The relationship between radial artery spasm and adropin levels in patients undergoing transradial coronary angiography.

Introduction: Transradial coronary angiography (TRA) is associated with a lower incidence of bleeding rate and access site complications and is associated with better outcomes compared to transfemoral angiography. However, radial artery spasm (RAS) is an important limitation of TRA procedures. Little is known regarding the relationship of serum vasodilator and inflammatory markers with RAS. Therefore, the present study aimed to investigate the association between serum adropin level and RAS in patients undergoing TRA. Methods: From February 2020 to January 2021, 39 consecutive patients who underwent elective daiagnostic TRA and experienced RAS during the procedure, and 42 age and sex matched controls who did not experience RAS were prospectively included into the study. The groups were compared regarding serum adropin levels and inflammatory markers. Results: Although adropin levels were found to be lower in the RAS group, this difference was not statistically significant between the the patients with RAS and controls (14.9 vs. 16.1, P=0.105). However, inflammatory parameters monocyte count and MHR (monocyte/HDL cholesterol ratio) were found to be statistically significantly higher in the RAS group compared to controls (P=0.001 and P=0.010, respectively). Moreover, a significant positive correlation was found between the monocyte count and RAS (r:0.360, P<0.001), and between MHR and RAS (r:0.288, P=0.009). Furthermore, multivariate analysis demonstrated that monocyte count (OR:1.671, 95%CI:1.312-2.094, P=0.001) and MHR (OR:1.116, 95%CI:1.054-1.448, P=0.022) were found to be independent predictors of RAS. Conclusion: Serum vasodilator and inflammatory markers may be useful in the prediction of RAS in patients undergoing TRA procedures.

Empagliflozin has favourable effect on frontal plane QRS-T angle in diabetic patients with cardiovascular disease.

WHAT IS KNOWN AND OBJECTIVE: Empagliflozin treatment is significantly associated with lower risk of cardiovascular events in patients with diabetes mellitus (DM) independent of its antihyperglycemic effect. However, little is known regarding the impact of empagliflozin on electrocardiography (ECG) parameters. This study aimed to investigate whether empagliflozin has favourable effect on frontal plane QRS-T (fQRST) angle, which is an ECG sign of ventricular repolarization heterogeneity, in patients with type 2 DM. METHODS: We prospectively enrolled 111 patients with known diagnosis of type 2 DM who newly prescribed empagliflozin on top of their standard anti-diabetic therapy. Patients were divided into two groups according to presence or absence of cardiovascular disease (CVD) at baseline and followed-up for 6 months. The impact of empagliflozin treatment on fQRST angle was investigated and patient groups were compared regarding the pre- and post-treatment fQRST angle. RESULTS AND DISCUSSION: Among 111 patients, 32 (28.8%) had CVD and 79 (71.2%) had no CVD. Empagliflozin treatment lead a significant decrease in the mean fQRST angle throughout the study period and mean fQRST angle was significantly lower at 3- and 6-month follow-up visits compared to baseline values (62° ± 17.4° vs. 57.2° ± 14.8° vs. 50.5° ± 13.6°, p < 0.001 for all dual comparisons). However, despite similar antihyperglycemic effect with empagliflozin treatment in patients with and without CVD, the significant decrease in the mean fQRST angle was observed only in patients with CVD and no significant decrease was observed in the mean fQRST angle in patients without CVD. WHAT IS NEW AND CONCLUSION: Empagliflozin leads a significant narrowing in the fQRST angle in type 2 DM patients with known CVD.

Electrocardiographic alterations in patients with chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk for cardiovascular events, and electrocardiography has an important role in detecting cardiac side effects of COPD-related hypoxia.

Coronary Artery Ectasia in the Pathophysiology of Myocardial Infarction With Nonobstructive Coronary Arteries.

