Annals of Noninvasive Electrocardiology

Publications in this journal

• Article: An Unusual ECG Artifact? Re: ST Elevation in One Lead.

  William F McIntyre, Adrian Baranchuk
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):304.
• Article: Single Oral Flecainide Dose to Unmask Type 1 Brugada Syndrome Electrocardiographic Pattern.

  Sergio Dubner, Damián Azocar, Sebastián Gallino, Alfonso Rafael Cerantonio, Sergio Muryan, Juan Medrano, Carlos Bruno
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  ABSTRACT: BACKGROUND: Brugada syndrome (BrS) includes a group of patients with a typical pattern of ST segment elevation in right precordial leads who are at risk for sudden cardiac death. The electrocardiogram pattern may be intermittent and unmasked by sodium channel blockers. The main objective of this study is to describe a serie of consecutive patients in whom oral administration of flecainide was used to unmask BrS type I electrocardiographic pattern. METHODS: We prospectively studied 14 symptomatic (palpitations/syncope) patients referred to our laboratory presenting a suggestive but not diagnostic Brugada ECG or family history of sudden death. Single oral dose of flecainide 400 mg was administered. Resting 12-lead ECG with upper and standard right precordial leads were performed after flecainide administration at 15, 30, 60 and 90 min and hourly until ECG became normal. RESULTS: Median age was 37.5 years (range = 22-50). None of them had structural heart disease. In 7 patients (50%) the typical coved-type ECG pattern of BrS was unmasked. PR interval, QRS duration and QTc median difference after-before test was 20 msec (min-max = -17-+57), 21 ms (min-max = 0 to +59) and 20 ms (min-max = -11-+77), respectively. There were no episodes of AV block, atrial or ventricular tachyarrhythmia. CONCLUSIONS: In our experience we found that oral administration of flecainide in a single dose of 400 mg is useful to unmask type 1 Brugada electrocardiographic pattern.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):256-261.
• Article: Electrocardiographic Algorithm for the Diagnosis of Inadvertent Implantation of Permanent Pacemaker Lead in the Left Ventricular Cavity.

  Gustavo Goldenberg, Zaza Iakobishvili, Boris Strasberg
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  ABSTRACT: Inadvertent placement of a pacemaker lead electrode in the left ventricle is an unusual complication and the electrocardiogram is a useful tool for the diagnoses. We present such a patient and review the electrocardiographic characteristics that should raise such a possibility.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):294-296.
• Article: Exercise-Induced Atrial Fibrillation by Myocardial Ischemia in a Young Male: A Rare Case Report.

  Virgilio Martínez-Mateo, Jose Plaza, Antonio Paule
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):297-298.
• Article: Diagnostic and Prognostic Value of Low QRS Voltages in Cardiac AL Amyloidosis.

  Roberta Mussinelli, Francesco Salinaro, Alessio Alogna, Michele Boldrini, Ambra Raimondi, Francesco Musca, Giovanni Palladini, Giampaolo Merlini, Stefano Perlini
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  ABSTRACT: BACKGROUND: In cardiac AL amyloidosis, myocardial infiltration is typically associated with "low QRS voltages" at the 12-lead electrocardiogram (ECG). Although considered as one of the hallmarks of the disease, its reported prevalence varies from 45% to 70%, mainly because of nonhomogeneous definitions. METHODS: To identify the "low QRS voltage" parameter having the best diagnostic value in identifying cardiac amyloidosis, and to assess its possible prognostic role, ECG and echocardiographic data were collected at diagnosis in 337 consecutive never-treated AL patients (233 with, 104 without cardiac involvement). Prognosis was assessed after a median follow-up of 14.5 months. RESULTS: "Low QRS voltage" prevalence varied from 84.12% when using Sokolow-Lyon index ≤15 mm to 27.04% with the definition of low total voltages (QRS amplitude ≤5 mm in each peripheral and ≤10 mm in each precordial lead), the widely used definition of low peripheral voltages (≤5 mm in each peripheral lead) being able to identify 66.52% cardiac AL patients. The presence of "low peripheral voltages" was associated with a more severe cardiac involvement, and was able to differentiate Mayo stage II patients' survival (i.e., AL patients with intermediate prognosis). According to receiver operator characteristic (ROC) curve analysis, sensitivity and specificity were 58.72% and 80.00%, for a peripheral QRS amplitude ≤24.5 mm (the sum of QRS in all the 6 peripheral leads), and 76.26% and 65.00% for a Sokolow-Lyon index ≤11 mm. CONCLUSIONS: In cardiac AL amyloidosis the prevalence of low QRS voltages is highly dependent on the method used for defining this ECG alteration.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):271-280.
• Article: The Mischievous Bundle: A Case of Varying Degrees of Right Bundle Branch Block on Alternate Beats during Exercise Stress Testing.

