1
|
Guo L, Ma Z, Yang W, Zhang F, Shao H, Liu L, Gao C, Tao L. Identifying Obstructive Hypertrophic Cardiomyopathy from Nonobstructive Hypertrophic Cardiomyopathy: Development and Validation of a Model Based on Electrocardiogram Features. Glob Heart 2023; 18:40. [PMID: 37547171 PMCID: PMC10402817 DOI: 10.5334/gh.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Background The clinical presentation and prognosis of hypertrophic cardiomyopathy (HCM) are heterogeneous between nonobstructive HCM (HNCM) and obstructive HCM (HOCM). Electrocardiography (ECG) has been used as a screening tool for HCM. However, it is still unclear whether the features presented on ECG could be used for the initial classification of HOCM and HNCM. Objective We aimed to develop a pragmatic model based on common 12-lead ECG features for the initial identification of HOCM/HNCM. Methods Between April 1st and September 30th, 2020, 172 consecutive HCM patients from the International Cooperation Center for Hypertrophic Cardiomyopathy of Xijing Hospital were prospectively included in the training cohort. Between January 4th and February 30th, 2021, an additional 62 HCM patients were prospectively included in the temporal internal validation cohort. External validation was performed using retrospectively collected ECG data with definite classification (390 HOCM and 499 HNCM ECG samples) from January 1st, 2010 to March 31st, 2020. Multivariable backward logistic regression (LR) was used to develop the prediction model. The discrimination performance, calibration and clinical utility of the model were evaluated. Results Of all 30 acquired ECG parameters, 10 variables were significantly different between HOCM and HNCM (all P < 0.05). The P wave interval and SV1 were selected to construct the model, which had a clearly useful C-statistic of 0.805 (0.697, 0.914) in the temporal validation cohort and 0.776 (0.746, 0.806) in the external validation cohort for differentiating HOCM from HNCM. The calibration plot, decision curve analysis, and clinical impact curve indicated that the model had good fitness and clinical utility. Conclusion The pragmatic model constructed by the P wave interval and SV1 had a clearly useful ability to discriminate HOCM from HNCM. The model might potentially serve as an initial classification of HCM before referring patients to dedicated centers and specialists. Highlights What are the novel findings of this work? Evident differences exist in the ECG presentations between HOCM and HNCM.To the best of our knowledge, this study is the first piece of evidence to quantify the difference in the ECG presentations between HOCM and HNCM.Based on routine 12-lead ECG data, a probabilistic model was generated that might assist in the initial classification of HCM patients.
Collapse
Affiliation(s)
- Lanyan Guo
- Department of Cardiology, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhiling Ma
- Department of Cardiology, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Weiping Yang
- Department of Cardiology, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Fuyang Zhang
- Department of Cardiology, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Hong Shao
- Department of Cardiology, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, China
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, China
| |
Collapse
|
2
|
Gossios T, Savvatis K, Zegkos T, Ntelios D, Rouskas P, Parcharidou D, Karvounis H, Efthimiadis GK. Deciphering hypertrophic cardiomyopathy with electrocardiography. Heart Fail Rev 2021; 27:1313-1323. [PMID: 34286451 DOI: 10.1007/s10741-021-10147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/30/2022]
Abstract
The comprehensive assessment of patients with hypertrophic cardiomyopathy is a complex process, with each step concurrently focusing on confirmation of the diagnosis, differentiation between sarcomeric and non-sarcomeric disease (phenocopy), and prognostication. Novel modalities such as genetic testing and advanced imaging have allowed for substantial advancements in the understanding of this condition and facilitate patient management. However, their availability is at present not universal, and interpretation requires a high level of expertise. In this setting, electrocardiography, a fast and widely available method, still retains a significant role in everyday clinical assessment of this population. In our review, we follow a stepwise approach for the interpretation of each electrocardiographic segment, discussing clinical implications of electrocardiographic patterns in sarcomeric disease, their value in the differential diagnosis from phenocopies, and impact on patient management. Outlining the substantial amount of information to be obtained from a simple tracing, we exhibit how electrocardiography is likely to remain an integral diagnostic tool in the future as well.