Coronary artery ectasia (CAE) is associated with an increased risk for acute myocardial infarction (AMI). A significant proportion of patients with AMI have no obstructive coronary artery disease (CAD), however, the underlying mechanism of myocardial infarction with nonobstructive coronary arteries (MINOCA) is poorly understood. Therefore, the present study aimed to investigate whether CAE has a role in the pathogenesis of MINOCA. A total of 1,284 patients who were admitted with a diagnosis of non-ST-segment elevation myocardial infarction were included in the study. Patients were divided into 2 groups according to the presence or absence of obstructive CAD (≥50% stenosis). Patients without obstructive CAD (MINOCA group) and patients with obstructive CAD (no-MINOCA group) were compared regarding the frequency of CAE. Additionally, the association between CAE and MINOCA was investigated. In the study participants, 101 patients (7.9%) were diagnosed with MINOCA, whereas 1,183 (92.1%) had AMI with obstructive CAD. Importantly, the frequency of patients with CAE was significantly higher in patients with MINOCA compared with those with obstructive CAD (22.8% vs 3.5%, p <0.001). Moreover, CAE was observed in 64 patients (4.9%). The frequency of MINOCA was found to be significantly higher in patients with CAE compared with patients without CAE (35.9% vs 6.4%, p <0.001). Furthermore, multivariate analysis demonstrated that the presence of CAE was an independent predictor of MINOCA in patients presented with a diagnosis of non-ST-segment elevation myocardial infarction (odds ratio 1.812, 95% confidence interval 1.376 to 2.581, p <0.001). In conclusion, CAE may be considered as a risk factor for MINOCA and may have a role in the pathophysiology of MINOCA.

Electrocardiographic differences in patients with true and pseudo-resistant hypertension.

Cardiovascular disease is the leading cause of mortality in hypertensives, and patients with true resistant hypertension have an increased risk for premature cardiovascular events. Electrocardiography (ECG) has an essential role in the monitoring of hypertensive heart disease; however, little is known about the importance of ECG parameters in patients with resistant hypertension. We aimed to investigate whether fragmented QRS (fQRS) and frontal plane QRS-T angle, which are novel ECG parameters indicating myocardial damage, predict true resistant hypertension in patients with uncontrolled blood pressure. Four hundred six hypertensive patients with resistant hypertension were prospectively enrolled for the study. Patients were divided into two groups as 'true resistant' or 'pseudo-resistant' hypertensives and compared regarding the ECG parameters. While 73 (18%) patients had true resistant hypertension, 333 (82%) patients had pseudo-resistant hypertension. The frequency of fQRS (47.9% vs. 20.1%, p < 0.001) and average frontal plane QRS-T angle (93.0° ± 19.7° vs. 53.8° ± 10.2°, p < 0.001) were significantly higher in patients with true resistant hypertension compared to those with pseudo-resistant hypertension. Also, fQRS in anterior leads was significantly more frequent in patients with true resistant hypertension (57.1% vs. 23.8%, p < 0.001). Moreover, ROC curve analysis demonstrated that an increased frontal plane QRS-T angle > 90.75° predicted true resistant hypertension with a sensitivity 96% and specificity 61% (AUC:0.874, p < 0.001). Furthermore, multivariate analysis demonstrated that fQRS in anterior leads (OR: 1.251, 95% CI: 1.174-1.778, p = 0.002) and frontal plane QRS-T angle (OR: 1.388, 95% CI: 1.073-1.912, p < 0.001) were independent predictors of true resistant hypertension. In conclusion, fQRS and frontal plane QRS-T angle may be useful to predict true resistant hypertension in patients with uncontrolled blood pressure.

Highlights in the association of fragmented QRS with myocardial fibrosis.

No abstract available.

Association between coronary dominance pattern and left ventricular mass index: Is there a gender disparity?

BACKGROUND: Increased left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) are independent predictors of adverse cardiovascular events. However, little is known regarding the association between coronary circulation and LVMI. We aimed to investigate the association between coronary dominance and LVMI, and to demonstrate the impact of coronary dominance pattern on the emergence of LVH. METHODS: In total, 367 consecutive patients without known cardiovascular disease and significant obstructive coronary artery disease who underwent diagnostic coronary angiography were prospectively included in the study. Patients were divided into three groups according to coronary dominance pattern. Patients with right dominance (RD), co-dominance (CD) and left dominance (LD) patterns were compared regarding echocardiographically detected LVMI. Additionally, the association between coronary dominance pattern and LVH was investigated. RESULTS: The frequency of RD, CD and LD patterns was 70.3%, 19.1% and 10.6%, respectively. LVMI was significantly higher in patients with CD pattern compared with those with RD and LD patterns (P < .001, for both comparisons). LVH was present in 71 (19.3%) patients. Importantly, the CD pattern was more frequent in patients with LVH compared with those without LVH (P < .001). No significant difference was found between women and men regarding the type of coronary dominance pattern. However, while the presence of CD pattern was found to be an independent predictor of LVH in women (OR:1.221, 95%CI:1.048-1.872, P < .001), no association was observed between coronary dominance pattern and LVH in men. CONCLUSIONS: Coronary dominance pattern may significantly affect the LVMI, and it may be useful in the further risk stratification of female patients.

