Browsing by Subject "QT INTERVAL"

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  • Porthan, Kimmo; Kentta, Tuomas; Niiranen, Teemu J.; Nieminen, Markku S.; Oikarinen, Lasse; Viitasalo, Matti; Hernesniemi, Jussi; Jula, Antti M.; Salomaa, Veikko; Huikuri, Heikki; Albert, Christine M.; Tikkanen, Jani T. (2019)
    Background: Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is an established risk factor for cardiovascular events. However, limited data is available on the prognostic values of different ECG LVH criteria specifically to sudden cardiac death (SCD). Our goal was to assess relationships of different ECG LVH criteria to SCD. Methods: Three traditional and clinically useful (Sokolow-Lyon, Cornell, RaVL) and a recently proposed (Peguero-Lo Presti) ECG LVH voltage criteria were measured in 5730 subjects in the Health 2000 Survey, a national general population cohort study. Relationships between LVH criteria, aswell as their selected composites, to SCD were analyzed with Cox regression models. In addition, population-attributable fractions for LVH criteria were calculated. Results: After a mean follow-up of 12.5 +/- 2.2 years, 134 SCDs had occurred. When used as continuous variables, all LVH criteria except for RaVL were associated with SCD in multivariable analyses. When single LVH criteria were used as dichotomous variables, only Cornell was significant after adjustments. The dichotomous composite of Sokolow-Lyon and Cornell was also significant after adjustments (hazard ratio for SCD 1.82, 95% confidence interval 1.20-2.70, P = 0.006) and was the only LVH measure that showed statistically significant population attributable fraction (11.0%, 95% confidence interval 1.9-19.2%, P=0.019). Conclusions: Sokolow-Lyon, Cornell, and Peguero-Lo Presti ECG, but not RaVL voltage, are associated with SCD risk as continuous ECG voltage LVH variables. When SCD risk assessment/adjustment is performed using a dichotomous ECG LVH measure, composite of Sokolow-Lyon and Cornell voltages is the preferred option. (c) 2018 The Authors. Published by Elsevier B.V.
  • Sánez Tähtisalo, Heini; Hiltunen, Timo P.; Kenttä, Tuomas; Junttila, Juhani; Oikarinen, Lasse; Virolainen, Juha; Kontula, Kimmo K.; Porthan, Kimmo (2020)
    Background T-wave area dispersion (TW-Ad) is a novel electrocardiographic (ECG) repolarization marker associated with sudden cardiac death. However, limited data is available on the clinical correlates of TW-Ad. In addition, there are no previous studies on cardiovascular drug effects on TW-Ad. In this study, we examined the relation between TW-Ad and left ventricular mass. We also studied the effects of four commonly used antihypertensive drugs on TW-Ad. Methods A total of 242 moderately hypertensive males (age, 51±6 years; office systolic/diastolic blood pressure during placebo, 153±14/100±8 mmHg), participating in the GENRES study, were included. Left ventricular mass index was determined by transthoracic echocardiography. Antihypertensive four-week monotherapies (a diuretic, a beta-blocker, a calcium channel blocker, and an angiotensin receptor antagonist) were administered in a randomized rotational fashion. Four-week placebo periods preceded all monotherapies. The average value of measurements (over 1700 ECGs in total) from all available placebo periods served as a reference to which measurements during each drug period were compared. Results Lower, i.e. risk-associated TW-Ad values correlated with a higher left ventricular mass index (r = −0.14, p = 0.03). Bisoprolol, a beta-blocker, elicited a positive change in TW-Ad (p = 1.9×10−5), but the three other drugs had no significant effect on TW-Ad. Conclusions Our results show that TW-Ad is correlated with left ventricular mass and can be modified favorably by the use of bisoprolol, although demonstration of any effects on clinical endpoints requires long-term prospective studies. Altogether, our results suggest that TW-Ad is an ECG repolarization measure of left ventricular arrhythmogenic substrate.