Collapse
Affiliation(s)
- Thomas Gossios
- Cardiology Department, NHS Foundation Trust, Guy's and St Thomas Westminster Bridge Road, London, SE1 7EH, UK. .,Inherited Cardiac Conditions Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK. .,Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
| | - Konstantinos Savvatis
- Inherited Cardiac Conditions Unit, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Thomas Zegkos
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitrios Ntelios
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Pavlos Rouskas
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Despoina Parcharidou
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Haralambos Karvounis
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Georgios K Efthimiadis
- Cardiomyopathies Laboratory, 1st Aristotle University of Thessaloniki Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| |
Collapse
|
3
|
Mahfouz Badran H, Soltan G, Eltahan E, Yacoub MH, Faheem N. Relation of atrial electromechanical delay to P-wave dispersion on surface ECG using vector velocity imaging in patients with hypertrophic cardiomyopathy. Ann Noninvasive Electrocardiol 2020; 26:e12801. [PMID: 32969115 PMCID: PMC7816806 DOI: 10.1111/anec.12801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/17/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives Heterogeneity of structural and electrophysiologic properties of atrial myocardium is common characteristic in hypertrophic cardiomyopathy (HCM). We assessed the dispersion of atrial refractoriness on surface ECG using P‐wave dispersion (PWD) and its relation to atrial electromechanical functions using vector velocity imaging (VVI) in HCM population. Methods Seventy‐nine HCM patients (mean age: 43.7 ± 13 years, 67% male) were compared with 25 healthy individuals as control. P‐wave durations, Pmax and Pmin, P‐wave dispersion (PWD), and P terminal force (PTF) were measured from 12‐lead ECG. LA segmental delay (TTP‐d) and dispersion (TTP‐SD) of electromechanical activation were derived from atrial strain rate curves. Results HCM patients had longer PR interval, PW duration, higher PWD, PTF, QTc compared to control (p < .001). HCM patients were classified according to presence of PWD into two groups, group I with PWD > 46 ms (n = 25) and group II PWD ≤ 46 ms (n = 54). Group I showed higher prevalence of female gender, higher PTF, QTc interval, left ventricular outflow tract (LVOT) obstruction, p < .01, LVOT gradient (p < .001), LV mass index (p < .01), E/E' (p < .01), and severe mitral regurgitation (p < .001). Moreover, PWD was associated with increased atrial electromechanical delay (TTP‐d) and LA mechanical dyssynchrony (TTP‐SD), p < .001. LA segmental delay and dispersion of electromechanical activation were distinctly higher among HCM patient. Conclusion PWD is simple ECG criterion, and it is associated with more severe HCM phenotype and LA electromechanical delay while PTF is linked only to atrial remodeling.
