Electrocardiographic Results Research Articles

ACİL SERVİSTE GEÇİCİ İSKEMİK ATAK TESPİTİNDE BİYOBELİRTEÇ OLARAK SERUM KOPEPTİN DÜZEYİ: PROSPEKTİF BİR VAKA KONTROL ÇALIŞMASI

Objective
 We aimed to investigate the diagnostic accuracy of
 copeptin to detect transient ischemic attack (TIA) by
 comparing the plasma copeptin levels of patients diagnosed
 with TIA who were admitted to the Emergency
 Department (ED) with those of healthy controls.
 Materials and Methods
 We conducted a prospective case-control study
 among patients admitted to the ED with a neurological
 symptom. The patients diagnosed with TIA by the
 neurologist were included. The results of electrocardiography,
 magnetic resonance imaging, and carotid
 doppler ultrasonography investigations of 38 patients;
 the ED outcomes (hospitalization, discharge), the risk
 group distribution (according to ABCD2 scores), and
 the variables regarding one-year re-event incidence
 were compared. Additionally, the serum copeptin levels
 of the patients were compared to those of healthy
 controls.
 Results
 The mean copeptin level was 435.80 ± 316.45 pg/ml
 in the patient group, whereas it was 770.20 ± 912.53
 pg/ml in the control group. The mean copeptin level of
 patients with TIA was significantly lower (p = 0.018). In
 the diagnosis of TIA, copeptin had 60.53% sensitivity
 and 68.42% specificity at a cut-off value of 386.28 pg/
 ml, in all the participants. In addition, in participants
 above 60 years old, copeptin had 75.86% sensitivity
 and 72.41% specificity at a cut-off value of 460.37 pg/
 ml.
 Conclusion
 To the best of our knowledge, this is the first study
 demonstrating the high efficacy of a serum biomarker
 in the diagnosis of TIA. Emergency physicians should
 search for alternative diagnoses in patients with a low
 degree of clinical suspicion and a lower copeptin value.

Selection of preoperative stress electrocardiography test for appropriate patients with non-small cell lung cancer.

Lobectomy is an established surgical procedure for treating non-small cell lung cancer; however, it significantly impacts postoperative cardiac function. The stress electrocardiography test is relatively easy to perform and is used to confirm the presence of coronary artery stenotic lesions. However, it has a low pre-test probability and may yield many false positives. We examined the factors that would enable the appropriate selection of patients for stress electrocardiography as a preoperative cardiovascular examination preceding lobectomy for non-small cell lung cancer. From June 2016 to July 2018, 240 patients at our institution who underwent stress electrocardiography before lobectomy for primary lung cancer were included in this study. Clinical information was extracted from electronic medical records and evaluated retrospectively. Smoking history, diabetes, hypertension, dyslipidemia, and ischemic heart disease were considered risk factors for coronary artery stenosis. We determined the coronary risk factors that were applicable to each participant and calculated the total number of coronary risk factors as a risk score. Patients with coronary risk factor scores of ≥ 3 were significantly more likely to have abnormal stress electrocardiography results. In addition, these patients also underwent more comprehensive examinations to identify coronary diseases. There were no patients with complications that could be attributed to ischemic heart disease. Stress electrocardiography may be more useful before lobectomy in non-small cell lung cancer patients if the patients are appropriately selected, with the test utilized mainly in patients with coronary risk factor scores of ≥ 3.

The State Of The Cardiovascular System In Patients With Covid-19 In The Early Rehabilitation Period

Purpose of the study: assessment of the study cardiovascular status in patients with postcovid syndrome and to determine their relationship with the functional status of patients. Material and research methods. There were 281 patients under observation, with the presence of clinical manifestations of postcovid syndrome. The comparison group (CG) consisted of 20 patients who had undergone COVID-19 and whose disease ended in full recovery. All patients underwent electrocardiographic (ECG) and echocardiographic (EchoCG) studies. The assessment of the functional status of patients after suffering COVID-19 was carried out using the PCFS method - Post-COVID-19 Functional Status (https://osf.io/qgpdv/). Research results. The study revealed signs of cardiovascular pathology according to ECG and EchoCG data in 255 (90.75%) patients with postcovid syndrome. According to the ECG results, cardiac arrhythmias were recorded significantly more often in patients in the main group than in the comparison group (p <0.001). The results of the echocardiography of the study showed that in the patients of the main group, compared with the comparison group, there was a significant increase in the size of the LV and RV of the heart (p <0.05), a decrease in LVEF (p <0.01) and a higher value of the mean pressure in the PA (p <0.05). Patients with a higher PCFS score are characterized by large sizes of both ventricles (p <0.05 for LV and p <0.01 for RV) and low LV ejection fraction (p <0.001). Conclusion. The present study showed that 255 (90.75%) patients who underwent COVID-19 in the early rehabilitation period have signs of cardiovascular pathology according to ECG and EchoCG data. Patients with a higher PCFS score (significant restriction of daily activity due to symptoms associated with the previous infection and the need for assistance in self-care) had more enlarged sizes of both ventricles and a lower LVEF.

Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation.

Atrial fibrillation (AF) leads to increased risk for stroke. Human immunodeficiency virus (HIV) is associated with cardiovascular disease (CVD), although it is unclear if HIV is associated with AF. The purpose of this study was to evaluate the association between HIV serostatus and the prevalence of AF in the Multicenter AIDS Cohort Study.A cross sectional study was conducted among 1674 HIV-infected (HIV+) and uninfected (HIV–) men who completed resting 12-lead electrocardiograms, and/or ambulatory electrocardiogram monitoring. Multivariable logistic regression was used to evaluate the association between AF, defined as the presence of either AF or atrial flutter, and HIV+ serostatus. Associations were adjusted for demographic variables, and then also for CVD risk factors.HIV+ men were younger than HIV– men (median 55.5 vs 61.7 years, P < .001) and were more frequently African-American (30.5% vs 17.8%, P < .001). Most HIV+ men (81%) had undetectable viral load. The age and race adjusted prevalence of AF was 3.0% in HIV+ and 3.3% in HIV– men. There was only 1 case of AF among African-American men. There were no associations between AF and HIV serostatus after adjusting for demographic factors (odds ratio 0.76; 95% CI 0.37 to –1.58; P = .47) or after further adjustment for CVD risk factors (odds ratio 0.84; 95% CI 0.39 to –1.81; P = .66).We found no association between HIV and AF in this cohort in which viral replication among the HIV+ men is generally suppressed. The overall prevalence of AF was low and was rare in African-American men.

Pengelolaan Anestesi pada Pasien yang dilakukan Eksisi Tumor Medula Spinalis Servikal 2-3 dengan Ventrikel Ekstra Sistole

Compression of the spinal cord can cause irritation to the autonomic nervous system. Hyperinervation of sympathetic nerves at high risk for arrhythmias characterized by electrocardiographic results in changes in P-wave duration, QRS duration, ST-segment depression, T-wave peak interval, and ventricular extrasystole. A 52-year-old male with an intra-extramedullar tumor in cervical 2-3, tetraparesis, dysrhythmias, and ventricular extrasystole bigemini. Wide excision of tumor and posterior stabilization would be performed. The pulse was 90x/minute palpable irregularly. Electrocardiography examination revealed irregular rhythm 82 x/minute and ventricular extrasystole 10 x/minute. Echocardiography showed grade 3 diastolic dysfunction with preserved LV function. Before the procedure, the patient was given management for the dysrhythmia and ventricular extrasystole with analgetics and amiodaron 150mg (10ml) in the first 10 minutes followed by 360mg (200mg) for the next 6 hours, 540mg for the next 18 hours and analgetics. General anesthesia carried out with midazolam 3mg, fentanyl 200mcg, lidocaine 60mg, propofol 100mg, and atricurium 30mg, with manual intubation in-line. After arterial line and central venous catheter insertion, the patient was placed in the prone position. Surgery lasted for approximately 6 hours. The patient was treated in the ICU for 2 days before moving to the usual ward. Amiodarone can be considered in ventricular extrasystole requiring immediate treatment with stable hemodynamic.

Association Between Left Atrial Volume Index and Ventricular Repolarization Heterogeneity: A Cross-Sectional Study of a Healthy Chinese Population.