  Sukhvinder Singh
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  ABSTRACT: A 78-year-old male was referred for exercise stress testing. He developed incomplete right bundle branch block during first stage of exercise and later on developed incomplete and complete right bundle branch block on alternate beats (2:1). During first minute of recovery he developed complete right bundle branch block on all beats (1:1). At 3 minutes of recovery, baseline electrocardiographic pattern was resumed. Variable degree of right bundle branch block on alternate beats is a rare phenomenon. The plausible mechanisms responsible for this phenomenon are being discussed.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):299-303.
• Article: Do LQTS Gene Single Nucleotide Polymorphisms Alter QTc Intervals at Rest and during Exercise Stress Testing?

  Peter F Aziz, Tammy S Wieand, Jamie Ganley, Jacqueline Henderson, Michael McBride, Maully J Shah
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  ABSTRACT: BACKGROUND: The impact of harboring, genetic variants or single nucleotide polymorphisms (LQT-PM) on the repolarization response during exercise and recovery is unknown. OBJECTIVE: To assess the QTc interval adaptation during exercise stress testing (EST) in children with LQT polymorphisms compared to a group of age and gender matched normal controls. METHODS: One hundred forty-eight patients were age and gender matched into two groups: LQT-PM and control. Each patient underwent a uniform exercise protocol employing a cycle ergometer followed by a 9 minute recovery phase with continuous 12-lead electrocardiogram (ECG) monitoring. Intervals (RR, QT and QTc) at rest (supine), peak exercise and in recovery (1, 3, 5, 7, and 9 minutes) were measured. RESULTS: Forty-three patients were positive for LQT-PM and the control group consisted of 105 patients. A total of 83 SNPs were identified: SCN5A n = 31 (37%), KCNE1 n = 29 (35%), KCNH2 n = 20 (24%), KCNQ1 n = 2 (2%) and KCNE2 n = 1 (1%). The QTc interval measurements of the LQT-PM were longer at rest, peak exercise and all phases of recovery when compared to the control group. Neither group demonstrated abnormal QTc interval adaptation in response to exercise. Patients with homozygous SNPs had longer resting QTc intervals when compared to patients with only heterozygous SNPs (435 ± 23 ms vs. 415 ± 20 ms, respectively, P value <0.006). CONCLUSIONS: Individuals with LQT-PM may have longer QTc intervals at rest as well as at peak exercise and all phases of the recovery period compared to normal controls. Additionally, subjects with homozygous SNPs had longer resting QTc intervals when compared to those with only heterozygous SNPs.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):288-293.
• Article: Quantitative Electrocardiographic Measures, Neuromuscular Disorders, and Survival in Left Ventricular Hypertrabeculation/Noncompaction.

