Value and limitations of heart rate-adjusted ST segment depression criteria for the identification of anatomically severe coronary obstruction: Test performance in relation to method of rate correction, definition of extent of disease, and β-blockade

1993 ◽  
Vol 125 (5) ◽  
pp. 1262-1268 ◽  
Author(s):  
Paul Kligfield ◽  
Peter M Okin ◽  
Harvey L Goldberg
Keyword(s):  
Heart Rate ◽  
Test Performance ◽  
St Segment ◽  
Definition Of ◽  
Coronary Obstruction ◽  
Extent Of Disease

Analysis of the Early Repolarization in Competitive Athletes: Comparison Between the Notch and The Slur

2021 ◽  
Author(s):  
A. Djellaoudji
Keyword(s):  
Heart Rate ◽  
Ventricular Hypertrophy ◽  
Early Repolarization ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Current Definition ◽  
St Segment ◽  
Competitive Athletes ◽  
Definition Of ◽  
Electrocardiographic Parameters

Early repolarization is currently defined by the presence of notch or slur, at the end of QRS complex, greater ≥ than 0.1 mV in two contiguous leads, and the ST-segment elevation is not necessary for diagnosis. Several studies have confirmed that early repolarization on the electrocardiogram has been associated with an increased risk of sudden arrhythmic death either in the general population or in athletes. However, no study has evaluated the prevalence of this anomaly, using the current definition of early repolarization, in the population of Algerian or North African athletes, no study analyzed notches and slurs separately, and no study compared them. The main objective of our study is to determine the prevalence of ER in an Algerian population of competitive athletes. The secondary objective was to compare the end-QRS Notching and Slurring, and to determine the influence on this prevalence of certain clinical and electrocardiographic parameters, to establish an epidemiological profile of this anomaly. Methods: In our study, we used the current definition of early repolarization. The study population is represented by 621 athletes participating in the various sports competitions organized in the region of Sétif, having undergone a cardiological examination, at the level of the cardiology service of Setif university hospital center, as part of the establishment of a medical certificate of no contraindication to the practice of the sport. Athletes also benefited from a clinical examination (weight, height, cardiac auscultation, functional signs (angina, palpitation, loss of awareness and dyspnea), palpation of the pulse, and measurement of the blood pressure). The electrocardiograms were collected at rest and away from any sporting activity. And in addition to the analysis of ER (prevalence, notch, slur, amplitude, and topography), criteria for ventricular hypertrophy (Sokolow-Lyon index and Cornell index), heart rate, and right bundle branch block were sought and analyzed. Results: The ECG was normal in 29.3% of the athletes, while the majority of athletes (66.3%) had adaptative electrocardiographic abnormalities to regular physical training (minimum of 4 h per week) and competition, 4.3% of athletes had abnormal electrocardiographic patterns suggesting underlying heart disease. The prevalence of ER in our athletes according to the new diagnostic criteria is 26.1%, with a clear male predominance. This prevalence increases with age, peaking in the third decade and then declines. The prevalence of ER is higher in bradycardic athletes and those with a Sokolow-Lyon index greater than 35 mm; for the Cornell index, no relationship was found. Moreover, ER is significantly lower in athletes with incomplete right Branch Block. In our series, ER is predominant in the inferior leads (40.7%) than lateral ones (34.6%), and the double location is found in 24.7%. This distribution of topographies is not influenced by age and gender. 31.8% of ER has an amplitude ≥ of 2 mm. 30.9% of ER is associated with ST-segment elevation. Notch is the predominant pattern whatever the topography of ER is (notch, 57.4%; slur, 18.5%; notch+slur, 24.1%); notch predominates in lateral leads (52.3%) while slur is predominant in inferior leads (68.0%).1%); only the notch has a significant relationship with male sex (23.8% vs 5.7%, p<0.001) with bradycardia (41.4% vs 16%, P<0.001) and with physical training. The prevalence of notches and slurs is significantly higher in athletes with a Sokolow-Lyon index greater than 35 mm. Conclusion: The pattern of ER is frequent in athletes; its prevalence is influenced by age, sex, heart rate, left ventricular hypertrophy, and incomplete right bundle branch block, type of sport, and intensity of the dynamic and static component of sports activity. The inferior topography (considered as a criterion of the high risk of ER) is found the most in our athletes; the notch is the most frequent pattern. It has been found that the two patterns "notch" and "slur", which are the basis of the definition of ER, are not influenced in the same way by the other clinical and electrocardiographic parameters.

