Biomarkers of ventricular remodelling in African hypertensives.

Includes abstract.Includes bibliographical references.There is substantial evidence that the burden of hypertension, hypertension with left ventricular hypertrophy and hypertensive heart failure is very enormous in sub-Saharan Africa. There is therefore the need to look for easier and faster means, compared to electrocardiography and echocardiography of diagnosing and differentiating the different effects of long standing hypertension on cardiac remodelling which ultimately lead to systolic and diastolic dysfunctions as this affects the prognosis, management and treatment modalities of hypertension. We studied 210 subjects who were subdivided into three groups after echocardiography: those without left ventricular hypertrophy (HT) (n=83); those with left ventricular hypertrophy (HTLVH) (n=50) and those with hypertensive heart failure (HHF) (n=77)

Peguero Electrocardiographic Left Ventricular Hypertrophy Criteria and Risk of Mortality

Background: Peguero electrocardiographic left ventricular hypertrophy (ECG-LVH) criteria are newly developed criteria that have shown better diagnostic performance than the traditional Cornell-voltage and Sokolow-Lyon criteria. However, prediction of poor outcomes rather than detection of increased left ventricular mass is becoming the primary use for ECG-LVH criteria which requires investigating any new ECG-LVH criteria in terms of prediction.Aims: To examine the prognostic significance of the newly developed Peguero ECG-LVH criteria.Methods: We compared the prognostic significance of Peguero ECG-LVH with Cornell-voltage and Sokolow-Lyon ECG-LVH criteria in 7,825 participants (age 59.8 ± 13.4 years; 52.7% women) from the third National Health and Nutrition Examination Survey who were free of major intraventricular conduction defects. ECG-LVH criteria were derived from digital ECG tracings processed at a central core laboratory.Results: At baseline, ECG-LVH was detected in 11.8% by Peguero; in 4.3% by Cornell voltage and in 6.4% by Sokolow-Lyon. During a median follow up of 13.8 years, 2,796 all-cause mortality events occurred. In multivariable models adjusted for demographics and cardiovascular risk factors, presence of Peguero ECG-LVH was associated with increased risk of all-cause mortality [HR (95% CI): 1.29 (1.16, 1.44)]. This association was not significantly different from the associations of Cornell voltage-LVH or Sokolow-Lyon LVH with all-cause mortality [HR (95%CI): 1.32 (1.12, 1.55) and 1.24 (1.07, 1.43), respectively; p-values for comparisons of these HRs with the HR of Peguero ECG-LVH 0.817 and 0.667, respectively]. Similar patterns of associations were observed with cardiovascular, ischemic heart disease and heart failure mortalities.Conclusion: Peguero ECG-LVH is predictive of increased risk of death similar to the traditional ECG-LVH criteria

Noninvasive evaluation of patients with coronary artery disease and heart failure

In dit proefschrift worden patiënten bestudeerd met een voorgeschiedenis van coronair lijden en hartfalen. De thesis is onderverdeeld in drie delen: 1. Niet-invasieve inschatting van vuldrukken door middel van geavanceerde echocardiografische technieken 2. Selectie van kandidaten voor cardiale resynchronizatietherapie met echocardiografie, nucleaire technieken en multi slice CT 3. Nietinvasieve prognostische markers waaronder nuchtere glycemie en determinanten van inspanningscapacitei

Ventricular Arrhythmias in Hypertensive Left Ventricular Hypertrophy

Abstract Not Provided

Electrocardiographic parameters of ventricular repolarization : modifiers and the prognostic value