Frontal plane QRS-T angle predicts early recurrence of acute atrial fibrillation after successful pharmacological cardioversion with intravenous amiodarone.

WHAT IS KNOWN AND OBJECTIVE: Although restoration of sinus rhythm is the integral part of the atrial fibrillation (Af) management, recurrence frequency of Af is high after cardioversion. However, little is known about the association of electrocardiography (ECG) parameters with Af recurrence after restoration of sinus rhythm. The present study aimed to investigate whether frontal plane QRS-T (fQRST) angle, as a marker of ventricular repolarization heterogeneity, predicts Af recurrence after successful pharmacological cardioversion. METHODS: One hundred and sixty-five paroxysmal Af patients with an acute Af episode who underwent successful pharmacological cardioversion with intravenous amiodarone infusion were included into the study. Patients were divided into two groups according to presence or absence of in-hospital Af recurrence. The association between fQRST angle and Af recurrence was investigated. RESULTS AND DISCUSSION: Af recurrence was observed in 42 (25.4%) patients. The mean fQRST angle was significantly higher in patients with Af recurrence compared to those without Af recurrence (90 ± 45.8 vs. 51 ± 38.2, p < 0.001). Also, Af recurrence was more frequent in patients who had fQRST angle >90˚, compared to patients with fQRST angle ≤90˚ (54.1% vs. 13.7%, p < 0.001). Moreover, ROC curve analysis demonstrated that an increased fQRST angle >92.5˚ predicted in-hospital Af recurrence with a sensitivity of 76.2% and a specificity of 81.4% (AUC:0.728, p < 0.001). Furthermore, multivariate analysis demonstrated that fQRST angle was an independent predictor of in-hospital Af recurrence after successful pharmacological cardioversion (OR: 1.892, 95% CI: 1.361-2.917, p < 0.001). WHAT IS NEW AND CONCLUSION: As a parameter that can be easily calculated from automated ECG recordings, fQRST angle may be useful in the prediction of early Af recurrence after successful pharmacological cardioversion with amiodarone.

Impact of blood pressure lowering on ventricular repolarization heterogeneity in patients with newly diagnosed hypertension.

OBJECTIVE: Frontal plane QRS-T (fQRS-T) angle is a marker of ventricular repolarization heterogeneity and increased fQRS-T angle is associated with arrhythmias, adverse events and mortality. However, little is known about the importance and usefulness of fQRS-T angle in hypertensive patients. The present study aimed to investigate the association between blood pressure (BP) levels and fQRS-T angle. The main goal was to demonstrate whether BP lowering has a favorable effect on fQRS-T angle in hypertensive patients. METHODS: This study included 392 newly diagnosed hypertensive patients who underwent antihypertensive therapy. Responders and nonresponders to antihypertensive therapy were compared regarding baseline and post-treatment fQRS-T angle. fQRS-T angle was calculated as the absolute difference between QRS and T wave axes that were obtained from electrocardiography. Response to treatment was defined as achieving BP levels <140/90 mmHg. RESULTS: At the 1-month follow-up visit, responders had significantly lower fQRS-T angle compared to nonresponders despite the similar baseline fQRS-T angle (baseline: 57° ± 18.2° vs.56.6° ± 16.3°; P = 0.819, at 1 month: 36.9° ± 13.7 vs.53.5° ± 15.6°; P < 0.001). Moreover, after 3 months of antihypertensive treatment, both responders at 1 month and 3 months had significantly lower fQRS-T angle compared to nonresponders (34.8° ± 13.3° vs. 35.4° ± 12.9° vs. 52.3° ± 13.9°; P < 0.001). Furthermore, a significant moderate positive correlation was observed between systolic BP and fQRS-T angle (r:0.797; P < 0.001), and between diastolic BP and fQRS-T angle (r:0.761; P < 0.001). CONCLUSION: In the present study, a significant decrease in fQRS-T angle was observed following BP lowering throughout the study period. Therefore, fQRS-T angle may be useful in the monitoring of antihypertensive treatment.

Characteristics of Circadian Blood Pressure Pattern of Hypertensive Patients According to Localization of Fragmented QRS on Electrocardiography.

