1
|
Kang J, Cho Y. Sex differences in the association between minor nonspecific ST-segment and T-wave abnormalities and coronary artery calcification. Atherosclerosis 2023; 384:117154. [PMID: 37316434 DOI: 10.1016/j.atherosclerosis.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Although minor nonspecific ST-segment and T-wave abnormalities (NSSTTA) have been associated with adverse cardiovascular outcomes, their relationship with subclinical atherosclerosis remains controversial. Therefore, the associations between electrocardiographic (ECG) abnormalities, including NSSTTA, and coronary artery calcification (CAC) were investigated in this study. METHODS This cross-sectional study included 136,461 Korean participants with no known cardiovascular disease or cancer, who underwent a health checkup including ECG and computed tomography to measure the coronary artery calcium score (CACS) by Agatston method between 2010 and 2018. ECG abnormalities were defined in accordance with the Minnesota Code using an automated ECG analysis program. A multinomial logistic regression model was used to calculate prevalence ratios (PRs) with 95% confidence intervals (CI) for each CACS category. RESULTS In men, both NSSTTA and major ECG abnormalities were associated with all levels of CACS. The multivariable-adjusted PRs (95% CI) for CACS >400 comparing NSSTTA and major ECG abnormalities to the reference (neither NSSTTA nor major ECG abnormalities) were 1.88 (1.29-2.74) and 1.50 (1.18-1.91), respectively. Women with major ECG abnormalities were more likely to have a CACS of 101-400, the PRs (95% CI) comparing major ECG abnormalities to the reference group was 1.75 (1.18-2.57). NSSTTA were not associated with any CACS level in women. CONCLUSIONS NSSTTA and major ECG abnormalities are associated with CAC in men, though NSSTTA were not associated with CAC in women, suggesting that NSSTTA should be considered sex-specific risk factors for coronary artery disease in men, but not in women.
Collapse
Affiliation(s)
- Jeonggyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 04514, Republic of Korea; Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06355, Republic of Korea
| | - Yongkeun Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, 41944, Republic of Korea.
| |
Collapse
|
2
|
Ho WHH, Lim DYZ, Thiagarajan N, Wang H, Loo WTW, Sng GGR, Lee JSW, Shen X, Dalakoti M, Sia C, Tan BYQ, Lim HY, Wang L, Chow W, Chua TSJ, Lim PCY, Yeo TJ, Chong DTT. Outcomes of Investigating T Wave Inversion With Echocardiography in an Unselected Young Male Preparticipation Cohort. J Am Heart Assoc 2023; 12:e026975. [PMID: 36942750 PMCID: PMC10122903 DOI: 10.1161/jaha.122.026975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 12/19/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND Electrocardiography (ECG) may be performed as part of preparticipation sports screening. Recommendations on screening of athletes to identify individuals with previously unrecognized cardiac disease are robust; however, data guiding the preparticipation screening of unselected populations are scarce. T wave inversion (TWI) on ECG may suggest an undiagnosed cardiomyopathy. This study aims to describe the prevalence of abnormal TWI in an unselected young male cohort and the outcomes of an echocardiography-guided approach to investigating these individuals for structural heart diseases, focusing on the yield for cardiomyopathies. METHODS AND RESULTS Consecutive young male individuals undergoing a national preparticipation cardiac screening program for 39 months were studied. All underwent resting supine 12-lead ECG. Those manifesting abnormal TWI, defined as negatively deflected T waves of at least 0.1 mV amplitude in any 2 contiguous leads, underwent echocardiography. A total of 69 714 male individuals with a mean age of 17.9±1.1 years were studied. Of the individuals, 562 (0.8%) displayed abnormal TWI. This was most frequently observed in the anterior territory and least so in the lateral territory. A total of 12 individuals (2.1%) were diagnosed with a cardiomyopathy. Cardiomyopathy diagnoses were significantly associated with deeper maximum TWI depth and the presence of abnormal TWI in the lateral territory, but not with abnormal TWI in the anterior and inferior territories. No individual presenting with TWI restricted to solely leads V1 to V2, 2 inferior leads or both was diagnosed with a cardiomyopathy. CONCLUSIONS Cardiomyopathy diagnoses were more strongly associated with certain patterns of abnormal TWI. Our findings may support decisions to prioritize echocardiography in these individuals.
