Electrocardiographic Findings Research Articles

QRS complex fragmentation status before and after cardiac resynchronization therapy predicts hospitalizations for heart failure

Abstract Introduction Cardiac resynchronization therapy (CRT) reduces mortality and hospitalization for heart failure (HF) in selected patients with HF with reduced ejection fraction (HFrEF). However, there is a significant percentage of non-responders who are readmitted for HF after implantation. Several biomarkers and electrocardiographic findings have been suggested as prognostic markers in this group of patients. Fragmentation of the QRS complex (QRSf) has been associated with worse prognosis in several cardiac diseases, but evidence in patients undergoing CRT remains to be limited. Purpose To evaluate if the changes in QRSf status before and after CRT implantation have a prognostic role in patients undergoing CRT in terms of hospitalization for HF. Methods Consecutive patients undergoing CRT were prospectively included from October 2009 to December 2022. Demographic clinical, electrocardiographic and echocardiographic variables were recorded. Prospective follow-up variables were collected from electronic clinical records and telephone interview. QRSf complex was defined by the presence of different RSR′ patterns including an additional R-waves (R′) and notches of the R-wave and S-wave in two contiguous leads corresponding to a main coronary artery territory in a 12-lead surface electrocardiogram performed before and after CRT. Results A total of 244 patients (mean age 72 ± 10 years, 80% male) were included. The etiology of the LV systolic dysfunction was ischemic in 50.0%. Mean LVEF before implantation was 25 ± 9% and mean paced QRS width was 141 ± 23 ms. CRT-D was implanted in 176 patients (72.2%). At baseline, 150 patients had a QRSf. After CRT implantation, 69 (28.4%) patients experimented a change in QRSf status: 29 patients (11.9%) without prior QRSf developed QRSf, whereas 40 patients (16.5%) resolved QRSf after CRT. Median follow-up time was 36.0 months (interquartile range 18.2-75.7). At follow-up, 90 patients died and 91 presented at least one hospitalization for HF. Multivariate Cox regression survival analysis showed that development of QRSf after CRT implantation (HR 8.87; 95% CI 1.85-42.50) and the presence of QRSf before implantation with or without paced QRSf after CRT (HR 8.21; 95% CI 1.75-38.50 and HR 16.70; 95% CI 3.88-71.80 respectively) were independently associated with hospitalizations for HF. Univariate and multivariate Cox regression analyses for HF hospitalization are presented in Table 1. Figure 1 presents Kaplan-Meier curves for QRSf status and hospitalizations for HF. Conclusions According to our results, QRSf status before and after CRT have a significant prognostic role in terms of hospitalization for HF after CRT, especially in those who develop QRSf after CRT and those with baseline QRSf regardless QRSf status after CRT. The worse prognosis was observed in those with QRSf before and after CRT. Therefore, these patients should be followed more strictly because they are at higher risk of decompensation.Table 1.Cox Regression Analyses

Electrocardiographic findings in newborns with inadequate intrauterine growth during pregnancy

Abstract Background Infants born small for gestational age (SGA) or following fetal growth restriction (FGR) have an increased risk of neonatal mortality as well as cardiovascular disease later in life. Prenatal electrocardiograms (ECGs) in fetuses with FGR exhibit QT prolongation. However, neonatal alterations in the conduction system in infants born SGA or with FGR has not previously been assessed in a large cohort of infants. Purpose To investigate potential variations in electrocardiographic parameters between infants born SGA or diagnosed with FGR, in comparison to infants born appropriate for gestational age (AGA). Methods This study was based on data from a population-based cohort study of infants (n>25,000) with prenatal inclusion and postnatal cardiac examination including eight-lead ECG between 2016-2018. We conducted a multiple linear regression analysis to compare ECG parameters among infants with FGR (birthweight <3rd percentile, n=544) and SGA (birthweight ≥3rd and <10th percentile, n=1,384) to infants born AGA (birthweight ≥10th percentile and <90th percentile, n=14,076). Parameters of interest included: heart rate (HR), uncorrected and corrected (Bazzet and Fridericia) QT intervals, QRS duration, PR interval, QRS axis, maximum amplitudes of the R- and S-waves in V1 and V6. All analyses were adjusted for infant sex, gestational age at birth, and weight, length, and age at ECG examination. Results Infants born SGA or with FGR had higher HR and consequently shorter uncorrected QT intervals compared with infants born AGA (Table 1). Infants with FGR had significantly shorter corrected (Fridericias) QT intervals. Infants born SGA had smaller amplitudes of both the R- and S-wave in V6, and significantly larger amplitude of the S-wave in V1, compared with infants born AGA (Table 1). Conclusion ECGs from infants born SGA and infants with FGR differed from infants born AGA, including higher HRs and shorter uncorrected QT-intervals even after adjustments for infant size and age at the examination. Furthermore, we saw infants born SGA had reduced amplitudes of the S and R wave in the lateral lead (V6), and an increased amplitude of the S-wave in V1, compared with infants born AGA. Follow-up examinations of these infants could determine whether these alterations persist beyond the neonatal period, and to fully understand their implications of the cardiac function later in life.