Collapse
Affiliation(s)
- Hala Mahfouz Badran
- Cardiology Department Menofia University, Shebin Elkom, Egypt.,The BAHCM National Program, Aswan, Egypt
| | - Ghada Soltan
- Cardiology Department Menofia University, Shebin Elkom, Egypt
| | - Eslam Eltahan
- Cardiology Department Menofia University, Shebin Elkom, Egypt
| | - Magdi H Yacoub
- The BAHCM National Program, Aswan, Egypt.,Imperial College, London, UK
| | - Naglaa Faheem
- Cardiology Department Menofia University, Shebin Elkom, Egypt.,The BAHCM National Program, Aswan, Egypt
| |
Collapse
|
4
|
Sepehri Shamloo A, Bollmann A, Dagres N, Hindricks G, Arya A. Natriuretic peptides: biomarkers for atrial fibrillation management. Clin Res Cardiol 2020; 109:957-966. [DOI: 10.1007/s00392-020-01608-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/21/2020] [Indexed: 01/04/2023]
|
5
|
Ortega MC, Ramos DBB, Novoa JCR, Suarez FJO, Ramírez FD, González MD. Impact of Transcatheter Device Closure of Atrial Septal Defect on Atrial Arrhythmias Propensity in Young Adults. Pediatr Cardiol 2020; 41:54-61. [PMID: 31673734 DOI: 10.1007/s00246-019-02221-0] [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: 05/12/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Abstract
Atrial septal defect (ASD) is a condition that requires early intervention because of the consequences over the right-side heart. Chronic atrial stretching promotes atrial conduction delay and the imbalance of the conduction homogeneity, which lead to the propensity to atrial arrhythmias (AA). We aim to evaluate the impact of transcatheter closure of ASD on atrial vulnerability markers leading to late AA in young adults. We conducted a prospective, longitudinal study in one hundred patients (mean age 25.2 ± 5.4 years) who underwent transcatheter closure of ASD at Cardiocentro Pediátrico William Soler. P-wave maximum (Pmax) and P-wave dispersion (Pd) were analyzed from 12-lead electrocardiogram. Left-side and right-side intraatrial and interatrial electromechanical delay (EMD) were measured with tissue Doppler imaging. Both electrocardiographic and echocardiographic analyses were performed during the study period. Compared to baseline, there was a significant reduction in P max (p ≤ 0.001) and Pd (p ≤ 0.001) after 3 months of procedure. All atrial electromechanical coupling parameters significantly reduced at 6 months of ASD closure and tend to remain at lower values till the last evaluation. Over 9.2 ± 1.6 years of follow-up, 15 subjects (15%) developed AA, of which intraatrial reentrant tachycardia (66.6%) became the main rhythm disturbance. Intra-right atrial EMD ≥ 16 ms (HR 4.08, 95% CI 1.15-14.56; p = 0.03) and Pd 45 ms (HR 1.66, 95% CI 1.06-2.59; p = 0.02) were identified as predictors of late AA. Transcatheter device closure of ASD in young adults promotes a significant reduction of electrocardiographic and echocardiographic markers of AA vulnerability, which persist during the long-term follow-up. Nevertheless, Pd and interatrial EMD were identified as independent risk factors of AA.
Collapse
Affiliation(s)
- Michel Cabrera Ortega
- Section of Arrhythmia and Cardiac Pacing, Cardiocentro Pediátrico William Soler, San Francisco e/ 100 y Perla, 10800, Boyeros, La Habana, Cuba.
| | - Dunia Bárbara Benítez Ramos
- Department of Pediatric Cardiology, Cardiocentro Pediátrico William Soler, 100 y Perla, Boyeros, Havana, Cuba
| | - Juan Carlos Ramiro Novoa
- Laboratory of Hemodynamia, Cardiocentro Pediátrico William Soler, 100 y Perla, Boyeros, Havana, Cuba
| | | | - Francisco Díaz Ramírez
- Laboratory of Hemodynamia, Cardiocentro Pediátrico William Soler, 100 y Perla, Boyeros, Havana, Cuba
| | - Mabel Domínguez González
- Laboratory of Hemodynamia, Cardiocentro Pediátrico William Soler, 100 y Perla, Boyeros, Havana, Cuba
| |
Collapse
|
6
|
Abstract
