Electrocardiography clues in assessment of patients with premature ventricular contractions

Background/aim: Some electrocardiography (ECG) parameters such as Tp-e interval, Tp-e / QT ratio, fragmented QRS (fQRS), and heart rate variability (HRV) are related to cardiovascular mortality and morbidity. We aim to investigate the relation between premature ventricular contraction burden and these parameters on 24-h ECG recording. Materials and methods: The study is a retrospective investigation of the 24-h Holter ECG and echocardiography of 199 patients who underwent the procedures due to complaints of palpitation. A frequency of < 10% PVCs / 24 h was classified as seldom group (98 patients), while > 10% PVCs / 24 h was designated as frequent group (101 patients). Results: Tp-e interval was significantly longer (62 [54­78] vs 75 [60­84], p < 0.001), Tp-e / QT ratio was significantly increased (0.18 [0.16­0.20] vs 0.21 [0.18­0.22], p = 0.001) in frequent PVC group. The percentage of fQRS was significantly increased in frequent PVC group (30.6% vs 47.5%, p = 0.015). When the groups were compared, no significant difference was found in HRV time domain indices. Positive correlations were observed between PVC burden and Tp-e (r = 0.304, p < 0.001), Tp-e / QT (r = 0.275, p < 0.001). Conclusion: Our study showed that Tp-e interval, Tp-e / QT and fQRS are associated with frequency of PVCs. These measurements in patients with PVCs may form part of assessment of cardiovascular risk.

Relationship between apical thrombus formation and blood viscosity in acute anterior myocardial infarction patients.

Aim: This study sought to investigate the predictive value of whole blood viscosity (WBV) to identify high-risk patients who will develop an apical thrombus during the acute phase of anterior transmural infarction. Materials & methods: Consecutive 1726 patients with first acute anterior myocardial infarction were evaluated. WBV was calculated according to the Simone's formula. Results: Patients with an apical thrombus had prolonged pain to balloon time, higher rate of post-PCI thrombolysis in myocardial infarction flow ≤1 and significantly higher mean WBV values at both shear rates than those without an apical thrombus. Conclusion: WBV values at both shear rates were found to be significant and independent predictors for early LV apical thrombus formation complicating a first-ever anterior wall myocardial infarction.

Fragmented QRS as a candidate marker for left ventricular nonrecovery in patients with peripartum cardiomyopathy.

BACKGROUND: Fragmented QRS (fQRS) complex, with various morphology, has been recently described as a diagnostic criterion of several cardiac diseases. However, there are little data regarding the prognostic role of fQRS in peripartum cardiomyopathy (PPCM) patients. We aimed to investigate the effect of fQRS on predicting left ventricular (LV) nonrecovery in patients with peripartum cardiomyopathy (PPCM). METHODS: Ninety patients (mean age: 34.7 ± 6.5 years) with the diagnosis of PPCM were analyzed retrospectively. The median follow-up period of was 67.0 (12.0-192.0) months. Fragmented QRS was defined as the presence of various RSR' patterns (QRS duration < 120 ms) with or without Q wave, which include an additional R wave (R' prime) or notching of the R wave or S wave, or the presence of more than one R' (fragmentation) without typical bundle branch block. Recovery of LV function was defined as the presence of LV ejection fraction (EF) >45%. RESULTS: Of the patients, 54 (60%) did not recover LV function at the last follow-up visit (nonrecovery group), while 36 of the patients (40%) exhibited LV recovery (recovery group). LV ejection fraction (EF) and fQRS were identified as independent predictors of LV nonrecovery in patients with PPCM (odds ratio OR: 5.546, 95% confidence interval CI: 0.792-0.979, p = .019 and OR: 5.986, 95% CI: 1.313-11.787, p = .014, respectively). CONCLUSION: Our data firstly indicated that presence of fQRS was a significant predictor of LV nonrecovery in patients with PPCM. The fQRS might assist in identifying high-risk patients.

Importance of lead aVR on predicting adverse cardiac events in patients with noncompaction cardiomyopathy.

