QT Interval Of Electrocardiogram Research Articles

Comparison of corrected QT (QTc) interval of electrocardiogram calculated from various formulas

QT interval in an electrocardiogram (ECG) is interpreted after correction (QTc) by various formulas. This study aimed to compare the QTcs calculated by nine formulas. Sinus rhythm ECG reports of 1140 anonymous subjects showed uncorrected QT interval of 388.49 ± 42.74 ms. The QTc calculated by Bazett (443.96 ± 57.58 ms), Fridericia (424.37 ± 50.1 ms), Dmitrienko (433.59 ± 53.37 ms), Framingham (422.59 ± 45.55 ms), Schlamowitz (433.89 ± 48.05 ms), Hodges (421.6 ± 46.4 ms), Ashman (434.33 ± 54.05 ms), Rautaharju (427.75 ± 47.4 ms), and Sarma (429.22 ± 48.67 ms) showed a significant difference F (8, 10251) = 22.78 p < 0.0001. Hence, ECG should contain the formula for proper reporting and ease of interpretation by clinicians.

Clinical and Genetic Characteristics of 18 Cases with Suspected Congenital Long QT Syndrome: A Retrospective Cross-Sectional Study

Background: Long QT syndrome (LQTS) is characterized by prolonged QT interval in electrocardiogram (ECG), which is highly associated with sudden cardiac death (malignant arrhythmia). The purpose of this study was to explore the clinical and genetic characteristics of LQTS in children. Materials and Methods: Whole-exome sequencing and Sanger sequencing were performed in 18 probands with prolonged QT interval on the surface ECG. The pathogenicity of the detected variants was evaluated. Results: 44.4% (8/18) of patients were diagnosed with LQTS in the QT prolongation cohort, among which five variants in KCNQ1 and three in SCN5A were detected. Syncope was the primary manifestation. The mean QTc for variant-positive patients was 522 ± 36 ms and that for patients with negative results was 481 ± 15 ms. High probability (7/11, 63.6%) of LQTS presented among the patients with high Schwartz score (Schwartz score ≥3.5). Partial variant carrier parents had no symptoms but prolonged QTc on ECG. Besides, a case masquerading as epilepsy was reported. Conclusions: For a rapid and accurate diagnosis of LQTS, genetic testing should be combined with assessment of clinical information and ECG. Moreover, routine ECG examination is proposed in seizure patients to avoid misdiagnosis. Two novel variants in SCN5A were detected and the variant spectrum of which was expanded. Besides, we discuss incomplete penetrance and phenotypic heterogeneity of LQTS and suggest focusing on the variant carriers with no obvious symptoms.

Phase I dose escalation study and pilot efficacy analysis of LXI-15029, a novel mTOR dual inhibitor, in Chinese subjects with advanced malignant solid tumors

BackgroundThe mammalian target of rapamycin (mTOR) kinase, a central component of the PI3K/AKT/mTOR pathway, plays a critical role in tumor biology as an attractive therapeutic target. We conducted this first-in-human study to investigate the safety, pharmacokinetics (PK), and pilot efficacy of LXI-15029, an mTORC1/2 dual inhibitor, in Chinese patients with advanced malignant solid tumors.MethodsEligible patients with advanced, unresectable malignant solid tumors after failure of routine therapy or with no standard treatment were enrolled to receive ascending doses (10, 20, 40, 60, 80, 110, and 150 mg) of oral LXI-15029 twice daily (BID) (3 + 3 dose-escalation pattern) until disease progression or intolerable adverse events (AEs). The primary endpoints were safety and tolerability.ResultsBetween June 2017 and July 2021, a total of 24 patients were enrolled. LXI-15029 was well tolerated at all doses. Only one dose-limiting toxicity (grade 3 increased alanine aminotransferase) occurred in the 150 mg group, and the maximum tolerated dose was 110 mg BID. The most common treatment-related AEs were leukocytopenia (41.7%), increased alanine aminotransferase (20.8%), increased aspartate aminotransferase (20.8%), prolonged electrocardiogram QT interval (20.8%), and hypertriglyceridemia (20.8%). No other serious treatment-related AEs were reported. LXI-15029 was absorbed rapidly after oral administration. The increases in the peak concentration and the area under the curve were greater than dose proportionality over the dose range. Eight patients had stable disease. The disease control rate was 40.0% (8/20; 95% CI 21.7–60.6). In evaluable patients, the median progression-free survival was 29 days (range 29–141).ConclusionsLXI-15029 demonstrated reasonable safety and tolerability profiles and encouraging preliminary antitumor activity in Chinese patients with advanced malignant solid tumors, which warranted further validation in phase II trials.Trial registrationNCT03125746(24/04/2017),http://ClinicalTrials.gov/show/NCT03125746

