scholarly journals Repolarization abnormalities at admission predict 30-day outcome in COVID-19

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
B Vandenberk ◽  
G Van De Sijpe ◽  
S Ingelaere ◽  
M Engelene ◽  
J Vermeulen ◽  
...  
Keyword(s):  
Predictive Value ◽  
Cox Regression ◽  
Troponin T ◽  
Cardiovascular Research ◽  
St Depression ◽  
Wave Inversion ◽  
Ecg Abnormalities ◽  
Repolarization Abnormalities ◽  
T Waves

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): BV is supported by a research grant of the Frans Van de Werf Fund for Clinical Cardiovascular Research. Introduction COVID-19 can be related with a poor clinical outcome. ECG abnormalities in COVID-19 have been widely described, but literature on the predictive value of a 12-lead ECG at hospital admission and normalization of these abnormalities after infection is limited. Purpose To describe the predictive value of ECG abnormalities on admission and after recovery of COVID-19. Methods After informed consent patients older than 18 years admitted with COVID-19 between March and July 2020 were included in a prospective registry. Diagnosis was confirmed by PCR-assay or based on suggestive clinical and radiological presentation. Demographic and clinical data were collected by review of the electronic medical record. All ECGs from admission until last follow-up were assessed lead by kead for repolarization abnormalities. The index ECG was defined as first ECG available after admission, a post-COVID ECG was obtained after hospital discharge in the absence of acute pathology. Minor abnormalities included iso-electric T-waves and ST-depression ≤2 mm. Major abnormalities were ST-depression >2 mm, ST-elevation, biphasic T-waves and T-wave inversion. Myocardial regions were defined as anterior (V1-V4), lateral (I, aVL, V5, V6) and inferior (II, III, aVF). Patients with a ventricular pacemaker were excluded. Results A total of 283 patients were included, median age 65 years and 64.7% were male. The 30-day mortality rate was 20.5%. In 96.8% of patients an ECG was available within 48 hours after admission. Repolarization abnormalities were observed in 48.8% of patients. In 27.2% this was limited to minor abnormalities. Abnormal repolarization was related to age, cardiovascular medical history, renal function, high-sensitive troponin-T and NT-proBNP levels. There were no significant differences in clinical presentation, ICU admission, need for ventilation or ECMO. On Kaplan-Meier analysis (figure) the presence (p < 0.001) and the extent of repolarization abnormalities (p < 0.001) were associated with 30-day mortality. Forward Cox regression modelling identiefied age (per year, HR 1.07, 95% CI 1.05-1.09), history of heart failure (HR 2.12, 95% CI 1.08-4.52), neurological disorders (HR 2.47, 95% CI 1.36-4.51), active oncological disease (HR 2.13, 95% CI 1.01-4.50) and the extent of repolarization abnormalities (per region, HR 1.37, 95% CI 1.05-1.79) as independent predictors. A post-COVID ECG was available in 172 patients (60.8%), the median time between index and post-COVID ECG was 63.3 days. There was 1 new first-degree AV-block and 1 new RBBB. Repolarization abnormalities were present in 32 patients (11.3%); however, only 3 patients (1.7%) had new abnormalities, 2 of whom died during further follow-up. Conclusions The extent of repolarization abnormalities on an ECG at admission for COVID-19 is an independent predictor of 30-day mortality. New ECG abnormalities after COVID-19 infection are uncommon but may be associated with adverse outcome. Abstract Figure.

Prevalence, pattern and associated cardiovascular risk of t-wave inversion in hypertensive patients: a 5-year follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kasiakogias ◽  
D Konstantinidis ◽  
K Dimitriadis ◽  
F Tatakis ◽  
I Zammanis ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cox Regression ◽  
Composite Endpoint ◽  
Hypertensive Patients ◽  
Cox Regression Analysis ◽  
T Wave ◽  
St Depression ◽  
Wave Inversion

