Index Of Cardiac Electrophysiological Balance Research Articles

Effect of long-term use of antipsychotics on the ventricular repolarization index

BackgroundThe risk of arrhythmia is usually assessed by the length of the corrected QT interval (QTc) when patients use antipsychotics. Prolonged QTc intervals are thought to increase the probability of malignant ventricular arrhythmias, and if we focus only on the QTc interval, we may be influenced by a single factor and make decisions that are not conducive to effective treatment. The index of cardiac electrophysiological balance (iCEB) is considered more valuable than the QTc for predicting drug-induced arrhythmias. It has been used in clinical practice, but no studies have observed changes in this index after the use of antipsychotics.ObjectiveTo investigate the changes in ventricular repolarization indices and the occurrence of arrhythmias in patients who have been using antipsychotic drugs for a long time, to compare the changes in iCEBc and QTc and to predict abnormal iCEBc values.MethodsPatients with schizophrenia who had been hospitalized for more than 4 years and who were receiving atypical antipsychotics underwent a 12-lead synchronized electrocardiogram (ECG) every 2–4 weeks. The baseline data were measured at admission, defined as the baseline (time0), and the most obvious abnormal changes in ventricular depolarization and repolarization measured every 12 months were one-year follow-up (time1), two-year follow-up (time2), three-year follow-up (time3), and four-year follow-up (time4). Repeated measures analysis of variance was used for comparisons. The types and doses of drugs taken at 5 time points were recorded and converted into chlorpromazine equivalents for comparison. The incidence of arrhythmia during the observation cycle was recorded.ResultsThe patients had been treated with antipsychotic medication for 4 years, and the duration of the QRS wave was longer in males than in females. TpTe, TpTe/QRS, TpTe/QT, TpTe/QTc, iCEB, and iCEBc increased significantly with hospital stay, while TpTe, TpTe/QRS, TpTe/QT, and TpTe/QTc exhibited more obvious changes in these indicators in female patients (P < 0.01). The changes in iCEB and iCEBc were more significant in males (P < 0.01). The incidences of arrhythmia (arrhythmic events included premature ventricular beats and premature atrial beats) within 5 time points were 2.5%, 6.25%, 6.25%, 6.25% and 5%, respectively. More than 90% of patients treated with antipsychotics did not have any arrhythmias. No TdP syncope or other cardiovascular symptoms were found in any of the patients.ConclusionAfter long-term use of antipsychotics, the ventricular repolarization index gradually increased with time. The new ventricular repolarization indices iCEB and iCEBc were more sensitive than the QTc at predicting arrhythmia. According to the abnormal QTc values in men and women, we predict that the abnormal value of the iCEBc in males is 4.528 and that in females is 5.315.

Influence of cigarette smoking on the Index of Cardiac Electrophysiological Balance in apparently healthy Angolans.

Background: Tobacco use accelerates atherosclerosis and is one of the predictors of death from ischemic heart disease, arrhythmias, heart failure, and sudden death. A new non-invasive parameter, the Index of Cardiac Electrophysiological Balance (iCEB) between depolarization and repolarization of the action potential, was considered a new biomarker for the identification of patients at increased arrhythmic risk. Objectives: We aimed to evaluate the iCEB in apparently healthy Angolans with habitual cigarette smoking compared to non-smokers. Subjects and methods: Data were obtained from the CardioBengo study, a cross-sectional community-based study in which a random sample of individuals aged between 15 and 84 years was selected. In total, 214 apparently healthy subjects, 102 smokers, and 112 non-smokers in the same age group were included in the final analysis. Results: The average age of the participants was 42.17±13.04 years old and 26.6% of the sample was female. Smoking subjects had higher iCEB and corrected Index of Cardiac Electrophysiological Balance (iCEBc) values compared with non-smoking controls (4.39 vs. 4.25; p = 0.024, respectively), and (4.74 vs. 4.57; p = 0.030, respectively). Conclusions: In summary, iCEB and iCEBc were significantly higher in habitual smokers than in nonsmokers, which represents an increased risk of ventricular arrhythmogenesis in healthy habitual smokers. To the best of our knowledge, this is the first study performed in Africa to evaluate iCEB in smokers, making this type of study very important in low- and middle-income countries in the context of epidemiological transition.