Predicting atrial fibrillation from ECG characteristics

Abstract Background/Introduction Atrial fibrillation (AF) is the most common cardiac arrythmia, and demographic shifts in age continues to increase the prevalence of atrial fibrillation on a global scale. With manifestations of short and intermittent duration, identifying and diagnosing AF often proves to be a challenge. As a consequence, patients who develop AF are at risk of experiencing stroke and other cardiac diseases such as heart failure (HF) before appropriate treatment is initialized. Despite the potential benefits of early AF detection, risk profiling based on electrocardiographic (ECG) findings is currently lacking. Several smaller studies have identified ECG characteristics associated with increased risk of AF, but these characteristics have not been individually evaluated in large-scale nationwide cohorts, and no evidence exists on the additive effect of these ECG characteristics. Purpose We aimed to evaluate the risk of new-onset AF, HF, and stroke according to five ECG characteristics previously linked to AF, in order to identify potential predictors of AF. Methods We used national registers and the Danish Nationwide ECG Cohort to include patients with ECG measurements taken between 2010 and 2022. Patients were grouped according to how many of the following ECG characteristics were present in their baseline ECG: Elevated heart rate (>80), prolonged PR-interval (≥196 ms for women and ≥204 ms for men), biphasic P-waves (positive and negative amplitude within same p-wave), abnormal P terminal force (≥ 6000 mV×ms), and prolonged P-wave duration(≥120 ms). Patients were followed for 2 years to evaluate the risk of atrial fibrillation, heart failure (HF), and stroke, according to baseline ECG characteristics. Results We included 1,505,474 patients of whom 594,702 had exactly one ECG characteristic, 197,367 had two characteristics, 44,983 had three characteristics, 6,390 had four characteristics, and 451 had all five characteristics on their baseline ECG. The risk of developing AF or HF increased with the number of ECG characteristics present on the baseline ECG. Patients with two ECG characteristics had a 2-fold increased risk of AF or HF compared to patients with no ECG characteristics (HR: 2.11 95%CI: 2.05-2.16). Patients with two or more ECG characteristics present on their baseline ECG exceeded a 5% 2-year absolute risk of developing either AF or HF. Among patients with only one ECG characteristic on their baseline ECG, elevated heart rate and prolonged PR interval were the factors most associated with an increased risk of AF compared to patients with none of the ECG characteristics on their baseline ECG. Conclusions The absolute and relative risk of atrial fibrillation, heart failure, and stroke increased with the number of ECG characteristics present on the baseline ECG. We suggest that the ECG characteristics evaluated in this study could be used in screening scenarios for atrial fibrillation to identify high risk patients.Absolute and relative 2-year risksRisk acc. to specific ECG characteristic

Electrocardiographic Findings in Patients with Severe COVID-19: Characterisation and Clinical Correlations

In a prospective study of 200 COVID-19 patients, categorised into mild symptoms (category A; n=39), mild symptoms with cardiopulmonary comorbidities (category B; n=68) and severe symptoms with haemodynamic compromise (category C), category C showed higher incidences of left axis deviations, left atrial enlargement, prolonged QRS, elevated left ventricular amplitude, poor R wave progression and T inversion in V1–V6. A novel marker, rS complex – R/S ratio >1 in lead III, was noted. Univariate analysis revealed left atrial enlargement, left axis deviation, left ventricular amplitude and poor R wave progression as mortality predictors. Multivariate analysis identified age and left atrial enlargement as independent predictors. These findings suggest possible elevated left ventricular end-diastolic pressure, which will help in categorising disease severity and predicting outcomes.

Relationship Between Exercise Electrocardiography Findings and Cardiovascular Events and the Extent of Coronary Artery Disease: What is New?

Relationship Between Exercise Electrocardiography Findings and Cardiovascular Events and the Extent of Coronary Artery Disease: What is New?

