Prognostic Significance of PVCs and Resting Heart Rate

Engel, Gregory; Cho, Shaun; Ghayoumi, Afshin; Yamazaki, Takuya; Chun, Sung; Fearon, William F.; Froelicher, Victor F.

doi:10.1111/j.1542-474x.2007.00150.x

Cited by 62 publications

(42 citation statements)

References 46 publications

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“…They also demonstrated an association between elevated heart rate and cardiovascular mortality even in the absence of PVCs. 49 Our study demonstrated that a much higher percentage of our patients had evidence of PVCs compared with other countries in Africa like Nigeria and Cameroon (6.8% vs. 4% vs. 4.8%, respectively).…”

mentioning

confidence: 42%

A retrospective analysis of electrocardiographic abnormalities found in black South African patients with diabetes attending a regional hospital in KwaZulu-Natal

Pillay

Hift

Aldous

2017

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Objectives: : Diabetes mellitus increases the risk of coronary heart disease and myocardial infarction (MI). Silent MI occurs with greater frequency in patients with diabetes with or without autonomic neuropathy and carries a similar prognosis to overt MI. Regular electrocardiographic (ECG) assessment is integral in the chronic management of patients with diabetes. Limited data exist on the spectrum of ECG abnormalities of black South African patients with diabetes. The primary aim of this study was a description of ECG abnormalities found and the secondary aim was the determination of factors associated with left ventricular hypertrophy (LVH) and MI.j Setting and participants: The study was carried out at a regional hospital diabetes clinic in Pietermaritzburg, KwaZulu-Natal. The initial ECGs performed on patients from October 1, 2012 to September 30, 2014 were analysed. The first ECGs of 637 black South African patients with diabetes were studied, representing 80.1% of all eligible patients. Results: The major ECG abnormalities detected were those suggestive of LVH (36.0%), MI (21.7%), conduction defects (17.7%), T-wave inversion (14.1%) and ventricular ectopics (6.8%). Most infarctions were silent (89.8%), and affected the inferior territory significantly more than anterior, lateral and antero-lateral territories (52.9% vs. 33.3% vs. 9.4% vs. 1. 5%, respectively). A substantial percentage of patients with MI failed to achieve target HbA1c and triglyceride levels and waist-to-height-ratios. Diet, exercise and self-monitoring of glucose were all associated with positive effects on both MI and LVH. A greater percentage of patients with LVH had evidence of MI versus those without hypertrophy (28.4% vs. 19.4%). Conclusion: This study demonstrates a high prevalence of undiagnosed MI within this cohort of South African patients with diabetes. Patients with LVH were more prone to infarction. Poor glycaemic and triglyceride control and obesity were associated with infarction. Improving glycaemic and lipid control together with lifestyle modification may help prevent macrovascular cardiac complications.

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confidence: 42%

A retrospective analysis of electrocardiographic abnormalities found in black South African patients with diabetes attending a regional hospital in KwaZulu-Natal

Pillay

Hift

Aldous

2017

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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“…30 Similarly, many other studies have shown that wQRS itself is a predictor of mortality in patients with CAD, but our study further identifies f-wQRS as a marker of the higher risk population (f-BBB, f-PVC, and f-QRS) in the wQRS group. [31][32][33] Our study does not provide the mechanism of death in patients with f-wQRS. One of the possible mechanisms of death may be myocardial scar-related heart failure or a coronary events in this high-risk population.…”

Section: F-wqrs As a Predictor Of Mortalitymentioning

confidence: 99%

Fragmented Wide QRS on a 12-Lead ECG

Das

Suradi

Maskoun

et al. 2008

Circ: Arrhythmia and Electrophysiology

312

125

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Background-Fragmented QRS (duration Ͻ120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS has not been defined in the presence of a wide QRS (wQRS; duration Ն120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block, premature ventricular complexes, or paced rhythms (f-pQRS) signify myocardial scar and higher mortality. Methods and Results-Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (bundle branch block, premature ventricular complex, or pQRS) were studied. f-wQRS was defined by the presence of Ͼ2 notches on the R wave or the S wave and had to be present in Ն2 contiguous inferior (II, III, aVF), lateral (I, aVL, V 6 ) or anterior (V 1 to V 5 ) leads. ECG analyses of 879 patients (age, 66.7Ϯ11.4 years; male, 97%; mean follow-up, 29Ϯ18 months) with bundle branch block (nϭ310), premature ventricular complex (nϭ301), and pQRS (nϭ268) revealed f-wQRS in 415 (47.2%) patients. Myocardial scar was present in 440 (50%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of f-wQRS for myocardial scar were 86.8%, 92.5%, 92.0%, and 87.5%, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6% and 94.4%, 81.4% and 88.4%, and 89.8% and 95.7% for f-bundle branch block, f-premature ventricular complex, and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction, and diabetes (Pϭ0.017). Conclusions-f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected coronary artery disease. f-wQRS is also an independent predictor of mortality. (Circ Arrhythmia Electrophysiol. 2008;1:258-268.)

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“…Finally, PVCs provide the triggers for ventricular arrhythmia, which in the presence of appropriate arrhythmogenic substrate and electrophysiological instability can trigger repeated ventricular arrhythmia. PVCs have been always associated with increased mortality either sudden or non-sudden cardiac death [48]. Our reported associations of early repolarization with these markers, however, were based on cross sectional analysis, so residual confounding from unrecognized factors cannot be excluded.…”

Section: Limitations and Strengthsmentioning

confidence: 51%