First Report on the Effects of Lisaftoclax (APG-2575) in Combination with Novel Therapeutic Regimens in Patients with Relapsed or Refractory Multiple Myeloma (R/R MM) or Immunoglobulin Light-Chain (Amyloid Light-Chain [AL]) Amyloidosis

*Drs. Yifan Zhai and Sikander Ailawadhi are co-corresponding authors Background R/R MM is an incurable condition, with virtually inevitable relapse. AL amyloidosis is a rare disease that may cause serious illness and even death. Lisaftoclax is a novel, potent, selective BCL-2 inhibitor under clinical development for treatment of patients with hematologic malignancies or solid tumors, and has shown clinical antitumor benefits. In a previous study on chronic lymphocytic leukemia, lisaftoclax was shown to require only a short (daily vs weekly) dose ramp-up to mitigate tumor lysis syndrome and was associated with a low incidence of adverse events (AEs) (Ailawadhi et al. J Clin Oncol 2021;39:abstract 7502; Davids et al. Blood 2022;140[suppl 1]:2326-2328). Methods This multicenter study evaluated lisaftoclax combined with pomalidomide and dexamethasone (Arms A and C) or daratumumab, lenalidomide, and dexamethasone (Arm B) in patients with R/R MM (Arm A and B) or R/R amyloidosis (Arm C). Eligible patients had an ECOG performance status ≤ 2; ≥ 1 prior line of therapy; and adequate organ function. Patients with R/R amyloidosis also needed confirmed symptomatic organ involvement, in addition to purpura and/or carpal tunnel syndrome. Lisaftoclax was administered orally daily (QD) at 5 dose levels (400, 600, 800, 1,000, and 1,200 mg) without ramp-up in repeated 28-day cycles. Pomalidomide, daratumumab, and lenalidomide were administered per label use. Dexamethasone 40 mg (20 mg for patients aged &amp;gt; 75 years) was administered on Days 1, 8, 15, and 22 of 28-day cycles. Study objectives were safety and efficacy assessments of the combination treatments. Results As of July 3, 2023, a total of 30 patients were enrolled: 22 in Arm A at dose levels of 400 (n = 3), 600 (n = 4), 800 (n = 3), 1,000 (n = 6), and 1,200 mg (n = 6); 3 in Arm B at 600 mg; and 5 in Arm C at 400 (n = 1) and 600 mg (n = 4). A total of 66.7% of patients were male, and the median (range) age was 70.5 (24-88) years, with 66.7% of patients above the age of 65. The median (range) lines of prior therapies was 4 (1-19), and median (range) time from diagnosis to first dose was 5.2 (1-29) years. The median (range) number of treatment cycles was 4 (1-19). A total of 18 patients were triple-class-exposed, 7 had received pomalidomide, and 3 harbored t(11;14) at baseline. A total of 19 patients reported experiencing any-grade lisaftoclax treatment-related adverse events (TRAEs), including neutropenia or nausea (16.7% each); and thrombocytopenia, leukopenia, abdominal distension, constipation, or diarrhea (6.7% each). Seven patients experienced grade ≥ 3 TRAEs, including neutropenia (10%) and febrile neutropenia, iron deficiency anemia, thrombocytopenia, prolonged electrocardiogram QT interval, and acute kidney injury (3.3% each). Two patients experienced lisaftoclax-related serious AEs, of which 1 was febrile neutropenia and 1 acute kidney injury. In Arm B, 1 patient experienced a dose-limiting toxicity (prolonged QT interval). A total of 12 patients discontinued treatment because of disease progression (n = 8), an AE (n = 1), noncompliance (n = 1), and investigator/patient decision (n = 2). In Arm A, 21 patients with R/R MM were evaluable, of whom 9 experienced a partial response (PR) and 5 a very good PR (VGPR). The overall response rate (ORR [PR or better]) was 66.7%, with a median (range) time to response of 1.2 (1-3) months. After a median (range) time to response of 1.4 (1-2) months, 2 patients with R/R MM in Arm B achieved a PR (n = 1) or VGPR (n = 1). In Arm C, 3 patients with R/R amyloidosis achieved a hematologic VGPR; the ORR was 60%; the median (range) time to response was 0.9 (1-1) month; and 1 patient experienced organ function improvement. Conclusion Lisaftoclax, combined with novel therapeutic regimens, was well tolerated and has demonstrated preliminary antitumor activity in patients with AL amyloidosis or R/R MM. Internal study identifier: APG-2575-MU101; clinical trial registration: NCT04942067.

