High Frequency QRS analysis to supplement ST-Analysis for Myocardial Ischemia: multi-center prospective cohort

Abstract Funding Acknowledgements Type of funding sources: None. Background Exercise testing is a well-known non-invasive assessment method for myocardial ischemia in patients with suspected coronary artery disease (CAD). Stress electrocardiography (ECG) alone is underutilized in this population despite guideline recommendations in part due to poor diagnostic accuracy. High frequency QRS analysis (HF-QRS) is a novel tool to supplement standard ST-analysis during stress ECG and has been shown in single-center retrospective analyses to identify any and substantial ischemia with high diagnostic accuracy. We sought to compare the diagnostic accuracy of HF-QRS + standard ST-analysis compared to standard ST-analysis alone for the identification of moderate to severe myocardial ischemia by exercise SPECT MPI. Methods The study population included 388 consecutive patients who underwent exercise SPECT MPI. An ischemic HF-QRS pattern was defined as an absolute reduction of ≥1 μV and a relative reduction of ≥50% between maximal and minimal values of the mean root square of the 150-250 Hz band signal in ≥3 leads. The diagnostic accuracy of HF-QRS + ST-analysis was compared with ST-analysis alone for moderate to severe myocardial ischemia using chi-square analysis and semi-quantitative gated SPECT MPI as the gold standard. The incremental diagnostic value of HF-QRS was assessed by logistic regression analysis. The likelihood of any ischemia by number of leads positive for HF-QRS was also determined. Results The study cohort was 71% male and 84% Caucasian with a mean age of 58.3 ± 11.8 years. ST- and HF-QRS analyses were positive in 96 (24.7%) and 121 (31.2%) of patients, respectively. HF-QRS had a substantially higher sensitivity than ST-analysis for moderate-severe ischemia (66.7% vs. 40.0%, p <0.003). There was no statistically significant difference in specificities for HF-QRS vs ST-analysis for moderate-severe ischemia. (70.5% vs 75.7%, p = 0.08). There was a stepwise increase in ischemia as number of positive HF-QRS leads increased (p = 0.0004). HF-QRS demonstrated incremental diagnostic value to clinical risk factors without ST-analysis (p = 0.006) compared to Clinical + ST depressions (p < 0.001) versus clinical factors. Conclusions This multicenter, prospective study expands the literature showing the benefit of HF-QRS analysis. HF-QRS analysis substantially improves detection of moderate-severe ischemia over ST-analysis and clinical risk factors in patients undergoing exercise stress ECG. This noninvasive adjunct may improve CAD risk stratification and encourage use of stress ECG without imaging, reducing costs and radiation exposure.

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Diagnostic value and prognostic impact of various invasively derived hemodynamic parameters in patients with severe aortic stenosis undergoing TAVI

European Heart Journal ◽

10.1093/eurheartj/ehab724.1620 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

D Grundmann ◽

M Linder ◽

A Gossling ◽

L Voigtlaender ◽

S Ludwig ◽

...

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Aortic Stenosis ◽

Diagnostic Value ◽

Left Ventricular ◽

Clinical Risk Factors ◽

Volume Index ◽

Prognostic Impact ◽

Hemodynamic Parameters ◽

Clinical Risk

Abstract Background Ejection time (ET) and Acceleration time (AT) have been described as echocardiographic markers for aortic stenosis (AS).1 Moreover, in a recent study time between invasively measured left ventricular and aortic systolic pressure peaks (T-LVAo) was associated with anatomic AS severity.2 However, the diagnostic value of these parameters has not been validated in a larger patient cohort and their prognostic impact in AS patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown. Purpose We aimed to assess the diagnostic value and prognostic impact of ET, AT, and T-LVAo as assessed by invasive measurements in patients undergoing TAVI for severe AS. Methods This retrospective single-centre analysis studied 1478 patients undergoing TAVI from 2014 to 2019 for severe AS. All patients received echocardiographic, multislice computed tomography (MSCT) and invasive hemodynamic evaluation with simultaneous pressure measurements in left ventricle and aorta prior to TAVI. Anatomic AS severity was assessed according to MSCT-derived aortic valve calcification density (AVCd) defined as calcium volume per annulus area. All hemodynamic parameters were calculated offline using a dedicated software. Results Median patients' age was 81.2 (76.8–84.7) years and 807 (54.6%) were women. Predicted operative risk for mortality was 3.8 (2.6–5.7)% according to STS Score. Medians of invasively derived parameters were 70.0 ms (46.0–98.0) for T-LVAo, 308.0 ms (276.0–336.0) for ET, 180.0 ms (146.0–206.0) for AT. In spline analysis correlation of T-LVAo (Spearman: r=0.35; p<0.001) and ET (Spearman: r=0.18; p<0.001) with AVCd was significant but weak. AT showed negligible correlation with ACVd (Spearman: r=−0.05; p=0.089). The optimal cutoff for death (CD) according to C-statistic was 274 ms for ET and 158 ms for AT. Patients with ET or AT ≥ CD showed lower short and mid-term mortality rates compared to patients with ET or AT < CD (ET ≥ vs. < CD: mortality at 1-year: 14.5 vs. 31.9%, 3-years: 28.3 vs. 53.5%, all p<0.001; AT ≥ vs < CD: mortality at 1-year: 15.5 vs. 25.9%, p<0.001, 3-years: 34.0 vs. 41.0%, p=0.0032). Moreover, multivariate analysis for mortality identified ET (HR 0.58 [95% CI 0.43–0.77; p<0.001]) and AT (HR 0.65 [95% CI 0.49–0.86; p=0.0027]) to be associated with beneficial outcome after TAVI, independent from clinical risk factors and echocardiography-derived parameters like LVEF, mean gradient or stroke volume index. In contrast, T-LVAo showed no prognostic impact according to uni- or multivariate analyses. Conclusion T-LVAo provides the highest diagnostic value among the investigational hemodynamic parameters, however correlation with AVCd was weak. ET and AT are strong independent outcome predictors beyond clinical risk factors and standard echocardiographic parameters in AS patients following TAVI. Accordingly, use of ET and AT might improve risk assessment in patients scheduled for TAVI. FUNDunding Acknowledgement Type of funding sources: None.

