Chagas disease (ChD) is endemic in Latin American countries, but has become a worldwide problem due to migration of infected individuals to developed countries. Electrocardiography has been considered an essential exam to evaluate ChD patients. The objective of this study is to identify prevalent abnormalities in the electrocardiogram (ECG) and common associated conditions in patients with ChD. Methods: In this observational and retrospective study, all 12-lead standard digital ECGs analyzed by cardiologists of a public telemedicine service in Brazil, from January to December 2011 were assessed. This service attends primary care of 660 cities in Minas Gerais province. ECGs were sent by IT professionals in remote sites over the internet to be analyzed centrally by cardiologists who were trained and experienced in the analysis and interpretation of ECGs. The prevalence of ECG abnormalities in patients known to have ChD was assessed. Results: During the study period, 264,324 patients were assessed; 7590 were ChD patients (mean age 57.0 ± 13.7 years, 64.1% women). Hypertension was the most frequent comorbidity (61.3% of the ChD patients), followed by diabetes (9.1%) and dyslipidemia (6.9%). Family history of coronary disease was reported by 32.6% of the patients, and 10.7% were smokers. Only 30.1% of them had normal ECGs. Regarding the rhythm, 86.9% had normal sinus rhythm, 5.3% atrial fibrillation or flutter, 5.4% ventricular premature beats, 2.5% supraventricular premature beats and 3.5% were pacemaker users. Right bundle branch block (RBBB) was observed in 22.7% of the ECGs, left bundle block in 3.1% and left anterior hemiblock (LAH) in 22.5%.The presence of first degree atrioventricular block was found in 4.9%, second and third degrees in 0.2% each. There was electrocardiographic evidence of left ventricular and atrial hypertrophy in 3.6% and 2.5% of patients, respectively. Conclusion: In this large sample of primary care patients with ChD, there was a high prevalence of ECG abnormalities. As expected, the most common abnormalities were RBBB and LAH.

Electrocardiographic abnormalities in elderly Chagas disease patients: a population-based study (the Bambuí study)

Introduction: Chagas disease (ChD) is endemic in Latin American countries, but has become a worldwide problem due to migration of infected individuals to developed countries. Electrocardiography has been considered an essential exam to evaluate ChD patients. The objective of this study is to identify prevalent abnormalities in the electrocardiogram (ECG) and common associated conditions in patients with ChD. Methods: In this observational and retrospective study, all 12-lead standard digital ECGs analyzed by cardiologists of a public telemedicine service in Brazil, from January to December 2011 were assessed. This service attends primary care of 660 cities in Minas Gerais province. ECGs were sent by IT professionals in remote sites over the internet to be analyzed centrally by cardiologists who were trained and experienced in the analysis and interpretation of ECGs. The prevalence of ECG abnormalities in patients known to have ChD was assessed. Results: During the study period, 264,324 patients were assessed; 7590 were ChD patients (mean age 57.0 ± 13.7 years, 64.1% women). Hypertension was the most frequent comorbidity (61.3% of the ChD patients), followed by diabetes (9.1%) and dyslipidemia (6.9%). Family history of coronary disease was reported by 32.6% of the patients, and 10.7% were smokers. Only 30.1% of them had normal ECGs. Regarding the rhythm, 86.9% had normal sinus rhythm, 5.3% atrial fibrillation or flutter, 5.4% ventricular premature beats, 2.5% supraventricular premature beats and 3.5% were pacemaker users. Right bundle branch block (RBBB) was observed in 22.7% of the ECGs, left bundle block in 3.1% and left anterior hemiblock (LAH) in 22.5%.The presence of first degree atrioventricular block was found in 4.9%, second and third degrees in 0.2% each. There was electrocardiographic evidence of left ventricular and atrial hypertrophy in 3.6% and 2.5% of patients, respectively. Conclusion: In this large sample of primary care patients with ChD, there was a high prevalence of ECG abnormalities. As expected, the most common abnormalities were RBBB and LAH.

Relationship between ECG findings and pulmonary artery pressure in patients with acute massive pulmonary thromboembolism.

Pulmonary thromboembolism (PTE) is associated with various electrocardiogram (ECG) abnormalities, but the utility of evaluating the severity of PTE based on ECG abnormalities alone has not been investigated in Japanese patients previously. The purpose of this study was to examine the relationship between ECG abnormalities and the mean pulmonary artery pressure (MPAP) in patients with acute massive PTE (AMPTE). ECG examination of 21 patients, who were diagnosed with AMPTE by pulmonary arteriography, found that S(1)Q(3)T (3) was the most frequently observed abnormality (in 67% of the patients), followed by negative T (62%), clockwise rotation (57%), and ST elevation (48%). When these patients were divided into 2 groups based on the level of MPAP, 8 of the 11 ECG findings, which were associated with PTE in a previous report, were more frequently observed in Group H (MPAP >/=40 mmHg) than in Group L (MPAP <40 mmHg). MPAP correlated significantly with the total number of ECG abnormalities (r=0.82, p<0.001). In particular, at least 5 ECG abnormalities were noted in patients with MPAP >/=45 mmHg. These results suggested that the total number of ECG abnormalities in patients with AMPTE can be used to evaluate the severity of APTE, including PAP level.

Heart rate-dependent electrocardiogram abnormalities in patients with postural tachycardia syndrome

We recently published data suggesting the presence of an intrinsic sinus node abnormality in a subgroup of patients with the postural tachycardia syndrome (POTS). Based on the hypothesis that more widespread abnormalities of cardiac electrophysiologic properties may be present in POTS, we undertook a study to compare cardiac conduction and repolarization at different heart rate levels in patients with POTS and healthy controls. Eleven healthy controls and fourteen patients with POTS participated in the study. Acquisition of 12-lead electrocardiogram recordings were made during supine rest and during gradual head-up tilt. The heart rate of controls was titrated by isoproterenol infusion to match the heart rate of patients. Indices for cardiac conduction (PR interval, QRS duration, and R wave axis) and repolarization (QT interval, QTc interval, and T wave axis) were then compared at different heart rate levels. The PR interval decreased with increasing heart rate in controls more than in patients, resulting in a significantly longer PR interval in patients at the fastest heart rate level. The QT and QTc intervals were significantly shorter in POTS over the entire analyzed heart rate range. The T wave axis decreased with increasing heart rate in patients only. This resulted in a significantly lower T wave axis in patients at the fastest heart rate level. Our data suggest abnormalities of atrioventricular conduction and ventricular repolarization in patients with POTS. These findings may reflect intrinsic cardiac electrophysiologic abnormalities or may be secondary due to abnormalities of cardiac autonomic innervation.

The Belgian Heart Disease Prevention Project: type "A" behavior pattern and the prevalence of coronary heart disease.

A relation between the Type A behavior pattern and the prevalence of coronary heart disease (CHD), independent of other coronary risk factors, was demonstrated in the Belgian Heart Disease Prevention Project. The association was strongest with angina pectoris or with electrocardiogram (ECG) abnormalities in subjects with known CHD; however, particular aspects of the Type A behavior pattern dealing with time urgency were also related to ECG abnormalities in patients with no angina pectoris and no history of CHD.