Cardiometabolic Effects of Antipsychotics in Challenging Behavior and Neuropsychiatric Symptoms in Patients With Intellectual Disability.

Introduction Despite the well-established association between antipsychotics and metabolic adverse effects in psychiatric disorders, the variable influence of long-term and off-label antipsychotic medication on behavioral disorders has not been investigated in detail. Objective To clarify the impact of antipsychotic use on challenging behavior (CB) and neuropsychiatric symptoms (NPS), we evaluated the clinical findings and cardiometabolic effects in individuals with intellectual disability (ID) hospitalized in our residential facility for profoundly disabled patients. Patients and methods A total of 130 individuals hospitalized in our residential facility were retrospectively investigated and divided into two groups - individuals with and without CB and NPS. Antipsychotics (first- and second-generation antipsychotics) are prescribed to all individuals in the CB and NPS-positive ID group. Conversely, antipsychotics were not prescribed to any individuals in the CB- and NPS-negative ID groups. To investigate the cardiometabolic effects of antipsychotics, the following metabolic parameters were measured: body weight (BW), total calorie intake per day, body mass index (BMI), blood pressure, serum lipid levels (total cholesterol, high-density lipoprotein cholesterol, and triglyceride), and corrected QT interval (QTc) of electrocardiogram (ECG). The etiology of disabilities, level of ID, severity of motor disability, and presence or absence of epilepsy were also examined. Results Two main results were derived: (1) Autism spectrum disorder was the most predominant etiology in individuals with CB and NPS who were prescribed antipsychotics, and (2) the mean values of metabolic parameters were all normal in both medicated and nonmedicated individuals, but the total calorie intake was significantly higher in individuals who were prescribed antipsychotics. Conclusions Our investigation demonstrated that in individuals with an adequate energy intake, most metabolic parameters can be maintained within normal limits. We suggest that body weight control is the primary step in avoiding the cardiometabolic adverse effects of antipsychotics in intellectually disabled individuals with CB and NPS.

Retraction.

[This retracts the article DOI: 10.1002/joa3.12817.].

Computerized misinterpretation of QT interval in 12-lead electrocardiogram and its clinical consequences: A case of recurrent syncope.

Don't blindly accept the automated assessment of electrocardiogram. It is important to raise long QT syndrome to the differential diagnosis of repeated syncope.

The value of QT interval in differentiating vasovagal syncope from epilepsy in children

BackgroundBoth vasovagal syncope (VVS) and epilepsy present with transient loss of consciousness and are often difficult to identify. Hence this study aimed to explore the value of QT interval in the differentiation of VVS and epilepsy in children.MethodsOne hundred thirteen children with unexplained transient loss of consciousness were selected. 56 children with VVS (VVS group), including 37 males and 19 females, the average age is 9.88 ± 2.55 years old. 57 children with epilepsy (epilepsy group), including 36 males and 21 females, the average age is 8.96 ± 2.67 years old. At the same time, the 60 healthy individuals (control group) were examined according to age and sex. The QT interval of 12-lead electrocardiogram in a basal state of three groups was measured and statistically analyzed by SPSS 24.0 software.ResultsCompared with the control group, (1) QTcmax, QTcmin and QTcd were significantly longer in VVS group (P < 0.05), QTmax and QTmin were significantly shorter in VVS group (P < 0.05), and there were no significant differences in QTd between the two groups (P > 0.05). (2) The QTmax and QTmin were significantly shorter in epilepsy group (P < 0.05), and there were no significant differences in QTd, QTcmax, QTcmin, QTcd between the two groups (P > 0.05). Compared with the epilepsy group, The QTcmax, QTcmin, QTcd were significantly longer in VVS group (P < 0.05), and there were no significant differences in QTd, QTmax, QTmin between the two groups (P > 0.05). When QTcmax > 479.84 ms, QTcmin > 398.90 ms and QTcd > 53.56 ms, the sensitivity and specificity of diagnosing VVS were 62.5% and 77.19%, 82.14% and 50.88%, 82.14% and 38.60% respectively.ConclusionQTcmax, QTcmin and QTcd have certain value in differentiating VVS from epilepsy in children.