Collapse
Affiliation(s)
- Wilbert H. H. Ho
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Daniel Y. Z. Lim
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Nishanth Thiagarajan
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Hankun Wang
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Wesley T. W. Loo
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Gerald G. R. Sng
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Joshua S. W. Lee
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Xiayan Shen
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore
| | - Mayank Dalakoti
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational University Heart Centre SingaporeSingaporeSingapore
- Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Ching‐Hui Sia
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational University Heart Centre SingaporeSingaporeSingapore
- Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Benjamin Y. Q. Tan
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
- University Medicine ClusterNational University Health SystemSingaporeSingapore
| | - Huai Yang Lim
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
| | - Luo‐Kai Wang
- HQ Medical Corps, Singapore Armed ForcesSingaporeSingapore
| | - Weien Chow
- Department of CardiologyChangi General HospitalSingaporeSingapore
| | | | - Paul C. Y. Lim
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore
| | - Tee Joo Yeo
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational University Heart Centre SingaporeSingaporeSingapore
- Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Daniel T. T. Chong
- Medical Classification CentreCentral Manpower Base, Singapore Armed ForcesSingaporeSingapore
- Department of CardiologyNational Heart Centre SingaporeSingaporeSingapore
| |
Collapse
|
3
|
Lim DYZ, Ho WHH, Wang L, Ang WK, Thiagarajan N, Sng GGR, Wang H, Loo WTW, Yang LH, Chow W, Chua TJ, Yeo TJ, Lim P, Chong TTD. Wolff-Parkinson-White Presenting as QRS Alternans and Other Differential Diagnoses in a Large Pre-Participation ECG Screening Cohort. Arq Bras Cardiol 2022; 119:940-945. [PMID: 36417617 PMCID: PMC9814817 DOI: 10.36660/abc.20220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Wolff-Parkinson-White (WPW) syndrome is a proarrhythmic condition that may require restriction from strenuous activities and is characterized by ECG signs, including delta waves. We observed cases of intermittent WPW patterns presenting as QRS alternans ('WPW alternans') in a large pre-participation ECG screening cohort of young men reporting for military conscription. OBJECTIVES We aimed to determine the WPW alternans pattern, case characteristics, and the prevalence of other relevant differential diagnoses presenting as QRS alternans in a pre-participation setting. METHODS One hundred twenty-five thousand one hundred fifty-eight prospective male military recruits were reviewed from January 2016 to December 2019. A review of electronic medical records identified cases of WPW alternans and WPW patterns or syndrome. Reviewing electronic medical records identified cases of relevant differential diagnoses that might cause QRS alternans. RESULTS Four individuals (2.2%) had WPW alternans out of 184 individuals with a final diagnosis of WPW pattern or syndrome. Two of these individuals manifested symptoms or ECG findings consistent with supraventricular tachycardia. The overall prevalence of WPW alternans was 0.003%, and the prevalence of WPW was 0.147%. WPW alternans represented 8.7% of individuals presenting with QRS alternans, and QRS alternans had a prevalence of 0.037% in the entire population. CONCLUSIONS WPW alternans is a variant of intermittent WPW, which comprised 2.2% of WPW cases in our pre-participation screening cohort. It does not necessarily indicate a low risk for supraventricular tachycardia. It must be recognized at ECG screening and distinguished from other pathologies that also present with QRS alternans.
