New Data and Concepts Concerning the Ventricular Gradient

Abildskov, J.A.; Burgess, Mary Jo; Millar, Kay; Wyatt, Roland

doi:10.1378/chest.58.3.244

Cited by 31 publications

(13 citation statements)

References 27 publications

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“…However, the tenet of the independence of the ventricular gradient from the order of myocardial activation has been called into question by some experimental results [12–14]. In fact, the ventricular gradient may change depending on the site of cardiac stimulation because variations in the order of cardiac depolarization can induce local changes in the order of cardiac repolarization and action potential duration [15,16], and/or primary repolarization changes potentially due to cardiac memory [17,18].…”

Section: History and Definition Of The Ventricular Gradientmentioning

confidence: 99%

“…In fact, the ventricular gradient may change depending on the site of cardiac stimulation because variations in the order of cardiac depolarization can induce local changes in the order of cardiac repolarization and action potential duration [15,16], and/or primary repolarization changes potentially due to cardiac memory [17,18]. Additionally, if the SVG is calculated from a transformed 12-lead ECG instead of from directly recorded X-, Y-, and Z-leads, variations in proximity of different leads to the heart and sites of stimulation might account for observed differences between theory and experiments [14]. These differences do not “disprove” the concept of the SVG, but rather suggest that other important/complex factors can influence it [14].…”

Section: History and Definition Of The Ventricular Gradientmentioning

confidence: 99%

“…Additionally, if the SVG is calculated from a transformed 12-lead ECG instead of from directly recorded X-, Y-, and Z-leads, variations in proximity of different leads to the heart and sites of stimulation might account for observed differences between theory and experiments [14]. These differences do not “disprove” the concept of the SVG, but rather suggest that other important/complex factors can influence it [14]. …”

Section: History and Definition Of The Ventricular Gradientmentioning

confidence: 99%

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Global electrical heterogeneity: A review of the spatial ventricular gradient

Waks

Tereshchenko

2016

Journal of Electrocardiology

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The ventricular gradient, an electrocardiographic concept calculated by integrating the area under the QRS complex and T-wave, represents the degree and direction of myocardial electrical heterogeneity. Although the concept of the ventricular gradient was first introduced in the 1930s, it has not yet found a place in routine electrocardiography. In the modern era it is relatively simple to calculate the ventricular gradient in three-dimensions (the spatial ventricular gradient (SVG)), and there is now renewed interest in using the SVG as a tool for risk stratification of ventricular arrhythmias and sudden cardiac death. This manuscript will review the history of the ventricular gradient, describe its electrophysiological meaning and significance, and discuss its clinical utility.

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Section: History and Definition Of The Ventricular Gradientmentioning

confidence: 99%

Section: History and Definition Of The Ventricular Gradientmentioning

confidence: 99%

Section: History and Definition Of The Ventricular Gradientmentioning

confidence: 99%

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Global electrical heterogeneity: A review of the spatial ventricular gradient

Waks

Tereshchenko

2016

Journal of Electrocardiology

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“…The ventricular gradient, which measures the deviation between the main QRS and T vectors (expressed as an angle and vector magnitude) 5,6 provides a global measure of the variations of action potential duration and morphology (i.e., repolarization heterogeneity) [7][8][9][10] and therefore could serve as an index of vulnerability to arrhythmia. 9,11,12 Until now, however, only one prospective population-based study has demonstrated that ventricular gradient is an independent predictor of cardiac mortality.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of heterogeneity of ventricular repolarization in survivors of acute myocardial infarction