Evaluation of Ventricular Arrhythmia Markers in Obstructive Sleep Apnea Syndrome Patients

Aim: Obstructive sleep apnea syndrome (OSAS) is a prevalent sleep condition marked by recurrent upper airway blockages causing intermittent hypoxia, fragmented sleep, and autonomic nervous system issues. Significant emphasis has been paid to the connection between OSAS and the development of ventricular arrhythmias in recent years. The index of cardiac electrophysiological balance (ICEB) represents a new measure designed to predict the likelihood of ventricular arrhythmias.&#x0D; Material and Methods: Forty OSAS patients and 40 healthy controls were enrolled in the research. Clinical and demographic variables of both groups were evaluated. Electrocardiogram was taken and routine blood values of the patients were studied. The ICEB is computed by dividing the QT interval by the QRS duration (QT/QRS). Apnea-hypopnea index was used to evaluate the severity of OSAS.&#x0D; Results: The body-mass index value of OSAS patients was significantly higher than HCs (p=0.002). No significant smoking status difference between OSAS patients and HCs (p=0.822). As a result, QT, QTc, and ICEB were substantially greater in OSAS patients than in HCs (p

Effect of the index of cardiac electrophysiological balance on major adverse cardiovascular events in patients with diabetes complicated with coronary heart disease.

To investigate the prognostic value of the index of cardio-electrophysiological balance (ICEB) and its association with major adverse cardiac events (MACE) and cardiovascular death in diabetic patients complicated with coronary heart disease. A total of 920 diabetic patients were enrolled in this longitudinal study. Participants were categorized into three groups based on their ICEB levels: normal ICEB, low ICEB, and high ICEB. The primary outcome was the occurrence of MACE, and secondary outcomes included cardiovascular death, coronary heart disease (CHD), heart failure (HF), and sudden cardiac arrest (SCA). Patients were followed for a median period of 3.26 years, and the associations between ICEB levels and various outcomes were evaluated. Over the follow-up period, 46 (5.0%) MACE were observed in the normal ICEB group, 57 (6.2%) in the low ICEB group, and 62 (6.8%) in the high ICEB group. Elevated ICEB levels were found to be associated with a higher risk of MACE and cardiovascular death. A significant relationship between ICEB levels and the risk of MACE was observed for both genders. The risk of MACE increased with each unit increment in the ICEB index. However, the two-stage linear regression model did not outperform the single-line linear regression models in determining the threshold effect. This study demonstrates the potential utility of ICEB, derived from a standard non-invasive ECG, as a prognostic tool for predicting MACE and cardiovascular death in diabetic patients complicated with CVD. The associations between ICEB levels and the risk of MACE highlight the importance of understanding cardiac electrophysiological imbalances and their implications in CVD.

Index of cardiac-electrophysiological balance in relapsing-remitting multiple sclerosis patients treated with fingolimod.

Fingolimod is indicated for the treatment of relapsing-remitting multiple sclerosis (RRMS) and also targets cardiovascular system due to receptors on cardiomyocytes. Results of previous studies are controversial for the effect of fingolimod in terms of ventricular arrhythmias. Index of cardio-electrophysiological balance (iCEB) is a risk marker for predicting malignant ventricular arrhythmia. There is no evidence on the effect of fingolimod on iCEB in patients with relapsing-remitting multiple sclerosis (RRMS). The aim of this study was to evaluate iCEB in patients with RRMS treated with fingolimod . A total of 86 patients with RRMS treated with fingolimod were included in the study. All patients underwent a standard 12-lead surface electrocardiogram at initiation of treatment and 6h after treatment. Heart rate, RR interval, QRS duration, QT, QTc (heart rate corrected QT), T wave peak-to-end (Tp-e) interval, Tp-e/QT, Tp-e/QTc, iCEB (QT/QRS) and iCEBc (QTc/QRS) ratios were calculated from the electrocardiogram. QT correction for heart rate was performed using both the Bazett and Fridericia formulas. Pre-treatment and post-treatment values were compared. Heart rate was significantly lower after fingolimod treatment (p< 0.001). While the post-treatment values of RR and QT intervals were significantly longer (p< 0.001) and post-treatment iCEB was higher (median [Q1-Q3], 4.23 [3.95-4.50] vs 4.53 [4.18-5.14]; p< 0.001), it was found that there was no statistically significant change in iCEB and other study parameters derived using QT after correcting for heart rate using both of two formulas. In this study, it was found that fingolimod did not statistically significantly change any of the heart rate-corrected ventricular repolarization parameters, including iCEBc, and it is safe in terms of ventricular arrhythmia.

Prognostic value of index of cardiac electrophysiological balance among US middle-aged adults.