Comparison of Electrocardiogram and QT Interval between Viral Hepatitis Cirrhosis and Alcoholic Cirrhosis.

Objective This study aims to compare the electrocardiogram (ECG) abnormalities and QT interval prolongation in 2,886 patients with viral hepatitis cirrhosis and 643 patients with alcoholic cirrhosis in order to understand the characteristics of ECG in patients with cirrhosis and provide information and evidence for clinical diagnosis and treatment. Methods The ECG data of patients with viral hepatitis cirrhosis and alcoholic liver cirrhosis in the outpatients and inpatients of our hospital from August 2012 to July 2018 were reviewed. The ECG data were recorded, and the ECG report was issued by ECG experts to analyze the abnormal ECG and QT interval of patients in these two groups. Results In the present study, 1,132 (39.22%) of the 2,886 patients with viral liver cirrhosis and 322 (50.08%) of the 643 patients with alcoholic liver cirrhosis had an abnormal ECG (P < 0.001). Among patients with QT prolongation, 388 patients had viral liver cirrhosis (13.44%) and 170 patients had alcoholic liver cirrhosis (26.44%, P < 0.001). Conclusion The hemodynamics and electrophysiology of the myocardium are often changed in patients with cirrhosis, and ECG changes may also occur. QT interval prolongation is one of the most common electrophysiological abnormalities in patients with cirrhosis, and QT prolongation is more common in patients with alcoholic liver cirrhosis. Prolonged QT is associated with severe arrhythmia and sudden death and can warn of malignant arrhythmia and sudden death. Therefore, the routine detection of abnormal ECG and QT interval in patients with liver cirrhosis is of significant importance for preventing malignant events.

Comparison Between QT and Corrected QT Interval Assessment by an Apple Watch With the AccurBeat Platform and by a 12‑Lead Electrocardiogram With Manual Annotation: Prospective Observational Study.

BackgroundAbnormal prolongation or shortening of the QT interval is associated with increased risk for ventricular arrhythmias and sudden cardiac death. For continuous monitoring, widespread use, and prevention of cardiac events, advanced wearable technologies are emerging as promising surrogates for conventional 12‑lead electrocardiogram (ECG) QT interval assessment. Previous studies have shown a good agreement between QT and corrected QT (QTc) intervals measured on a smartwatch ECG and a 12-lead ECG, but the clinical accuracy of computerized algorithms for QT and QTc interval measurement from smartwatch ECGs is unclear.ObjectiveThe prospective observational study compared the smartwatch-recorded QT and QTc assessed using AccurKardia’s AccurBeat platform with the conventional 12‑lead ECG annotated manually by a cardiologist.MethodsECGs were collected from healthy participants (without any known cardiovascular disease) aged >22 years. Two consecutive 30-second ECG readings followed by (within 15 minutes) a 10-second standard 12-lead ECG were recorded for each participant. Characteristics of the participants were compared by sex using a 2-sample t test and Wilcoxon rank sum test. Statistical comparisons of heart rate (HR), QT interval, and QTc interval between the platform and the 12-lead ECG, ECG lead I, and ECG lead II were done using the Wilcoxon sign rank test. Linear regression was used to predict QTc and QT intervals from the ECG based on the platform’s QTc/QT intervals with adjustment for age, sex, and difference in HR measurement. The Bland-Altman method was used to check agreement between various QT and QTc interval measurements.ResultsA total of 50 participants (32 female, mean age 46 years, SD 1 year) were included in the study. The result of the regression model using the platform measurements to predict the 12-lead ECG measurements indicated that, in univariate analysis, QT/QTc intervals from the platform significantly predicted QT/QTc intervals from the 12-lead ECG, ECG lead I, and ECG lead II, and this remained significant after adjustment for sex, age, and change in HR. The Bland-Altman plot results found that 96% of the average QTc interval measurements between the platform and QTc intervals from the 12-lead ECG were within the 95% confidence limit of the average difference between the two measurements, with a mean difference of –10.5 (95% limits of agreement –71.43, 50.43). A total of 94% of the average QT interval measurements between the platform and the 12-lead ECG were within the 95% CI of the average difference between the two measurements, with a mean difference of –6.3 (95% limits of agreement –54.54, 41.94).ConclusionsQT and QTc intervals obtained by a smartwatch coupled with the platform’s assessment were comparable to those from a 12-lead ECG. Accordingly, with further refinements, remote monitoring using this technology holds promise for the identification of QT interval prolongation.