Collapse
Affiliation(s)
- Daniel Y. Z. Lim
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Wilbert H. H. Ho
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Luokai Wang
- HQ Medical CorpsSingapore Armed ForcesCingapuraHQ Medical Corps, Singapore Armed Forces, Cingapura,Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| | - Wee Kiat Ang
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Nishanth Thiagarajan
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Gerald GR Sng
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Hankun Wang
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Wesley TW Loo
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Lim Huai Yang
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Weien Chow
- HQ Medical CorpsSingapore Armed ForcesCingapuraHQ Medical Corps, Singapore Armed Forces, Cingapura
| | - Terrance J Chua
- Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| | - Tee Joo Yeo
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura,Department of CardiologyNational University Heart Centre SingaporeCingapuraDepartment of Cardiology, National University Heart Centre Singapore, Cingapura,University Medicine ClusterNational University Health SystemCingapuraUniversity Medicine Cluster, National University Health System, Cingapura
| | - Paul Lim
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura,Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| | - Thuan Tee Daniel Chong
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura,Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| |
Collapse
|
4
|
Zhao X, Zhang J, Gong Y, Xu L, Liu H, Wei S, Wu Y, Cha G, Wei H, Mao J, Xia L. Reliable Detection of Myocardial Ischemia Using Machine Learning Based on Temporal-Spatial Characteristics of Electrocardiogram and Vectorcardiogram. Front Physiol 2022; 13:854191. [PMID: 35707012 PMCID: PMC9192098 DOI: 10.3389/fphys.2022.854191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Myocardial ischemia is a common early symptom of cardiovascular disease (CVD). Reliable detection of myocardial ischemia using computer-aided analysis of electrocardiograms (ECG) provides an important reference for early diagnosis of CVD. The vectorcardiogram (VCG) could improve the performance of ECG-based myocardial ischemia detection by affording temporal-spatial characteristics related to myocardial ischemia and capturing subtle changes in ST-T segment in continuous cardiac cycles. We aim to investigate if the combination of ECG and VCG could improve the performance of machine learning algorithms in automatic myocardial ischemia detection. Methods: The ST-T segments of 20-second, 12-lead ECGs, and VCGs were extracted from 377 patients with myocardial ischemia and 52 healthy controls. Then, sample entropy (SampEn, of 12 ECG leads and of three VCG leads), spatial heterogeneity index (SHI, of VCG) and temporal heterogeneity index (THI, of VCG) are calculated. Using a grid search, four SampEn and two features are selected as input signal features for ECG-only and VCG-only models based on support vector machine (SVM), respectively. Similarly, three features (SI, THI, and SHI, where SI is the SampEn of lead I) are further selected for the ECG + VCG model. 5-fold cross validation was used to assess the performance of ECG-only, VCG-only, and ECG + VCG models. To fully evaluate the algorithmic generalization ability, the model with the best performance was selected and tested on a third independent dataset of 148 patients with myocardial ischemia and 52 healthy controls. Results: The ECG + VCG model with three features (SI,THI, and SHI) yields better classifying results than ECG-only and VCG-only models with the average accuracy of 0.903, sensitivity of 0.903, specificity of 0.905, F1 score of 0.942, and AUC of 0.904, which shows better performance with fewer features compared with existing works. On the third independent dataset, the testing showed an AUC of 0.814. Conclusion: The SVM algorithm based on the ECG + VCG model could reliably detect myocardial ischemia, providing a potential tool to assist cardiologists in the early diagnosis of CVD in routine screening during primary care services.