Magnitude of cardiac abnormality and its associated factors among hyperthyroidism patients on follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BackgroundThyroid hormones have an effect on every organ system, in particular, the heart responds to minimal changes in serum thyroid hormone level. Thyroid hormone causes a lot of changes in the cardiovascular system, such as increased heart rate, contractility, systolic hypertension, changes in peripheral vascular resistance, atrial fibrillation (AF), and hypercoagulability from the direct effect of thyroid hormone on cardiac myocyte and /or due to increased metabolic state. However, the magnitude of such heart abnormalities and its associated factors were not well studied in Ethiopia.ObjectiveTo determine the magnitude of cardiac abnormality and its associated factors among hyperthyroidism patients on follow-up at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, 2022.MethodsAn institution-based cross-sectional study was carried out among 318 hyperthyroid patients who were on follow-up at the endocrine clinic of TASH, Addis Ababa, Ethiopia from June to October 2022. The data were collected using a pretested structured interviewer administered questionnaire. The data were entered into the computer using EpiData version 3.1 and analyzed using SPSS version 25 software. Bivariable and multivariable logistic regression models were fitted to determine the association between the independent and dependent variables. Adjusted odds ratio with its 95% confidence interval and p-value < 0.05 were used to declare the presence and strength of statistically significant associations.ResultIn this study a total of 318 hyperthyroid patients were participated, most (90.9%) of them were females. The overall prevalence of heart failure among hyperthyroid patients was 17.0% (95% CI = 13.0, 21.6). More than half (52.7%) and one third (33.2%) of the participants showed abnormal electrocardiographic and echocardiographic findings respectively. Marital status (not married) [AOR = 2.37, 95% CI (1.03, 5.44)], pattern of hyperthyroidism [AOR = 13.09, 95% CI (4.70, 36.41)], being Asthmatic [AOR = 7.63, 95% CI (1.55, 37.52)], type of medication [AOR = 3.49, 95% CI (1.11, 11.02)] and duration of treatment [AOR = 4.95, 95% CI (2.05,11.99)] were significantly associated with cardiac abnormality.ConclusionA significant portion of hyperthyroid patients overburdened by cardiac abnormalities. Being unmarried, overt hyperthyroid, Asthmatic, long stay on treatment and type of treatment were significantly associated with cardiac abnormality. Hence, attention should be given for cardiac abnormalities while treating hyperthyroid patients.

Association Between Electrocardiographic Abnormalities and In-Hospital Adverse Outcome in COVID-19 Patients

Background: SARS-CoV-2 is increasingly recognized for its cardiovascular complications. To address the knowledge gap in our region, this study investigated the relationship between electrocardiographic (ECG) features and in-hospital mortality among COVID-19 patients. Methods: A prospective cohort study was conducted involving 140 RT-PCR-confirmed COVID-19 patients at Dhaka Medical College Hospital from August 2021 to July 2022. Patients were divided into two groups based on ECG findings: normal (Group A) and abnormal (Group B). Clinical data and ECG parameters were analyzed using SPSS 24.0. Results: Patients with abnormal ECGs were older, more likely male, and presented with higher rates of dyspnea and palpitations. They were also at increased risk of severe COVID-19 and had longer hospital stays. In-hospital mortality was significantly higher in Group B (21.4% vs.4.3%). ST-T changes and atrial fibrillation were associated with increased mortality. Independent predictors of in-hospital mortality included ECG abnormalities and admission SpO₂ &lt; 90%. Conclusion: ECG abnormalities are significantly associated with adverse outcomes in COVID-19 patients. Further large-scale studies are warranted to strengthen these findings.

Electrocardiographic Changes, Mortality, and Late Period Findings in Methyl Alcohol Poisoning