BACKGROUND This study evaluated the early postoperative benefits of laparoscopic sleeve gastrectomy (LSG) on the left ventricular (LV) function and left atrial (LA) structural, mechanical, and electrical functions in severely obese patients. METHODS Thirty-two patients with severe obesity who were consecutively scheduled for LSG and 30 healthy controls were included in the study. LV global longitudinal strain (LGS), peak atrial longitudinal strain (PALS), and strain rates (S-Sr, E-Sr, and A-Sr) of the lateral and septal LA walls, and intra- and interatrial dyssynchrony periods for all subjects were evaluated using strain echocardiography. The measurements were repeated in patients 1 month after surgery. RESULTS LGS of the LV was significantly depressed in the patient group compared with the control group (p < 0.001). LA peak septal and lateral wall strain values were significantly lower in patients than in controls (both p values <0.001). LA intra- and interatrial dyssynchrony periods were longer in patients than in controls (p = 0.012 and p = 0.004, respectively). LGS significantly improved after LSG (p < 0.001). Significant reductions were noted in the LA antero-posterior diameter (p < 0.001), LA volume index (LAVI, p = 0.001), and in the mitral velocity to the early diastolic velocity of the mitral annulus ratio (E/e' ratio, p = 0.046). The PALS of the septal and lateral LA walls significantly increased (p = 0.001 and p < 0.001, respectively). S-Sr, E-Sr, and A-Sr values of the septal LA wall (p = 0.049, p < 0.001, and p = 0.001, respectively) and the lateral LA wall (p = 0.009, p = 0.007, and p = 0.002, respectively) significantly improved postoperatively. Intra- and interatrial dyssynchrony significantly decreased (p = 0.001 and p < 0.001, respectively). Weight loss positively correlated with changes in LGS (R = 0.39, p = 0.039), LAVI (R = 0.39, p = 0.034), intra-atrial dyssynchrony (R = 0.45, p = 0.021), interatrial dyssynchrony (R = 0.42, p = 0.038), septal LA wall peak strain (R = 0.44, p = 0.027), lateral LA wall peak strain (R = 0.46, p = 0.017), septal LA wall A-Sr (R = 0.43, p = 0.028), and lateral LA wall A-Sr (R = 0.46, p = 0.019). The comparison of postoperative findings of the patients with controls revealed that the LA diameter, both LA volume and volume index (LAVI), E/e' ratio, S-Sr and E-Sr of both lateral and septal LA walls, intra- and interatrial LA dyssynchrony of the patient group became similar to the control group (all p value >0.05). Postoperative A-Sr values of both LA walls (both p value <0.001) were higher in patients than controls. CONCLUSION The benefits of LSG on LV and LA function may be observed even in the early postoperative phase. The resulting weight loss correlates with LV and LA reverse remodeling in severely obese patients.
Collapse
|
7
|
Utility of P-Wave Dispersion in the Prediction of Atrial Fibrillation. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:5-11. [PMID: 30595848 PMCID: PMC6286725 DOI: 10.12865/chsj.43.01.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/14/2017] [Indexed: 11/18/2022]
Abstract
Prevention is important in the case of the most common sustained arrhythmia-atrial fibrillation, with the intention of obtaining both medical and economic benefits. Electrocardiographic parameters have been tested as predictors of atrial fibrillation in different settings, and indices of P-wave have been assiduously studied.Increased P-wave dispersion has been described in different illnesses and correlated with several echocardiographic and clinical parameters. Several studies have demonstrated the relationship between P-wave dispersion with the first episode or paroxysmal atrial fibrillation, as well as with the recurrence of atrial fibrillation after conversion to sinus rhythm. Despite of some critics, the current evidencesentitleus to continue studying P-wave dispersion and use it for identifying patients with risk for atrial fibrillation.