Electrocardiographic characteristics and associated outcomes in patients with Takotsubo syndrome. Insights from the RETAKO registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Martin-Demiguel ◽  
I Nunez-Gil ◽  
A Perez-Castellanos ◽  
O Vedia ◽  
A Uribarri ◽  
...  
Keyword(s):  
Heart Rate ◽  
Primary Endpoint ◽  
Qt Interval ◽  
Protective Factor ◽  
Independent Predictor ◽  
Prognostic Significance ◽  
Takotsubo Syndrome ◽  
St Segment Elevation ◽  
Corrected Qt Interval ◽  
St Segment

Abstract Background Our aim was to describe the prevalence and prognostic significance of electrocardiographic features in patients with Takotsubo syndrome (TTS). Methods Our data come from the Spanish Multicenter REgistry of TAKOtsubo syndrome (RETAKO). All patients with complete electrocardiogram were included. Results 246 patients were studied, mean age was 71.3±11.5 and 215 (87.4%) were women. ST-segment elevation was seen in 143 patients (59.1%) and was present in ≥2 wall leads in 97 (39.8%). Exclusive elevation in inferior leads was infrequent (5 - 2.0%). After 48 hours, 198 patients (88.0%) developed negative T-waves in a median of 8 leads with a mean amplitude of 0.7±0.5 mV. Mean corrected QT interval was 520±72 ms and it was independently associated with the primary endpoint of all-cause death and nonfatal cardiovascular events (p=0.002) and all-cause death (p=0.008). A higher heart rate at admission was also an independent predictor of the primary endpoint (p=0.001) and of developing acute pulmonary edema (p=0.04). ST-segment elevation with reciprocal depression was an independent predictor of all-cause death (p=0.04). Absence of ST-segment deviation was a protective factor (p=0.005) for the primary endpoint. Arrhythmias were independently associated with cardiogenic shock (p&lt;0.001). Conclusion Prolonged corrected QT interval, arrhythmia, heart rate at admission and broader repolarization alterations are associated with a poor outcome in TTS. Typical ECG at admission and after 48h. Funding Acknowledgement Type of funding source: None

Variability of the haemodynamic responses to laboratory tests employed in assessment of neural cardiovascular regulation in man

1985 ◽  
Vol 69 (5) ◽  
pp. 533-540 ◽  
Author(s):  
Gianfranco Parati ◽  
Guido Pomidossi ◽  
Agustin Ramirez ◽  
Bruno Cesana ◽  
Giuseppe Mancia
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Test Performance ◽  
Blood Pressure Response ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Cardiovascular Regulation ◽  
Pressor Test ◽  
Carotid Baroreceptor ◽  
Baroreceptor Stimulation

1. In man evaluation of neural cardiovascular regulation makes use of a variety of tests which address the excitatory and reflex inhibitory neural influences that control circulation. Because interpretation of these tests is largely based on the magnitude of the elicited haemodynamic responses, their reproducibility in any given subject is critical. 2. In 39 subjects with continuous blood pressure (intra-arterial catheter) and heart rate monitoring we measured (i) the blood pressure and heart rate rises during hand-grip and cold-pressor test, (ii) the heart rate changes occurring during baroreceptor stimulation and deactivation by injection of phenylephrine and trinitroglycerine, and (iii) the heart rate and blood pressure changes occurring with alteration in carotid baroreceptor activity by a neck chamber. Each test was carefully standardized and performed at 30 min intervals for a total of six times in each subject. 3. The results showed that the responses to any test were clearly different from one another and that this occurred in all subjects studied. For the group as a whole the average response variability (coefficient of variation) ranged from 10.2% for the blood pressure response to carotid baroreceptor stimulation to 44.2% for the heart rate response to cold-pressor test. The variability of the responses was not related to basal blood pressure or heart rate, nor to the temporal sequence of the test performance. 4. Thus tests employed for studying neural cardiovascular control in man produce responses whose reproducibility is limited. This phenomenon may make it more difficult to define the response magnitude typical of each subject, as well as its comparison in different conditions and diseases.