Collapse
Affiliation(s)
- Xiaoye Zhao
- School of Instrument Science and Opto-Electronic Engineering, Hefei University of Technology, Hefei, China.,School of Electrical and Information Engineering, North Minzu University, Yinchuan, China.,Key Laboratory of Atmospheric Environment Remote Sensing of Ningxia, Yinchuan, China
| | - Jucheng Zhang
- Department of Clinical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yinglan Gong
- Hangzhou Maixin Technology Co., Ltd., Hangzhou, China.,Institute of Wenzhou, Zhejiang University, Wenzhou, China
| | - Lihua Xu
- Hangzhou Linghua Biotech Ltd., Hangzhou, China
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Shujun Wei
- Department of Cardiology, Ningxia Hui Autonomous Region People's Hospital, Yinchuan, China
| | - Yuan Wu
- Department of Cardiology, Ningxia Hui Autonomous Region People's Hospital, Yinchuan, China
| | - Ganhua Cha
- School of Electrical and Information Engineering, North Minzu University, Yinchuan, China
| | - Haicheng Wei
- School of Electrical and Information Engineering, North Minzu University, Yinchuan, China
| | - Jiandong Mao
- School of Instrument Science and Opto-Electronic Engineering, Hefei University of Technology, Hefei, China.,School of Electrical and Information Engineering, North Minzu University, Yinchuan, China.,Key Laboratory of Atmospheric Environment Remote Sensing of Ningxia, Yinchuan, China
| | - Ling Xia
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou, China
| |
Collapse
|
5
|
Haq KT, Cooper BL, Berk F, Roberts A, Swift LM, Posnack NG. Demographic and Methodological Heterogeneity in Electrocardiogram Signals From Guinea Pigs. Front Physiol 2022; 13:925042. [PMID: 35721548 PMCID: PMC9202081 DOI: 10.3389/fphys.2022.925042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Electrocardiograms (ECG) are universally used to measure the electrical activity of the heart; however, variations in recording techniques and/or subject demographics can affect ECG interpretation. In this study, we investigated variables that are likely to influence ECG metric measurements in cardiovascular research, including recording technique, use of anesthesia, and animal model characteristics. Awake limb lead ECG recordings were collected in vivo from adult guinea pigs using a platform ECG system, while recordings in anesthetized animals were performed using both a platform and needle ECG system. We report significant heterogeneities in ECG metric values that are attributed to methodological differences (e.g., ECG lead configuration, ECG recording platform, presence or absence of anesthesia) that persist even within the same cohort of animals. Further, we report that variability in animal demographics is preserved in vivo ECG recordings—with animal age serving as a significant contributor, while sex-specific influences were less pronounced. Methodological approaches and subject demographics should be fully considered when interpreting ECG values in animal models, comparing datasets between studies, or developing artificial intelligence algorithms that utilize an ECG database.
Collapse
Affiliation(s)
- Kazi T. Haq
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
| | - Blake L. Cooper
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
- Department of Pharmacology & Physiology, Washington D.C., DC, United States
| | - Fiona Berk
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
| | - Anysja Roberts
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
| | - Luther M. Swift
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
| | - Nikki Gillum Posnack
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington D.C., DC, United States
- Children’s National Heart Institute, Washington D.C., DC, United States
- Department of Pharmacology & Physiology, Washington D.C., DC, United States
- Department of Pediatrics, Washington D.C., DC, United States
- *Correspondence: Nikki Gillum Posnack,
| |
Collapse
|
6
|
Li Y, Wang S, Zhang J, Ma X, Cao S, Sun Y, Feng S, Fang T, Kong D. A Highly Stretchable and Permeable Liquid Metal Micromesh Conductor by Physical Deposition for Epidermal Electronics. ACS APPLIED MATERIALS & INTERFACES 2022; 14:13713-13721. [PMID: 35262322 DOI: 10.1021/acsami.1c25206] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Stretchable electronics allow functional devices to integrate with human skin seamlessly in an emerging wearable platform termed epidermal electronics. Compliant conductors represent key building components for functional devices. Among the various candidates, gallium-based liquid metals stand out with metallic conductivity and inherent deformability. Currently, the widespread applications of liquid metals in epidermal electronics are hindered by the low steam permeability and hence unpleasant wearing perceptions. In this study, a facile physical deposition approach is established to create a liquid metal micromesh over an elastomer sponge, which exhibits low sheet resistance (∼0.5 Ω sq-1), high stretchability (400% strain), and excellent durability. The porous micromesh shows textile-level permeability to achieve long-term wearing comfort. The conformal interaction of the liquid metal micromesh with the skin gives rise to a low contact impedance. An integrated epidermal sensing sleeve is demonstrated as a human-machine interface to distinguish different hand gestures by recording muscle contractions. The reported stretchable and permeable liquid metal conductor shows promising potentials in next-generation epidermal electronics.
