Determinination of the Frequency of Altered Cardiac Repolarization by Measuring the Heart rate Corrected QT Interval in COPD Patients

Objectives: To determine the frequency of altered cardiac repolarization by measuring the heart rate corrected QT interval in COPD patients. Setting: Department of Medicine at LUMHS hospital Hyderabad/Jamshoro. Study Design: Descriptive Cross sectional study. Duration of Study: 6 months from 01-03-2019 to 31-08-2019. Methods: A total of 232 patients with severe acute exacerbation of COPD were included in this study. A 12 lead ECG was performed. QT intervals were measured on a resting ECG tracing in lead II. The QT interval was measured manually from the starting point of the QRS complex to the terminal point of the down slope of the T wave. Results: A total of 232 patients with COPD were included in this study. Most of the cases were above 50 years of age. The average age of the patients was 53.74±4.35 years. There were 92.67% (215/232) male and 7.33% (17/232) female. Out of 232 patients, 21.14% were current smoker and 75.86% were ex-smoker. A QTc interval >0.44 seconds was considered abnormally prolonged. Frequency of altered cardiac repolarization by measuring the heart rate corrected QT interval in COPD patients was 31.47% (73/232). Rate of altered cardiac repolarization was not significant among different age groups (p=0.641). Rate of altered cardiac repolarization was significantly high in male as compare to female (33.5% vs. 5.9%; p=0.018). This was not significant between obese and non-obese groups (p=0.100). Rate of altered cardiac repolarization was significantly high in former smoker (p=0.0005) and those patients whose duration of COPD was above 15 years (p=0.0005). Conclusion: Patients with hypoxic chronic obstructive pulmonary disease (COPD) have evidence of a subclinical parasympathetic autonomic neuropathy, with apparent preservation of sympathetic function. Measuring heart rate corrected QT interval (QTc) test is repeatable, easy to perform and a sensitive indicator for autonomic dysfunction in breathlessness individuals with COPD.

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ROLE OF PHARMACIST INTERVENTION ON COPD PATIENTS OF SELECTED AREAS IN CHITRADURGA: A KAP STUDY

Journal of Biomedical and Pharmaceutical Research ◽

10.32553/jbpr.v8i2.586 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Melvin K Mathews ◽

Abubaker Siddiq ◽

Bharathi D R

Keyword(s):

Illness Perceptions ◽

Pharmacist Intervention ◽

Cross Sectional Study ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

Post Test ◽

Knowledge Practice ◽

And Control

Background: Chronic obstructive pulmonary disease (COPD) is preventable and treatable disease state characterized by air flow limitation that is not fully reversible. Severity of the symptoms is increased during exacerbations. Objectives: The purpose of the study is to assess and improve the knowledge regarding COPD among study subjects. Materials and Methods: A Cross-sectional interventional study was carried out among the peoples in selected areas of the Chitradurga city for a period of six months. Result: A total 207 subjects enrolled in the study in that 155 male and 52 females. In our study mean score of post test was more (5.87±1.68) when compare to pre-test (2.63±1.46) which show significant increase in their knowledge after educating them (p=0.000). A total of 207 subjects were enrolled into the study. SPSS Software was used to calculate the statistical estimation. Paired t-test was used to detect the association status of different variables. Conclusion: The relatively good level of COPD awareness needs to be maintained to facilitate future prevention and control of the disease. This study had identified that negative illness perceptions should be targeted, so that they will not avoid patients from seeking for COPD treatment and adhere to it. Key words: Cross sectional study, Knowledge, practice, COPD.