  Claudia Stöllberger, Daniel Gerger, Christian Wegner, Josef Finsterer
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  ABSTRACT: BACKGROUND: Left ventricular hypertrabeculation/noncompaction (LVHT) is frequently associated with neuromuscular disorders (NMDs) and electrocardiographic (ECG) abnormalities. Quantitative ECG-measures (QEMs) are risk markers for mortality in cardiomyopathies. We measured QEMs in the ECGs in LVHT patients with and without NMDs. METHODS: Included were patients in whom (a) LVHT was diagnosed between 1995 and 2011 and (b) baseline ECG recordings were available. All underwent a clinical examination and were invited for a neurological investigation. QRS duration, QT, QTc and PR intervals were analyzed. Survival status was assessed in June 2011. RESULTS: In 141 patients (mean age 54 years, 49 females) QRS duration ranged from 40 to 200 ms, a QRS duration >120 ms was found in 19% and was associated with increased age, heart failure, left ventricular dilatation and systolic dysfunction (P < 0.001). QT intervals ranged from 240 to 600 ms. The QTc intervals ranged from 302 to 612 ms, a QTc interval >440 ms was found in 38% and was associated with left ventricular dilatation and systolic dysfunction (P < 0.001). PR intervals ranged from 90 to 360 ms, a PR interval >200 ms was found in 16% and associated with left ventricular dilatation (P < 0.01). No QEM differences were found in 86 patients with and 13 without NMD. During 59 months follow-up 45 patients died. QEMs were no mortality predictors, whereas multivariate analysis identified heart failure (P < 0.01), atrial fibrillation (P < 0.01) and diabetes mellitus (P < 0.05) as mortality predictors. CONCLUSIONS: Prolonged QRS complexes, PR and QTc intervals in LVHT are associated with heart failure and left ventricular dilatation, but not with NMD. The prognostic role of QEMs in LVHT needs further investigations in larger series.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):251-255.
• Article: f-Wave Suppression Method for Improvement of Locating T-Wave Ends in Electrocardiograms during Atrial Fibrillation.

  Xiaochuan Du, Nini Rao, Feng Ou, Guogong Xu, Lixue Yin, Gang Wang
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  ABSTRACT: This article is to propose an algorithm for improving T-wave ends location during atrial fibrillation (AF). The traditional algorithms do not take the irregular baseline fibrillation of AF into consideration, so their location accuracy is relatively low. Based on simple assumptions that AF is a random signal while T waves and QRS complexes are deterministic signals, we suggest a novel method to suppress f wave for improving location of T-wave ends during AF. We firstly define a new cardiac cycle and then match R peaks and T peaks in the three adjacent cardiac cycles. Finally, we suppress the interference of the f wave by averaging. When evaluating with the PhysioNet QT database and simulated AF signals in terms of the mean and the standard deviation of the T-wave ends location errors, the proposed algorithm improves the performance of existing popular methods. Besides, the clinical significance of the proposed method is illustrated.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):262-270.
• Article: Electrocardiographic Predictors of Sudden Cardiac Death in Patients with Left Ventricular Hypertrophy.

  Ragesh Panikkath, Kyndaron Reinier, Audrey Uy-Evanado, Carmen Teodorescu, Karen Gunson, Jonathan Jui, Sumeet S Chugh
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  ABSTRACT: BACKGROUND: Left ventricular hypertrophy (LVH) has been associated with increased risk of sudden cardiac death (SCD), and improvements in risk stratification methodology are warranted. METHODS: We evaluated electrocardiographic intervals as potential markers of SCD risk in LVH. Corrected QT, QRS, and JT intervals were evaluated in consecutive cases with SCD and LVH from the ongoing Oregon Sudden Unexpected Death study who underwent a 12-lead electrocardiogram (EKG) and echocardiogram prior to and unrelated to the SCD event. Comparisons of age, gender, body mass index, LV ejection fraction, and EKG intervals together with clinical conditions (hypertension and diabetes) were conducted with geographically matched controls that had coronary artery disease but no history of ventricular arrhythmias or cardiac arrest. LVH was determined using the modified American Society of Echocardiography equation for LV mass. Independent samples t-test, Pearson's chi-square test, and multiple logistic regression were used for statistical comparisons. RESULTS: Of the 109 cases and 49 controls who met study criteria, age, gender, and comorbidities were similar among cases and controls. The mean LV mass index was not significantly different in cases compared to controls. However mean QTc (470.6 ± 53.6 ms vs 440.7 ± 38.7 ms; P < 0.0001) and QRS duration (113.6 ± 30.0 ms vs 104.9 ± 18.7 ms; P = 0.03) were significantly higher in cases than controls. In logistic regression analysis, prolonged QTc was the only EKG interval significantly associated with SCD (OR 1.72 [1.23-2.40]). CONCLUSION: Prolonged QTc was independently associated with SCD among subjects with LVH and merits further evaluation as a predictor of SCD in LVH.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):225-229.
• Article: Sinus Bradycardia and Sinus Pauses Immediately after Electrical Cardioversion of Persistent Atrial Fibrillation-What Do They Mean?