Collapse
Affiliation(s)
- Yanyan Li
- College of Engineering and Applied Sciences, State Key Laboratory of Analytical Chemistry for Life Science, and Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, People's Republic of China
| | - Shaolei Wang
- College of Engineering and Applied Sciences, State Key Laboratory of Analytical Chemistry for Life Science, and Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, People's Republic of China
| | - Jiaxue Zhang
- College of Engineering and Applied Sciences, State Key Laboratory of Analytical Chemistry for Life Science, and Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, People's Republic of China
| | - Xiaohui Ma
- College of Engineering and Applied Sciences, State Key Laboratory of Analytical Chemistry for Life Science, and Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, People's Republic of China
| | - Shitai Cao
- College of Engineering and Applied Sciences, State Key Laboratory of Analytical Chemistry for Life Science, and Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, People's Republic of China
| | - Yuping Sun
- College of Engineering and Applied Sciences, State Key Laboratory of Analytical Chemistry for Life Science, and Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, People's Republic of China
| | - Shuxuan Feng
- College of Engineering and Applied Sciences, State Key Laboratory of Analytical Chemistry for Life Science, and Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, People's Republic of China
| | - Ting Fang
- College of Engineering and Applied Sciences, State Key Laboratory of Analytical Chemistry for Life Science, and Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, People's Republic of China
| | - Desheng Kong
- College of Engineering and Applied Sciences, State Key Laboratory of Analytical Chemistry for Life Science, and Jiangsu Key Laboratory of Artificial Functional Materials, Nanjing University, Nanjing 210046, People's Republic of China
| |
Collapse
|
7
|
Mirahmadizadeh A, Farjam M, Sharafi M, Fatemian H, Kazemi M, Geraylow KR, Dehghan A, Amiri Z, Afrashteh S. The relationship between demographic features, anthropometric parameters, sleep duration, and physical activity with ECG parameters in Fasa Persian cohort study. BMC Cardiovasc Disord 2021; 21:585. [PMID: 34876028 PMCID: PMC8650512 DOI: 10.1186/s12872-021-02394-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
Backgrounds Cardiovascular Diseases (CVDs) are the first leading cause of death worldwide. The present study aimed to investigate the relationship between demographics, anthropometrics, sleep duration, physical activity, and ECG parameters in the Fasa Persian cohort study. Methods In this cross-sectional study, the basic information of 10,000 participants aged 35–70 years in the Fasa cohort study was used. The data used in this study included demographic data, main Electrocardiogram (ECG) parameters, anthropometric data, sleep duration, and physical activity. Data analysis was performed using t-test, chi-square, and linear regression model. Results Based on multivariate linear regression analysis results, increased age was significantly associated with all study parameters. Nevertheless, gender and body mass index showed no significant relationship with SV3 and PR. Wrist circumference, hip circumference and waist circumference significantly increased the mean values of the ECG parameters. However, sleep duration was not significantly associated with the ECG parameters. In addition, hypertension was major comorbidity, which was shown to increase the mean values of the ECG parameters. Conclusion Several factors affected the ECG parameters. Thus, to interpret ECGs, in addition to age and gender, anthropometric indices, physical activity, and previous history of comorbidities, such as hypertension and ischemic heart disease, should be taken into consideration.