Index of cardiac electrophysiological balance (iCEB) has been widely used in clinical practice but no studies investigated the association between iCEB and prognosis in the general population. To assess the correlation between the iCEB and the prognosis in the general population. This retrospective cohort study involved adults aged 40-65 years who participated in the Third National Health and Nutrition Examination Survey (NHANES-III) and whose electrocardiograms were in sinus rhythm. The corrected iCEB (iCEBc) was the ratio of corrected QT interval (QTc) to QRS duration, and outcomes were cardiac and all-cause mortality. Cox proportional hazards regression model was used to identify the associations of iCEBc with end point. The value of iCEBc for predicting adverse events was evaluated by reclassification and discrimination analyses. Among 5,010 participants (mean age 51.10 ± 7.67 years, 52.5% female), 3,454 (68.9%) were Non-Hispanic White. The mean iCEBc was 4.45 ± 0.56. A total of 2,147 deaths were recorded during a median follow-up of 319 months. The adjusted model shown iCEBc was an independent risk factor for all-cause death. The iCEBc was linearly correlated with all-cause mortality and the optimal cutoff value was 4.57 in males and 4.98 in females. In the resultant model, prolonged iCEBc remained independently associated with a higher rate of mortality (HR: 1.25; 95% CI: 1.11-1.42) and cardiac death (HR: 1.34; 95% CI: 1.04-1.71). Among the complete study population or the group with normal QTc interval, the performance of the predictive model after addition of iCEBc was not weaker than the model after the addition of prolonged QTc. Elevated iCEBc (male ≥4.57 and female ≥4.98) is an independent risk factor for cardiac or all-cause death among the middle-age adults. The clinical application value of iCEBc is firmly based on basic physiological principles and its application deserves further attention.

Relationship Between Index of Cardiac Electrophysiological Balance, Frontal QRS-T Angle and Retinopathy in People with Type 2 Diabetes.

Diabetic retinopathy (DR) is strongly associated with cardiovascular disease, which is a risk factor for sudden cardiac death (SCD). The index of cardiac electrophysiological balance (iCEB) and the frontal QRS-T angle are recommended to predict the risk of ventricular arrhythmias more than other ECG parameters. However, the relationships between these two markers and DR have not yet been explored. The aim of this study was to investigate the variation in the iCEB, corrected iCEB (iCEBc) and frontal QRS-T angle in different stages of DR and determine whether there are associations between these markers and DR. The sample comprised 665 patients with Type 2 diabetes mellitus (T2DM) who were classified into three groups: no DR (NDR), mild to moderate non-proliferative DR (NPDR), and vision-threatening DR (VTDR). Twelve-lead ECG was performed and the QT, QTc, QRS duration, iCEB, iCEBc and frontal QRS-T angle were recorded and compared across the groups. The VTDR group had a significantly higher iCEBc and frontal QRS-T angle than the NDR and NPDR groups. After controlling for confounding variables, the correlations between the iCEBc (OR=2.217, 95% CI=1.464-3.358, P<0.001), frontal QRS-T angle (OR=1.017, 95% CI=1.008-1.025, P<0.001) and DR risk remained (P<0.05). Subjects in the fourth iCEBc quartile (adjusted OR=2.612, 95% CI=1.411-4.834, p=0.002) had a much higher chance of developing DR compared to those in the first quartile. In comparison to the first frontal QRS-T angle quartile, subjects in the third (adjusted OR=1.998, 95% CI=1.167-3.422, P=0.012) and fourth (adjusted OR=2.430, 95% CI=1.420-4.160, P=0.001) frontal QRS-T angle quartiles had significantly greater risks of DR. With the progression of DR, the iCEBc and frontal QRS-T angle increase. An increased iCEBc and frontal QRS-T angle are associated with an increased risk of DR.

Evaluation of Index of Cardiac Electrophysiological Balance in Patients With Myotonic Dystrophy Type 1.