Background: Methyl alcohol poisoning (MAP) is a common commercial compound that can lead to significant morbidity and mortality when exposed to high levels. This study aims to describe MAP-related electrocardiography (ECG) changes and post-acute late complications. Materials and Methods: The study was conducted through a retrospective data review between 2017 and 2023. Patient data were recorded, including demographic information, medication use, and laboratory results. Twelve-lead ECG recordings were evaluated and the results were recorded. The cases included in the study were grouped according to QTc distance, ECG findings, late-term complications, treatment status, and mortality. Results: The mean age of all cases included in the study (n = 227) was 43.23 ± 11.11 years, 8 (3.5%) cases were female, and the age distribution was between 19 and 68 years (p = 0.792). The age distribution of QTc groups was not significant (p = 0.792). The mean QTc distance was 442.7 ± 60.1 ms in all cases (n = 227) and 514.08 ± 5.45 ms in cases with mortality (n = 49) (p &lt; 0.001). The mean time to application of the patients to the hospital (n = 227) was 19.1 ± 4.61 h, and blood sugar was 130.7 ± 32.09 mg/dL (p &lt; 0.001). In addition, the mean pH of the cases (n = 227) was 7.14 ± 0.2, bicarbonate was 17.17 ± 4.86 mmol/L, the base deficit was −6.21 ± 3.18 mmol/L, the anion gap was 19.36 ± 7.31 mmol/L, and lactate was 4.82 ± 2.45 mmol/L (p &lt; 0.001). Mortality occurred in 49 (21.6%) of the patients, and all of them were in-hospital deaths. In all cases where mortality occurred, pH was below 6.93 ± 0.22 and severe acidosis was directly related to death. MAP, sinus tachycardia in 31 (13.7%) cases, bradycardia in 8 (3.5%), atrial fibrillation in 5 (2.2%), accelerated idioventricular rhythm in 3 (1.3%), and 11 (4.8%), left bundle branch block, and right bundle branch block were detected in 22 (9.7%). All of these ECG findings were newly developed conditions with no previous history. In the 6-month follow-up after discharge, 4 (1.8%) of the cases developed neurological deficit, 15 (6.6%) had acute coronary syndrome and severe heart failure, 23 (10.1%) had permanent blindness, 6 (2.7%) had renal failure, and 6 (2.7%) had pancreatitis. Conclusion: Methyl alcohol poisoning can cause various ECG changes; sinus tachycardia, nonspecific changes, and QTc prolongation are the most common findings. These changes are more pronounced in cases of severe acidosis. Patients should be warned of late signs of MAP.

Clinical Findings, Laboratory Results, Electrocardiography and Echocardiography Findings in Dairy Buffaloes with Theileriosis.

Tropical theileriosis is a tick-borne haemoprotozoan disease, and cardiac function assessment in buffaloes with theileriosis was poorly documented. The Present study was carried out from April 2022 to December 2022. Theileriosis was confirmed by microscopic examination of stained blood smears and lymphnode smearsfurther confirmed by PCR assay. Electrocardiography was performed byusing the base apex lead system, and echocardiography was performed byusing the right parasternal view. The incidence of theileriosis was 16.25% by examination of stained blood smears, and 30.42% by PCR examination in 240 buffaloes. Repeatedly noted clinical signs were the absence of rumination, anorexia, loss of milk yield, depressed demeanour, emaciation, hyperthermia, lymphadenopathy, tick infestation, tachycardia, cardiac arrhythmia, and increased intensity of heartbeat. Haematological findings disclosed decreased haemoglobin, packed cell volume, total erythrocyte count, and neutrophils; increased eosinophils and monocytes. Serum biochemical findings revealed decreased albumin, albumin/globulin ratio, glucose, calcium, phosphorous, sodium, potassium, and chloride; increased globulin, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, cholesterol, lactate dehydrogenase, gamma-glutamyl transferase, and creatine kinase myocardial band isoenzymes. Electrocardiography explorations were sinus tachycardia, broad T wave, and sinus arrhythmia. Echocardiography examination showed ventricular wall thickening, cardiac chamber dilatation, valvular defects/valvular regurgitation, and pericarditis/cardiac tamponade. The present research proposes the changes in the electrocardiography and echocardiography findings in buffaloes with theileriosis, which are essential in clinics to identify the secondary complications during theileriosis and formulate therapeutics.

Fragmented QRS in patients with preeclampsia.

This study aims to investigate the prevalence, clinical correlates, and prognostic implications of fragmented QRS complexes (fQRS) in pregnant women with preeclampsia (PE), shedding light on the potential role of electrocardiographic markers in identifying cardiac involvement in hypertensive disorders of pregnancy. Patients with PE and age-matched low-risk control patients were recruited at a tertiary hospital between January 2015 and January 2023. A comprehensive assessment, including heart rate, PR duration, QRS duration, corrected QT duration, and fragmented QRS, was conducted by 12-lead electrocardiography. Baseline clinical characteristics, laboratory parameters, and electrocardiographic findings were compared between the study groups. 128 preeclampsia patients and 122 age- and comorbidity-matched controls were included in the study. The prevalence of fQRS was significantly higher in preeclamptic women compared to normotensive controls (14.1% vs. 3.3%, p = 0.04). ALT levels of pregnant women with preeclampsia and without preeclampsia groups were 43,77 (35.25-48.22) and 23,18 (13.75-33.00) (p: 0.038), respectively. In univariate regression analyses, Na and fragmented QRS were found to be associated with preeclampsia. (p: 0.016 and 0.009, respectively). After multivariable adjustment for variables, Na and fragmented QRS remained strongly associated with preeclampsia (OR: 4.787 (1.556-14.720), p: 0.06; 0.941 (0.893-0.992), p: 0.023, respectively). This study provides compelling evidence of an association between preeclampsia and fragmented QRS complexes, implicating electrolyte imbalances and hemodynamic stress as potential contributors to myocardial electrical instability in hypertensive disorders of pregnancy. Further research is warranted to validate these findings and improve risk stratification and clinical outcomes in affected women. Number: 2023/4705 Retrospectively Registered.