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Diagnostic Accuracy of Imaging Study and the Impact of Clinical Risk Factors on the Presence of Residual Tumor Following Unplanned Excision of Soft Tissue Sarcomas

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2019.54.2.150 ◽

2019 ◽

Vol 54 (2) ◽

pp. 150

Author(s):

Eunsun Oh ◽

Sung Wook Seo ◽

Jeonghwan Jeong

Keyword(s):

Risk Factors ◽

Soft Tissue ◽

Diagnostic Accuracy ◽

Soft Tissue Sarcomas ◽

Imaging Study ◽

Residual Tumor ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Unplanned Excision ◽

The Impact

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438 Predictive impact of clinical risk factors and the inducibility of ventricular fibrillation in patients with an asymptomatic Brugada-type ECG

EP Europace ◽

10.1016/s1099-5129(05)80290-9 ◽

2005 ◽

Vol 7 ◽

pp. 98-98

Keyword(s):

Risk Factors ◽

Ventricular Fibrillation ◽

Clinical Risk Factors ◽

Clinical Risk

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The impact of standard clinical risk factors on determination of optimal mammographic density cutpoints

10.26226/morressier.5ade45fdd462b8029238e7dc ◽

2018 ◽

Author(s):

Sian Iles

Keyword(s):

Risk Factors ◽

Mammographic Density ◽

Clinical Risk Factors ◽

Clinical Risk ◽

The Impact

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Faculty Opinions recommendation of Molecular and clinical risk factors for recurrence of skull base chordomas: gain on chromosome 2p, expression of brachyury, and lack of irradiation negatively correlate with patient prognosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718084150.793526065 ◽

2016 ◽

Author(s):

Carlos Bagley

Keyword(s):

Risk Factors ◽

Skull Base ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Risk Factors For Recurrence ◽

Skull Base Chordomas ◽

Patient Prognosis

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Long-Term Follow-Up of Patients With Isolated Side Branch Coronary Artery Disease

Angiology ◽

10.1177/00033197211028024 ◽

2021 ◽

pp. 000331972110280

Author(s):

Sukru Arslan ◽

Ahmet Yildiz ◽

Okay Abaci ◽

Urfan Jafarov ◽

Servet Batit ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Vessel Diameter ◽

Side Branch ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Artery Disease

The data with respect to stable coronary artery disease (SCAD) are mainly confined to main vessel disease. However, there is a lack of information and long-term outcomes regarding isolated side branch disease. This study aimed to evaluate long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with isolated side branch coronary artery disease (CAD). A total of 437 patients with isolated side branch SCAD were included. After a median follow-up of 38 months, the overall MACCE and all-cause mortality rates were 14.6% and 5.9%, respectively. Among angiographic features, 68.2% of patients had diagonal artery and 82.2% had ostial lesions. In 28.8% of patients, the vessel diameter was ≥2.75 mm. According to the American College of Cardiology lesion classification, 84.2% of patients had either class B or C lesions. Age, ostial lesions, glycated hemoglobin A1c, and neutrophil levels were independent predictors of MACCE. On the other hand, side branch location, vessel diameter, and lesion complexity did not affect outcomes. Clinical risk factors seem to have a greater impact on MACCE rather than lesion morphology. Therefore, the treatment of clinical risk factors is of paramount importance in these patients.

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