Electric activity of the heart consists of repeated cardiomyocyte depolarizations and repolarizations. Abnormalities in repolarization predispose to ventricular arrhythmias. In body surface electrocardiogram, ventricular repolarization generates the T wave. Several electrocardiographic measures have been developed both for clinical and research purposes to detect repolarization abnormalities. The study aim was to investigate modifiers of ventricular repolarization with the focus on the relationship of the left ventricular mass, antihypertensive drugs, and common gene variants, to electrocardiographic repolarization parameters. The prognostic value of repolarization parameters was also assessed. The study subjects originated from a population of more than 200 middle-aged hypertensive men attending the GENRES hypertension study, and from an epidemiological survey, the Health 2000 Study, including more than 6000 participants. Ventricular repolarization was analysed from digital standard 12-lead resting electrocardiograms with two QT-interval based repolarization parameters (QT interval, T-wave peak to T-wave end interval) and with a set of four T-wave morphology parameters. The results showed that in hypertensive men, a linear change in repolarization parameters is present even in the normal range of left ventricular mass, and that even mild left ventricular hypertrophy is associated with potentially adverse electrocardiographic repolarization changes. In addition, treatments with losartan, bisoprolol, amlodipine, and hydrochlorothiazide have divergent short-term effects on repolarization parameters in hypertensive men. Analyses of the general population sample showed that single nucleotide polymorphisms in KCNH2, KCNE1, and NOS1AP genes are associated with changes in QT-interval based repolarization parameters but not consistently with T-wave morphology parameters. T-wave morphology parameters, but not QT interval or T-wave peak to T-wave end interval, provided independent prognostic information on mortality. The prognostic value was specifically related to cardiovascular mortality. The results indicate that, in hypertension, altered ventricular repolarization is already present in mild left ventricular mass increase, and that commonly used antihypertensive drugs may relatively rapidly and treatment-specifically modify electrocardiographic repolarization parameters. Common variants in cardiac ion channel genes and NOS1AP gene may also modify repolarization-related arrhythmia vulnerability. In the general population, T-wave morphology parameters may be useful in the risk assessment of cardiovascular mortality.Sydämen kammioiden sähköinen palautumisvaihe, repolarisaatio, havaitaan sydänsähkökäyrässä (EKG) T-aaltona. Repolarisaation poikkeavuudet altistavat rytmihäiriöille, joista osa voi olla henkeä uhkaavia. Tutkimme EKG:n repolarisaation yhteyttä sydämen vasemman kammion massaan, verenpainelääkkeisiin ja vaihteluun sydänlihassolujen ionivirtauksiin liittyvissä geeneissä. Tutkimme myös EKG:n repolarisaatiomuuttujien yhteyttä kuolemiin. Aineisto koostui suomalaisista verenpainepotilaista (200 keski-ikäistä miestä) sekä kotimaisesta väestöotoksesta (6000 yli 30-vuotiasta henkilöä, joista 45% miehiä). Koehenkilöille suoritettiin sairaustietojen kysely ja lääkärintarkastus, tehtiin mittauksia ja otettiin verinäytteitä. Henkilöiltä rekisteröitiin myös tavallinen 12-kanavainen lepo-EKG, joka tallennettiin sähköisesti ja analysoitiin tietokoneella. Repolarisaatiomittareina käytettiin useita muuttujia: repolarisaation kestoa (QT-aika), repolarisaation loppuosan kestoa (TPE-aika) sekä neljää T-aallon 3-ulotteista muotoa kuvaavaa muuttujaa (T-aallon morfologiamuuttujat). Tulokset 200 verenpainepotilaan joukossa osoittavat, että jo vähäinen sydämen vasemman kammion massan kasvu liittyy EKG:n epäedullisiin repolarisaatiomuutoksiin. Tutkimuslöydös on uusi. Koska verenpaine on vasemman kammion massan kasvun vahva riskitekijä, havainto korostaa kohonneen verenpaineen tehokkaan hoidon merkitystä. Tulokset samassa aineistossa osoittavat myös, että neljän viikon kuluttua verenpainelääkkeen aloituksesta eri verenpainelääkkeillä on toisistaan poikkeavia repolarisaatiovaikutuksia: losartaanilla ja bisoprololilla on edullisia vaikutuksia QT-aikaan, TPE-aikaan ja T-aallon morfologiamuuttujiin; hydroklooritiatsidilla on epäedullisia vaikutuksia TPE-aikaan; amlodipiinillä ei ole repolarisaatiovaikutuksia. Myös tämä tutkimuslöydös on uusi, ja sillä voi olla merkitystä verenpainelääkityksen aloituksessa. Tulokset 6000 henkilön väestöotoksessa vahvistavat aiempien väestötutkimuksien havaintoja ja osoittavat, että suomalaisilla esiintyy yksittäisten emästen vaihtelua (polymorfismia) sydänlihassolujen ionivirtauksiin liittyvissä geeneissä. Osa polymorfismeista liittyy EKG:n edullisiin, osa puolestaan epäedullisiin repolarisaatiomuutoksiin. Pääosin tutkittujen geenimuutosten vaikutukset EKG:n repolarisaatioon ovat lieviä. Väestöotoksessa havaittiin myös, että kuuden vuoden seurannassa T-aallon morfologiamuuttujilla oli toisin kuin QT-ajalla ja TPE-ajalla itsenäinen yhteys sydän- ja verisuonitautikuolleisuuteen. Tällä löydöksellä voi olla merkitystä kehitettäessä EKG-menetelmiä vakavien rytmihäiriöiden vaaran tunnistamiseksi

Borderline hypertension in young men

Abstract available : p.16-1

Advances in Electrocardiograms

Electrocardiograms have become one of the most important, and widely used medical tools for diagnosing diseases such as cardiac arrhythmias, conduction disorders, electrolyte imbalances, hypertension, coronary artery disease and myocardial infarction. This book reviews recent advancements in electrocardiography. The four sections of this volume, Cardiac Arrhythmias, Myocardial Infarction, Autonomic Dysregulation and Cardiotoxicology, provide comprehensive reviews of advancements in the clinical applications of electrocardiograms. This book is replete with diagrams, recordings, flow diagrams and algorithms which demonstrate the possible future direction for applying electrocardiography to evaluating the development and progression of cardiac diseases. The chapters in this book describe a number of unique features of electrocardiograms in adult and pediatric patient populations with predilections for cardiac arrhythmias and other electrical abnormalities associated with hypertension, coronary artery disease, myocardial infarction, sleep apnea syndromes, pericarditides, cardiomyopathies and cardiotoxicities, as well as innovative interpretations of electrocardiograms during exercise testing and electrical pacing