Characteristics of heart rate variability in patients with acute coronary syndrome without ST segment elevation in comparison with clinical and biochemical parameters

2021 ◽  
Vol 29 (3) ◽  
pp. 369-378
Author(s):  
Aleksej A. Nizov ◽  
Aleksej I. Girivenko ◽  
Mihail M. Lapkin ◽  
Aleksej V. Borozdin ◽  
Yana A. Belenikina ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Acute Coronary Syndrome ◽  
Creatine Phosphokinase ◽  
Spectral Power ◽  
Low Frequency ◽  
Heart Rhythm ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

BACKGROUND: The search for rational methods of primary, secondary, and tertiary prevention of coronary heart disease. To date, there are several publications on heart rate variability in ischemic heart disease. AIM: To study the state of the regulatory systems in the organism of patients with acute coronary syndrome without ST segment elevation based on the heart rhythm, and their relationship with the clinical, biochemical and instrumental parameters of the disease. MATERIALS AND METHODS: The open comparative study included 76 patients (62 men, 14 women) of mean age, 61.0 0.9 years, who were admitted to the Emergency Cardiology Department diagnosed of acute coronary syndrome without ST segment elevation. On admission, cardiointervalometry was performed using Varicard 2.51 apparatus, and a number of clinical and biochemical parameters were evaluated RESULTS: Multiple correlations of parameters of heart rate variability and clinical, biochemical and instrumental parameters were observed. From this, a cluster analysis of cardiointervalometry was performed, thereby stratifying patients into five clusters. Two extreme variants of dysregulation of the heart rhythm correlated with instrumental and laboratory parameters. A marked increase in the activity of the subcortical nerve centers (maximal increase of the spectral power in the very low frequency range with the underlying reduction of SDNN) in cluster 1 was associated with reduction of the left ventricular ejection fraction: cluster 147.0 [40.0; 49.0], cluster 260.0 [58.0; 64.0], cluster 360.0 [52.5; 64.5] % (the data are presented in the form of median and interquartile range; Me [Q25; Q75], p 0,05). Cluster 5 showed significant reduction in SDNN (monotonous rhythm), combined with increased level of creatine phosphokinase (CPC): cluster 5446,0 [186.0; 782.0], cluster 4141.0 [98.0; 204.0] IU/l; Me [Q25; Q75], p 0.05) and MВ-fraction of creatine phosphokinase; cluster 532.0 [15.0; 45.0], 4 cluster 412.0 [9.0; 18.0] IU/l; Me [Q25; Q75], p 0.05). CONCLUSIONS: In patients with acute coronary syndrome without ST segment elevation, cluster analysis of parameters of heart rate variability identified different peculiarities of regulation of the heart rhythm. Pronounced strain of the regulatory systems of the body was found to be associated with signs of severe pathology: the predominance of VLF (spectral power of the curve enveloping a dynamic range of cardiointervals in the very low frequency range) in spectral analysis with an underlying reduced SDNN is characteristic of patients with a reduced ejection fraction, and a monotonous rhythm is characteristic of patients with an increased level of creatine phosphokinase and MB-fraction of creatine phosphokinase.

Abstract P372: Evaluation of International Classification of Disease-Ninth Edition (ICD-9) codes for Determining Subclasses and Anatomic Location of Myocardial Infarction in the Community

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Wayne D Rosamond ◽  
Rachel Kloss ◽  
Natalia Petruski-ivleva ◽  
Lisa Wruck ◽  
Erin Michos ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Biomarkers ◽  
General Category ◽  
Atherosclerosis Risk In Communities ◽  
International Classification Of Disease ◽  
Anatomic Location ◽  
St Segment ◽  
Definition Of ◽  
Anatomic Locations ◽  
Epidemiology Studies