BACKGROUND: Noncompaction cardiomyopathy (NCCM) is a relatively rare cardiac abnormality with high rates of mortality and morbidity. T-wave amplitudes during ventricular repolarization in lead aVR (TaVR) have been reported to be associated with the prognosis of various cardiovascular diseases. This study sought to investigate the prevalence and prognostic role of positive TaVR in patients with NCCM. METHODS: We evaluated consecutive 161 patients with NCCM (65.8% men, mean age 42.5 ± 15.2 years old). Presentation electrocardiogram was assessed regarding classical parameters as well as T-wave amplitudes in lead aVR. The primary endpoint was defined as composite lethal arrhythmic events, including sudden cardiac death, ventricular fibrillation, or sustained ventricular tachycardia or appropriate implantable cardioverter-defibrillator shock. Heart failure requiring hospitalization, cardiovascular death, and all-cause mortality were also investigated as secondary endpoints. RESULTS: Patients with positive TaVR showed higher rates for arrhythmic events, hospitalization for heart failure, and death compared with patients without it. In multivariate Cox model, after adjusting for other known clinical and electrocardiographic risk factors, the positive TaVR was found to be a strong independent predictor of primary endpoint (HR: 4.8, 95% CI: 1.2-19.3; p = .025) and all-cause death (HR: 3.5, 95% CI: 1.0-12.1; p = .045). CONCLUSION: Our findings revealed that positive TaVR is significantly and independently associated with adverse outcomes in NCCM patients. This unique ECG criterion in the often ignored lead provides incremental information beyond what is available with other traditional risk factors.

A Rare Cause of Multiple Pseudoaneurysms of Radial Artery After Coronary Angiography: Behcet's Disease.

Patients with Behçet's disease are at risk for iatrogenic aneurysms after interventions. Presently described is the case of a 55-year-old male with multiple pseudoaneurysms occurring in the late period after a coronary angiography procedure performed via the radial artery. There was no previous diagnosis of vasculitis. Behçet's disease was revealed to be the underlying pathology.

Evaluation of the effect of non-ergot dopamine agonists on left ventricular systolic function with speckle tracking echocardiography.

OBJECTIVE: Parkinson's disease (PD) is a neurological disorder, and ergot dopamine agonists (DAs) are no longer usually preferred in the treatment due to the increased risk of valvular heart disease. Some recent studies have shown that commonly used non-ergot DA also increases the risk of heart failure. On the other hand, there are studies showing conflicting data about this relationship. The aim of the present study was to investigate the cardiac effects of non-ergot DAs in patients with PD using echocardiography. METHODS: Conventional echocardiography and two-dimensional (2D) speckle tracking strain echocardiography were performed to determine the possible systolic dysfunction prior to the development of apparent systolic heart failure. Ninety-one (55 male, 64±10 years) patients with PD were included in the study. Furthermore, 25 subjects with newly diagnosed PD and using no drug were enrolled as the control group. All patients were divided into groups according to their medication. Patients using levodopa were classified as Group 1 (36), levodopa+pramipexole as Group 2 (27), and levodopa+ropinirole as Group 3 (28). RESULTS: Left ventricle dysfunction with non-ergot DA use in patients with PD was not established with conventional echocardiographic evaluation. For 2D strain analysis, global longitudinal strain values were obtained as -18.5%, -18.5%, and -18.9% in the groups, respectively. Strain and strain rate values of the left ventricle were not different between the groups (p=0.816 and p=0.881, respectively). CONCLUSION: There was no significant relationship between left ventricular dysfunction and use of non-ergot DA in patients with PD. Similar results were obtained in strain analysis showing left ventricular subclinical dysfunction. Our study appears to confirm the safety of non-ergot DA in the point of heart failure risk. To our knowledge, this is the first study to evaluate the effect of this group of drugs on subclinical left ventricular systolic function.

Classical electrocardiographic clues for left main coronary artery disease.

Prediction of left main coronary artery (LMCA) or equivalent disease is important with regard to selecting the appropriate treatment strategy. The classical electrocardiographic pattern of LMCA disease includes ST elevation (STE) in lead aVR in the presence of extensive ST depression (most prominent in leads I, II, and V4-6) with the STE in aVR≥V1. Patients with these findings may potentially require early coronary angiography and coronary bypass surgery; therefore selected patients with these findings on exercise testing might benefit from more urgent or expedited angiography.