Maternal hypertensive disorders of pregnancy and electrocardiographic findings among newborns: The Copenhagen Baby Heart Study.

Maternal preeclampsia is associated with both congenital heart defects and changes in left ventricular structure and function in the offspring. Whether preeclampsia and gestational hypertension also affect the offspring's cardiac conduction system is unknown. This study assesses whether infants exposed to maternal hypertensive disorders of pregnancy (HDPs) exhibit changes in their electrocardiogram (ECG) compared with infants unexposed to HDPs. This population-based cohort study included newborns from the Copenhagen Baby Heart Study who had an ECG performed within 30 days of birth and had available obstetric information. ECG parameters of newborns exposed to maternal HDPs were compared with those of unexposed newborns using linear regression. Our study cohort included 11,826 newborns, including 441 exposed to maternal preeclampsia and 320 exposed to gestational hypertension. Infants exposed to preeclampsia had prolonged QRS durations (adjusted mean difference 0.6 ms, 95% confidence interval [CI] 0.04, 1.16) and lower maximum amplitudes of the R-wave in V1 (adjusted mean difference, linear scale 0.95, 95% CI 0.90, 1.00), compared with unexposed infants. Exposure to maternal preeclampsia was not associated with changes in other ECG parameters. Exposure to gestational hypertension was associated with increased QT interval durations (QTc Bazett, adjusted mean difference 2.48 ms, 95% CI -0.23, 5.20; QTc Fridericia, adjusted mean difference 2.32 ms, 95% CI -0.19, 4.83). Our findings suggest that the newborn cardiac conduction system is affected by exposure to maternal preeclampsia. This could reflect the previously described thickening of the left ventricular myocardium in infants exposed to preeclampsia.

A-019 Unexpectedly High Cardiac Troponin Values in Healthy Athletes after SARS-CoV-2 Infection

Abstract Background Elevated levels of cardiac troponin I or T (cTnI, cTnT) in general have immediate clinical consequences including invasive cardiac imaging and rhythm monitoring. Macro-troponin is a complex of antitroponin autoantibodies and cTnI or cTnT and may result in falsely elevated values. In athletes, a reliable exclusion of cardiac disease is crucial to allow for intensive exercise. The prevalence and causes of falsely elevated cTn in professional athletes after SARS-CoV-2 infection are unknown. Methods These are preliminary results of an observational study including 35 professional athletes (16 -75 years old, median 24 years; 19 females, 16 males) who had post-Covid-19 check-ups at their practicing sports physician mostly in the year 2022 (6 athletes in 2023). One female athlete did not have a proven SARS-CoV-2 infection but vaccination. Divergences in high sensitivity (hs) cTn concentrations were investigated according to the sex-specific cut-off values of 4 different assays (hs-cTnI: Alinity/Abbott Diagnostics, Atellica/Siemens Healthineers, Access/Beckman Coulter and hs-cTnT: Cobas/Roche Diagnostics). All athletes were advised to stop training 48h before routine blood drawing and if required underwent electrocardiography (ECG), echocardiography and magnetic resonance imaging to exclude myocardial involvement, particularly when suspicious symptoms were present. Athletes with divergent hs-cTn assay results were further analyzed for the presence of macro-troponin using the reference method sucrose gradient ultracentrifugation. Results The two main professional sports were cycling (mountain biking or road biking) and soccer, further sports comprised curling, swimming, running including marathon, floorball, cross-country skiing or rhythmic gymnastics. Athletes mostly suffered from postviral exhaustion, mild infectious symptoms like headache, sore throat, dry cough, subfebrile temperature, or sniffles or had atypical thoracic pain. There were two males with known secondary diagnoses, one 25 years old with diabetes mellitus type 1 and one 75 years old with atherosclerosis and hypercholesterolemia. Eighteen (18/35) athletes had hs-cTn concentrations within the sex-specific cut-off values in all assays and did not undergo further investigation for macro-troponin by sucrose gradient ultracentrifugation. However, in 17 athletes (17/35) hs-cTn was increased in at least one assay method which was mostly a hs-cTnI method (for 2/17 all assays elevated). The sucrose-gradient ultracentrifugation method proved macro-troponin in 15/17 with original hs-cTn values for Abbott Alinity: 5 - 170 ng/L; Siemens Atellica: 9.6 - 376 ng/L; Beckman Access: 0.5 - 55 ng/L and Roche Cobas 4 - 77 ng/L. However, 2/17 had the free troponin form, one with only a minor hs-cTnT increase above the sex-specific cut-off and the other with increased values in all hs-cTn assays but normal values in a 2- and 4-days control follow-up measurement. Notably, there were no ECG or cardiac imaging findings including echocardiography or cardiac magnetic resonance imaging suggestive of myocarditis in the investigated athletes. Conclusions After SARS-CoV-2 infection, cTn might be increased in athletes without a correlate in ECG or imaging reports. This should prompt physicians to consider an assay interference by macro-troponin, particularly if a second troponin method such as hs-cTnT remains normal. AHL &amp; CK share first and OH &amp; CM share last authorship