Vicious LQT induced by a combination of factors different from hERG inhibition.

Clinically, drug-induced torsades de pointes (TdP) are rare events, whereas the reduction of the human ether-à-go-go-related gene (hERG) current is common. In this study, we aimed to explore the specific factors that contribute to the deterioration of hERG inhibition into malignant ventricular arrhythmias. Cisapride, a drug removed from the market because it caused long QT (LQT) syndrome and torsade de pointes (TdP), was used to induce hERG inhibition. The effects of cisapride on the hERG current were evaluated using a whole-cell patch clamp. Based on the dose-response curve of cisapride, models of its effects at different doses (10, 100, and 1,000 nM) on guinea pig heart in vitro were established. The effects of cisapride on electrocardiogram (ECG) signals and QT interval changes in the guinea pigs were then comprehensively evaluated by multi-channel electrical mapping and high-resolution fluorescence mapping, and changes in the action potential were simultaneously detected. Cisapride dose-dependently inhibited the hERG current with a half inhibitory concentration (IC50) of 32.63 ± 3.71 nM. The complete hERG suppression by a high dose of cisapride (1,000 nM) prolonged the action potential duration (APD), but not early after depolarizations (EADs) and TdP occurred. With 1 μM cisapride and lower Mg2+/K+, the APD exhibited triangulation, dispersion, and instability. VT was induced in two of 12 guinea pig hearts. Furthermore, the combined administration of isoproterenol was not therapeutic and increased susceptibility to ventricular fibrillation (VF) development. hERG inhibition alone led to QT and ERP prolongation and exerted an anti-arrhythmic effect. However, after the combination with low concentrations of magnesium and potassium, the prolonged action potential became unstable, triangular, and dispersed, and VT was easy to induce. The combination of catecholamines shortened the APD, but triangulation and dispersion still existed. At this time, VF was easily induced and sustained.

In vivo Overexpression of Electrogenic Sodium/Bicarbonate Cotransporter (NBCe1) by AAV9 Modifies the Cardiac Action Potential and the QT Interval in Mice.

Cardiac cells depend on specific sarcolemmal ion transporters to assure the correct intracellular pH regulation. The sodium/bicarbonate cotransporter (NBC) is one of the major alkalinizing mechanisms. In the heart two different NBC isoforms have been described: the electroneutral NBCn1 (1Na+:1) and the electrogenic NBCe1 (1Na+:2). NBCe1 generates an anionic repolarizing current that modulates the action potential duration (APD). In addition to regulating the pH, the NBC is a source of sodium influx. It has been postulated that NBC could play a role in the development of hypertrophy. The aim of this research was to study the contribution of NBCe1 in heart electrophysiology and in the development of heart hypertrophy in an in vivo mouse model with overexpression of NBCe1. Heart NBCe1 overexpression was achieved by a recombinant cardiotropic adeno-associated virus (AAV9) and was evidenced by western-blot and qPCR. AAV9-mCherry was used as a transduction control. NBCe1 overexpression fails to increase heart growth. Patch clamp and electrocardiogram were performed. We observed a reduction on both, ventricular myocytes APD and electrocardiogram QT interval corrected by cardiac rate, emphasizing for the first time NBCe1 relevance for the electrical activity of the heart.

Estimation of cardiac QTc intervals in people prescribed antipsychotics: a comparison of correction factors.