  • Toukola, Tomi; Junttila, M. Juhani; Holmström, Lauri T. A.; Haukilahti, M. Anette; Tikkanen, Jani T.; Terho, Henri; Kenttä, Tuomas V.; Aro, Aapo L.; Anttonen, Olli; Kerola, Tuomas; Pakanen, Lasse; Kortelainen, Marja-Leena; Kiviniemi, Antti; Huikuri, Heikki V. (2018)
    Introduction: Little is known about the association between electrocardiographic abnormalities and exercise-related sudden cardiac death.Therefore, our aim was to identify possible electrocardiographic findings related to exercise-induced sudden cardiac death. Methods and results: The FinGesture study includes 3,989 consecutive sudden cardiac deaths in northern Finland between 1998 and 2012, out of whom a total of 647 subjects had a previously recorded electrocardiography acquired from the archives of Oulu University Hospital. In 276 of these cases the death was witnessed, and the activity at the time of death was either rest or physical exercise (PEj; in 40 {14%} cases sudden cardiac death was exercise-related and in 236 (86%) cases death took place at rest. Fragmented QRS complex in at least two consecutive leads within anterior leads (V1-V3) was more common in the exercise-group compared to rest-group (17 of 40, 43% vs. 51 of 236,22%, P = 0.005). Pathologic Q wave in anterior leads was more common in the PE group (9 of 40,23% vs. 26 of 236,11%; P = 0.044). Median QRS duration was prolonged in the exercise-group compared to the rest-group (100 milliseconds vs. 94 milliseconds, P = 0.047), QTc interval, the prevalence of inverted T-waves, or other electrocardiographic abnormalities did not differ significantly between the two groups. Conclusions: As a conclusion, fragmented QRS complex in the anterior leads is associated with an increased risk of sudden cardiac death during PE.
  • Jansweijer, Joeri A.; van Spaendonck-Zwarts, Karin Y.; Tanck, Michael W. T.; van Tintelen, J. Peter; Christiaans, Imke; van der Smagt, Jasper; Vermeer, Alexa; Bos, J. Martijn; Moss, Arthur J.; Swan, Heikki; Priori, Sylvia; Rydberg, Annika; Tfelt-Hansen, Jacob; Ackerman, Michael; Olivotto, Iacopo; Charron, Philippe; Gimeno, Juan R.; van den Berg, Maarten; Wilde, Arthur A. M.; Pinto, Yigal M. (2019)
    Background Mutations in genes encoding ion channels or sarcomeric proteins are an important cause of hereditary cardiac disease. However, the severity of the resultant disease varies considerably even among those with an identical mutation. Such clinical variation is often thought to be explained largely by differences in genetic background or ` modifier genes'. We aimed to test the prediction that identical genetic backgrounds result in largely similar clinical expression of a cardiac disease causing mutation, by studying the clinical expression of mutations causing cardiac disease in monozygotic twins. Methods We compared first available clinical information on 46 monozygotic twin pairs and 59 control pairs that had either a hereditary cardiomyopathy or channelopathy. Results Despite limited power of this study, we found significant heritability for corrected QT interval (QTc) in long QT syndrome (LQTS). We could not detect significant heritability for structural traits, but found a significant environmental effect on thickness of the interventricular septum in hypertrophic cardiomyopathy. Conclusions Our study confirms previously found robust heritability for electrical traits like QTc in LQTS, and adds information on low or lacking heritability for structural traits in heritable cardiomyopathies. This may steer the search for genetic modifiers in heritable cardiac disease.
  • Kauppila, Esa; Vanninen, Esko; Kaurijoki, Salla; Karhunen, Leila; Pietiläinen, Kirsi Hannele; Rissanen, Aila; Tiihonen, Jari; Pesonen, Ullamari; Kaprio, Jaakko (2013)
  • Aro, Aapo L.; Rusinaru, Carmen; Uy-Evanado, Audrey; Reinier, Kyndaron; Phan, Derek; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S. (2017)
    Background: Syncope has been associated with increased risk of sudden cardiac arrest (SCA) in specific patient populations, such as hypertrophic cardiomyopathy, heart failure, and long QT syndrome, but data are lacking on the risk of SCA associated with syncope among patients with coronary artery disease (CAD), the most common cause of SCA. We investigated this association among CAD patients in the community. Methods: All cases of SCA due to CAD were prospectively identified in Portland, Oregon (population approximately 1 million) as part of the Oregon Sudden Unexpected Death Study 2002-2015, and compared to geographical controls. Detailed clinical information including history of syncope and cardiac investigations was obtained from medical records. Results: 2119 SCA cases (68.4 +/- 13.8 years, 66.9% male) and 746 controls (66.7 +/- 11.7 years, 67.0% male) were included in the analysis. 143 (6.8%) of cases had documented syncope prior to the SCA. SCA cases with syncope were > 5 years older and had more comorbidities than other SCA cases. After adjusting for clinical factors and left ventricular ejection fraction (LVEF), syncope was associated with increased risk of SCA (OR 2.8; 95%CI 1.68-4.85). When analysis was restricted to subjects with LVEF >= 50%, the risk of SCA associated with syncope remained significantly elevated (adjusted OR 3.1; 95%CI 1.68-5.79). Conclusions: Syncope was associated with increased risk of SCA in CAD patients even with preserved LV function. These findings suggest a role for this clinical marker among patients with CAD and normal LVEF, a large subgroup without any current means of SCA risk stratification. (C) 2016 Published by Elsevier Ireland Ltd.