  Dritan Poçi, Britt-Marie Abrahamsson, Nils Edvardsson, Lennart Bergfeldt
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  ABSTRACT: BACKGROUND: To determine the role of sinus bradyarrhythmia (SB) immediately after electrical cardioversion of persistent atrial fibrillation (AF) on the short-term recurrence rate and long-term pacemaker need and all-cause mortality. METHODS: SB defined as sinus bradycardia (sinus rate <40 bpm for ≥2 consecutive cycles) and/or sinus pauses (>2 s), were recorded during 5 minutes immediately after successful DC cardioversion in 140 consecutive patients with persistent AF. RESULTS: SB was observed during the first minute of SR in 31 patients (22%). Sinus bradycardia was present in 27 patients, sinus pauses in 16 (>3 s in 10) patients, and both in 12 patients. Compared to patients without SB, the mean heart rate during the first minute after cardioversion was lower, 57 ± 13 versus 63 ± 11 bpm; P < 0.05, while the mean heart rates during the subsequent 4 minutes were not statistically significantly different. The AF recurrence rates were not significantly different at 1 week (45% vs. 40%), or at 3 months (68% vs. 53%) in patients with or without SB. After a mean follow-up of 86 ± 6 months the pacemaker implantation rate was 10% versus 11% (NS) and an all-cause mortality of 26 versus 18% (NS). CONCLUSIONS: SB immediately after electrical cardioversion of persistent AF had no significant impact on the 3-month AF recurrence rate, the long-term need for pacemaker or all-cause mortality.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):281-287.
• Article: Predicting Recovery of Myocardial Function by Electrocardiography after Acute Infarction.

  Minna M Kylmälä, Teijo Konttila, Paula Vesterinen, Mats Lindholm, Heikki Väänänen, Matti Stenroos, Markku S Nieminen, Helena Hänninen, Lauri Toivonen
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  ABSTRACT: BACKGROUND: In acute ischemic left ventricular (LV) dysfunction, distinguishing viable myocardium is clinically important. METHODS: Body surface potential mapping (Electrocardiography [ECG] with 123 leads), was recorded in 62 patients with acute coronary syndrome (ACS). ECG variables were computed from de- and repolarization phases. LV segmental wall motion was assessed by echocardiography acutely and after 1 year. RESULTS: The number of dysfunctional segments (DFS) diminished during follow-up in 37 patients (recovery group) and remained the same or increased in 25 patients (nonrecovery group). Acutely, DFS was 5.7 ± 2.1 versus 4.4 ± 2.4 (P = 0.02), and peak CK-MBm 141 ± 157 versus 156 ± 167 μg/L (P = 0.78) in the recovery versus nonrecovery group. At follow-up, DFS was 1.9 ± 1.7 versus 6.5 ± 2.6 (P < 0.001). The best ECG variable to predict decrease in DFS depended on the region of acute LV dysfunction: The best variable in the left anterior descending region was the integral of the first QRS integral (area under the curve [AUC] 0.82, P = 0.002); in the right coronary artery region, this was the integral of the ST segment (AUC 0.98, P = 0.003); and in the left circumflex region, the area including the ST segment and the T wave (AUC 0.97, P = 0.006). CONCLUSIONS: In ACS patients, computed ECG variables predict recovery of LV function from ischemic myocardial injury, even in the presence of comparable CK-MBm release and LV dysfunction.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):230-239.
• Article: First-Degree AV Block-An Entirely Benign Finding or a Potentially Curable Cause of Cardiac Disease?