Abstract Background Data on prevalence and associated prognosis of repolarization abnormalities among hypertensive patients are limited. Purpose We investigated the presence and extent of ST-segment and T-wave changes in a hypertensive population and their predictive ability for cardiovascular disease. Methods We studied 1851 white Caucasian hypertensive patients (age 58±12 years, 51%females) without a history of cardiovascular disease for a mean period of 5.3±3.4 years. At the baseline examination, all patients underwent standard 12-lead electrocardiography. T-wave inversion (TWI) was defined as T-wave deflection ≥−0.1 mV in ≥2 contiguous leads,unless associated with bundle branch block. Anterior, lateral or inferior TWI was defined as TWIin leads V2-V4 or V5,V6, I, AVL or II, aVF respectively. Thedepth in millimeters of TWI in each lead was recorded and the maximum depth per location was calculated. ST depression was defined as ≥1mm in depth in two or more contiguous leads.During follow-up, patients underwent clinic visits at least yearly for management of hypertension and risk factors. The outcome studied was theincidence of cardiovascular morbidity set as the composite of non-fatal coronary artery disease and stroke. Results In the entire population, prevalence of TWI was 3.8%, of which 39% presented withanterior TWI, 73% withlateral TWI and 11% with inferior TWI. ST depression was observed in 3.6% of patients (anterior in 0.8%, inferior in 0.9% and lateral in 2.6%). Incidence of the composite endpoint during follow-up was 4%. Cox regression analysis revealed that presence of TWI was associated with a significantly greater risk for cardiovascular events (HR: 2.6, 95% CI: 1.1–5.9, p=0.025). The association was stronger for lateral TWI (HR: 3.3, 95%: CI: 1.34–8.30, p=0.01) compared to other locations. In multivariate models controlling for standard confounders these associations were overall sustained. Depth of TWI and presence of ST depression were not associated with cardiovascular risk. Conclusions Among hypertensive patients without cardiovascular disease, TWI is infrequent but significantly associated with future cardiovascular events.Lateral TWI carries the worse prognosis Funding Acknowledgement Type of funding source: None

scholarly journals Electrocardiographic Abnormalities and Troponin Elevation in COVID-19

2020 ◽  
Author(s):  
Ehud Chorin ◽  
Matthew Dai ◽  
Edward Kogan ◽  
Lalit Wadhwani ◽  
Eric Shulman ◽  
...  
Keyword(s):  
Laboratory Finding ◽  
Laboratory Data ◽  
Clinical Severity ◽  
Troponin Elevation ◽  
St Depression ◽  
Wave Inversion ◽  
St Elevation ◽  
Ecg Abnormalities ◽  
Electrocardiographic Abnormalities ◽  
Repolarization Abnormalities

AbstractBackgroundthe COVID19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or nonspecific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities and mortality.MethodsWe retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion.ResultsMortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was >1 ng/ml. In patients with mild Troponin rise (0.05 – 1.00 ng/ml) the presence of ECG abnormality resulted in significantly greater mortality.ConclusionECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID19.

scholarly journals Neutropenia and T-Wave Inversion as Toxin-Mediated Complications of a Streptococcal Infection

2017 ◽  
Vol 3 (4) ◽  
pp. 166-171 ◽  
Author(s):  
Cristina Popescu ◽  
Anca Leuştean ◽  
Alina Elena Orfanu ◽  
Codruţa Georgiana Carp ◽  
Victoria Aramă
Keyword(s):  
Streptococcal Infection ◽  
Penicillin G ◽  
Severe Neutropenia ◽  
Case Presentation ◽  
Wave Inversion ◽  
History Of ◽  
Ecg Abnormalities ◽  
Allergic Disorders ◽  
Streptococcal Tonsillitis ◽  
T Waves

Abstract Introduction: Streptococcal infection can be responsible for multiple complications, such as toxic, septic or allergic disorders. Toxin-mediated complications (TMC) can appear during the acute phase of disease and can involve any organ, causing carditis, arthritis, nephritis, hepatitis etc. Case presentation: The case of a young woman without a history of recurrent streptococcal tonsillitis, admitted to “Matei Balş” National Institute for Infectious Diseases, Bucharest, Romania, presenting with fever, sore throat and exudative tonsillitis, is detailed. The initial test for Streptococcus pyogenes was negative. The patient had leukopenia with severe neutropenia, high values of inflammatory biomarkers and electrocardiographic (ECG) changes with inverted T waves in leads V1-4 and flattened T waves in V5-6. There were no other cardiac signs or symptoms. The patient received cefuroxime for two days. On admission, the patient was prescribed Penicillin G and dexamethasone which resulted in a rapid recovery. The leucocytes count returned to normal as did the ECG abnormalities. At the time of discharge, the antistreptolysin O titre was high. Conclusions: The case highlights the toxin-mediated complications (TMC) of streptococcal infection which occur from the outset of the disease.

scholarly journals suPAR Cut-offs for Stratification of Low, Medium, and High-risk Acute Medical Patients in the Emergency Department