Myotonic dystrophy type 1(MD1), which is characterized by decreased muscle tone, progressive muscle weakness, and cardiac involvement, is an autosomal dominant and progressive congenital muscle disease. Cardiac involvement more often manifestsas conduction abnormalities and arrhythmias (such as supraventricular or ventricular). Approximately one-third of MD1-related deaths occur due tocardiac causes. The index of cardiac-electrophysiological balance (ICEB) is a current parameter calculated as QT interval/QRS duration. The increase in this parameter has been associated with malignant ventricular arrhythmias. In this study, our aim was to compare the ICEB values ​​of MD1 patients and the normal population. A total of 62 patients were included in our study. They were divided into two groups - 32 MD patients and 30 controls. The demographic, clinical, laboratory, and electrocardiographic parameters of the two groups were compared. The median age of the study population was 24 (20-36 IQR), and 36 (58%) of these patients were female. Body mass index was higher in the control group (p = 0.037). While in the MD1 group creatinine kinasewas significantly higher (p <0.001),In the control group creatinine, aspartate aminotransferase, alanine aminotransferase, calcium, and lymphocyte levels were significantly higher (p=0.031, p= 0.003, p=0.001, p=0.002, p=0.031, respectively).ICEB [3.96 (3.65-4.46) vs 3.74 (3.49-3.85) p=0.015] and corrected ICEB (ICEBc) [4.48 (4.08-4.92) vs 4.20 (4.03-4.51) p = 0.048] were significantly higher in the MD1 group. In our study, ICEB was found to be higher in MD1 patients than in the control group. Increased ICEB and ICEBc values ​​in MD1 patients may precipitateventricular arrhythmias in the future. Close monitoring of these parameters can be helpful in predicting possible ventricular arrhythmias and in risk stratification.

The effect of coronary slow flow on ventricular repolarization parameters

IntroductionIschemia due to microvascular dysfunction may be responsible for the heterogeneity of ventricular repolarization in coronary slow flow. To our knowledge, there is no study in which QT interval, Tp-Te interval, index of cardiac-electrophysiological balance (iCEB), and frontal QRS-T angle were evaluated together in patients with CSF. In this study, we examined for the first time the relationship between all these myocardial repolarization parameters and CSF. Materials and methodsThe study group included 178 patients (99 female, mean age: 50.6 ± 8.6 years) with isolated CSF without stenotic lesions and with angiographically proven normal coronary arteries. The control group included 120 patients (71 female, mean age: 49.3 ± 9.4 years) with normal coronary angiography. QRS duration, QT interval, QTc interval, Tp-Te interval, Tp-Te/QT, Tp- Te/QTc, iCEB score, and frontal QRS-T angle were calculated from 12‑lead ECGs. ResultsThere was no significant difference in demographic parameters between the two groups. Compared with the control group, patients with CSF had significantly longer QTmax duration, QT dispersion, Tp-Te interval, and higher iCEB score, wider frontal QRS-T angle. ConclusionIn our study, we found that many of the ventricular repolarization parameters were adversely affected in patients with CSF. Impaired parameters may be associated with the risk of malignant ventricular arrhythmias.

The relationship between premature ventricular complexes and index of cardiac-electrophysiological balance

Premature ventricular complexes are common in healthy individuals' ambulatory monitoring. The index of cardiac-electrophysiological balance may predict malignant ventricular arrhythmias. This study investigated the relation between Premature ventricular complex burden and index of cardiac-electrophysiological balance in 24-h Holter monitoring. A total of 257 patients who were admitted to a cardiology outpatient clinic without structural heart disease and underwent 24-h Holter monitoring were included in the study. Demographic features, laboratory parameters, and electrocardiographic and echocardiographic values of all patients were obtained from the hospital database. Patients were categorized into the following four groups according to their premature ventricular complex burden: ≤5% premature ventricular complexes as group 1, >6 and ≤10% premature ventricular complexes as group 2, >11 and ≤20% premature ventricular complexes as group 3, and >20% premature ventricular complexes as group 4. QRS, QT, and T peak to end interval were measured by resting electrocardiography. QT interval was corrected using Bazett's formula. T peak to end interval/QT, T peak to end interval/corrected QT interval, index of cardiac-electrophysiological balance, and corrected index of cardio-electrophysiological balance ratios were calculated. There was no significant difference between groups regarding cardiovascular risk factors. In group 4, beta-blocker usage was significantly higher, and the serum magnesium levels were significantly lower than in other groups. There was no difference in QT duration or index of cardiac-electrophysiological balance values; however, corrected index of cardio-electrophysiological balance was significantly lower in the highest premature ventricular complex group (5.1, 5.1, 4.8, 4.7, p=0.005). In multivariate backward logistic regression analyses, it was found that lower corrected index of cardio-electrophysiological balance, lower serum magnesium levels, lower serum creatinine levels, larger left atrium size, and higher T peak to end interval were associated with higher premature ventricular complexes. Corrected index of cardio-electrophysiological balance is a novel and noninvasive marker that can predict premature ventricular complex burden in patients with structurally normal hearts.

