Abstract 14854: A Prognostic Study of the J wave Patterns on the Resting Electrocardiogram in Ambulatory Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vedant S Pargaonkar ◽  
Marco V Perez ◽  
Akash Jindal ◽  
Victor F Froelicher
Keyword(s):  
Cardiovascular Death ◽  
Conduction Delay ◽  
St Segment ◽  
Ambulatory Patients ◽  
Long Term Follow Up ◽  
Upward Deflection ◽  
Electrocardiogram Ecg ◽  
J Wave

Introduction: The prognostic value of J waves and terminal QRS slurs remains controversial. Population studies have demonstrated differing results, with some suggesting that J waves and slurs are associated with cardiovascular death (CVD). Hypothesis: We tested the hypothesis that J waves or terminal QRS slurs on the electrocardiogram (ECG) were associated with cardiovascular death. Methods: Resting digitized 12-lead ECGs from 20,661 ambulatory individuals at the VA Palo Alto Health Care System were visually coded using computer display. Using ≥ 0.1 mV as the amplitude criteria, J-waves were measured at the top of the upward deflection and QRS slurs at the top of the conduction delay on the QRS down-stroke in at least two contiguous leads. Multivariate Cox hazard regression analyses were used to study the associations between J waves, terminal QRS slurs, ST segment slope and CVD. Results: Of the 20,661 subjects, 90% were male (43 ± 8 years of age) and 10% were female (40 ± 10 years of age); 16% were African-American and 7% were Hispanic. Over a median follow-up of 17 years, there were 859 cardiac deaths. A total of 4219 (20%) ECGs had J waves and/or slurs present in the inferior and/or lateral territories: 3318 (16%) ECGs had J waves and/or slurs only in inferior leads (II, III, aVF), 1701 (8%) only in lateral leads (V4-6, I, aVL) and 1198 (6%) in both inferior and lateral leads. None of the J wave/terminal QRS slur patterns were associated with higher rates of cardiovascular mortality (Figure). The subset of ECGs with J wave/terminal QRS slur patterns that also had downward ST slopes were also not associated with CVD. Conclusion: We found no association between higher rates of CVD and any pattern of J waves/terminal QRS slurs, with or without downward ST slope. While previous studies have shown that J waves and terminal QRS slurs are present at higher rates in patients with idiopathic ventricular fibrillation, we did not find them to be predictive of CVD in long-term follow up of a clinical cohort.

scholarly journals 8-Isoprostanes and Asymmetric Dimethylarginine as Predictors of Mortality in Patients Following Coronary Bypass Surgery: A Long-Term Follow-Up Study

2022 ◽  
Vol 11 (1) ◽  
pp. 246
Author(s):  
Aleksandra Gołąb ◽  
Dariusz Plicner ◽  
Anna Rzucidło-Hymczak ◽  
Lidia Tomkiewicz-Pająk ◽  
Bogusław Gawęda ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Cardiovascular Mortality ◽  
Bypass Surgery ◽  
Asymmetric Dimethylarginine ◽  
Prostaglandin F2α ◽  
Cardiovascular Death ◽  
Long Term Follow Up ◽  
Nitric Oxide Bioavailability

Background: We previously demonstrated that enhanced oxidative stress and reduced nitric oxide bioavailability are associated with unfavorable outcomes early after coronary artery bypass grafting. It is not known whether these processes may impact long-term results. We sought to assess whether during long-term follow-up, markers of oxidative stress and nitric oxide bioavailability may predict cardiovascular mortality following bypass surgery. Methods: We studied 152 consecutive patients (118 men, age 65.2 ± 8.3 years) who underwent elective, primary, isolated on-pump bypass surgery. We measured plasma 8-iso-prostaglandin F2α and asymmetric dimethylarginine before surgery and twice after surgery (18–36 h and 5–7 days). We assessed all-cause and cardiovascular death in relation to these two biomarkers during a mean follow-up time of 11.7 years. Results: The overall mortality was 44.7% (4.7 per 100 patient-years) and cardiovascular mortality was 21.0% (2.2 per 100 patient-years). Baseline 8-iso-prostaglandin F2α was associated with cardiovascular mortality (HR 1 pg/mL 1.010, 95% CI 1.001–1.021, p = 0.036) with the optimal cut-off ≤ 364 pg/mL for higher survival rate (HR 0.460, 95% CI 0.224–0.942, p = 0.030). Asymmetric dimethylarginine > 1.01 μmol/L measured 18–36 h after surgery also predicted cardiovascular death (HR 2.467, 95% CI 1.140–5.340, p = 0.020). Additionally, elevated 8-iso-prostaglandin F2α measured at the same time point associated with all-cause mortality (HR 1 pg/mL 1.007, 95% CI 1.000–1.014, p = 0.048). Conclusions: Our findings indicate that in advanced coronary disease, increased oxidative stress, reflected by 8-iso-prostaglandin F2α before bypass surgery and enhanced asymmetric dimethylarginine accumulation just after the surgery are associated with cardiovascular death during long-term follow-up

Impact of new onset atrial fibrillation on long-term prognosis in patients with acute ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A Baturova ◽  
M.M Demidova ◽  
J Carlson ◽  
D Erlinge ◽  
P.G Platonov
Keyword(s):  
Clinical Characteristics ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Long Term Prognosis ◽  
New Onset