Collapse
|
8
|
Schumacher K, Dagres N, Hindricks G, Husser D, Bollmann A, Kornej J. Characteristics of PR interval as predictor for atrial fibrillation: association with biomarkers and outcomes. Clin Res Cardiol 2017; 106:767-775. [DOI: 10.1007/s00392-017-1109-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
|
9
|
Zheng LH, Yao Y, Wu LM, Zhang KJ, Zhang S. Relationships of High-sensitive C-reactive Protein and P-wave Dispersion in Lone Atrial Fibrillation. Chin Med J (Engl) 2016; 128:1450-4. [PMID: 26021499 PMCID: PMC4733780 DOI: 10.4103/0366-6999.157649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Current evidence links atrial fibrillation (AF) to the inflammation. Inflammatory indexes such as high-sensitive C-reactive protein (hs-CRP) have been related to the development and persistence of AF. However, the role of inflammation in the atrial electrophysiological remodeling indexed by P-wave dispersion (Pd) remains unclear. Methods: The study consisted of 71 patients with lone paroxysmal AF (AF group) and 71 age- and gender-matched controls of paroxysmal supraventricular tachycardia without history of AF (control group). Electrocardiography, Pd, hs-CRP, and other clinical characteristics were compared between the two groups. Results: There was no significant difference between the two groups regarding age, gender, hyperlipidemia, etc. Compared to controls, left atrial diameter (44 ± 7 vs 39 ± 7 mm), Pd (49 ± 13 vs 26 ± 8 ms), and hs-CRP (2.17 [1.46–2.89] vs 1.12 [0.74–1.41] mg/L) were increased (P < 0.05), respectively. Linear regression identified hs-CRP as an independent correlation of Pd level both in the total population and the AF group (r = 0.464 and 0.313; P < 0.001, respectively). Multiple logistic regression revealed hs-CRP as an independent determinant of AF (odds ratio [OR] =15.430, 95% confidence interval: 6.031–39.476: P <0.001). Further adjusted for Pd, both Pd and hs-CRP were independent predictors for AF, but the OR for hs-CRP in predicting AF has been attenuated from 15.430 to 6.246. Conclusions: In lone AF, Pd and plasma hs-CRP concentration are inter-associated and related to AF. The interaction between hs-CRP and AF may be mediated by Pd, suggesting an important role of inflammation in the atrial electrophysiological remodeling predisposing to AF.
Collapse
Affiliation(s)
| | - Yan Yao
- State Key Laboratory of Cardiovascular Disease, Clinical EP Laboratory and Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | | | | | | |
Collapse
|
10
|
Tuluce K, Yakar Tuluce S, Kahya Eren N, Kocabas U, Akyildiz Akcay F, Gunduz R, Akyildiz ZI, Ergene O. Predictors of Future Atrial Fibrillation Development in Patients with Hypertrophic Cardiomyopathy: A Prospective Follow-Up Study. Echocardiography 2015; 33:379-85. [DOI: 10.1111/echo.13093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kamil Tuluce
- Department of Cardiology; Tepecik Training and Research Hospital; Izmir Turkey
| | - Selcen Yakar Tuluce
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Nihan Kahya Eren
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Ugur Kocabas
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Filiz Akyildiz Akcay
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Ramazan Gunduz
- Department of Cardiology; Merkez Efendi State Hospital; Manisa Turkey
| | - Zehra I. Akyildiz
- Department of Cardiology; Katip Celebi University Ataturk Training and Research Hospital; Izmir Turkey
| | - Oktay Ergene
- Department of Cardiology; Dokuz Eylul University Faculty of Medicine; Izmir Turkey
| |
Collapse
|
11
|
Tuluce K, Tuluce SY. Predictors of Atrial Fibrillation Risk in Hypertrophic Cardiomyopathy. J Atr Fibrillation 2015; 7:1200. [PMID: 27957152 DOI: 10.4022/jafib.1200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/09/2015] [Accepted: 03/20/2015] [Indexed: 11/10/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease that predisposes individuals to the development of arrhythmias. The most common sustained arrhythmia is atrial fibrillation (AF). Compared with the general population, patients with HCM are more prone to the development of AF. To avoid embolic complications and the clinical deterioration caused by the development of AF in HCM, identifying patients with a tendency toward AF might affect the management of HCM. In this review, we evaluated the predictors of AF development in patients with HCM.
Collapse
Affiliation(s)
- Kamil Tuluce
- Department of Cardiology, Karsiyaka State Hospital, Izmir, Turkey
| | - Selcen Yakar Tuluce
- Department of Cardiology, Ataturk Training and Research Hospital, Izmir, Turkey
| |
Collapse
|