BackgroundElectromechanical coupling may play a significant role in the association between abnormal myocardial mechanics and heterogeneity of repolarization. This study sought to assess the potential relationship between the left atrial volume index (LAVI), which is an important marker of cardiac diastolic function, and ventricular repolarization variables, such as the QT interval, Tpeak-to-Tend (Tpe) interval and Tpe/QT ratio, in an apparently healthy Chinese population.MethodsThis was a community-based cross-sectional study conducted in Shenyang, China. A total of 414 healthy subjects aged 35–91 years, including 186 men (44.9%), were enrolled. In addition to performing clinical and laboratory measurements, all subjects underwent comprehensive echocardiography and standard 12-lead electrocardiography. Echocardiographic and electrocardiographic results were analysed separately and in a blinded fashion. Correlation and regression analyses were applied to determine associations.ResultsSubjects were divided into four groups according to quartile of LAVI levels (<16.0, 16.0–18.9, 19.0–22.5 and >22.5 mL/m2). Ventricular repolarization variables, such as QT interval and QTc interval, gradually increased with the progression from low to high LAVI levels (P<0.05). LAVI was positively and significantly correlated with the QT interval, the QTc interval, and the Tpe interval (P<0.01). After adjusting for age and other possible confounders, LAVI showed significant and independent associations with the QT interval and the QTc interval (P<0.001; P=0.003).ConclusionEchocardiographic LAVI is linearly associated with ventricular repolarization variables even in healthy people.

Analysis of Electrocardiogram Indicators of Cows with Myocardial Dystrophy in Postpartum Period

The study of the myocardium state of cattle with the usage of electrocardiography makes it possible to diagnose many types of cardiac pathologies. This helps to select the optimal treatment and prevent loss of animal productivity. The purpose of the research is to study the features of the electrocardiogram (ECG) of cows with myocardial dystrophy during the postpartum period. The studies were conducted in “Gridino” - agricultural production cooperative in Kostroma region, on highly productive clinically healthy (n=5) cows and cows with the clinical symptoms of the myocardiodystrophy (n=15), both groups were of Kostroma breed, 20 days after calving (3-4 lactation). ECG traces were recorded in six cardiographic leads: three standard and three augmented leads (aVR, aVL, aVF) via veterinary electrocardiograph “Poly-Spectrum-8/B” (Russia). Animals were in a freestanding position, the leads were traced using clamp electrodes, which were fixed to the skin on the left and right side of the chest and pelvic limbs according to the standard technique. For the ECG analysis, the amplitude (mV) and the directions of the P, Q, R, S, T waves were considered as well as the duration of the P wave and the intervals P-Q, R-R, Q-T (ms). It was found that for clinically healthy cows the length of the P wave was 71,8±1,9 ms, and for others with the symptoms of the myocardiodystrophy it was 9,5% more. The P-R interval of clinically healthy animals lasted 181,2±8,0 ms, while the one of sick cows was 12,6% less. The height of the clinically healthy cows P wave in leads I and II was 0,15±0,02 and 0,19±0,01 mV, respectively, while the voltage of the P wave of sick cows was 40% lower in lead I (P <0,05), and in II – by 21%. The clinically healthy cows had the Q wave voltage in the range from -0.08±0,01 to -0,12±0,01 mV, and the R wave voltage – from 0,24 ± 0,02 to 0,53 ± 0,04 mV. The cows with symptoms of myocardiodystrophy showed similar tendency, but in lead II the R wave was 47.2% less (P <0.01). Among the sick cows, the S wave was absent in lead I in 80.0% of cases, in lead II – absent at all, and in lead III it was not recorded in 60.0% of animals, the rest 40% had the wave -0,28±0,18 mV, which was 2 times deeper than one of clinically healthy animals. The T wave of all cows with symptoms of myocardial dystrophy was low and variable in the direction in lead I, and in lead II in 80% of cases it was 3 times less (P <0.05) than one of clinically healthy animals. In lead III, it was observed negative in 20.0% of cows, but its voltage was within the normal range, while in 60.0% of animals it was positive (0.10 ± 0.02 mV), and in 20.0 % - not registered. Thus, according to the results of electrocardiography, clinically healthy cows in the postpartum period showed signs of left atrial hypertrophy. The cows with symptoms of myocardial dystrophy detected violation of the myocardial contractility ad function of conductivity, a decrease in the voltage of the P, R, T waves and a reduction of the time of impulse conducting through the atria.

Prognostic significance of Tp-e interval and Tp-e/QTc ratio in patients with COVID-19.