INTRODUCTION: A narrow fragmented QRS complex (fQRS) indicates myocardial fibrosis and hypertensive cardiomyopathy in hypertensive patients. However, no study has investigated the importance of localization of fQRS on electrocardiography (ECG) in these subjects. AIM: To investigate the association between circadian blood pressure (BP) pattern and localization of fQRS on ECG. METHODS: A total of 291 hypertensive patients who had fQRS in anterior or inferior leads were included into the study. Patients were divided into two groups according to localization of fQRS in inferior or anterior leads. All patients underwent a 24-h ambulatory blood pressure monitoring for detailed evaluation of circadian BP pattern. The association between localization of fQRS and non-dipping was investigated. RESULTS: Among study population, 182 (62.5%) patients had fQRS in inferior leads and 109 (37.5%) patients had fQRS in anterior leads. The frequency of patients with non-dipping BP pattern was significantly higher in patients with fQRS in anterior leads compared to patients with fQRS in inferior leads (47.7% vs 24.1%, p < 0.001). Moreover, the frequency of fQRS in anterior leads was significantly higher in non-dippers compared to dippers (64.6% vs. 24.1%, p < 0.001). Furthermore, in multivariate analysis, presence of fQRS in anterior leads was found to be an independent predictor of non-dipping BP pattern in hypertensive patients (OR: 1.748, 95% CI 1.362-2.446, p < 0.001). CONCLUSIONS: Presence of fQRS in anterior leads is significantly associated with non-dipping BP pattern in hypertensive patients. Therefore, localization of fQRS on ECG may provide useful information regarding further risk assessment of hypertensive subjects.

Frontal plane QRS-T angle in the monitoring of intravenous amiodarone infusion for pharmacological cardioversion of acute atrial fibrillation.

WHAT IS KNOWN AND OBJECTIVE: Intravenous amiodarone infusion is effective and widely used treatment for pharmacological cardioversion of recent-onset atrial fibrillation (Af). Although amiodarone may trigger various alterations in cardiac electrophysiology and electrocardiography (ECG), the impact of amiodarone treatment on frontal plane QRS-T angle remains unclear. Frontal plane QRS-T angle is the angle between the depolarization and repolarization axes and indicates instability in the cardiac cellular electrophysiology. Therefore, the present study aimed to investigate whether intravenous amiodarone infusion has effect on frontal plane QRS-T angle in patients with acute Af. METHODS: A total of 179 patients with acute-onset Af who underwent pharmacological cardioversion with intravenous amiodarone infusion were included into the study. Patients with successful and failed pharmacological cardioversion were compared regarding pre- and post-treatment frontal plane QRS-T angle. RESULTS AND DISCUSSION: At the end of the amiodarone infusion, sinus rhythm was restored in 112 (62.6%) patients, whereas Af was persisted in 67 (37.4%) patients. Despite the similar frontal plane QRS-T angle at baseline (59.6°±21.73°vs.60.4°±25.67°, p = 0.822), patients with failed pharmacological cardioversion had significantly higher post-treatment frontal plane QRS-T angle compared to patients with successful pharmacological cardioversion (68.8°±21.71°vs.58.6°±25.15° p < 0.001). Furthermore, multivariate analysis demonstrated that post-treatment increased frontal plane QRS-T angle was found to be an independent predictor of failure of pharmacological cardioversion with amiodarone infusion (OR:1.233, 95% CI:1.147-1.919, p = 0.024). WHAT IS NEW AND CONCLUSION: Amiodarone may significantly affect the frontal plane QRS-T angle. As a parameter that can be easily calculated from automated ECG recordings, frontal plane QRS-T angle may be useful in the monitoring of intravenous amiodarone treatment.

Fragmented QRS as a Marker of Myocardial Fibrosis in Hypertension: a Systematic Review.

PURPOSE OF REVIEW: Hypertension cause damage in cardiac structure and induce pathological myocardial fibrosis that leads to hypertensive cardiomyopathy. A narrow fragmented QRS complex (fQRS) is associated with myocardial fibrosis and scar tissue in various cardiovascular diseases. It is also associated with myocardial fibrosis in hypertensive patients even in the absence of any structural heart diseases. This article aimed to demonstrate importance and usefulness of fQRS in hypertensive patients. RECENT FINDINGS: Current evidence suggest that the frequency of fQRS is significantly higher in hypertensive patients compared to normotensives. Also, fQRS seems to be a predictor of left ventricular hypertrophy, increased systolic blood pressure, non-dipping, deterioration of the left ventricular geometry, and worse systolic and diastolic functions in hypertensive patients. As a simple and easy detectable electrocardiographic finding, fQRS may indicate myocardial fibrosis, uncontrolled blood pressure, and deteriorated cardiac structure in hypertensive patients even in the absence of other structural heart diseases, and may also be useful to predict high-risk hypertensives.