Haemodialysis Alters the Index of Cardiac-Electrophysiological Balance

Objective: To study electrocardiographic changes during haemodialysis and determine the relationship between electrolyte alterations and acid-base balance.Study Design: Cross-sectional analytical study.&#x0D; Place and Duration of Study: Haemodialysis Unit, Combined Military Hospital, Peshawar Pakistan, from Jun to Jul 2022.&#x0D; Methodology: Adult patients with end-stage renal disease on maintenance hemodialysis were selected by convenience sampling. Exclusion criteria included current hospitalization, chest pain during haemodialysis, intra-dialytic hypotension,atrial fibrillation, pericardial effusion, shortening of haemodialysis sessions and unwillingness to participate in the study.Twelve lead electrocardiograms were recorded immediately before the start and end of haemodialysis sessions. At the same time, serum urea, creatinine, potassium, calcium and phosphate were measured. Bicarbonate levels were assessed by venous blood gas analysis. In addition, measurements for heart rate and durations of the PR interval, QRS complex, QT interval andcorrected QT interval reported by ECG machine software were recorded.&#x0D; Results: There were 35 patients with a mean age of 48.69±11.39 years. Duration of QRS complex increased from 92.83±9.98 to 100.00± 17.94 seconds after haemodialysis (p=0.017). Changes in other parameters were insignificant. QT/QRS and QTc/QRS ratios reduced by 0.27±0.62 and 0.31±0.62 after haemodialysis (p=0.014 and 0.005, respectively). Changes in none of the biochemical parameters during haemodialysis could predict the reduction in QT/QRS or QTc/QRS ratios.&#x0D; Conclusion: The reduction in the index of cardiac electrophysiological balance during hemodialysis was not related to intradialytic changes in different electrolytes or base content.

The relationship between white coat hypertension and the index of cardiac electrophysiological balance (ICEB)

Aim: The index of cardiac electrophysiological balance (ICEB) is a new marker that can show the potential for ventricular arrhythmia and indicate the balancebetween ventricular depolarization and repolarization. A tendency toward ventricular arrhythmia has been shown innon-dipper hypertension and prehypertensive patients in various studies. White coat hypertension (WCH) has been shown to be associated with target organ damage and the actual development of hypertension. In this study, we aimed to evaluate the effect of dipper and non-dipper patterns on the ICEB in patients diagnosed with WCH.&#x0D; Material and Method: A total of 108 patients were included in this study. Patients were divided into two groups as dipper and non-dipper patterns according to ABPM. QT/QRS (ICEB) and cQT/QRS (ICEBc) were recorded with computerized interpretation of the electrocardiogram.&#x0D; Results: While electrocardiographic parameters including heart rate, PR interval, QT interval, cQT interval, and ICEB were similar in both groups (p&gt;.05), in the non-dipper group, QRS duration was lower (p=.017) and ICEBc was higher (p=.001).&#x0D; Conclusion: ICEBc may predict asusceptibility to ventricular arrhythmias in WCH patients. Therefore, non-dipper WCH patients with a high ICEBc should be followed for arrhythmia outcomes in addition to hypertensive outcomes.

Electrocardiography is Useful to Predict Postoperative Ventricular Arrhythmia in Patients Undergoing Cardiac Surgery: A Retrospective Study

Background: Preoperative detection of high-/low-risk postoperative ventricular arrhythmia (POVA) patients using a noninvasive method is an important issue in the clinical setting. This study mainly aimed to determine the usefulness of several preoperative electrocardiographic (ECG) markers in the risk assessment of POVA with cardiac surgery. Method: We enrolled 1024 consecutive patients undergoing cardiac surgery, and a total of 823 patients were included in the study. Logistic regression analysis determined preoperative ECG markers. A new risk predicting model were developed to predict occurrence of POVA, and the receiver operating characteristic curve (ROC) was used to validate this model. Results: Of these, 337 patients experienced POVA, and 485 patients did not experience POVA in this retrospective study. Among 15 ECG markers, a univariate analysis found a strong association between POVA and preoperative VA, the R-wave in lead aVR, the QRS wave, index of cardiac electrophysiological balance (iCEB), QT interval corrected (QTc), Tpeak–Tend interval (Tpe) in lead V2, the J wave in the inferolateral leads, pathological Q wave, and SV1+RV5>35 mm. Multivariate analysis showed that a preoperative J wave [adjusted odds ratio (AOR): 3.80; 95% CI: 1.88–7.66; p < 0.001], Tpe >112.5-ms (AOR: 2.80; 95% CI: 1.57–4.99; p < 0.001), and SV1+RV5 >35 mm (AOR: 2.92; 95% CI: 1.29–6.60; p = 0.01) were independently associated with POVA. A new risk predicting model were developed in predicting POVA. Conclusion: The ECG biomarkers including J wave, Tpe >112.5 ms, and SV1+RV5 >35 mm were significantly predicted POVAs. A risk predicting model developed with electrocardiographic risk markers preoperatively predicted POVAs.