2021 ◽  
Author(s):  
Santeri Seppälä ◽  
Andreas Peter Andersen ◽  
Kristiina Nyyssönen ◽  
Jesper Eugen-Olsen ◽  
Harri Hyppölä
Keyword(s):  
High Risk ◽  
Predictive Value ◽  
Cox Regression ◽  
Medical Patients ◽  
Urokinase Plasminogen Activator Receptor ◽  
Cox Regression Analysis ◽  
Protein Levels ◽  
Reactive Protein ◽  
Roche Diagnostics

Abstract Background: Soluble urokinase plasminogen activator receptor (suPAR) levels have previously been associated with readmission and mortality in acute medical patients in the ED. However, no specific cut-offs for suPAR has been tested in this population. Methods: Prospective observational study of acute medical patients. Follow-up of mortality and readmission was carried out for 30- and 90 days stratified into baseline suPAR < 4, 4-6 and > 6 ng/ml. suPAR levels were measured using suPARnostic® Turbilatex assay on a Cobas c501 (Roche Diagnostics Ltd) analyser. Results: A total of 1747 acute medical patients in the ED were included. Median age was 70 (IQR: 57-79) and 51.4% were men. Cox regression analysis showed that suPAR, independently of age, sex and C-reactive protein levels, predicted 30- and 90-day mortality (both p<0.001). Among patients with suPAR below 4 ng/ml (N=804, 46.0%), 8 (1.0%) died within 90-day follow-up, resulting in a negative predictive value of 99.0% and a sensitivity of 94.6%. Altogether 514 (29.4%) patients had suPAR4-6 ng/ml, of whom 43 (8.4%) died during 90-day follow-up. Among patients with suPAR above 6 ng/ml (N=429, 24.6%), 87 patients (20.3%) died within 90-day follow-up, resulting in a positive predictive value of 20.1% and a specificity of 78.7%. Conclusions: suPAR cut-offs of below 4, between 4-6 and above 6 ng/ml can identify acute medical patients who have low, medium or high risk of 30- and 90-day mortality. The turbidimetric assay provides fast suPAR results that may aid in the decision of discharge or admission of acute medical patients.

scholarly journals Electrocardiographic Risk Stratification in COVID-19 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Ehud Chorin ◽  
Matthew Dai ◽  
Edward Kogan ◽  
Lalit Wadhwani ◽  
Eric Shulman ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Laboratory Finding ◽  
Laboratory Data ◽  
Clinical Severity ◽  
Troponin Elevation ◽  
T Wave ◽  
St Depression ◽  
Wave Inversion ◽  
St Elevation ◽  
Ecg Abnormalities

Background: The COVID-19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or non-specific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities, and mortality.Methods: We retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID-19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion.Results: Mortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was &gt;1 ng/ml. In patients with mild Troponin rise (0.05–1.00 ng/ml) the presence of ECG abnormality and particularly T wave inversions resulted in significantly greater mortality.Conclusion: ECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID-19.

P5979Impact of disease stage on performance of strain markers for prediction of atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Ramkumar ◽  
F Pathan ◽  
H Kawakami ◽  
A Ochi ◽  
H Yang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Value ◽  
Regression Models ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Disease Stage ◽  
Risk Levels ◽  
Lv Dysfunction ◽  
Lv Mass

Abstract Background Efforts to predict incident atrial fibrillation (AF) may be associated with complications, and there is interest in AF prediction in primary prevention (PP; pts with risk factors) and secondary prevention (SP; pts with possible AF complications). These pts have different risk levels, we sought whether that influenced the predictive value of LV dysfunction (measured as global longitudinal strain, GLS) or LA dysfunction (LA reservoir strain). Methods The PP cohort comprised 351 community-based pts ≥65 years with ≥1 risk factor for AF (age 70±4y,43% male, median follow-up 22 months) and the SP cohort comprised 532 pts after transient ischaemic attack or stroke (age 68±12y, 51% male, median follow-up 36 months). GLS and LA strain were measured offline (Image Arena-Tomtec, Germany). AF was diagnosed by 12 lead ECG, Holter or by single lead monitor. The clinical and echocardiographic characteristics of those with AF were compared to those in sinus rhythm. Nested Cox-regression models were used to assess for independent and incremental predictive value of LA strain/GLS in both cohorts. Results Compared to SP, PP had higher clinical AF risk (CHARGE-AF 5.6±5.5% vs 4.7±12.1%, p=0.02) but a lower thromboembolic risk (CHA2DS2-VASC 3±2 vs. 4±2, p<0.001). AF developed in 42 PP pts (12%) and 61 SP (12%). AF patients were older, with higher CHARGE-AF score, LA volume and LV mass. Pts developing AF had reduced GLS (17±4% vs. 20±3%, p<0.001), reservoir (28±11% vs. 35±8%, p<0.001) and pump strain (13±7% vs. 17±5%, p<0.001). GLS and LA strain had greater AUC in SP (0.84 vs 0.58 for GLS and 0.85 vs 0.57 for reservoir strain, both p<0.001). Nested cox-regression models showed that LA reservoir strain was independently associated with AF in both cohorts (p<0.05). GLS was only independently associated with incident AF in SP (Figure). Conclusion LA reservoir strain is independently associated with AF in different risk cohorts and its effect is incremental to clinical parameters and LA volume. GLS may be more useful in AF risk assessment in those in SP. Acknowledgement/Funding This study was partially supported by the Tasmanian Community Fund and Siemens Healthcare Australia.