Batchvarov¹,

Hnatkova²,

Poloniecki³

et al. 2004

Clinical Cardiology

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SummaryBackground: The expansion of indications for implantation of cardioverter-defibrillators (ICD) has enhanced the need for risk stratification of patients post myocardial infarction (MI), while the improved treatment of acute MI has decreased mortality and diminished the prognostic power of traditional risk variables.Hypothesis: Increased heterogeneity of ventricular repolarization quantified by TCRT (total cosine R-to-T, angular difference between spatial QRS and T loops, decreased with increase in repolarization heterogeneity) is an independent predictor of mortality in patients post MI.Methods: Left ventricular ejection fraction (EF), QRS duration on signal-averaged ECG, number of ventricular ectopic beats (VE)/h, heart rate variability (HRV) triangular index, heart rate turbulence slope on 24-h Holter recording, and TCRT were analyzed in 334 survivors of acute MI followed up for 41 ± 20 months.Results: In multivariate analysis, EF < 35% (relative risk [RR] 2.3, 95% confidence interval [CI] 1.1-4.7, p = 0.023), VE > 10/h (RR 2.2, CI 1.0-4.6, p = 0.044), HRV < 20 U (RR 2.2, CI 1.1-4.5, p = 0.032), and TCRT < Ϫ0.896 (RR 4.3, CI 2.2-8.5, p = 0.00001) were independent predictors of cardiac mortality (11%). Independent predictors of arrhythmic mortality (5%) were VE, HRV, and TCRT (RR 5.8, CI 2.1-15.6, p = 0.0004). Cardiac and arrhythmic mortality of patients with both EF < 35% and TCRT < Ϫ0.896 were > 60 and > 30%,

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“…Experimental and theoretical studies have demonstrated that the SVG is related to global heterogeneity of both action potential duration and morphology6, 7 and that it is theoretically independent of the specific ventricular activation sequence 8. SVG is a vector sum of spatial QRS and T vectors, reflecting implication of the spatial QRS‐T angle 9.…”

Section: Introductionmentioning

confidence: 99%

Genome‐Wide Associations of Global Electrical Heterogeneity ECG Phenotype: The ARIC (Atherosclerosis Risk in Communities) Study and CHS (Cardiovascular Health Study)

Tereshchenko

Sotoodehnia

Sitlani

et al. 2018

JAHA

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Background ECG global electrical heterogeneity (GEH) is associated with sudden cardiac death. We hypothesized that a genome‐wide association study would identify genetic loci related to GEH.Methods and ResultsWe tested genotyped and imputed variants in black (N=3057) and white (N=10 769) participants in the ARIC (Atherosclerosis Risk in Communities) study and CHS (Cardiovascular Health Study). GEH (QRS‐T angle, sum absolute QRST integral, spatial ventricular gradient magnitude, elevation, azimuth) was measured on 12‐lead ECGs. Linear regression models were constructed with each GEH variable as an outcome, adjusted for age, sex, height, body mass index, study site, and principal components to account for ancestry. GWAS identified 10 loci that showed genome‐wide significant association with GEH in whites or joint ancestry. The strongest signal (rs7301677, near TBX3) was associated with QRS‐T angle (white standardized β+0.16 [95% CI 0.13–0.19]; P=1.5×10−26), spatial ventricular gradient elevation (+0.11 [0.08–0.14]; P=2.1×10−12), and spatial ventricular gradient magnitude (−0.12 [95% CI −0.15 to −0.09]; P=5.9×10−15). Altogether, GEH‐SNPs explained 1.1% to 1.6% of GEH variance. Loci on chromosomes 4 (near HMCN2), 5 (IGF1R), 11 (11p11.2 region cluster), and 7 (near ACTB) are novel ECG phenotype‐associated loci. Several loci significantly associated with gene expression in the left ventricle (HMCN2 locus—with HMCN2;IGF1R locus—with IGF1R), and atria (RP11‐481J2.2 locus—with expression of a long non‐coding RNA and NDRG4).ConclusionsWe identified 10 genetic loci associated with ECG GEH. Replication of GEH GWAS findings in independent cohorts is warranted. Further studies of GEH‐loci may uncover mechanisms of arrhythmogenic remodeling in response to cardiovascular risk factors.

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New Data and Concepts Concerning the Ventricular Gradient

Cited by 31 publications

References 27 publications

Global electrical heterogeneity: A review of the spatial ventricular gradient

Global electrical heterogeneity: A review of the spatial ventricular gradient

Prognostic value of heterogeneity of ventricular repolarization in survivors of acute myocardial infarction

Genome‐Wide Associations of Global Electrical Heterogeneity ECG Phenotype: The ARIC (Atherosclerosis Risk in Communities) Study and CHS (Cardiovascular Health Study)

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