  Fredrik Holmqvist, James P Daubert
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  ABSTRACT: First-degree atrioventricular (AV) block is a delay within the AV conduction system and is defined as a prolongation of the PR interval beyond the upper limit of what is considered normal (generally 0.20 s). Up until recently, first-degree AV block was considered an entirely benign condition. In fact, some complain that it is a misnomer since there is only delay and no actual block in the AV conduction system (usually within the AV node). However, it has long been acknowledged that extreme forms of first-degree AV block (typically a PR interval exceeding 0.30 s) can cause symptoms due to inadequate timing of atrial and ventricular contractions, similar to the so-called pacemaker syndrome. Consequently, the current guidelines state that permanent pacemaker implantation is reasonable for first-degree AV block with symptoms similar to those of pacemaker syndrome or with hemodynamic compromise, but also stresses that there is little evidence to suggest that pacemakers improve survival in patients with isolated first-degree AV block. Recent reports suggest that it may be time to revisit the impact of first-degree AV block. Also, several findings in post hoc analyses of randomized device trials give important insights in possible treatment options. The present review aims to provide an update on the current knowledge concerning the impact of first-degree AV block and also to address the issue of pacing in patients with this condition.
  Annals of Noninvasive Electrocardiology 05/2013; 18(3):215-224.
• Article: Indexes of temporal myocardial repolarization dispersion and sudden cardiac death in heart failure: any difference?

  Gianfranco Piccirillo, Pietro Rossi, Marilena Mitra, Raffaele Quaglione, Annalaura Dell'armi, Daniele Di Barba, Damiana Maisto, Andrea Lizio, Francesco Barillà, Damiano Magrì
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  ABSTRACT: The QT variability index, calculated between Q- and the T-wave end (QTend VI), is an index of temporal myocardial repolarization lability associated with sudden cardiac death (SCD) in chronic heart failure (CHF). Little is known about temporal variability in the other two temporal myocardial repolarization descriptors obtained from Q-Tpeak and Tpeak -Tend intervals. We therefore investigated differences between these indexes in patients with CHF who died suddenly and in those who survived with a left ventricular ejection fraction (LVEF) ≤35% or >35%. We selected 127 ECG and systolic blood pressure (SPB) recordings from outpatients with CHF all of whom had been followed up for 30 months. We calculated RR and SPB variability by power spectral analysis and QTend VI, QTpeak VI, Tpeak Tend VI. We then subdivided data patients into three groups SCD, LVEF ≤ 35%, and LVEF > 35%. The LVEF was higher in the SCD than in the LVEF ≤ 35% group, whereas no difference was found between the SCD and LVEF > 35% groups. QTend VI, QTpeak VI, and Tpeak Tend VI were higher in the SCD and LVEF ≤ 35% groups than in the LVEF > 35% group. Multivariate analysis detected a negative relationship between all repolarization variability indexes, low frequency obtained from RR intervals and LVEF. Our data show that variability in the first (QTpeak VI) and second halves of the QT interval (Tpeak -Tend VI) significantly contributes to the QTend VI in patients with CHF. Further studies should investigate whether these indexes might help stratify the risk of SCD in patients with a moderately depressed LVEF.
  Annals of Noninvasive Electrocardiology 03/2013; 18(2):130-9.
• Article: Effectiveness of cardiac resynchronization therapy with defibrillator in at-risk black and white cardiac patients.