Out-of-hospital cardiac arrest 30-day-outcomes: the importance of the first electrocardiogram after successful resuscitation

BackgroundWhile there is substantial evidence on the impact of prehospital resuscitation efforts on survival after out-of-hospital cardiac arrest, the importance of the first electrocardiogram after return of spontaneous circulation has been much less studied. ObjectivesThe aim of this study was to identify prognostically relevant electrocardiographic findings in patients after out-of-hospital cardiac arrest due to myocardial infarction. Methods119 patients admitted to hospital after suffering an out-of-hospital cardiac arrest due to myocardial infarction were retrospectively analysed. Patient characteristics and the first 12-lead electrocardiogram after return of spontaneous circulation were collected. The primary outcome was 30-day mortality. ResultsA number of electrocardiographic findings were significantly associated with 30-day mortality: atrial fibrillation/flutter (HR 2.29 (95% CI 1.17 - 4.49, p = 0.015)), right bundle branch block (HR 2.23 (95% CI 1.14 - 4.56, p = 0.020)), bifascicular block (HR 2.51 (95% CI 1.04 - 6.059, p = 0.040)), T inversion (HR 2.01 (95% CI 1.02 - 3.99, p = 0.043)), QTc duration ≥ 500ms (HR 2.21 (95% CI 1.10 - 4.42, p = 0.025)) and QT dispersion ≥ 100 ms (HR 2.11 (95% CI 1.02 - 4.37, p = 0.045)). ConclusionsSeveral different electrocardiographic findings are associated with increased mortality in patients with out-of-hospital cardiac arrest due to myocardial infarction.

Investigating the effects of systemic thrombolysis on electrocardiography and pulmonary artery blood pressure in patients with pulmonary embolism.

We aimed to evaluate the association between electrocardiography (ECG) and echocardiographic findings in patients with pulmonary embolism (PE) before and after systemic thrombolysis. We included 38 PE patients admitted to the hospital with approved right ventricular (RV) dysfunction who were indicated for systemic thrombolysis. Indications for systemic thrombolysis were considered as patients who were either hemodynamically unstable on admission or became unstable in the course of hospital admission. Systemic thrombolysis was performed by either Reteplase or Alteplase. ECG and echocardiographic findings were documented at baseline and 12-24 h following systemic thrombolysis. Our results showed that TAPSE significantly increased while RV size and pulmonary artery systolic pressure (PAP) notably decreased after systemic thrombolysis (p < 0.001). The ECG abnormalities markedly diminished after systemic thrombolysis in PE patients (p < 0.001). Additionally, 100% of our patients had more than one ECG abnormality at baseline, while 55.3% had no ECG abnormalities after systemic thrombolysis. Further, the median number of ECG abnormalities remarkably attenuated after systemic thrombolysis (from 2.0 (1.0) to 0.0 (1.0), p < 0.001). Our results also revealed that delta RV size (r = 0.51, p = 0.001) and delta TAPSE (r = 0.4, p = 0.012) were positively correlated while mortality (r = -0.55, p = 0.001) was negatively associated with changes in the number of ECG abnormalities before and after systemic thrombolysis. We showed that systemic thrombolysis improved echocardiographic and electrocardiographic findings in PE patients. Additionally, a greater decreased number of ECG abnormalities after systemic thrombolysis was accompanied by more improvement in RV size and TAPSE and a lower mortality rate.