scholarly journals Functional Aging Index Complements Frailty in Prediction of Entry Into Care and Mortality

2019 ◽  
Vol 74 (12) ◽  
pp. 1980-1986 ◽  
Author(s):  
Deborah Finkel ◽  
Ola Sternäng ◽  
Juulia Jylhävä ◽  
Ge Bai ◽  
Nancy L Pedersen
Keyword(s):  
Predictive Value ◽  
Cox Regression ◽  
Frailty Index ◽  
Rate Of Change ◽  
Chronological Age ◽  
Biological Aging ◽  
Growth Curve Models ◽  
Aging Index ◽  
Hazard Ratios

Abstract Background The aim of this study was to develop a functional aging index (FAI) that taps four body systems: sensory (vision and hearing), pulmonary, strength (grip strength), and movement (gait speed) and to test the predictive value of FAI for entry into care and mortality. Method Growth curve models and Cox regression models were applied to data from 1,695 individuals from three Swedish longitudinal studies of aging. Participants were aged 45–93 at intake and data from up to eight follow-up waves were available. Results The rate of change in FAI was twice as fast after age 75 as before, women demonstrated higher mean FAI, but no sex differences in rates of change with chronological age were identified. FAI predicted entry into care and mortality, even when chronological age and a frailty index were included in the models. Hazard ratios indicated that FAI was a more important predictor of entry into care for men than women, whereas it was a stronger predictor of mortality for men than women. Conclusions Measures of biological aging and functional aging differ in their predictive value for entry into care and mortality for men and women, suggesting that both are necessary for a complete picture of the aging process across genders.

The association of anemia with high-sensitive cardiac troponin and its influence on the ESC 0/1h and 0/3h algorithms to triage patients with suspected acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.M Haller ◽  
J.T Neumann ◽  
N.A Soerensen ◽  
A Gossling ◽  
T.S Hartikainen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Predictive Value ◽  
Cox Regression ◽  
Similar Efficacy ◽  
Cardiovascular Death ◽  
Funding Source ◽  
Cardiovascular Research ◽  
Cox Regression Analysis ◽  
Suspected Acute Myocardial Infarction

