Low voltage on the electrocardiogram is a marker of disease severity and a risk factor for adverse outcomes in patients with heart failure due to systolic dysfunction

Kamath, Sandeep; Neto, Januario de P. Meo; Canham, Russell M.; Uddin, Fatema S.; Toto, Kathleen H.; Nelson, Lauren L.; Kaiser, Patricia A.; Lemos, James A. de; Drazner, Mark H.

doi:10.1016/j.ahj.2005.12.021

Cited by 34 publications

(28 citation statements)

References 16 publications

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“…Bhatia and colleagues 5 found that patients with preserved LV function tended to be older women with diagnoses of hypertension with atrial fibrillation. Patients with systolic HF with a high risk for negative outcomes were found to have low electrocardiographic voltage, prolonged QRS duration, and left bundle branch block 6–8 …”

Section: Discussionmentioning

confidence: 99%

“…Patients with systolic HF with a high risk for negative outcomes were found to have low electrocardiographic voltage, prolonged QRS duration, and left bundle branch block. [6][7][8] Systolic time intervals, including the pre-ejection period, LV ejection time, and their ratio (STR), have long been studied as measures of LV performance using phonocardiography and carotid pulse tracing analysis. Stack and colleagues 9 found a high degree of correlation between STR and changes in cross-sectional diameter by echocardiography in patients with coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

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Systolic Time Ratio by Impedance Cardiography to Distinguish Preserved vs Impaired Left Ventricular Systolic Function in Heart Failure

Thompson

Drazner

Dries

et al. 2008

Congestive Heart Failure

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Left ventricular ejection fraction (EF) is used to assess patients with heart failure (HF); however, frequent measurements are not cost-effective. Impedance cardiography (ICG) is a low-cost, noninvasive test that measures systolic time intervals and may be a method for detecting impaired vs intact EF. This study evaluated the relationship between EF by echocardiography or gated nuclear ventriculography and systolic time ratio (STR) by ICG in outpatients with chronic HF. A retrospective chart review identified 52 patients with EF and STR measured within 2 weeks. There was an inverse correlation between STR and EF (r=-0.54; P<.001). The area under the receiver operating characteristic curve for STR to identify reduced EF was 0.86. An EF < or =50% and STR > or =0.50 demonstrated 93% sensitivity and 85% specificity. STR was able to distinguish intact (>50%) from impaired EF (< or =50%). STR by ICG has the potential to be a reliable method to monitor ventricular function in chronic HF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systolic Time Ratio by Impedance Cardiography to Distinguish Preserved vs Impaired Left Ventricular Systolic Function in Heart Failure

Thompson

Drazner

Dries

et al. 2008

Congestive Heart Failure

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“…Left axis deviation >–30° in patients with LBBB is a marker of significant left ventricular systolic dysfunction, although it does not correlate well with ejection fraction, 10 . (8) persistent ST elevation in association with predominantly positive QRS complexes (usually V5 and V6) in the presence of LBBB suggestive of ventricular aneurysm and DCM, 11 (9) persistent ST elevation in association with predominantly positive QRS complexes (usually V1‐V3) in the presence of RBBB suggestive of ventricular aneurysm and DCM, 12 (10) low amplitude QRS complexes suggestive of mutual electrical cancellation of large myocardial zones of infarction opposite each other, 13,14 although this feature is also found in some patients with chronic nonischemic DCM, 15,16 and acute myocarditis, with transient cardiac dilatation and CHF 17 (it is a misconception that low amplitude QRS complexes is a specific feature of restrictive or infiltrative cardiomyopathy without cardiac dilatation), (11) low amplitude of the limb leads, with high voltage of the precordial leads, and an R/S ratio <1.0 in lead V4, which has been described to be associated with CHF, 18 (12) the “strain pattern” in hypertensive patients with ECG LVH, receiving aggressive blood pressure lowering, which was found to be predictive of new onset of, and dying from, CHF, 19 although it was not independently predictive of those patients with more severe diastolic dysfunction 20 . The ECG, in general, has not been implemented prospectively as a predictor for the development of CHF; this will require studies with long follow‐up and serial ECGs, in patients at risk, (13) an LBBB‐like ECG pattern, found in patients with CHF and pacemakers or implantable cardioverter/defibrillators (ICD), (14) an intraventricular conduction delay ECG pattern, seen in patients with CHF and implanted CRT systems, (15) a widened P wave in limb and precordial leads, an increase in P‐wave dispersion, and an accentuated negative component of the P wave in lead V1, found in patients with CHF, and which indicate intra‐atrial block, 21 left atrial hypertrophy, hypertension, or dilatation (not specific for any of the four), which predict emergence of atrial fibrillation in patients with CHF, and show dynamic changes with therapy 22,23 .…”