Ventricular arrhythmias were the most frequent manifestations in patients with COVID-19. Both the natural course of the disease and the treatment drugs used have effects on ventricular repolarization. The objective of this study was to evaluate the effects of repolarization parameters obtained from surface electrocardiography (ECG) on prognosis. Participants were 205 consecutive patients hospitalized with COVID-19 diagnosis. The 12-lead surface ECG was obtained from each patient on admission. The ECG results were evaluated against the patients' clinical characteristics and outcomes by experienced cardiology specialists. The mean age was higher in the non-survivor group compared to the survivor group (57.4 ± 15.7 vs. 65.6 ± 16.6; p = 0.001). The demographical characteristics were similar between the survivor and non-survivor groups. Multivariate analyses demonstrated that age (OR: 1.041; p = 0.009), D-dimer (OR: 1.002; p = 0.031), high-sensitivity troponin I (hs-TnI) (OR: 1.010; p = 0.041), pneumonia on computed tomography (CT) (OR: 4.985; p < 0.001), the peak-to-end interval of the T wave (Tp-e) (OR: 3.421; p < 0.001), and Tp-e/QTc ratio (OR: 1.978; p = 0.013) were statistically significant independent predictors in terms of determining mortality. Prolonged Tp-e interval and increased Tp-e/QTc ratio on admission are decent predictors and linked with mortality. ECG is a practical study to evaluate prognosis and potential arrhythmias, as well as initiating suitable treatment.

Needle in the heart: a rare case of cardiac tamponade caused by a migrated foreign body and mimicking ST segment elevation myocardial infarction

BackgroundPericardial tamponade is a serious condition which may eventually lead to severe haemodynamic disturbances and cardiac arrest. It is most often caused by the accumulation of fluid inside the pericardium, as a result of different aetiological factors such as pericarditis, neoplastic diseases, lymphatic dysfunctions, or idiopathic pericardial disease. Pericardial tamponade can develop after cardiac surgical procedures or as a complication of myocardial infarction. Collection of blood inside the pericardial sack can be the result of pericardial or cardiac trauma. It is exceedingly rare for the injury to be caused by a migrating foreign body. Although a typical picture of pericardial tamponade has been previously described, the disorder may clinically resemble an acute myocardial infarction.Case presentationWe report the case of a 58-year-old female patient complaining of new onset thoracic pain and shortness of breath. Electrocardiographic examination results were suggestive of an acute inferior myocardial infarction. However, echocardiography revealed significant pericardial tamponade. The cause was found to be a needle which remained inside the pelvis following a previous cesarean delivery, which the patient had undergone 18 years prior. In emergency setting, the needle was removed and the pericardial tamponade was resolved. Due to the prompt and efficient management, the patient had an uneventful postoperative recovery and presented no recurrence at the follow-up examinations.ConclusionsThe migration of foreign bodies through tissues is exceedingly rare. If present, it may cause life-threatening complications. Since the aetiology of pericardial tamponade is vast, a thorough assessment is highly important. Therefore, echocardiography is the imaging modality of choice. We wish to highlight the possibility of migrating foreign bodies as probable cause for pericardial tamponade, as well as the importance of echocardiographic methods in the fast-track evaluation of such critical conditions.

Evaluation of Clinically Significant Cardiac Abnormalities in Patients With Normal Electrocardiogram Using Transthoracic Echocardiography

Cardiac abnormalities have been suspected and identified using transthoracic echocardiography in patients with normal electrocardiographic results have been reported. It is, however, not clear whether these abnormalities are clinically significant or can lead to a change in clinical management. The aim of this study was to evaluate the prevalence and clinical significance of cardiac abnormalities found in patients with normal electrocardiographic results. Transthoracic echocardiography was conducted on outpatients on referral despite having normal electrocardiographic results. Clinical symptoms were identified, and parameters such as BMI, smoking status, blood pressure, blood glucose levels, and hypercholesterolemia status were evaluated. The data obtained from these parameters were compared with findings of cardiac abnormalities in the patients. Out of 552 patients analyzed with a mean age of 50.53±15.04 years, 412, representing 74%, had abnormalities in their transthoracic echocardiographic reports. The significant majority of active smoking patients (82.2%) had cardiac abnormalities. The major findings were valvular heart disease observed in 123 patients, grade I and II diastolic dysfunction in 85 patients, hypertensive heart disease in 76 patients, and non-significant valve disease reported in 50 patients. The common symptoms included atypical chest pain, shortness of breath, and epigastric pain. Hypertension, hypercholesterolemia, and diabetes mellitus were observed among patients with abnormal transthoracic echocardiographic reports. There is a high prevalence of clinically significant cardiac abnormalities evaluated using transthoracic echocardiography in patients with normal electrocardiographic results. These cardiac abnormalities are associated with symptoms, and cardiometabolic disease hence might warrant a change in clinical management.