Tip 1 Diabetes Mellitusta Kardiyak Elektrofizyolojik Denge İndeksinin Değerlendirilmesi

Background: Type 1 diabetes mellitus (T1DM) has been suggested to carry the risk of developing cardiac arrhythmias. The risk of cardiovascular events and sudden death is higher in patients with T1DM. The index of cardiac electrophysiological balance (iCEB), which shows the balance between ventricular depolarization and repolarization, is a new electrocardiographic (ECG) parameter when compared to other ECG parameters. iCEB provides more information on ventricular arrhythmo-genesis than the other traditional ECG parameters such as QT and corrected QT (QTc) intervals. The aim of this study is to evaluate the relationship between T1DM and iCEB.Materials and Methods: This study was conducted retrospectively. The patient group consisted of 50 patients (58% male, mean age 32.9 ± 8.7 years) diagnosed with T1DM, while the control group consisted of 50 healthy individuals (58% male, mean age 33.9 ± 6.8 years). The clinical, demo-graphic and ECG records of the patients were obtained from our hospital's medical documentation system. iCEB and corrected iCEB (iCEBc) values of all participants were calculated by dividing the relevant QT and QTc intervals by the QRS duration.Results: Mean PR, QRS, and QT intervals were similar between groups, while mean heart rate and QTc interval were found to be higher in the T1DM group than in healthy subjects [(83.1 ± 9.8 vs 78.9 ± 13.3 bpm, respectively, p = 0.019) and (425 ± 20.4 vs 397.6 ± 10.6 ms, respectively, p &amp;lt; 0.001)]. The iCEBc of the patient group with T1DM was higher than the control group (5.1 ± 0.5 vs 4.7 ± 0.4 ms, p &amp;lt;0.001, respectively). However, there was no significant difference in iCEB be-tween the patient and control groups (4.3 ± 0.4 and 4.3 ± 0.4 ms, respectively, p = 0.402).Conclusions: In our study, iCEBc was found to be significantly increased in T1DM patients com-pared to healthy subjects. Consequently; it is important to evaluate the risk of ventricular ar-rhythmia with iCEBc in T1DM patients.Key Words: Electrocardiography, Index of cardiac electrophysiological balance, Type 1 diabetes mellitus, Ventricular arrhythmia

Gender differences in ECG markers of increased risk for malignant arrhythmias, peripheral blood parameters, and adverse outcomes in patients with COVID-19 pneumonia

Background: The available data on gender differences in a) markers of cardiac involvement, b) peripheral blood parameters, and c) clinical adverse outcomes related to COVID-19 pneumonia severity are limited in the literature.: Objectives: To investigate gender differences in ECG markers of increased risk for malignant arrhythmias. This includes T from peak to end (Tp-e) interval, corrected QT (QTc), transmural dispersion of repolarization (TDR)(Tp-e/QTc), and index of cardiac electrophysiological balance (iCEB)(QTc/QRS), peripheral blood parameters, and in-hospital adverse outcomes in patients with COVID-19 pneumonia. Methods: A cross sectional study enrolled patients with COVID-19 pneumonia admitted to hospital from August 20th, to September 30th, 2020. Results: A total of 197 patients were included. Ninety-six (47%) were men and 101 women. There were no significant gender related differences concerning comorbidities. Men had higher QRS values, Tp-e interval and TDR, and lower values of iCEB. No significant gender differences were observed in the distribution of QTc interval. Men stayed longer in the hospital and had more extensive lung injury than women. In men, prolonged QTc interval, low lymphocytes %, high platelet distribution width (PDW), and low hemoglobin (Hb) were the main predictors of adverse in-hospital outcome, while prolonged QTc interval, high PDW, and low platelet count were the main predictors of adverse in-hospital outcome for women. Conclusions: Men had higher TDR values, lower iCEB, stayed longer in the hospital, and had more extensive lung injury than women, suggesting that, despite that there was no significant difference in mortality incidents between the two genders, the difference in surrogate markers may indicate that men are at a higher risk for adverse outcomes.