  Meena Elanchenny, Arthur J Moss, Scott McNitt, Mehmet Aktas, Slava Polonsky, Wojciech Zareba, Ilan Goldenberg
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  ABSTRACT: There are limited data regarding racial differences in response to cardiac resynchronization therapy with defibrillator (CRT-D). We assessed the effectiveness of CRT-D, as compared to implantable cardioverter defibrillator (ICD) therapy alone, in reducing the risk of heart failure (HF) or death and changes in cardiac volumes among 1638 (90%) white patients and 143 (8%) black patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT). Enrolled black patients displayed a higher frequency of diabetes mellitus, treated hypertension, higher creatinine levels, and a lower distance walked in the baseline 6-minute walk test. Kaplan-Meier survival analysis showed that at 3 years of follow-up the cumulative probability of HF or death was higher among blacks (29%) as compared with whites (22%; P = 0.05). Both black and white patients experienced similar and pronounced reductions in cardiac volumes with CRT-D therapy (all P values for comparison between the two groups >0.10). Risk reduction conferred by CRT-D therapy as not significantly different between blacks and whites (hazard ratio = 0.78 and 0.60, respectively; P for the difference = 0.44). However, possibly due to sample size limitations the CRT-D versus ICD only adjusted risk for HF/death in blacks was not statistically significant. Black patients in MADIT-CRT experienced increased risk of HF or death as compared with whites, but displayed a similar magnitude echocardiographic response to CRT-D. These findings suggest that cardiac resynchronization therapy may be an effective therapeutic modality in black patients. However, further studies are needed to assess the clinical response to CRT-D in this high-risk population.
  Annals of Noninvasive Electrocardiology 03/2013; 18(2):140-8.
• Article: The findings of electrocardiography in patients with cardiac amyloidosis.

  Zhongwei Cheng, Kongbo Zhu, Zhuang Tian, Dachun Zhao, Quancai Cui, Quan Fang
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  ABSTRACT: The electrocardiography (ECG) was the simplest and common adjunctive diagnostic tool for cardiac amyloidosis (CA). We sought to clarify the findings of ECG in patients with CA in order to early identification of CA according to the findings of ECG. A total of 276 patients with diagnosis of systemic amyloidosis admitted to Peking Union Medical College Hospital from January 2000 to December 2011, were enrolled. Two groups were classified according to the cardiac involvement or not, namely CA (n = 189) and control (n = 87) groups. The low voltage on limb leads defined by the amplitude of the QRS complex in each limb leads ≤0.5 mV. The pseudo-infarct pattern defined by the presence of pathologic Q waves on at least two contiguous leads on ECG without obstructive coronary artery disease. The mean age was 55 ± 12 (15-88) years, 168 patients (61%) were male. Atrial arrhythmia (15.9% vs 3.4%, P = 0.003), low voltage on limb leads (54.5% vs 20.7%, P < 0.001), atrioventricular block (14.8% vs 1.1%, P = 0.001) and pseudo-infarct pattern (40.2% vs 4.6%, P < 0.001) were more prevalent in CA than control groups. The combination of low voltage on limb leads and pseudo-infarct pattern was more common (28.0% vs 2.3%, P < 0.001) in CA than control groups. The sensitivity, specificity, positive and negative predictive values of the presence of low voltage on limb leads and pseudo-infarct pattern for the diagnosis of CA were 28%, 98%, 96%, and 39%, respectively. In CA patients, low voltage on limb leads and pseudo-infarct pattern were the most common ECG findings. Atrial arrhythmia and atrioventricular block were the most common arrhythmias in CA patients. The combination of low voltage on limb leads and pseudo-infarct pattern had high specificity and positive predictive value for the diagnosis of CA.
  Annals of Noninvasive Electrocardiology 03/2013; 18(2):157-62.
• Article: Notched QRS Complex in Lateral Leads as a Novel Predictor of Response to Cardiac Resynchronization Therapy.