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STUDY OF HS-CRP AND TNF-A LEVELS IN COPD PATIENTS ACCOMPANIED WITH CORONARY ARTERY DISEASE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.4_5.6 ◽

2014 ◽

pp. 48-56

Author(s):

Van Thi Tran ◽

Van Bang Le ◽

Thị Thu Huong Hoang

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Systemic Inflammation ◽

Chronic Obstructive ◽

Low Grade ◽

Cross Sectional ◽

Copd Patients ◽

Coronary Artery Angiography ◽

Hs Crp ◽

Artery Disease

Aim: Some studies have linked the present of chronic obstructive oulmonary disease (COPD) to coronary artery disease (CAD). Low grade systemic inflammation occurs in patients with COPD as well as patients with CAD. This study was designed to find out the concentration differences of hs-CRP and TNF-a in patients having both chronic obstructive pulmonary and coronary artery diseases with those having either. Methods: A cross - sectional descriptive study was conducted in 200 patients undergoing a coronary artery angiography in the Heart Institute, Thong Nhat Hospital and 115 People Hospital. COPD was diagnosed using GOLD classification. Result: Our study had shown that the levels of hs-CRP and TNF-a were statistically increased in patients with COPD, CAD as well as in patients who had COPD with CAD (p<0,05). The levels of hs-CRP were higher in CAD than in COPD nad the levels of TNF-a were higher in COPD than in CAD. In patients with COPD and CAD, there were increased the levels of both hs-CRP and TNF-a in serum. Conclusion: Systemic inflammation presents in both COPD and CAD. Key words: hs-CRP, TNF-a, coronary artery disease (CAD).

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Antipsychotics in routine treatment are minor contributors to QT prolongation compared to genetics and age

Journal of Psychopharmacology ◽

10.1177/02698811211003477 ◽

2021 ◽

pp. 026988112110034

Author(s):

Leif Hommers ◽

Maike Scherf-Clavel ◽

Roberta Stempel ◽

Julian Roth ◽

Matthias Falter ◽

...

Keyword(s):

Qt Interval ◽

Multivariate Regression Analysis ◽

Cardiac Repolarization ◽

Qtc Interval ◽

Serum Concentrations ◽

Drug Induced ◽

Individual Level ◽

Main Determinants ◽

The Individual ◽

Polygenic Variation

Background: Drug-induced prolongation of cardiac repolarization limits the treatment with many psychotropic drugs. Recently, the contribution of polygenic variation to the individual duration of the QT interval was identified. Aims: To explore the interaction between antipsychotic drugs and the individual polygenic influence on the QT interval. Methods: Retrospective analysis of clinical and genotype data of 804 psychiatric inpatients diagnosed with a psychotic disorder. The individual polygenic influence on the QT interval was calculated according to the method of Arking et al. Results: Linear regression modelling showed a significant association of the individual polygenic QT interval score (ßstd = 0.176, p < 0.001) and age (ßstd = 0.139, p < 0.001) with the QTc interval corrected according to Fridericia’s formula. Sex showed a nominal trend towards significance (ßstd = 0.064, p = 0.064). No association was observed for the number of QT prolonging drugs according to AZCERT taken. Subsample analysis ( n = 588) showed a significant association of potassium serum concentrations with the QTc interval (ßstd = −0.104, p = 0.010). Haloperidol serum concentrations were associated with the QTc interval only in single medication analysis ( n = 26, ßstd = 0.101, p = 0.004), but not in multivariate regression analysis. No association was observed for aripiprazole, clozapine, quetiapine and perazine, while olanzapine and the sum of risperidone and its metabolite showed a negative association. Conclusions: Individual genetic factors and age are main determinants of the QT interval. Antipsychotic drug serum concentrations within the therapeutic range contribute to QTc prolongation on an individual level.

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Classification of COPD patients and compliance to recommended treatment in Greece according to GOLD 2017 report: the RELICO study

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01576-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nikolaos Tzanakis ◽

Nikolaos Koulouris ◽

Katerina Dimakou ◽

Konstantinos Gourgoulianis ◽

Epameinondas Kosmas ◽

...