Cardiovascular Effects of Treatment with Atropine 0.01% Eyedrops to prevent the Progression of Childhood Myopia

The effectiveness of atropine eyedrops in preventing myopia progression in children has been confirmed, but cardiovascular effects have never been analysed. The objective of this study was to assess cardiovascular changes after treatment with atropine 0.01% eyedrops in 60 paediatric patients who were treated with atropine eyedrops due to myopic progression. Patients were analysed before treatment and 3 months after starting 1 drop daily. The parameters assessed were cardiovascular constants and electrocardiographic data. The average age was 10.2 years, with a higher women percentage. The average follow-up period was 3.5 months. No patients presented pathological electrocardiographic findings and one patient reported symptoms: palpitations. A statistically significant decrease in heart rate (79 vs. 75 bpm) was reported, but without clinical significance. No changes in blood pressure were observed. In conclusion, chronic therapy with low doses of atropine as a treatment for myopia progression does not result in pathological heart changes.

Enhancing patient care: a multimodality strategy for dilated cardiomyopathy in Chagas disease

Chagas disease is a systemic illness characterized by acute and chronic phases. If untreated, it can lead to dysfunction of vital organs, notably the heart, ultimately resulting in heart failure. Transmission primarily occurs through the feces of triatomine insects carrying the protozoan parasite Trypanosoma cruzi, either via a bite wound or intact mucous membranes. Diagnosis of Chagas disease involves serological tests, electrocardiographic findings, and imaging studies. A 58-year-old male patient from Peru with chronic dilated cardiomyopathy underwent evaluation at a tertiary care hospital. Given the uncertain etiology, a comprehensive diagnostic approach was adopted, emphasizing the pivotal role of cardiovascular magnetic resonance imaging and computed tomography angiography in managing chronic cardiomyopathy of Chagas disease. Leveraging these imaging modalities together could augment our ability to evaluate myocardial inflammation and tailor therapeutic strategies accordingly.

Electrocardiographic ventricular arrhythmia parameters during diagnosis and after the treatment of acromegaly: A case-control study

BackgroundThe risk of death is increased in acromegaly patients compared to the general population, and cardiovascular system-related complications are among the risk factors decreasing life expectancy. The Tp-e interval, which is the distance between the point where the T-wave peaks and ends on electrocardiography (ECG), shows ventricular rapolarization and, together with the Tp-e/QT and Tp-e/QTc ratios, these are relatively new tools that predict ventricular arrhythmia. We aimed to evaluate the ECG of acromegaly patients at the time of diagnosis and compare the results with current ECG findings. Material and methodsThe study included 103 acromegaly patients and 81 control subjects. Of the 103 patients, 41 patients had only baseline ECG, 23 patients had only current ECG and 39 patients had both baseline and current ECGs. Heart rate, QT interval and corrected QT (QTc) interval, Tp-e, Tp-e/QT, Tp-e/QTc values on the ECGs were measured by a cardiologist. ResultsIn the acromegaly patients with both baseline and current ECGs, heart rate, QRS duration, Tp-e, and Tp-e/QTc ratio were decreased. The decrease in these arrhythmia parameters was similar in active and remission patients. Compared to the control group, in acromegaly patients with only baseline ECG, heart rate, QTc interval, Tp-e, Tp-e/QT, and Tp-e/QTc were decreased. ConclusionVentricular arrhythmia parameters improve with treatment in patients with acromegaly. The decrease in ventricular arrhythmia parameters was similar in active and remission patients, which can be explained by the significant decrease in IGF-1 levels compared to the time of diagnosis, even in patients with active disease.

Cardiac metastasis in uterine cervical cancer : Asystematic review and case study.

Cardiac metastasis from cervical cancer is rare and only scarcely documented. We aim to present anew case and systematically summarize the available literature. PubMed, Scopus, Web of Science, Central, and ClinicalTrials.gov were systematically searched following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. Results were screened via title, abstract, and full text. Additionally, the reference lists of all papers chosen for the review were screened. Eighty-one papers were identified, describing 86cases in total. Cardiac metastasis occurred at all stages of cervical cancer and in all age groups. Median time from initial diagnosis to diagnosis of cardiac metastasis was 12months. Patients mainly complained of dyspnea and chest pain, 60.8% had pathologic ECG (electrocardiographic) findings. The cardiac mass was most frequently detected by transthoracic echography. The most common tumor histology was squamous cell carcinoma. Chemotherapy and surgical interventions were the main treatment modalities. Median survival after diagnosis of cardiac metastasis was 3months. This largest review on cardiac metastases from cervical cancer confirmed the heart as avery infrequent site of metastasis. There are < 100 cases described in the literature, with very poor prognosis and undefined clinical management.

