Abnormal dispersion of the QT interval (QTd), measured as interlead variability of QT, may reflect a regional variation in duration of ventricular action potential and, hence, of cardiac electrical instability. In this retrospective study, we analyzed the effect of QTd on survival and its relation to other known predictors of subsequent cardiac death (CD) and sudden cardiac death (SCD) in 162 patients with coronary heart disease (CHD). QTd was calculated as the difference between the highest and lowest values measured in each of the 12 ECG leads (Qtmax - QTmin). Seventeen CDs occurred, including nine SCDs, during a 25 +/- 11 month follow-up. There were significant differences in CD (P < 0.001 in log-rank test) and in SCD (P < 0.01). The 1- and 3-year survivals were 87.5% and 76.5% in patients with QTd > 0.060 seconds versus 98% and 93.5% in patients with QTd < 0.060 seconds, respectively. Additionally, a stepwise Cox regression analysis revealed that increased QTd was an independent risk factor of CD and SCD. A cut-off value of 60 ms for QTd had a 53% sensitivity and 79% specificity in discriminating patients who are at risk of CD. The positive and negative prognostic values were 23% and 93%, respectively. Our findings support the hypothesis that increased QTd has a prognostic value in the stratification of patients with CHD independent of other known risk factors.
Introduction: Despite progress in medical and interventional treatment of acute myocardial infarction (AMI) resulting in low in-hospital mortality, the post-discharge prognosis in MI survivors is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawał) is a program introduced by Poland's National Health Fund aiming at comprehensive care for patients with AMI to improve prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), scheduled outpatient follow-up, and prevention of sudden cardiac death. The aim of the study was to assess the effect of MC-AMI on major adverse cardiovascular events (MACE) in 3-month follow-up. Material and methods: In this single-center, retrospective observational study we enrolled 1211 patients, and compared them to 1130 subjects in the control group. After 1 : 1 propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI and other variables on MACE. Results: MC-AMI participation is related to reduced MACE rate by 45% in a 3-month observation. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACE at 3 months (HR = 0.476, 95% CI: 0.283-0.799, p < 0.005). Also, older age, male sex (HR = 2.0), history of unstable angina (HR = 3.15), peripheral artery disease (HR = 2.17), peri-MI atrial fibrillation (HR = 1.87) and diabetes (HR = 1.5) were significantly associated with MACE. Conclusions: Participation in MC-AMI-the first comprehensive in-hospital and post-discharge care for AMI patients-improves prognosis and is related to a MACE rate reduction by 45% as soon as in 3 months.
Background
Aortic valve stenosis (AS) generates a chronic pressure overload that induces left ventricular hypertrophy (LVH). The aim of this study was to assess the prevalence of the electrocardiographic criteria for LVH in patients with clinically significant AS and to evaluate the relationship between the ECG criteria for LVH and echocardiographic parameters.
Methods
The clinical data of 95 patients with moderate to severe AS were retrospectively analyzed. Eight ECG criteria for LVH were used and compared to the results of transthoracic echocardiography (TTE).
Results
In 59% of patients, at least one of the ECG criteria for LVH was found. These patients had a greater LVMI (142.1 ± 35.6 vs. 124.1 ± 22.5 g/m2, p = 0.01) and peak aortic jet velocity (4.2 ± 0.8 vs. 3.8 ± 0.9 m/s, p = 0.01) along with smaller aortic valve area (0.72 ± 0.28 vs. 0.86 ± 0.22 cm2, p = 0.02) compared to patients with a negative ECG for LVH. The ECG parameters had a low sensitivity (6%–36.9%) with a specificity of up to 100%. The Cornell Voltage criteria had the best sensitivity with a specificity of 63.6% and the highest correlation with the LVMI (r = 0.38, p < 0.001). All of the ECG parameters correlated positively with the peak aortic jet velocity as well as with the mean aortic gradient.
Conclusion
The electrocardiographic criteria for LVH in patients with moderate or severe AS have a poor sensitivity in identifying LVH confirmed by TTE. The values of the selected ECG criteria for LVH correlate weakly with both the TTE indices of LVH and the markers of AS severity.
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