Abstract Introduction New onset AF is a known complication in patients with acute ST-segment elevation myocardial infarction (STEMI). However, whether new-onset AF affects the long-term prognosis to the same extent as pre-existing AF is not fully clarified and prescription of oral anticoagulants (OAC) in patients with new-onset AF remains a matter of debates. Purpose We aimed to assess the impact of new-onset AF in STEMI patients undergoing primary percutaneous intervention (PCI) on outcome during long-term follow-up in comparison with pre-existing AF and to evaluate effect of OAC therapy in patients with new-onset AF on survival. Methods Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010 (age 66±12 years, 70% male). AF prior to STEMI was documented by record linkage with the Swedish National Patient Register and review of ECGs obtained from the digital archive containing ECGs recorded in the hospital catchment area since 1988. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission, including new-onset AF and OAC at discharge. All-cause mortality was assessed using the Swedish Cause-of-Death Register 8 years after discharge. Results AF prior to STEMI was documented in 177 patients (8%). Among patients without pre-existing AF (n=2100), new-onset AF was identified in 151 patients (7%). Patients with new-onset AF were older than those without AF history (74±9 vs 65±12 years, p<0.001), but did not differ in regard to other clinical characteristics. Among 2149 STEMI survivors discharged alive, 523 (24%) died during 8 years of follow-up. OAC was prescribed at discharge in 45 (32%) patients with new onset AF and in 49 (31%) patients with pre-existing AF, p=0.901. In a univariate analysis, both new-onset AF (HR 2.18, 95% CI 1.70–2.81, p<0.001) and pre-existing AF (HR 2.80, 95% CI 2.25–3.48, p<0.001) were associated with all-cause mortality, Figure 1. After adjustment for age, gender, cardiac failure, diabetes, BMI and smoking history, new-onset AF remained an independent predictor of all-cause mortality (HR 1.40, 95% CI 1.02–1.92, p=0.037). OAC prescribed at discharge in patients with new-onset AF was not significantly associated with survival (univariate HR 0.86, 95% CI 0.50–1.50, p=0.599). Conclusion New-onset AF developed during hospital admission with STEMI is common and independently predicts all-cause mortality during long-term follow-up after STEMI with risk estimates similar to pre-existing AF. The effect of OAC on survival in patients with new-onset AF is inconclusive as only one third of them received OAC therapy at discharge. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

P5029Inducibility of ventricular tachyarrhythmias by up to two extrastimuli does not predict future cardiac events in asymptomatic Brugada patients: results from long-term follow-up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Takagi ◽  
T Kamakura ◽  
T Shinohara ◽  
Y Sekiguchi ◽  
Y Yokoyama ◽  
...  
Keyword(s):  
Family History ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Tachyarrhythmias ◽  
Cardiac Events ◽  
Long Term Follow Up ◽  
History Of ◽  
J Wave

Abstract Background Most recent consensus conference report recommends Implantable Cardioverter Defibrillator (ICD) implantation for asymptomatic Brugada patients with spontaneous or fever-induced type-1 ECG (A-BrS) and inducible ventricular tachyarrhythmias (VTs) by up to two extrastimuli as class IIb indication. However, the validity of the inducible VTs by up to two extrastimuli in A-BrS is still unknown. Purpose To evaluate the validity of the inducibility by up to two extrastimuli in A-BrS in a large Japanese cohort of BrS (The Japan Idiopathic Ventricular Fibrillation Study [J-IVFS]). Methods A total of 193 consecutive A-BrS patients performed programmed electrical stimulation (PES) with non-aggressive uniform protocol (mean age 50±13 years, 180 males) were enrolled. PES protocol was using 2 basic pacing cycles and the order of introduction of up to 2 ventricular extra-stimuli from right ventricular apex [RVA] first, then right ventricular outflow tract [RVOT], 3 ventricular extra-stimuli from RVA then RVOT down to the minimum of 200ms. Clinical outcomes during the follow-up period were compared between A-BrS patients with and without inducible VTs by up to two extrastimuli. Results Thirty-five A-BrS (18%) had inducible VTs by up to two extrastimuli. During a mean follow-up period of 101±48 months, 7 A-BrS experienced cardiac events (sudden cardiac death [SCD] or VTs, 0.4%/yr). None of the 7 A-BrS had inducible VTs by up to two extrastimuli. The incidences of cardiac events tended to be higher in A-BrS without inducible VTs by up to two extrastimuli than in those with inducible VTs (p=0.10), as determined by the Kaplan-Meier method. In the A-BrS, the annual incidences of cardiac events in A-BrS with family history of SCD, inferolateral J wave, wide QRS duration >90msec in lead V2, or inducible VT/VF by 3 extrastimuli were 0.7, 0.7, 0.6, and 0.3%/yr, respectively. Conclusions Our large-scaled multicentre study with long-term follow-up revealed the inducibility of ventricular tachyarrhythmias by up to two extrastimuli does not predict future cardiac events in A-BrS, even using non-aggressive uniform protocol. Rather, other parameters such as family history of SCD or inferolateral J wave might be helpful for risk assessment in A-BrS.

Impact of minor electrocardiographic ST-segment and/or T-wave abnormalities on cardiovascular mortality during long-term follow-up

2003 ◽  
Vol 91 (9) ◽  
pp. 1068-1074 ◽  
Author(s):  
Philip Greenland ◽  
Xiaoyuan Xie ◽  
Kiang Liu ◽  
Laura Colangelo ◽  
Youlian Liao ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
T Wave ◽  
St Segment ◽  
Long Term Follow Up
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