Keyword(s):

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Medical Practitioners ◽

Recommended Treatment ◽

Copd Patients ◽

Assessment Approach ◽

Impaired Lung Function ◽

Group B

Abstract Background Chronic obstructive pulmonary disease (COPD) is a multifactorial clinical condition, characterized by chronic progressive (or worsening) respiratory symptoms, structural pulmonary abnormalities, and impaired lung function, and is often accompanied by multiple, clinically significant comorbid disorders. In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) issued a new report on COPD prevention, diagnosis and management, aiming at personalizing the maintenance therapeutic approach of the stable disease, based on the patients’ symptoms and history of exacerbations (ABCD assessment approach). Our objective was to evaluate the implementation of GOLD suggestions in everyday clinical practice in Greece. Methods This was a cross-sectional observational study. Sixty-five different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, vaccination data, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, COPD treatments) were collected from 3615 nation-wide COPD patients (Greece). Results The mean age at the time of initial COPD diagnosis was 63.8 (± 10.2). Almost 60% of the subjects were classified into group B, while the remaining patients were falling into groups A (18%) and D (21%), and only a small minority of patients belonged to Group C, according to the ABCD assessment approach. The compliance of respiratory physicians to the GOLD 2017 therapeutic suggestions is problematic, especially when it comes to COPD patients belonging to Group A. Conclusion Our data provide valuable information regarding the demographic and medical profile of COPD patients in Greece, the domains which the revised ABCD assessment approach may show some clinical significance on, and the necessity for medical practitioners dealing with COPD patients to adhere closer to international recommendations for the proper management of the disease.

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.1816 ◽

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<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

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Abstract 187: Electrocardiographic Heart Rate-corrected Qt Interval And Risk Of Stroke In The REasons For Geographic And Racial Differences In Stroke (REGARDS) Study

Stroke ◽

10.1161/str.43.suppl_1.a187 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Elsayed Z Soliman ◽

George Howard ◽

Mary Cushman ◽

Brett Kissela ◽

...

Keyword(s):

Heart Rate ◽

Racial Differences ◽

Qt Interval ◽

Proportional Hazards ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Corrected Qt Interval ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Regards Study

Background: Prolongation of heart rate-corrected QT interval (QTc) is a well established predictor of cardiovascular morbidity and mortality. Little is known, however, about the relationship between this simple electrocardiographic (ECG) marker and risk of stroke. Methods: A total of 27,411 participants aged > 45 years without prior stroke from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study were included in this analysis. QTc was calculated using Framingham formula (QTcFram). Stroke cases were identified and adjudicated during an up to 7 years of follow-up (median 2.7 years). Cox proportional hazards analysis was used to estimate the hazard ratios for incident stroke associated with prolonged QTcFram interval (vs. normal) and per 1 standard deviation (SD) increase, separately, in a series of incremental models. Results: The risk of incident stroke in the study participants with baseline prolonged QTcFram was almost 3 times the risk in those with normal QTcFram [HR (95% CI): 2.88 (2.12, 3.92), p<0.0001]. After adjustment for age, race, sex, antihypertensive medication use, systolic blood pressure, current smoking, diabetes, left ventricular hypertrophy, atrial fibrillation, prior cardiovascular disease, QRS duration, warfarin use, and QT-prolonging drugs (full model), the risk of stroke remained significantly high [HR (95% CI): 1.67 (1.16, 2.41), p=0.0060)], and was consistent across several subgroups of REGARDS participants. When the risk of stroke was estimated per 1 SD increase in QTcFram, a 24% increased risk was observed [HR (95% CI): 1.24 (1.16, 1.33), p<0.0001)]. This risk remained significant in the fully adjusted model [HR (95% CI): 1.12 (1.03, 1.21), p=0.0055]. Similar results were obtained when other QTc correction formulas including Hodge’s, Bazett’s and Fridericia’s were used. Conclusions: QTc prolongation is associated with a significantly increased risk of incident stroke independently from known stroke risk factors. In light of our results, examining the risk of stroke associated with QT-prolonging drugs may be warranted.

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Association between physical performance and electrocardiographic heart rate corrected-QT interval in elderly subjects

Japanese Journal of Physical Fitness and Sports Medicine ◽

10.7600/jspfsm.62.283 ◽

2013 ◽

Vol 62 (4) ◽

pp. 283-291 ◽

Cited By ~ 3

Author(s):

Ryoma Michishita ◽

Chika Fukae ◽

Rikako Mihara ◽

Masahiro Ikenaga ◽

Kazuhiro Morimura ◽

...

