Electrocardiogram and clinical characteristics of patients referred for cardiac transplantation: Implications for pacing in heart failure

Freudenberger, Ronald S; Sikora, Jo Ann H.; Fisher, Michael L.; Wilson, Alan C.; Gold, Michael R.

doi:10.1002/clc.4960270311

Cited by 16 publications

(12 citation statements)

References 8 publications

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“…Prolongation of QRS (Ն120 ms) is a significant predictor of LV systolic dysfunction in patients with HF (4,8,10,11,22). In contrast, the significance of QRS prolongation has not yet been evaluated in HF with a normal LVEF and diastolic dysfunction.…”

Section: Function and Clinical Statusmentioning

confidence: 88%

“…In contrast, the significance of QRS prolongation has not yet been evaluated in HF with a normal LVEF and diastolic dysfunction. In patients with HF, an inverse correlation exists between QRS prolongation and LVEF (Table 1) (4,8,10,11,13,18). In a study of nearly 3,500 patients with HF, Shenkman et al (7) found a stepwise increase in the prevalence of systolic LV dysfunction as QRS complex duration increased progressively above 120 ms. A more recent study conducted in 343 patients with HF reported LVEF of 41%, 36%, 29%, and 25% in patients with QRS durations of Ͻ100 ms, 100 to 119 ms, 120 to 149 ms, and Ն150 ms, respectively (10).…”

Section: Function and Clinical Statusmentioning

confidence: 94%

“…Some patients with HF may not have had true LV systolic dysfunction, particularly in studies in which the LV ejection fraction (LVEF) was not determined. Some study populations consisted of patients with advanced HF (11,15), others involved HF patients with implanted defibrillators (a group that generally has more severe disease than the populations in most other reports) (14), whereas others focused on clinically stable outpatients (13).…”

Section: Incidencementioning

confidence: 98%

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Significance of QRS Complex Duration in Patients With Heart Failure

Kashani

Barold

2005

Journal of the American College of Cardiology

344

246

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Prolongation of QRS (> or =120 ms) occurs in 14% to 47% of heart failure (HF) patients. Left bundle branch block is far more common than right bundle branch block. Left-sided intraventricular conduction delay is associated with more advanced myocardial disease, worse left ventricular (LV) function, poorer prognosis, and a higher all-cause mortality rate compared with narrow QRS complex. It also predisposes heart failure patients to an increased risk of ventricular tachyarrhythmias, but the incidence of cardiac or sudden death remains unclear because of limited observations. A progressive increase in QRS duration worsens the prognosis. No electrocardiographic measure is specific enough to provide subgroup risk categorization for excluding or selecting HF patients for prophylactic implantable cardioverter-defibrillator (ICD) therapy. In ICD patients with HF, a wide underlying QRS complex more than doubles the cardiac mortality compared with a narrow QRS complex. There is a high incidence of an elevated defibrillation threshold at the time of ICD implantation in patients with QRS > or =200 ms. Mechanical LV dyssynchrony potentially treatable by ventricular resynchronization occurs in about 70% of HF patients with left-sided intraventricular conduction delay, a fact that would explain the lack of therapeutic response in about 30% of patients subjected to ventricular resynchronization according to standard criteria relying on QRS duration. The duration of the basal QRS complex does not reliably predict the clinical response to ventricular resynchronization, and QRS narrowing after cardiac resynchronization therapy does not correlate with hemodynamic and clinical improvement. Mechanical LV dyssynchrony is best shown by evolving echocardiographic techniques (predominantly tissue Doppler imaging) currently in the process of standardization.

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Section: Function and Clinical Statusmentioning

confidence: 88%

Section: Function and Clinical Statusmentioning

confidence: 94%

Section: Incidencementioning

confidence: 98%

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Significance of QRS Complex Duration in Patients With Heart Failure

Kashani

Barold

2005

Journal of the American College of Cardiology

344

246

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“…It is particularly important since some studies showed QRS duration increases as left ventricular function worsens (Iuliano et al, 2002;Stellbrink et al, 1999). Others (Freudenberger, Sikora, Fisher, Wilson, & Gold, 2004;Shamim et al, 1999;Silverman, 1995), demonstrated that patients with QRS prolongation have higher all-cause mortality and possibly a higher incidence of sudden death (or cardiac death) than those with narrow QRS complexes. On the other hand, PR interval duration did not differ between high and moderate exercise(HVE = 116.6 ± 24.5 ms vs. MVE = 134.1 ± 26.1 ms), but the HVE group showed lower limits of PR compared to recommended standard values(between 120 ms -200 ms).…”

Section: Discussionmentioning

confidence: 99%

<b>Profile of the cardiac repolarization in cervical spinal cord injury subjects performing physical exercise

Magalhães

Martins

Maior

et al. 2017

Acta Sci. Health Sci.

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ABSTRACT. The aim of the study was to compare rest QT interval and QTcorrected intervals of electrocardiogram in trained men with and without cervical spinal cord injury (CSCI) and investigate cardiac electrocardiogram parameters in trained men with CSCI submitted to maximal effort test. Thirty men were separated into three groups: Control without CSCI (CON, 25.3 ± 4.1 yrs, strength training: 3 days week Perfil da repolarização cardíaca de sujeitos com lesão medular cervical submetidos a exercícios físicos RESUMO. O objetivo do presente estudo foi comparar o perfil dos intervalos QT e QT corrigido (QTc) em homens treinados com e sem lesão medular cervical (LMC) e investigar o perfil eletrocardiográfico de homens treinados com LMC submetidos ao teste de esforço máximo. Trinta homens foram separados em três grupos: controle sem LMC (CON, indivíduos fisicamente ativos; n = 10), LMC praticantes de alto volume de exercícios (praticantes de rugby em cadeira de rodas 180 min. Semana -1 ; n = 12) e LMC praticantes de moderado volume de exercícios (praticantes de rugby em cadeira de rodas 120 min. Semana -1 ; n = 8). Todos os participantes do grupo LMC apresentavam lesões incompletas (C5-C7) mais do que 12 meses. Eletrocardiograma foi registrado em repouso, durante e após o teste de esforço. O intervalo QT apresentou redução significativa (p = 0,001) no grupo de alto volume de exercícios quando comparado ao controle. O QTc não mostrou diferença entre os distintos volumes de exercícios (p > 0,05). Ambos os grupos LMC não apresentaram mudanças significativas no intervalo QT, QTc, intervalos PR e QRS entre o repouso e pós-esforço (p > 0,05). Concluimos que o alto volume de exercícios semanais parece promover anormalidades na repolarização cardíaca.Palavras-chave: lesão medular cervical, treinamento físico, eletrocardiograma, repolarização ventricular.

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“…HF is the leading indication for hospitalization in elderly patients (SOLVD Investigators 1991 ;Packer et al 1996 ;MERIT Merit -HF Study Group 1999 ;Bubien and Ching 2004 ;American Heart Association 2008 ), accounting for $40 billion annual expenditures in the United States (O ' Connell and Bristow 1994 ;McMurray and Stewart 2000 ). and a LVEF < 35% secondary to ischemic and nonischemic cardiomyopathy (Huang et al 1995 ;Silverman et al 1995 ;Shamin et al 1998 ;Juliano et al 2002 ;Shenkman et al 2002 ;Bade et al 2004 ;Freudenberger et al 2004 ). These electrical timing abnormalities adversely effect critical mechanical interactions that further impair LV function.…”

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confidence: 99%