Clinical analysis of maternal autoantibody-mediated complete left bundle branch block in 9 children

Objective: To analyze the clinical characteristics, treatment, and outcomes of children with complete left bundle branch block (CLBBB) mediated by maternal autoantibodies. Methods: A retrospective analysis was conducted on nine children diagnosed with maternal autoantibody-mediated CLBBB, treated at Beijing Anzhen Hospital and Fujian Provincial Hospital from March 2015 to August 2023. Their clinical characteristics, electrocardiographic and echocardiographic findings before and after treatment were reviewed. Paired sample t-test was used for inter-group comparison. Results: Among the mothers, 6 had positive antinuclear antibodies (ANA), 5 had anti-Sjogren syndrome antigen A antibodies, and 3 had anti-Ro-52 antibodies. The cohort included one female and eight male children, diagnosed with CLBBB at the age of 1 (2, 13) months. The positive autoantibodies in the infants, consisted with maternal antibodies, were detected within the first 3 months of life among 3 cases. Treatments included anti-heart failure therapy, myocardial nutritional support, intravenous immunoglobulin (IVIG) and glucocorticoids. Before treatment, the levels of troponin I (0.175 (0.060, 10.270) μg/L) and N-terminal pro-B-type natriuretic peptide (420 (327, 12 865) ng/L) were elevated, which normalized in most cases after treatment. Post-treatment, the QRS duration significantly shortened compared to pre-treatment ((137±15) vs.(169±25) ms, t=3.76, P<0.001), and the QTc interval significantly decreased ((433±41) vs. (514±27) ms, t=4.95, P=0.001). Before treatment, varying degrees of mitral and tricuspid regurgitation and marked interventricular septal dyskinesia were observed in echocardiography. After treatment, valve regurgitation and ventricular septum motion significantly improved, with a marked increase in left ventricular ejection fraction ((51±13)% vs. (27±6)%, t=-6.66, P<0.001). Conclusions: Maternal autoantibody-mediated CLBBB in children presents with chronic heart failure in infancy. Early treatment with anti-heart failure medications, IVIG and glucocorticoids can improve clinical symptoms.

Electrocardiographic, Ultrasonographic, and Echocardiographic Findings in Hypothyroidism: A Cross-Sectional Study

Background: Hypothyroidism, a common endocrine disorder, significantly impacts cardiovascular health and thyroid gland structure. Electrocardiography (ECG), ultrasonography (USG) of the neck, and echocardiography (2D Echo) are essential tools for evaluating these complications. Despite the well-known risks, comprehensive assessments combining these modalities are often underutilized in clinical practice. The study evaluated electrocardiographic, ultrasonographic, and echocardiographic findings in hypothyroid patients to identify prevalent abnormalities and associated risk factors. Methods: A total of 260 hypothyroid patients were included. Data collection involved clinical history, blood tests, ECG, USG neck, and 2D Echo. Statistical analysis was done using SPSS version 20, with qualitative variables analyzed using Chi-square tests and quantitative variables using multivariate analysis and logistic regression. Results: The study revealed that 65% of patients had abnormal ECG findings, with sinus bradycardia (20%) and prolonged QT interval (17%) being most common. USG neck showed thyromegaly in 48.1% and nodules in 40% of patients. Echocardiographic assessment indicated systolic dysfunction in 30% and diastolic dysfunction in 40% of patients. Higher TSH levels were significantly associated with increased prevalence of cardiac dysfunction (p &lt; 0.01). Conclusion: Hypothyroidism significantly affects both cardiac function and thyroid gland structure. The study underscores the necessity for comprehensive diagnostic assessments, including ECG, USG, and echocardiography, to detect and manage complications early. Effective control of thyroid function is crucial in mitigating cardiovascular risks. Recommendations: Regular monitoring of thyroid and cardiac health in hypothyroid patients is recommended. Future research should focus on long-term outcomes of integrated diagnostic assessments and the effectiveness of early interventions. Keywords: Hypothyroidism, Electrocardiography, Ultrasonography, Echocardiography, Cardiac Dysfunction