The characteristics and efficacy of catheter ablation of focal atrial tachycardia arising from an epicardial site.

BackgroundAlthough epicardial structures around the atrium such as adipose tissue possess arrhythmogenicity, little is known about atrial tachycardias (ATs) originating from epicardial sites (Epi‐ATs). This study aimed to elucidate the prevalence, characteristics, and outcome after radiofrequency catheter ablation (RFCA) of Epi‐ATs and to reveal the association between Epi‐ATs and the epicardial structures.MethodsThe electrocardiographic, electrophysiologic, and anatomical properties and results of RFCA were analyzed in 42 patients with a total of 49 ectopic ATs.ResultsSix Epi‐ATs (12%) were observed in six patients (14%). Four of six were respiratory cycle‐dependent ATs and one was a swallowing‐induced AT. The Epi‐AT origins were adjacent to a pulmonary vein (five cases) and vein of Marshall (one case). A Valsalva maneuver or atropine infusion to define the arrhythmia mechanism affected the appearance of the Epi‐ATs. The congruity rate between epicardial adipose tissue and the AT origin was significantly higher (100% vs. 44%, p = .045), and the epicardial adipose tissue volume of the atrium was significantly larger (104.1 vs. 64.6 ml, p = .04) in the Epi‐AT group. Endocardial RFCA targeting the AT foci resulted in acute success in five of five cases. However, electrical isolation including of the AT foci resulted in acute failures (two of three cases) or a recurrence (one of one case).ConclusionsSix Epi‐ATs were associated with thoracic veins and epicardial arrhythmogenic structures. The main cause provoking the Epi‐ATs was associated with autonomic nerve activity.

Incremental value of cardiovascular magnetic resonance imaging in family screening for hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Genetic testing in relatives of hypertrophic cardiomyopathy (HCM) patients can lead to early identification of carriers of pathogenic DNA variants (G+), before onset of left ventricular hypertrophy (LVH). Repeated evaluation by electrocardiography (ECG) and transthoracic echocardiography (TTE) is recommended to detect HCM during follow-up. Cardiovascular magnetic resonance (CMR) imaging has become valuable in the work-up of HCM, although its role in G+ subjects has not been extensively evaluated. In this study, we investigated the value of CMR in the G+/LVH- population. We included 55 G+ subjects who underwent CMR in addition to ECG and TTE, with a maximal wall thickness (MWT) &amp;lt;15mm on TTE. The CMR imaging protocol consisted at least of steady state free procession imaging and 2-dimensional late gadolinium enhancement (LGE) images. ECGs were considered abnormal in case of pathologic Q waves, T wave inversion or signs of LVH (by voltage criteria including Sokolow-Lyon and a Romhilt-Estes score ≥4). TTEs were abnormal in case of LVH (defined as MWT≥10mm). For both modalities, the diagnosis of HCM was based on a MWT≥13mm. The yield of CMR relative to ECG/TTE was assessed by comparing the proportion of HCM diagnoses and the presence of other phenotypic features. Forward step logistic regression was used to assess whether the presence of TTE/ECG abnormalities could predict reclassifications or abnormalities (crypts and LGE) on CMR. An overview of ECG/TTE and CMR findings is shown in the Figure. Two of 16 (13%) subjects diagnosed with HCM on TTE were reclassified as having no HCM on CMR, and 8 of 39 (21%) subjects without HCM on TTE were reclassified as HCM on CMR. These 8 subjects had a mean MWT of 15.4 ± 2.6 mm on CMR and a mean MWT difference of 4.5 ± 2.9 mm (range 1.7-9.4) compared to TTE, which in 3 cases was explained by a hook-shaped thickening of the basal anterior wall in the 2 chamber view, not visible on TTE. Compared to subjects without HCM on both modalities, the reclassified group had a significantly higher QRS duration (104 ± 14 vs 93 ± 11 ms, p = 0.03) and anterior mitral valve leaflet length (30 ± 4 vs 26 ± 3 mm, p = 0.01). Of the 13 subjects with normal ECG/TTE results, none were reclassified as HCM using CMR. The proportion of additional CMR abnormalities was large in subjects with and without abnormal ECG/TTE results (57% vs 38%, p = 0.24). Subjects with poor TTE image quality were equally likely to be reclassified compared to those with sufficient image quality (10% vs 24%, p = 0.19). Logistic regression demonstrated that the presence of TTE/ECG abnormalities (odds ratio [OR] 8.7 [1.3-59.0], p = 0.03) and age (OR 1.1 [1.0-1.2], p &amp;lt; 0.01) independently predicted reclassifications or presence of abnormalities using CMR. Additional CMR imaging reclassifies 18% of subjects. Subjects with normal ECG and TTE results are not diagnosed as HCM on CMR, but the prevalence of HCM-related abnormalities on CMR was high in subjects with and without ECG/TTE abnormalities. Abstract Figure. Diagnostic approach and CMR findings