Background:A prolonged electrocardiogram (ECG) QT interval is associated with cardiac events and increased mortality. Antipsychotics can prolong the QT interval. The QT interval requires correction (QTc) for heart rate using a formula or QT-nomogram. The QT and QTc can be calculated automatically by the ECG machine or manually; however, machine-measured QT(c) intervals may be inaccurate.Objective:We aimed to investigate the mean QTc and proportion of prolonged QTc intervals in people taking antipsychotic medicines.Methods:We conducted an observational retrospective chart review and data analysis of all consecutive patients taking antipsychotics, with an ECG record, admitted to the psychiatric unit of a large tertiary hospital in Brisbane, Australia, between 1 January 2017 and 30 January 2019. We investigated the mean QTc of people taking antipsychotics to determine differences using (a) machine versus manual QT interval measurement and (b) QTc correction formulae (Bazett, Fridericia, Framingham, Hodges and Rautaharju) and the QT-nomogram. We also determined the number of people with a prolonged QTc using different methods and compared rates of prolonged QTc with antipsychotic monotherapy and polypharmacy.Results:Of 920 included people, the mean (±SD) machine-measured, Bazett-corrected QT interval (recorded from the ECG) was 435 ms (±27), significantly longer (p < 0.001) than the mean manually measured corrected QT intervals with Fridericia 394 ms (±24), Framingham 395 ms (±22), Hodges 398 ms (±22) and Rautaharju 400 ms (±24) formulae. There were significantly more people with a prolonged QTc using machine-measured QT and the Bazett formula (12.0%, 110/920) when compared with manually measured QT and the Fridericia formula (2.2%, 20/920) or QT-nomogram (0.7%, 6/920). Rates of QTc prolongation did not differ between people taking antipsychotic polypharmacy compared with monotherapy.Conclusion:Machine-measured QTc using the Bazett formula overestimates the QTc interval length and number of people with a prolonged QTc, compared with other formulae and the QT-nomogram. We recommend manually measuring the QT and correcting with the Fridericia formula or QT-nomogram prior to modifying antipsychotic therapies.

The Changes of T-Wave Amplitude and QT Interval Between the Supine and Orthostatic Electrocardiogram in Children With Dilated Cardiomyopathy.

Objectives: Electrocardiogram (ECG) can be affected by autonomic nerves with body position changes. The study aims to explore the ECG changes of children with dilated cardiomyopathy (DCM) when their posture changes.Materials and methods: Sixty-four children diagnosed with DCM were recruited as research group and 55 healthy children as control group. T-wave amplitude and QT interval in ECG were recorded, and their differences between supine and orthostatic ECG were compared in both groups. Subsequently, the children with DCM were followed up and the differences before and after treatment compared.Results: ① Comparisons in differences: Differences of T-wave amplitude in lead II and III, aVF, and V5 and differences of QT interval in lead II, aVL, aVF, and V5 were lower in the research group than in the control group. ② Logistic regression analysis and diagnostic test evaluation: The differences of T-wave amplitude in lead III and QT interval in lead aVL may have predictive value for DCM diagnosis. When their values were 0.00 mV and 30 ms, respectively, the sensitivity and specificity of the combined index were 37.5 and 83.6%. ③ Follow-up: In the response group, the T-wave amplitude difference in lead aVR increased and the difference of QT interval in lead V6 decreased after treatment. In the non-response group, there was no difference before and after treatment. When the combined index of the differences of T-wave amplitude difference in lead aVR and QT interval difference in lead V6, respectively, were −0.05 mV and 5 ms, the sensitivity and specificity of estimating the prognosis of DCM were 44.4 and 83.3%.Conclusions: The differences of T-wave amplitude and QT interval may have a certain value to estimate DCM diagnosis and prognosis.