Background: Epidemiology studies of acute myocardial infarction (MI) often rely on hospital discharge codes or claims data to identify events. The fourth digit of ICD-9 code 410 is meant to identify anatomic location of an MI. Although the validity of ICD-9 410 codes to identify the general category of MI has been studied, far less is known about the validity of ICD codes to identify ST segment MI (STEMI) and non-STEMI (NSTEMI) and to identify anatomic location of STEMI infarcts. Methods: From 1987 to 2010 we evaluated random samples of hospitalizations with ICD-9 discharge codes 410-414, 402, 427, 428, or 518.4 among men and women age 35-74 years from hospitals serving the 4 communities of the Atherosclerosis Risk in Communities (ARIC) Study (400,000 base population in 2010). Trained staff abstracted medical records and copied up to three 12-lead electrocardiograms (ECG) that were coded by Minnesota Code. A standardized algorithm was applied to data on chest pain, cardiac biomarkers, and ECG evidence to determine MI diagnosis. Validated MI events with abnormal biomarkers were further classified by ECGs as STEMI or NSTEMI. ICD-9 codes 410.0-410.6 and 410.8 were used to define STEMI while codes 410.7 or 410.9 defined NSTEMI. STEMI infarct location was assessed by ECG and categorized as anterior, inferior, lateral, or multi-location. We determined the validity of code-based definitions using the ARIC algorithm and ECG evidence as referent standards. All analyses were weighted to account for sampling. Results: Between 1987 and 2010, 208,920 (weighted) hospitalizations with discharge codes suggestive of MI occurred in the 4 ARIC communities. Of these, 19% (38,729/208,920) were validated as MI. The positive predictive value (PPV) of an ICD-9 410 code to identify a validated MI was 72% (22218/30652). This PPV declined slightly from 78% (862/1111) in 1987 to 71% (1031/1462) in 2010. Center differences by community were seen (range 63% (197/315) to 78% (173/222) in 2010). Sensitivity of a 410 code to identify validated MIs remained stable from 1987 to 2010 at about 57% (22218/38,729). The PPV of the ICD-9 code-based STEMI definition improved after 2005 but remained moderate at 41% (175/430) in 2010. The PPV of the ICD-9 code based definition of NSTEMI was 63% (599/945) in 2010 and was stable over time. The PPV of codes to identify anterior and inferior infarctions were high (66% (1145/1741) and 78% (1956/2518), respectively). However codes for lateral and multiple site infarctions had lower PPV (53% (327/619) and 21% (153/727), respectively). Conclusions: The PPV of an ICD-9 code 410 to identify MI remained stable over the past 2 decades, but geographic differences persist. ICD-9 codes are better at correctly identifying NSTEMI than STEMI and better at identifying inferior infarcts than other anatomic locations. These data suggest caution in interpreting studies of MI trends based solely on ICD-9 codes.

The slope of ST segment/heart rate relationship during exercise in the prediction of severity of coronary artery disease

1982 ◽  
Vol 3 (5) ◽  
pp. 449-458 ◽  
Author(s):  
M. KARDASH ◽  
M. S. ELAMIN ◽  
D. A. S. G. MARY ◽  
W. WHITAKER ◽  
D. R. SMITH ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
St Segment ◽  
Rate Relationship ◽  
Artery Disease

scholarly journals Heart rhythm and autonomic regulation disorders in chronic coronary syndrome patients with community-aсquired pneumonia

2021 ◽  
Vol 23 (6) ◽  
pp. 766-771
Author(s):  
T. O. Kulynych ◽  
O. O. Lisova ◽  
O. V. Shershnova ◽  
A. V. Hrytsai
Keyword(s):  
Heart Rate ◽  
Total Duration ◽  
Heart Rhythm ◽  
Main Group ◽  
Autonomic Regulation ◽  
Control Group ◽  
Ecg Monitoring ◽  
Coronary Syndrome ◽  
St Segment ◽  
Heart Rhythm Disorders

Pneumonia presents a considerable challenge in patients with cardiovascular disease due to an increase in the incidence, difficulties of diagnosis and treatment, high mortality. Aim: to study the characteristics of cardiac arrhythmias and heart rhythm autonomic regulation in patients with chronic coronary syndrome (CCS) and community-acquired pneumonia (CAP), and to define their relationship with the clinical features of the disease. Materials and methods. A monocenter cross-sectional study analyzed 90 patients with CCS in parallel groups. The main group included 60 CCS patients with CAP; the control group consisted of 30 patients without concomitant CAP. A complex clinical examination of patients was performed on 1–3 days of hospital stay in accordance with the National Recommendations. Holter ECG monitoring was performed using a CARDIOSENS K device (XAI-MEDICA, Ukraine). Results. Based on the results of 24-hour ECG monitoring, heart rhythm disorders, increased duration of myocardial ischemia and ST-segment depression depth with an increase in the total duration of tachycardia episodes within 24 hours were more common in the main group patients. The severity of CAP on the PSI/PORT scale was correlated with the 24-hour mean heart rate (r = +0.31, P < 0.05), the number of ventricular extrasystoles – with respiratory rate (r = +0.29, P < 0.05), supraventricular extrasystoles – with the duration of ST-segment depression (r = +0.57, P < 0.05). In patients with CCS and CAP, there was a decrease in the total heart rate variability (HRV), mainly in the passive period, combined with an increase in the LF/HF ratio and stress index (SI), which was directly correlated with the severity of CAP and intoxication syndrome. Conclusions. Patients with CCS and CAP are characterized by the increased 24-hour heart rate, duration of ST-segment depression, frequency of supraventricular and ventricular arrhythmias on 24-hour Holter monitoring, paroxysms of atrial fibrillation with the decreased total HRV combined with significantly increased activity of the sympathetic autonomic nervous system.

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