  Wenzhi Pan, Yangang Su, Wenqin Zhu, Xianhong Shu, Junbo Ge
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  ABSTRACT: Notched QRS (nQRS) may be an indicator of ventricular delay. There are very few studies investigating the value of nQRS. The aim of the study was to identify the predictive value of nQRS for response to cardiac resynchronization therapy (CRT). Eighty-two patients with heart failure (HF) and widened QRS (≥120 ms) were implanted with a CRT device. nQRS was defined as presence of ≥2 R waves, or ≥1 notch in the R wave or S wave in ≥2 contiguous leads. Response to CRT was defined as percentage of left ventricular end-systolic volume (LVESV) reduction after 6 months CRT (ΔLVESV%) ≥15%. nQRS was presented in 62 (76%) patients, 16 of whom had nQRS in anterior leads, 47 in inferior leads, and 42 in lateral leads. The rate of CRT response (65% vs 50%, P = 0.29) and ΔLVESV% (21.7 ± 31.7% vs 7.9 ± 25.4%, P = 0.09) were not different between patients with and without nQRS. But the rate of CRT response was higher in patients with nQRS in lateral leads (nQRS-L) than in those without nQRS-L (76% vs 45%, P = 0.006). ΔLVESV% was greater in patients with nQRS-L than in those without nQRS-L (25.2 ± 34.3% vs 10.1 ± 24.5%, P = 0.004). After adjusting for potential confounders including QRS duration, presence of nQRS-L still predicted positive CRT response (OR = 4.04, P = 0.009). nQRS-L may be a novel predictor of response to CRT in patients with HF and widened QRS. Large-scale studies are needed to confirm this prognostic value of nQRS-L.
  Annals of Noninvasive Electrocardiology 03/2013; 18(2):181-7.
• Article: The prognostic value of electrocardiographic estimation of left ventricular hypertrophy in dialysis patients.

  Adrian C Covic, Laura-Dumitriţa Buimistriuc, Darren Green, Alina Stefan, Silvia Badarau, Philip A Kalra
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  ABSTRACT: Left ventricular hypertrophy (LVH) is associated with poor cardiovascular outcome in CKD. Electrocardiogram (ECG) is low-cost but infrequently used to assess presence of LVH in dialysis patients. The aim of this study was to establish which ECG-determined LVH method is most sensitive in dialysis patients, and also most predictive of death. This was a longitudinal observational study in dialysis patients from a single center, undergoing interval ECGs. Fourteen methods of ECG LVH assessment were compared. Survival was also compared between four LVH evolutionary categories: persistent LVH; new LVH; LVH regression; and no LVH. The study included 418 dialysis patients (46.3% women, mean age 51 years, mean follow up 67 months, 76 deaths, 37 cardiovascular deaths). LVH prevalence varied according to method (range 13.4-41.9%). No measurement predicted all-cause mortality. After Cox regression, there was an independent association between LVH and cardiovascular mortality using Novacode (HR = 3.04; 95% [CI] = 1.11-8.28, P < 0.05), but not with other methods. Patients with persistent ECG changes of LVH had increased risk of cardiovascular mortality compared to other LVH evolutionary categories (P < 0.044). ECG scoring of LVH can be predictive of cardiovascular mortality. The Novacode method, based on repolarization abnormalities, is a better predictor than standard ECG techniques that are based on voltage criteria. Novacode LVH estimation at dialysis initiation may prove to be a noninvasive and cost-effective bedside tool for cardiovascular risk stratification in patients receiving dialysis.
  Annals of Noninvasive Electrocardiology 03/2013; 18(2):188-98.
• Article: Risk stratification of patients with early repolarization…still an unresolved matter!

  Sérgio Nuno Craveiro Barra, Rui Providência
  Annals of Noninvasive Electrocardiology 03/2013; 18(2):210-1.