Keyword(s):

Heart Rate ◽

Physical Performance ◽

Qt Interval ◽

Elderly Subjects ◽

Corrected Qt Interval

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Inhaler Technique and Adherence to Inhaled Medications among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Vietnam

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16020185 ◽

2019 ◽

Vol 16 (2) ◽

pp. 185 ◽

Cited By ~ 7

Author(s):

Chau Ngo ◽

Dung Phan ◽

Giap Vu ◽

Phu Dao ◽

Phuong Phan ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Medication Adherence ◽

Pulmonary Disease ◽

Associated Factors ◽

Chronic Obstructive ◽

Inhaler Technique ◽

Linear Regression Models ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Copd Patients

Sub-optimal chronic obstructive pulmonary disease (COPD) management has been found largely due to patients’ medication non-adherence and incorrect inhaler technique. This study aimed to examine inhaler use technique and medication adherence among Vietnamese COPD patients as well as potential associated factors. A cross-sectional study involving 70 COPD exacerbators was conducted. Inhaler technique and adherence were evaluated by the 10-item and 12-item Test of Adherence to Inhaler (TAI). Data on the history of COPD, home prescription of inhalers and duration of hospitalization were also collected. Generalized linear regression models were used to determine the associated factors with inhaler use and medication adherence. The results showed that the proportion of patients with good inhaler technique was 22.7% for metered-dose inhalers (MDI), 30.4% for dry powder inhalers (DPI) and 31.8% for soft-mist inhalers (SMI). Full exhalation was the most common mistake. The rates of non-compliance patterns were: “ignorant” (77.1%), “sporadic” (58.6%), and “deliberate” (55.7%). Worse dyspnea, greater health condition impairment, and an increased frequency of exacerbations and hospitalizations were found to be associated negatively with correct inhaler use and treatment adherence. Instructions to COPD patients about using inhalers should focus on correct inhaler technique and adherence even when feeling healthy.

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Clinical and inflammatory phenotyping by breathomics in chronic airway diseases irrespective of the diagnostic label

European Respiratory Journal ◽

10.1183/13993003.01817-2017 ◽

2018 ◽

Vol 51 (1) ◽

pp. 1701817 ◽

Cited By ~ 51

Author(s):

Rianne de Vries ◽

Yennece W.F. Dagelet ◽

Pien Spoor ◽

Erik Snoey ◽

Patrick M.C. Jak ◽

...

Keyword(s):

Principal Component ◽

Chronic Obstructive ◽

Exhaled Breath ◽

Dependent Manner ◽

Cross Sectional ◽

Exacerbation Rate ◽

Copd Patients ◽

Validation Set ◽

Inflammatory Phenotypes ◽

Chronic Airway

Asthma and chronic obstructive pulmonary disease (COPD) are complex and overlapping diseases that include inflammatory phenotypes. Novel anti-eosinophilic/anti-neutrophilic strategies demand rapid inflammatory phenotyping, which might be accessible from exhaled breath.Our objective was to capture clinical/inflammatory phenotypes in patients with chronic airway disease using an electronic nose (eNose) in a training and validation set.This was a multicentre cross-sectional study in which exhaled breath from asthma and COPD patients (n=435; training n=321 and validation n=114) was analysed using eNose technology. Data analysis involved signal processing and statistics based on principal component analysis followed by unsupervised cluster analysis and supervised linear regression.Clustering based on eNose resulted in five significant combined asthma and COPD clusters that differed regarding ethnicity (p=0.01), systemic eosinophilia (p=0.02) and neutrophilia (p=0.03), body mass index (p=0.04), exhaled nitric oxide fraction (p<0.01), atopy (p<0.01) and exacerbation rate (p<0.01). Significant regression models were found for the prediction of eosinophilic (R2=0.581) and neutrophilic (R2=0.409) blood counts based on eNose. Similar clusters and regression results were obtained in the validation set.Phenotyping a combined sample of asthma and COPD patients using eNose provides validated clusters that are not determined by diagnosis, but rather by clinical/inflammatory characteristics. eNose identified systemic neutrophilia and/or eosinophilia in a dose-dependent manner.

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