Multimodal Diagnosis of Right Ventricular Hamartoma

Primary cardiac tumors occur quite rarely, while the symptoms in patients with this pathology are very nonspecific. The data of physical examination and the results of electrocardiography and radiography are often less informative. In this connection, modern high-tech medical imaging tools play a very important role in the identification and differential diagnosis of this category of space-occupying lesions. The paper describes a case of right ventricular hamartoma diagnosedd in an adult patient with the long-term asymptomatic course of the disease.

Effect of traditional Chinese medicine on anthracycline-induced cardiotoxicity in animal models: A systematic review and meta-analysis

To evaluate the effect of traditional Chinese medicine (TCM) on anthracycline-induced cardiotoxicity (AIC) in animal models. Separate systematic searches for preclinical studies were performed in the PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Chinese Scientific Journal Database, and Wanfang Data from inception to August 2019. The primary outcomes were echocardiography, serum assays for myocardial enzymograms, histological assessments, and electrocardiograms. The secondary outcomes mainly included body weight and safety evaluations. The protocol is registered on PROSPERO (CRD42019145819). RevMan (V.5.3) was used for meta-analysis. We identified 10 studies from 9 international scientific publications describing the efficacy of TCM on AIC animal models. All the included studies reported that, compared with animal model without any intervention, TCM significantly improved ventricular function, cardiac biomarkers, electrocardiograph results, and cardiac fibrosis. Improved survival rates and body mass indices were also observed with TCM. We further pooled the available data from four studies (63 animals) for the meta-analysis and the results showed that, compared with models without any intervention, TCM significantly increased the ejection fraction by 14.13% (95% CI, 9.96–18.29) and fraction shortening by 8.66% (95% CI, 6.05–11.26). Creatine kinase-MB (SMD = −2.49, 95% CI: −3.12 to −1.85) and lactate dehydrogenase (SMD = −2.78, 95% CI: −3.45 to −2.12) were also significantly decreased by TCM. TCM is effective in improving AIC in animal models and has tremendous potential to be translated to treat AIC in clinical practice. Additionally, the systematic review and meta-analysis of animal experiments may be valuable in enhancing and guiding animal experiments and promoting the transformation of the results.

Benefits and limitations of electrocardiographic and echocardiographic screening in top level endurance athletes.

The study was designed to assess the usefulness of routine electrocardiography (ECG) as well as transthoracic echocardiography (TTE) in screening top level endurance athletes. An additional goal was to attempt to identify factors determining occurrence of adaptive and abnormal changes in ECG and TTE. The retrospective analysis included basic medical data, ECG and TTE results of 262 athletes (123 rowers, 32 canoeists and 107 cyclists), members of the Polish National Team. The athletes were divided into two age groups: young (≤ 18 years; n = 177) and elite (> 18 years; n = 85). ECG and TTE measurements were analysed according to the International Recommendations from 2017 and 2015, respectively. Adaptive ECG changes were found in 165 (63%) athletes. Abnormal ECG changes were identified in 10 (3.8%) athletes. 98% of athletes exceeded TTE norms for the general population and 26% exceeded norms for athletes. The occurrence of both adaptive ECG findings and abnormalities in the TTE (in norms for athletes) was strongly associated with the years of training, hours of training per week and the age of the athlete. Male gender and the years of training were independent predictors of the ECG and TTE findings. Abnormal ECG changes were not related to the time of sport. Among 10 athletes with ECG changes, only 3 had changes in TTE and no relationship was found between abnormal finding in ECG and TTE (p = 0.45). ECG and TTE screening complement each other in identifying endurance athletes requiring treatment or verification. Unlike abnormal ECG changes, adaptive ECG changes and TTE abnormalities are strongly related to the training duration, which reflects physiological adaptation of the heart to physical exertion in high endurance athletes.