Collapse
Affiliation(s)
- Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mehdi Sharafi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hossein Fatemian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Kazemi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Zahra Amiri
- Noncommunicable Diseases Research Center, Hormozgan University of Medical Sciences, Hormozgan, Iran
| | - Sima Afrashteh
- Department of Public Health, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran
| |
Collapse
|
8
|
Guettler N, Sammito S. Electrocardiographic abnormalities in medically screened German military aircrew. J Occup Med Toxicol 2021; 16:37. [PMID: 34465360 PMCID: PMC8407018 DOI: 10.1186/s12995-021-00327-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A resting electrocardiogram (ECG) is a well-tolerated, non-invasive, and inexpensive test for overt electrical signs of cardiac pathology and is widely used in the screening of aircrew and other high-hazard occupations. Given the low number of pathological results leading to disqualification or restriction however, there is an ongoing debate as to how often screening ECGs should be performed in different age groups. METHODS We restrospectively analyzed 8275 resting 12-lead ECGs registered between 2007 and 2020 in the German Air Force Centre of Aerospace Medicine. Findings were categorized according to consensus recommendations published by the NATO Working Group on Occupational Cardiology in Military Aircrew, based on ECG screening criteria published for athletes which were used at the time of registration. Age, sex, height, weight, and body mass index of the probands were also captured. Additionally, 4839 pilot and non-pilot aircrew members were analyzed longitudinally over a maximum period of 13.4 years. RESULTS Out of all the ECGs only 18 revealed findings requiring further investigation, and only one individual was temporarily disqualified because of a ventricular pre-excitation (delta wave) as a sign of an antegrade conducting accessory pathway. The longitudinal analysis of 25,829 ECGs revealed 28 abnormalities requiring further investigation, and only two ECG findings (in probands aged 48.8 and 59.1 years) led to temporary, or permanent disqualification. In a third case, the ECG showed signs of a myocardial infarction, which was already known from the proband's history. CONCLUSIONS Initial ECG screening for asymptomatic aircrew revealed extremely low numbers of individuals requiring further investigation in our cohort. This would appear to justify an initial screening ECG and follow-up ECGs at certain intervals starting at a certain age, but routine ECG screening of applicants in professions with a higher risk tolerance or frequent, e.g. annual, follow-up ECGs in younger aircrew is not supported by our data because of the minimal yield of ECG findings requiring further investigation.
Collapse
Affiliation(s)
- Norbert Guettler
- German Air Force Centre of Aerospace Medicine, Cologne, Germany.,Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Giessen, Germany
| | - Stefan Sammito
- German Air Force Centre of Aerospace Medicine, Cologne, Germany. .,Department of Occupational Medicine, Medical Faculty, Otto von Guericke University, Magdeburg, Germany.
| |
Collapse
|
9
|
Abstract
The normal physiologic range of QRS complex duration spans between 80 and 125 ms with known differences between females and males which cannot be explained by the anatomical variations of heart sizes. To investigate the reasons for the sex differences as well as for the wide range of normal values, a technology is proposed based on the singular value decomposition and on the separation of different orthogonal components of the QRS complex. This allows classification of the proportions of different components representing the 3-dimensional representation of the electrocardiographic signal as well as classification of components that go beyond the 3-dimensional representation and that correspond to the degree of intricate convolutions of the depolarisation sequence. The technology was applied to 382,019 individual 10-s ECG samples recorded in 639 healthy subjects (311 females and 328 males) aged 33.8 ± 9.4 years. The analyses showed that QRS duration was mainly influenced by the proportions of the first two orthogonal components of the QRS complex. The first component demonstrated statistically significantly larger proportion of the total QRS power (expressed by the absolute area of the complex in all independent ECG leads) in females than in males (64.2 ± 11.6% vs 59.7 ± 11.9%, p < 0.00001—measured at resting heart rate of 60 beats per minute) while the second component demonstrated larger proportion of the QRS power in males compared to females (33.1 ± 11.9% vs 29.6 ± 11.4%, p < 0.001). The analysis also showed that the components attributable to localised depolarisation sequence abnormalities were significantly larger in males compared to females (2.85 ± 1.08% vs 2.42 ± 0.87%, p < 0.00001). In addition to the demonstration of the technology, the study concludes that the detailed convolution of the depolarisation waveform is individual, and that smoother and less intricate depolarisation propagation is the mechanism likely responsible for shorter QRS duration in females.