The effect of risperidone and electroconvulsive therapy on corrected QT interval in electrocardiogram of psychiatric patients

BACKGROUNDSome types of antidepressants and antipsychotic medications have cardiovascular side effects that can be life-threatening. Electroconvulsive therapy (ECT) is capable of generating physiological stress and may lead to increased QT interval followed by arrhythmias. Risperidone can also increase the risk of arrhythmia by increasing the corrected QT (QTc) interval. Since many patients require co-administration of risperidone and ECT, this study aimed to investigate the concurrent effect of ECT and risperidone administration on the QTc interval.METHODSFor this cross-sectional study, 60 patients (18-65 years) admitted in 22 Bahman Psychiatric Hospital (Qazvin, Iran) that were candidate for treatment with risperidone, ECT, or both methods were concurrently divided into three groups. The groups included patients treated with ECT, risperidone, and combination treatment (risperidone and ECT). At the beginning of the study, electrocardiogram (ECG) was obtained for all patients and QT was performed manually, and finally, QTc interval was measured two times for each group. Required information was collected through medical records. Then, inferential statistics, analysis of variance (ANOVA), was used to determine differences between different variables.RESULTSA significant increase in heart rate (HR) in the third group compared to first and second groups was observed. None of the treatments had a significant effect on QTc interval, but the QTc interval increased slightly in groups treated with the ECT alone and particularly, the ECT plus risperidone in comparison to the baseline values.CONCLUSIONOur study showed that risperidone, ECT, and their concomitant combination did not affect the QTc interval. Therefore, risperidone and ECT are safe and their combination can also be a good option for refractory patients undergoing ECG monitoring and cardiopulmonary devices.

Molecular determinants of pro-arrhythmia proclivity of d- and l-sotalol via a multi-scale modeling pipeline

Drug isomers may differ in their proarrhythmia risk. An interesting example is the drug sotalol, an antiarrhythmic drug comprising d- and l- enantiomers that both block the hERG cardiac potassium channel and confer differing degrees of proarrhythmic risk. We developed a multi-scale in silico pipeline focusing on hERG channel – drug interactions and used it to probe and predict the mechanisms of pro-arrhythmia risks of the two enantiomers of sotalol. Molecular dynamics (MD) simulations predicted comparable hERG channel binding affinities for d- and l-sotalol, which were validated with electrophysiology experiments. MD derived thermodynamic and kinetic parameters were used to build multi-scale functional computational models of cardiac electrophysiology at the cell and tissue scales. Functional models were used to predict inactivated state binding affinities to recapitulate electrocardiogram (ECG) QT interval prolongation observed in clinical data. Our study demonstrates how modeling and simulation can be applied to predict drug effects from the atom to the rhythm for dl-sotalol and also increased proarrhythmia proclivity of d- vs. l-sotalol when accounting for stereospecific beta-adrenergic receptor blocking.

Tamarindus indica. Linn leaves ameliorates experimental induced heart failure in Wistar rats

Cardiovascular diseases (CVDs) are highly prevalent in various countries, and heart failure accounts for the majority of deaths. The present study focuses on determining the protective effect of ethanol extract of leaves of Tamarindus indica (TIEE) by in vitro and in vivo methods. In vitro cardiotonic activity was determined using Langendorff's heart perfusion assembly. In vivo studies were performed using Doxorubicin (1.5mg/kg, i.p for sevendays) induced cardiotoxicity in rats. These animals were simultaneously treated with the TIEE at a low dose (200mg/kg, p.o), high dose (400mg/kg, p.o) and standard drug Digoxin (100μg/kg, p.o) for sevendays. At the end of the study, various parameters like electrocardiogram (ECG) recording, serum levels of serum glutamic pyruvic transaminase (SGPT), lactate dehydrogenase (LDH), creatinine phosphokinase (CPK), and presence of cardiac troponin (cTnI) were determined. Isolated hearts were subjected to histopathological studies. The TIEE at a concentration of 60μg/mL showed a significant cardiotonic effect in vitro that was evident by increased force of contraction, heart rate, and cardiac output. In vivo studies revealed that the TIEE decreased the prolongation of QT and RR interval of ECG, lowered the serum enzyme levels like LDH, CPK indicating cardiac protection, and the same was established by the absence of cTnI in blood. Histopathological examinations of heart tissue sections showed improved architecture in the treatment groups when compared with diseased groups. The study revealed the cardioprotective activity of T.indica leaf extract by both in vitro and in vivo methods.

Antiepileptic rufinamide and QTc interval shortening in a patient with long QT syndrome: case report.