Elective lung resection increases spatial QRS-T angle and QTc interval.

Lung resection changes intra-thoracic anatomy, which may affect electrocardiographic results. While postoperative cardiac arrhythmias have been recognized after lung resection, no study has documented changes in vectorcardiographic variables in patients undergoing this surgery. The purpose of this study was to analyse changes in spatial QRS-T angle (spQRS-T) and corrected QT interval (QTc) after lung resection. Adult patients undergoing elective lung resection under general anaesthesia were studied. The patients were allocated into four groups: those undergoing (1) left lobectomy (LL); (2) left pneumonectomy (LP); (3) right lobectomy (RL); and (4) right pneumonectomy (RP). The spQRS-T angle and QTc interval were measured one day before surgery (baseline) and 24, 48 and 72 h after surgery. Seventy-one adult patients (47 men and 24 women) aged 47-80 (65 ± 7) years were studied. In the study group as a whole, lung resection was associated with significant increases in spQRS-T (p < 0.001) and QTc (p < 0.05 at 24 and 48 h and p < 0.01 at 72 h). The greatest changes were noted in patients undergoing LP. Postoperative atrial fibrillation (AF) was noted in 6.4% of patients studied, in whom the widest spQRS-T angle and the most prolonged QTc intervals were also noted. Lung resection widens the spQRS-T angle and prolongs the QTc interval, especially in patients undergoing LP. While postoperative AF was a relatively rare complication after lung resection in this study, it was associated with the widest spQRS-T angles and most prolonged QTc intervals.

The diagnostic capability of electrocardiography on the cardiogenic shock in the patients with acute myocarditis

BackgroundThe study was performed to assess the diagnostic capability of ECG on the cardiogenic shock (CS) in acute myocarditis. A new score was derived from the combination of the ECG parameters and the diagnostic value was also evaluated.MethodsTotal 103 consecutive patients with acute myocarditis admitted in Nanjing Drum Hospital were enrolled in the current study. The cohort was divided into fulminant myocarditis group (FM, n = 20) and non fulminant myocarditis group (NFM, n = 83). The demographic features, results of electrocardiography (ECG) and ultracardiography were compared. Logistic regression analysis was conducted to identify the relevant factors in ECG parameters. We created a new variable called “ECG score” by certain combination of ECG parameters. The diagnostic capability of ECG score for CS was compared with the existing diagnostic indices using regression model and receiver-operating characteristics (ROC) analysis.ResultsThere were several changes on ECG significantly different between the two groups. Multivariate regression analysis demonstrated PR + QRS interval (P = 0.008), ventricular arrhythmia (P = 0.001) and pathological Q wave (P = 0.003) were the independent relevant factors of CS. The derived variable “ECG score” was identified as a significant relevant factor of CS by multivariate regression model. ROC analysis showed PR + QRS interval, ventricular arrhythmia and pathological Q wave all had equivalent diagnostic capability to left ventricular ejection fraction (LVEF) and shock index (SI). ECG score was equivalent to LVEF but superior to SI in diagnosing CSConclusionsECG was valuable in diagnosing CS due to acute myocarditis. The ECG score was superior to the traditional diagnostic indices and could be used for an rapid recognition of CS.

Prediction of Mortality Associated with Cardiac and Radiological Findings in Patients with Pulmonary Embolism

Abstract Background: In this study, we aimed to compare echocardiography, electrocardiography (ECG) abnormalities, Doppler ultrasonography (USG), and computed tomography pulmonary angiography (CTPA) results in predicting 3-month mortality in patients with acute pulmonary embolism (PE). Methods: This retrospective cohort study included 124 patients (72 females, 52 males) with acute PE. Demographics, symptoms, clinical signs, comorbidities, history of surgery, arterial blood gas, liver-renal functions, complete blood count, echocardiography, ECG, Doppler USG, and CTPA results, as well as 3-month mortality were recorded. Results: pH (z = –2.623; p &lt;0.01), hemoglobin (z = –3.112; p &lt;0.01), and oxygen saturation (z = –2.165; p &lt;0. 01) were significantly higher in survivors. White blood cell (z = –2.703; p &lt;0.01), blood urea nitrogen (z = –3.840; p &lt;0.01), creatinine (z = –3.200; p &lt;0.01), respiratory rate (z = –2.759; p &lt;0.01), and heart rate (z = –2.313; p &lt;0.01) were significantly higher in non-survivors. Nonspecific ST changes (AUC 0.52, 95% CI 0.43–0.61), p pulmonale (AUC 0.52, 95% CI 0.43–0.61), normal axis (AUC 0.61), right axis deviation (AUC 0.56), right ventricle strain pattern (AUC 0.59), and right pulmonary artery embolism (AUC 0.54) on CTPA showed the highest mortality prediction. Conclusions: Nonspecific ST changes, p pulmonale, normal axis and right axis deviation in ECG, RV strain in echocardiography, and right pulmonary artery embolism on CTPA are associated with a higher mortality in patients with PE.