Collapse
|
10
|
Carro A, Sanz-de la Garza M, Caselli S. Reply: Right ventricular remodeling in athletes and crista supraventricularis pattern. Clin Cardiol 2020; 43:658. [PMID: 32441823 PMCID: PMC7368347 DOI: 10.1002/clc.23382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 11/10/2022] Open
|
11
|
Xia Y, Li X, Zhang H, Liu L, Fu L, Yan W, Li Q, Zhang Y, Yu M, Liu J, Fang P. Diagnostic Capability and Influence Factors for a New Electrocardiogram Criterion in the Diagnosis of Left Ventricular Hypertrophy in a Chinese Population. Cardiology 2020; 145:294-302. [PMID: 32289773 DOI: 10.1159/000505421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Based on a small sample of patients with hypertension, a few studies have reported that the newly proposed SD + SV4 criterion for left ventricular hypertrophy (LVH) is better than traditional criteria. This study aimed to verify the diagnostic capability of the SD + SV4 criterion in a Chinese population with or without hypertension and to analyze the factors affecting the diagnostic accuracy of LVH. METHODS A total of 248 patients with LVH or paroxysmal supraventricular tachycardia (PSVT) discharged from Fuwai Hospital from January 2010 to July 2018 were enrolled. Patients with LVH were diagnosed according to the left ventricular mass index calculated by the echocardiogram parameter as the gold standard in this study. The receiver operating curve (ROC) curve was performed to assess the diagnostic capability and cut-off values of the SD + SV4, RavL + SV3, and SV1 + RV5/RV6 criteria for LVH. Then, multivariate logistic regression analyses were performed to in-vestigate the factors affecting the accuracy of the SD + SV4 criterion. RESULTS There were 170 (68.5%) patients with hypertension and 110 (44.4%) with PSVT. According to echocardiography, 107 (43.1%) patients were diagnosed with LVH. The area under the curve (AUC) of the SD + SV4 criterion was the largest compared with that of the RavL + SV3 and SV1 + RV5/RV6 criteria (AUC 0.765 vs. 0.718 vs. 0.713, respectively). The sex-specific SD + SV4 criterion had the highest consistency with the gold standard (r = 0.532 ± 0.054, p < 0.01), accompanied by the highest sensitivity (70.1%) and specificity (85.8%). The cut-off values of the sex-specific SD + SV4 criterion for LVH were ≥2.65 mV (male)/2.15 mV (female). The left ventricular ejection fraction (LVEF; OR 0.920, 95% CI 0.882-0.959, p < 0.001) was significantly different between the SD + SV4 criterion and the gold standard for LVH after adjusting for hypertension, PSVT history, body surface area, interventricular septum thickness, posterior wall thickness, and left ventricular internal diameter. CONCLUSION The newly proposed SD + SV4 criterion provides improved sensitivity and accuracy for the diagnosis of LVH in the Chinese population. A decrease in LVEF is an independent factor affecting the diagnostic accuracy of LVH.