BackgroundThere is limited pharmacologic therapy to reduce the QT interval in hereditary long QT syndrome (LQTS).Case summaryWe describe a child with Allan–Herndon–Dudley syndrome, Lennox–Gastaut epileptic syndrome (LGS), and LQTS Type 1 (LQTS1). Rufinamide was added to his antiepileptic medications to improve seizure control and was noted to be associated with a marked improvement in electrocardiogram QT interval. To the best of our knowledge, this is the first reported case of successful pharmacologic shortening of the QT interval in LQTS1.DiscussionThis case report highlights the potential benefits of rufinamide, a drug associated with mild QT shortening in normal individuals, to markedly reduce and normalize QT duration in a subject with LQTS1.

COMPARISON OF VARIOUS TECHNIQUES FOR MANAGEMENT OF FISTULA-IN-ANO

INTRODUCTION: Cirrhosis is a condition that is defined histopathologically and has a variety of clinical manifestations and complications, some of which can be life-threatening. Patients with cirrhosis and portal hypertension exhibit characteristic cardiovascular & pulmonary hemodynamic changes. The cardiovascular complications include systolic dysfunction, diastolic dysfunction & electrochemical abnormalities like prolonged QT interval in Electrocardiogram (ECG), and Respiratory complications include Consolidation, Pleural Effusion & Pulmonary Arterial Hypertension, which may be due to Hepatopulmonary or Portopulmonary syndrome STUDY DESIGN: A two-year prospective observational study was conducted from July,2014 to June 2016 AIM: To study the different cardiac and pulmonary complications in the patients of Liver Cirrhosis. MATERIALS & METHODS: A two-year prospective observational study was conducted from July,2014 to June 2016 at a tertiary care hospital in Ahmedabad, Gujarat, India, including 30 patients (>12 years old), who were known cases of cirrhosis of liver as well as those newly diagnosed with it, with cardiopulmonary complications, developed after liver cirrhosis, in the absence of other etiological factors. Clinical profile with laboratory studies and diagnostic tests were studied. RESULTS: This study showed that cardiopulmonary complications in cirrhotic patients are more frequently seen in males than females, which commonly manifest during third & fourth decade. Dyspnoea is the most common symptom seen in the study. Among the pulmonary complications, Pneumonia & Hydrothorax are more common compared to hepatopulmonary & portopulmonary syndromes, and among cardiac complications, Diastolic dysfunction is a major complication in such patients, which increases with increasing severity of cirrhosis, as indicated by CP score. CONCLUSION: Among these patients, Cardiac and pulmonary complications have nearly the same incidences.

Cardiac & Pulmonary Complications Seen in Liver Cirrhosis-An Observational Study at a Tertiary Care Hospital

INTRODUCTION: Cirrhosis is a condition that is defined histopathologically and has a variety of clinical manifestations and complications, some of which can be life-threatening. Patients with cirrhosis and portal hypertension exhibit characteristic cardiovascular & pulmonary hemodynamic changes. The cardiovascular complications include systolic dysfunction, diastolic dysfunction & electrochemical abnormalities like prolonged QT interval in Electrocardiogram (ECG), and Respiratory complications include Consolidation, Pleural Effusion & Pulmonary Arterial Hypertension, which may be due to Hepatopulmonary or Portopulmonary syndrome STUDY DESIGN: A two-year prospective observational study was conducted from July,2014 to June 2016 AIM: To study the different cardiac and pulmonary complications in the patients of Liver Cirrhosis. MATERIALS & METHODS: A two-year prospective observational study was conducted from July,2014 to June 2016 at a tertiary care hospital in Ahmedabad, Gujarat, India, including 30 patients (>12 years old), who were known cases of cirrhosis of liver as well as those newly diagnosed with it, with cardiopulmonary complications, developed after liver cirrhosis, in the absence of other etiological factors. Clinical profile with laboratory studies and diagnostic tests were studied. RESULTS: This study showed that cardiopulmonary complications in cirrhotic patients are more frequently seen in males than females, which commonly manifest during third & fourth decade. Dyspnoea is the most common symptom seen in the study. Among the pulmonary complications, Pneumonia & Hydrothorax are more common compared to hepatopulmonary & portopulmonary syndromes, and among cardiac complications, Diastolic dysfunction is a major complication in such patients, which increases with increasing severity of cirrhosis, as indicated by CP score. CONCLUSION: Among these patients, Cardiac and pulmonary complications have nearly the same incidences.