Electrocardiographic Evaluation of the Ventricular Arrhythmia Risk in Patients Diagnosed With Schizophrenia.

The purpose of this study was to examine electrocardiographic ventricular arrhythmia predictors in patients with schizophrenia by comparing with healthy controls. The study included 100 patients with schizophrenia and 100 healthy controls. Electrocardiography (ECG) was performed on all participants in resting position. T-wave peak to end (Tp-e), QT ranges, P-wave dispersion (Pd), and R-R range were measured. Then, the Schizophrenia Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS) were applied to the schizophrenia group. The PANSS positive symptom subscale was calculated as 10.41 (SD = 2.27), the negative symptom subscale was calculated as 14.44 (SD = 5.42), and the overall functionality level was calculated as 27.04 (SD = 5.43). The mean CDSS score was determined to be 3.74 (SD = 2.15). No differences were detected in the heart rate measurements of the patient and control groups in ECG results (P = .427). The minimum QT interval and minimum Tp-e wave times were found to be low in the patient group (P < .001 for both intervals). Corrected QTc dispersion, Pd, Tp-e dispersion, and QT dispersion were found to be higher in the patient group than in healthy controls (P < .001 for all intervals). Based on our results, it is possible to speculate that patients with schizophrenia are at a risk of developing cardiac arrhythmia and cardiac dysfunction if they do not receive treatment. For this reason, clinicians should pay attention to cardiac transmission problems when organizing the treatment of patients. Further studies should be conducted to determine cardiac problems in patients with schizophrenia.

Exercise-associated rhythm disturbances in poorly performing Thoroughbreds: risk factors and association with racing performance.

Exercise-associated cardiac rhythm disturbances are common, but there is a lack of evidence-based criteria on which to distinguish clinically relevant rhythm disturbances from those that are not. To describe and characterise rhythm disturbances during clinical exercise testing; to explore potential risk factors for these rhythm disturbances and to determine whether they influenced future racing. Retrospective cohort using a convenience sample. Medical records were reviewed from two clinical services to identify horses with poor performance and/or respiratory noise with both exercise endoscopy and electrocardiography results. Respiratory and ECG findings recorded by the attending clinicians were described, and for polymorphic ventricular rhythms (n=12), a consensus team agreed the final rhythm characterisation. Several statistical models analysing risk factors were built and racing records were reviewed to compare horses with and without rhythm disturbance. Of 245 racehorses, 87 (35.5%) had no ectopic/re-entrant rhythms, 110 (44.9%) had isolated premature depolarisations during sinus rhythm and 48 (19.6%) horses had complex tachydysrrythmias. Rhythm disturbances were detected during warm-up in 20 horses (8.2%); during gallop in 61 horses (24.9%) and during recovery in 124 horses (50.6%). Most complex rhythm events occurred during recovery, but there was one horse with a single couplet during gallop and another with a triplet during gallop. Fifteen horses (one with frequent isolated premature depolarisations and 14 complex rhythms) were considered by clinicians to be potentially contributing to poor performance. Treadmill exercise tests, the presence of exercise-associated upper respiratory tract obstructions and National Hunt racehorses were associated with rhythm disturbances. The proportion of horses racing again after diagnosis (82%) was similar in all groups and univariable analysis revealed no significant associations between subsequent racing and the presence of any ectopic/re-entrant rhythm, or the various sub-groups based on phase of exercise in which this was detected. Reliance on retrospective data collection from medical records with no control group. Exercise ECGs were collected using only 1 or 2 leads. Variables examined as risk factors could be considered to be inter-related and our sub-groups were small. This study confirms a high prevalence of cardiac rhythm disturbances, including complex ectopic/re-entrant rhythms, in poorly performing racehorses. Detection of rhythm disturbances may vary with exercise test conditions and exercise-associated upper respiratory tract obstructions increase the risk of rhythm disturbances.