Association Between Non-Dipping and Fragmented QRS Complexes in Prehypertensive Patients / Associação entre Ausência de Descenso da Pressão Arterial Durante o Sono e a Fragmentação do Complexo QRS em Pacientes Pré-Hipertensos

Abstract Background: Fragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients. Objectives: The aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients. Methods: Two hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients. Results: According to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936). Conclusions: We found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.

Resumo Fundamento: A fragmentação do QRS (fQRS) é um sinal de eventos cardiovasculares adversos em várias doenças cardiovasculares. É associado também à pressão arterial elevada e à ausência de descenso da pressão arterial durante o sono (non-dipping) em pacientes pré-hipertensos. Objetivos: O objetivo do estudo presente é investigar a relação entre fQRS e ausência de descenso da pressão arterial durante o sono em pacientes pré-hipertensos. Métodos: Duzentos e dezesseis pacientes elegíveis, recém-diagnosticados com pré-hipertensão, que foram submetidos a monitorização ambulatorial da pressão arterial (MAPA) durante 24 horas para avaliação mais aprofundada da pressão arterial entre junho de 2015 e julho de 2016, foram incluídos no estudo. De acordo com os resultados da MAPA, os pacientes foram divididos em três grupos: normotensos, pré-hipertensos com descenso da pressão arterial durante o sono (padrão dipping) e pré-hipertensos com ausência de descenso da pressão arterial durante o sono (padrão non-dipping). Os grupos foram comparados quanto à presença de fQRS no eletrocardiograma. Adicionalmente, utilizou-se a análise de regressão logística multinomial para determinar a relação entre a fQRS e o padrão de pressão arterial em pacientes pré-hipertensos. Resultados: De acordo com os registos da MAPA, 61 pacientes apresentavam padrão de pressão arterial normotenso (pressão arterial sistólica < 120 mmHg e pressão arterial diastólica < 80 mmHg). Dos 155 pacientes pré-hipertensos, 83 tinham padrão dipping e 72 tinham padrão non-dipping. Os pacientes pré-hipertensos com padrão non-dipping tinham uma frequência significativamente mais alta de fQRS em comparação com os pacientes normotensos (p = 0,048). Além disso, a análise de regressão logística multinomial revelou que fQRS é um preditor independente do padrão non-dipping de pressão arterial em pacientes pré-hipertensos (p = 0,017, OR: 4,071, 95 % CI: 1,281-12,936). Conclusões: Verificamos que a fQRS é um preditor do padrão non-dipping em pacientes pré-hipertensos. Como marcador de fibrose e aumento na carga fibrótica do miocárdio, a fQRS pode ser útil na identificação de pacientes pré-hipertensos de alto risco antes do desenvolvimento da hipertensão.

Association Between Non-Dipping and Fragmented QRS Complexes in Prehypertensive Patients.

BACKGROUND: Fragmented QRS (fQRS) is a sign of adverse cardiovascular events in various cardiovascular diseases. It is also associated with increased blood pressure and non-dipping in hypertensive patients. However, no study has investigated the importance of fQRS in prehypertensive patients. OBJECTIVES: The aim of our study is to investigate the relationship between fQRS and non-dipper status in prehypertensive patients. METHODS: Two hundred and sixteen eligible, newly diagnosed prehypertensive patients who underwent 24-hour ambulatory blood pressure monitoring (ABPM) for further evaluation of blood pressure between June 2015 and July 2016 were included into the study. Patients were divided into three groups according to ABPM results: normotensives, dipper prehypertensives, and non-dipper prehypertensives. Groups were compared regarding presence of fQRS on electrocardiography. Additionally, multinomial logistic regression analysis was used to determine the relationship between fQRS and blood pressure pattern in prehypertensive patients. RESULTS: According to ABPM recordings, 61 patients had normotensive blood pressure pattern (systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg). Of the remaining 155 prehypertensive patients, 83 were dippers and 72 were non-dippers. Non-dipper prehypertensives had a significantly higher frequency of fQRS compared to normotensives (p = 0.048). Furthermore, multinomial logistic regression analysis revealed that fQRS is an independent predictor of non-dipping blood pressure pattern in prehypertensive patients (p = 0.017, OR: 4.071, 95% CI: 1.281-12.936). CONCLUSIONS: We found that fQRS is a predictor of non-dipping in prehypertensives. As a marker of fibrosis and higher fibrotic burden within myocardium, fQRS may be useful in identifying high-risk prehypertensive patients before the development of hypertension.