OR47. Index of Cardiac Electrophysiological Balance (iCEB) in Patients with COVID-19

AimsWe aimed to examine whether there is abnormal value of index of cardiac electrophysiological balance (iCEB=QT/QRS) in patients with confirmed coronavirus disease 2019 (COVID-19), which can predict ventricular arrhythmias (VAs), including non-Torsades de Pointes-like ventricular tachycardia/ventricular fibrillation (non-TdPs-like VT/VF) in low iCEB and Torsades de Pointes (TdPs) in high iCEB. We also investigated low voltage ECG among COVID-19 group.Methods and ResultsThis is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. Electrocardiographic marker of iCEB were calculated manually from 12-lead ECG. Low voltage ECG defined as peak-to-peak QRS voltage less than 5 mm in all limb leads and less than 10 mm in all precordial leads. Patients with COVID-19 more often had low iCEB, defined as iCEB below 3.24 compared to control group (56.6% vs 11.1%), (OR = 10.435; 95%CI 4.015 – 27.123; p = 0.000). There were no significant association between COVID-19 and high iCEB, defined as iCEB above 5.24 (OR = 1.041; 95%CI 0.485 – 2.235; p = 0.917). There were no significant difference of the number of low voltage ECG between COVID-19 and control groups (15.1% vs 6.3%), (OR = 2.622; 95%CI 0.743 - 9.257, p = 0.123).ConclusionIn this study showed that patients with COVID-19 are more likely to have low iCEB, suggesting that patients with COVID-19 may be proarrhytmic (towards non-TdPs-like VT/VF event), due to the alleged myocardial involvement in SARS-CoV-2 infection.

Evaluation of Tp-e interval, Tp-e/QT ratio and index of cardiac-electrophysiological balance in patients with tinnitus

BackgroundTinnitus is a common auditory symptom. Dysfunction in the autonomic nervous system (ANS) is an essential part of the etiopathogenesis of tinnitus. ANS regulates heart rate and heart rhythm and can lead to ventricular repolarization changes, which can cause malignant ventricular arrhythmias. T wave peak-to-end T(p-e) interval and T(p-e)/QT ratio are known ventricular arrhythmia indexes, and the index of cardiac-electrophysiological balance (iCEB) is a novel index that can be used to predict the risk of malignant ventricular arrhythmia. The goal of the study was to investigate these ventricular arrhythmia indexes in patients with tinnitus.MethodsThe study population consisted of 240 patients with tinnitus and 240 healthy subjects. A standard 12-channel surface electrocardiogram was applied to both groups. T(p-e) interval, QT interval and QRS duration were determined. Corrected QT (QTc) was determined via Bazett’s formula. To predict ventricular arrhythmia, iCEB (QT/QRS), T(p-e)/QT, corrected iCEB (QTc/QRS) and T(p-e)/QTc values were determined and compared between groups.ResultsCompared to the control group, QT (376.46 ± 36.54 vs 346.52 ± 24.51 ms), QTc (426.68 ± 24.68 vs 390.42 ± 24.04 ms), T(p-e) (75.86 ± 14.68 vs 62.42 ± 8.64 ms), T(p-e)/QT (0.201 ± 0.06 vs 0.180 ± 0.01) and T(p-e)/QTc (0.177 ± 0.06 vs 0.159 ± 0.02) were significantly higher in patients with tinnitus (p < 0.001 for all). QT/QRS (3.92 ± 0.68 vs 3.56 ± 0.32) and QTc/QRS (4.44 ± 1.03 vs 4.01 ± 0.64) were also significantly higher in patients with tinnitus (p = 0.018 and p = 0.008, respectively). In addition, significant positive correlations were found between T(p-e), T(p-e)/QTc ratio and disease duration (r = 0.792, p < 0.001; r = 0.500, p < 0.001, respectively).ConclusionAs a result, patients with tinnitus may have an increased risk of malignant ventricular arrhythmia.

Effect of ranolazine on Tp-e interval, Tp-e/QTc, and P-wave dispersion in patients with stable coronary artery disease.