Collapse
Affiliation(s)
- Yu Xia
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Li
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Zhang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Liu
- Department of Cardiology, Qitaihe City People's Hospital, Heilongjiang, China
| | - Lijuan Fu
- Department of Cardiology, Chuiyangliu Hospital, Tsinghua University, Beijing, China
| | - Wei Yan
- Department of Cardiology, Youjiang Medical University for Nationalities, Guangxi, China
| | - Qingxia Li
- Intensive Care Unit, Gansu Provincial Hospital of Traditional Chinese Medicine, Gansu, China
| | - Yukun Zhang
- Department of Cardiology, Guizhou Aerospace Hospital, Guizhou, China
| | - Miao Yu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pihua Fang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW The optimal approach to screening young people to decrease the risk of sudden death remains unknown. It deserves the passionate attention that researchers, clinicians and families have given it. The new data from January 2018 to July 2019 are reviewed here. RECENT FINDINGS Cardiac findings associated with a risk of sudden death were reported in 0.4% of screened athletes. Well run programs continue report varying sensitivity for screening ECGs (between 86 and 100%). One major article reported a higher incidence of sudden death in young people than has been previously published (6.8/100 000 athletes). SUMMARY The rate of important findings in sophisticated screening programs is approximately 0.4%, suggesting that this is near the population rate of detectable disease in most athletic groups. ECGs are unquestionably capable of detecting disease that can be missed by history and physical, but the performance characteristics of ECGs continue to vary from study to study. In addition, the underlying cost and infrastructure of ECG and echocardiographic screening remains unaddressed by the recent literature. A few small studies have started to look at alternative technology approaches to ECG screening. VIDEO ABSTRACT.
Collapse
|
13
|
Sia CH, Dalakoti M, Tan BYQ, Lee ECY, Shen X, Wang K, Lee JS, Arulanandam S, Chow W, Yeo TJ, Yeo KK, Chua TSJ, Tan RS, Lam CSP, Chong DTT. A Population-wide study of electrocardiographic (ECG) norms and the effect of demographic and anthropometric factors on selected ECG characteristics in young, Southeast Asian males-results from the Singapore Armed Forces ECG (SAFE) study. Ann Noninvasive Electrocardiol 2019; 24:e12634. [PMID: 30707472 DOI: 10.1111/anec.12634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/15/2018] [Accepted: 12/28/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Routine use of pre-participation electrocardiograms (ECGs) has been used by the Singapore Armed Forces, targeting early detection of significant cardiac diseases. We aim to describe the impact of demographic and anthropometric factors on ECG variables and establish a set of electrocardiographic reference ranges specific to a young male multiethnic Southeast Asian cohort. METHODS AND RESULTS Between November 1, 2009, and December 31, 2014, 144,346 young male conscripts underwent pre-participation screening that included a 12-lead ECG, demographic and anthropometric measurements. The Chinese population had the longest PR interval (146.7 ± 19.7 vs. 145.21 ± 19.2 in Malays vs. 141.2 ± 18.8 ms in Indians), QRS duration (94.5 ± 9.8 vs. 92.6 ± 9.7 in Malays vs. 92.5 ± 9.4 ms in Indians) and QTcB interval (408.3 ± 21.3 vs. 403.5 ± 21.6 in Malays vs. 401.2 ± 21.4 ms in Indians) (all p < 0.001). Body mass index (BMI) >25 kg/m2 and body fat >25% were independently associated with lower prevalence of increased QRS voltage on ECG. Systolic blood pressure of >140 mmHg or diastolic blood pressure of >90 mmHg independently increased the prevalence of increased QRS voltage on ECG. CONCLUSIONS Electrocardiographic parameters vary across different ethnicities and in comparison with international norms. In our population, diagnosis of increased QRS voltage by ECG is less prevalent with obesity and increased body fat. Further analysis of gold standard measurements for the diagnosis of LVH in our population is ongoing, to improve the accuracy of the ECG screening process.
Collapse
Affiliation(s)
- Ching-Hui Sia
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Mayank Dalakoti
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Benjamin Y Q Tan
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Edward C Y Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Xiayan Shen
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Kangjie Wang
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Joshua S Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Shalini Arulanandam
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Weien Chow
- HQ Medical Corps, Singapore Armed Forces, Singapore, Singapore
| | - Tee Joo Yeo
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Terrance S J Chua
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Daniel T T Chong
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|