Abstract Introduction According to the 4th Universal Definition of Myocardial Infarction (UDMI), anemia may cause acute and chronic myocardial injury indicated by elevated high-sensitive troponin (hs-cTn) concentrations, with unknown influence on triaging patients with suspected acute myocardial infarction (AMI). Purpose To investigate the influence of anemia on hs-cTnI and the diagnostic performance of the ESC 0/1 and 0/3 hour (h) algorithms. Methods Patients with suspected AMI were prospectively enrolled and stratified based on the hemoglobin (Hb) concentration at admission (females &lt;12 g/dl, males &lt;13g/dl). Hs-cTnI was measured at presentation, 1 and 3h later. Three independent cardiologists adjudicated the final diagnoses according to the 4th UDMI. Patients with ST-elevation AMI were excluded. Our primary endpoints were the safety to rule-out (negative predictive value [NPV]) and the efficacy to rule-in (positive predictive value [PPV]) AMI. Patients were followed for up to 4 years to assess all-cause mortality. Results We included 2,223 patients (64.1% males, age 65 [52; 75]) of whom 415 (18.7%) had anemia. The prevalence of AMI was numerically different for patients with and without anemia (16.4% and 12.9%, p=0.072). Hs-cTnI concentrations were significantly higher in patients with anemia and no AMI (p&lt;0.001 for baseline, 1h and 3h, respectively), but not in patients with AMI (Fig, 1A). Sex- and age-adjusted linear regression modelling in patients without AMI revealed a significant association of Hb with hs-cTnI (Beta −0.10 [95% CI: −0.14, −0.06]; p&lt;0.001; Fig. 1B). Safety and efficacy of both ESC algorithms were similar in patients with and without anemia; 0/1h (NPV 100.0% [95% CI: 94.7, 100.0]; PPV 52.7% [95% CI: 43.0, 62.3] vs. NPV 99.4% [95% CI: 98.5, 99.8]; PPV 55.7% [95% CI: 50.1, 61.1]); 0/3h (NPV 98.0% [95% CI: 95.3, 99.3]; PPV 48.4% [95% CI: 39.4, 57.5] vs. NPV 97.9 [95% CI: 97.0, 98.6], PPV 59.2 [95% CI: 53.7, 64.6]). During a median follow-up of 1.7 years and after stratification by either ESC algorithm, patients with compared to those without anemia experienced significantly worse outcome for all-cause death (p&lt;0.001; Fig. 1C). In sex-, age- and baseline hs-cTnI-adjusted Cox-regression analysis, anemia was an independent predictor for all-cause death (adjusted hazard ratio [adjHR] 3.6 [95% CI: 2.6, 5.0]), cardiovascular death (adjHR 3.0 [95% CI: 1.8, 5.2]) and rehospitalization (adjHR 1.2 [95% CI: 1.0, 1.5], but not for incidental AMI (adjHR 2.0 [95% CI: 0.8, 4.9]) or revascularization (adjHR 0.8 [95% CI: 0.5, 1.3]). Conclusion Despite the revealed association of Hb and hs-cTnI in the stable setting, the application of the ESC 0/1h and 0/3h algorithms in patients with suspected AMI and concomitant anemia is safe and provides similar efficacy. Patients with anemia experience considerable worse outcome and might therefore benefit from additional diagnostic measures and, potentially, treatment targeting anemia and its cause. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): German Center of Cardiovascular Research (DZHK) and an unrestricted grant by Abbott Diagnostics, Prevencio and Singulex.

scholarly journals Prevalence and Risk Factors of Electrocardiogram Abnormalities in Patients with Rheumatoid Arthritis: A Machine Learning Study with Follow-Up Data

2021 ◽  
Author(s):  
Zuoyu Hu ◽  
Zhuoran Hu ◽  
Xinghua Guo ◽  
Weizhen Weng ◽  
Ye Chen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Machine Learning ◽  
Risk Factors ◽  
Rheumatoid Factor ◽  
Qt Interval ◽  
Associated Factors ◽  
Cox Regression ◽  
Qt Interval Prolongation ◽  
Ecg Abnormalities

Abstract BACKGROUNDElectrocardiogram (ECG) abnormalities could predict some subsequent cardiovascular events. Cardiac involvement is a major extra-articular manifestation in rheumatoid arthritis (RA). We aimed to determine the prevalence of three major ECG abnormalities in RA patients, discover the associated ECG abnormalities associated with machine learning (ML) approaches, and then examine these preselected factors in the follow-up patients with traditional Cox regression.METHODSConsecutive RA patients' records were retrieved from the hospital database; about one-third of patients had follow-up data. Abnormal ECGs with clinical significance were grouped into non-specific ST-segment/T-wave changes, QT interval prolongation, and QRS-T angle increase. Machine learning approaches assessed the associated factors of these abnormalities. The top-important factors selected by the most optimal ML would be used to construct Cox regression models.RESULTSTwo hundred twenty-six patients were enrolled for the first step cross-sectional study. Non-specific ST-T changes (27%) were the most prevalent abnormalities among patients with abnormal ECGs. Random forest models had the best performance in the discovery of associated factors for three outcomes. Cox regression validated that rheumatoid factor and low-density lipoprotein were common risk factors within those three abnormalities. Hypertension, ESR, and serum immunoglobulin G were influential factors for non-specific ST-T changes, prolonged QT interval, and increased QRS-T angle specifically.CONCLUSIONSNon-specific ST-T changes were the most common abnormalities seen in ECGs of RA patients. Our finding suggests that rheumatoid factor, LDL, hypertension, and inflammatory indicators are important risk factors for these ECG abnormalities.

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