IntroductionRanolazine is an antianginal drug and also exhibits antiarrhythmic effect by affecting action potential time, refractory period, and repolarization reserve. We evaluated the effect of ranolazine therapy on myocardial repolarization parameters (Tp‐e, QT, QTc intervals, Tp‐e/QT, and Tp‐e/QTc ratios), index of cardiac electrophysiological balance (iCEB) (QT/QRS, QTc/QRS) and P‐wave dispersion (PWD) in patients with stable coronary artery disease (CAD).MethodsThis study included 175 patients, aged between 35 and 90 years who were followed with stable CAD for at least 3 months. Ninety patients had been receiving ranolazine for at least 1 month, and 85 patients had never received ranolazine. All patients' basic demographic data, risk factors, medications, and echocardiographic parameters recorded. Myocardial repolarization parameters, P‐wave times, and PWD were analyzed from 12 lead electrodes.ResultsThere was no variation between the groups in terms of basic demographic parameters and CAD risk factors. Tp‐e interval (87.3 ± 14.4 vs. 90.8 ± 12.4 msn, P < .001), Tp‐e/QT (0.22 ± 0.04 vs. 0.23 ± 0.03; P = .03), Tp‐e/QTc (0.21 ± 0.04 vs. 0.22 ± 0.04 P = .001), and PWD (39.2 ± 13.7 vs. 43.5 ± 12.9 P = .028) were significantly lower in the ranolazine group. But iCEB was similar in both groups. In multivariate analysis after adjusted confounding factors such as age and BMI, Tp‐e/QTc ratio, QTc, Pmax, and PWD were found significantly in ranolazine group again.ConclusionTp‐e/QTc ratio, QTc, Pmax, and PWD were significantly lower in stable CAD patients under ranolazine therapy. In stable CAD patients, the prognostic significance of ranolazine for arrhythmic events requires further evaluation of these parameters through long‐term follow‐up and large‐scale prospective studies.

Effects of treatment with hydroxychloroquine and azithromycin on the index of cardiac electrophysiological balance in patients with COVID-19: A retrospective cohort study

Background/Aim: The common cardiac toxicities of hydroxychloroquine (HCQ) and azithromycin (AZ) are not well defined in COVID-19 patients. Index of cardiac electrophysiological balance (iCEB) is used as a novel risk marker for drug-induced arrhythmias. The purpose of this study was to evaluate ventricular repolarization using iCEB and other conventional ECG parameters such as the end of electrocardiographic T wave (Tp-e) interval, Tp-e/QT ratio, and Tp-e/ heart rate-corrected QT (QTc) ratio in COVID-19 patients treated with HCQ and AZ. Methods: This retrospective study enrolled 164 patients diagnosed with COVID-19 pneumonia in the Emergency Department (ED) and then transferred to the ward or the intensive care unit in April 2020. Results: A total of 164 patients with a mean age of 47 (18) years (range: 18-97 years) included 83 (50.6%) females. There were 38 and 126 patients in Groups HTQ and HTQ+AZ, respectively. On the 5th day of hospitalization, all patients’ heart rates were significantly lower (P

Sarkoidozlu Hastalarda Kardiyak-Elektrofizyolojik Denge İndeksinin ve Elektrokardiyografik Değişimlerin Değerlendirilmesi

Objective: Cardiac sarcoidosis (CS) can manifest with different clinical signs and has a poor prognosis, but the heart is rarely affected alone. We aim to evaluate the arrhythmogenic effects of sarcoidosis by using electrocardiography (ECG) in patients with or without cardiac involvement. Materials and Methods: A total of 61 patients under follow-up for pulmonary sarcoidosis were retrospectively reviewed and 50 healthy volunteers were enrolled in the study. Sarcoidosis patients were also grouped as with or without cardiac involvement (n=11/ n=35). QRS, QT, Tp-e, P wave morphology were measured manually. Then, Tp-e/QT, Tp-e/QTc, QT/QRS (index of cardiac electrophysiological balance), and QTc/QRS ratios were calculated and compared between groups. Results: Heart rate on ECG, QT/QTc interval, Tp-e intervals and Tp-e/QT ratio and PWD were significantly higher (p values < 0.018) and iCEB or iCEBc values, obtained with the QT/QRS ratio, were lower in the sarcoidosis group (p = 0.001). And we could not find a relationship between non-cardiac and CS and ECG parameters including QTc, Tp-e/QT ratio and iCEB (p= 0.501, p= 0.753 and p=0.490, respectively). Conclusion: The present study demonstrated a lower iCEB value and higher repolarization findings in sarcoidosis patient. However, there are no differences between with or without cardiac involvement.