Section: Introductionmentioning

confidence: 99%

The Resting Electrocardiogram in the Management of Patients with Congestive Heart Failure: Established Applications and New Insights

Madias

2007

Pacing Clinical Electrophis

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The resting electrocardiogram (ECG) furnishes essential information for the diagnosis, management, and prognostic evaluation of patients with congestive heart failure (CHF). Almost any ECG diagnostic entity may turn out to be useful in the care of patients with CHF, revealing the non-specificity of the ECG in CHF. Nevertheless a number of CHF/ECG correlates have been proposed and found to be indispensable in clinical practice; they include, among others, the ECG diagnoses of myocardial ischemia and infarction, atrial fibrillation, left ventricular hypertrophy/dilatation, left bundle branch block and intraventricular conduction delays, left atrial abnormality, and QT-interval prolongation. In addition to the above well-known applications of the ECG for patients with CHF, a recently described association of peripheral edema (PERED), sometimes even imperceptible by physical examination, with attenuated ECG potentials, could extend further the diagnostic range of the clinician. These ECG voltage attenuations are of extracardiac mechanism, and impact the amplitude of QRS complexes, P-waves, and T-waves, occasionally resulting also in shortening of the QRS complex and QT interval duration. PERED alleviation, in response to therapy of CHF, reverses all above alterations. These fresh diagnostic insights have potential application in the follow-up of patients with CHF, and in their selection for implantation of cardioverter/defibrillator and/or cardiac resynchronization systems. If sought, PERED-induced ECG changes are abundantly present in the hospital and clinic environments; if their detection and monitoring are incorporated in the clinician's "routine," considerable improvements in the care of patients with CHF may be realized.

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“…The amplitude and duration of the QRS complex reflects conduction through the left ventricle and is well correlated with left ventricular mass as measured by echocardiography (1,2). ECG measurements of the QRS complex are important in clinical and pre-clinical cardiovascular diseases, such as cardiac hypertrophy, heart failure, and various cardiomyopathies; in addition, they can predict cardiovascular mortality (3–6). …”

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confidence: 99%

52 Genetic Loci Influencing Myocardial Mass

Harst

Setten

Verweij

et al. 2016

Journal of the American College of Cardiology

121

123

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BACKGROUND Myocardial mass is a key determinant of cardiac muscle function and hypertrophy. Myocardial depolarization leading to cardiac muscle contraction is reflected by the amplitude and duration of the QRS complex on the electrocardiogram (ECG). Abnormal QRS amplitude or duration reflect changes in myocardial mass and conduction, and are associated with increased risk of heart failure and death. OBJECTIVES This meta-analysis sought to gain insights into the genetic determinants of myocardial mass. METHODS We carried out a genome-wide association meta-analysis of 4 QRS traits in up to 73,518 individuals of European ancestry, followed by extensive biological and functional assessment. RESULTS We identified 52 genomic loci, of which 32 are novel, that are reliably associated with 1 or more QRS phenotypes at p < 1 × 10−8. These loci are enriched in regions of open chromatin, histone modifications, and transcription factor binding, suggesting that they represent regions of the genome that are actively transcribed in the human heart. Pathway analyses provided evidence that these loci play a role in cardiac hypertrophy. We further highlighted 67 candidate genes at the identified loci that are preferentially expressed in cardiac tissue and associated with cardiac abnormalities in Drosophila melanogaster and Mus musculus. We validated the regulatory function of a novel variant in the SCN5A/SCN10A locus in vitro and in vivo. CONCLUSIONS Taken together, our findings provide new insights into genes and biological pathways controlling myocardial mass and may help identify novel therapeutic targets.

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Low voltage on the electrocardiogram is a marker of disease severity and a risk factor for adverse outcomes in patients with heart failure due to systolic dysfunction

Cited by 34 publications

References 16 publications

Systolic Time Ratio by Impedance Cardiography to Distinguish Preserved vs Impaired Left Ventricular Systolic Function in Heart Failure

Systolic Time Ratio by Impedance Cardiography to Distinguish Preserved vs Impaired Left Ventricular Systolic Function in Heart Failure

The Resting Electrocardiogram in the Management of Patients with Congestive Heart Failure: Established Applications and New Insights

52 Genetic Loci Influencing Myocardial Mass

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