Electrocardiography and cardiac magnetic resonance imaging in the detection of left ventricular hypertrophy : the impact of indexing methods

Background: Discrepancies between increased left ventricular mass (LVM) and electrocardiographic (ECG) criteria for the diagnosis of left ventricular hypertrophy (LVH) are described in the literature. Aims: This study aimed to evaluate the usefulness of ECG criteria in the diagnosis of LVH, as determined by cardiac magnetic resonance (CMR) imaging, using various LVM indexing methods. Methods: We included 53 patients who underwent CMR imaging and had electrocardiograms of appropriate quality available in their medical records. The majority of the study patients had cardiovascular diseases. We defined CMR‑LVH as increased LVM, also assessed after LVM indexing to body surface area (LVM/BSA), height1.7, height2.7, or as the percentage of predicted LVM (%pLVM). To determine ECG‑LVH, 10 different ECG-LVH criteria were used. Results: The prevalence of CMR‑LVH ranged from 11% (for %pLVM) to 72% (for LVM/BSA). At the same time, for a single criterion, the prevalence of ECG‑LVH ranged between 1.9% (for R wave amplitude in lead V5 / V6 greater than 2.6 mV, Sokolow–Lyon product, and Gubner–Ungerleider criterion) and 45.3% (for Peguero–Lo Presti criterion), showing high sensitivity, from 55.3% (95% CI, 38.3–71.4) to 100% (95% CI, 54.1–100). The sensitivity of ECG‑LVH criteria when all criteria were applied together ranged from 57.9% (95% CI, 40.8–73.7) to 100% (95% CI, 63.1–100). The best performance regarding the endpoint of CMR‑LVH diagnosis after LVM indexing was achieved by the Peguero–Lo Presti and Cornell criteria (area under the curve, 0.621–0.876; P, 0.001–0.17). Conclusions: Thediagnosis of LVH strongly depends on ECG- and CMR‑based definitions. ThePeguero–Lo Presti criterion and the Cornell criteria, which are sex‑specific, may provide the highest level of diagnostic accuracy and should be considered when screening patients with cardiovascular diseases for LVH

Ischemic and non-ischemic patterns of late gadolinium enhancement in heart failure with reduced ejection fraction

Background: Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) may revealmyocardial fibrosis which is associated with adverse clinical outcomes in patients undergoing implantablecardioverter-defibrillator (ICD) placement. At the same time, transmural LGE in the posterolateral wall isrelated to nonresponse to conventional cardiac resynchronization therapy (CRT). Herein, the aim was toassess the presence and determinants of LGE in CMR in heart failure (HF) with reduced ejection fraction.Methods: Sixty-seven patients were included (17.9% female, aged 45 [29–60] years), who underwentLGE-CMR and had left ventricular ejection fraction (LVEF) as determined by echocardiography.Results: In HF patients with LVEF ≤ 35% (n = 29), ischemic and non-ischemic patterns of LGE wereobserved in 51.7% and 34.5% of patients, respectively. In controls (n = 38), these patterns were noted in23.7% and 42.1% of patients, respectively. HF patients with LVEF ≤ 35% and transmural LGE in theposterolateral wall (31.0%) were characterized by older age, coronary artery disease (CAD) and previousmyocardial infarction (MI) (61 ± 6 vs. 49 ± 16 years, p = 0.008, 100% vs. 40%, p = 0.003 and 78%vs. 25%, p = 0.014, respectively). In patients with LVEF ≤ 35%, LGE of any type, diagnosed in 86.2%of patients, was associated with CAD (68% vs. 0%, p = 0.02), while only trends were observed for itsassociation with older age and previous MI (p = 0.08 and p = 0.12, respectively).Conclusions: Among HF patients with LVEF ≤ 35%, clinical factors including older age, CAD, andprevious MI are associated with transmural LGE in the posterolateral wall, while CAD is associated with LGE. This data may have potential implications for planning ICD and CRT placement procedures

Sarcopenic Obesity in Children and Adolescents: A Systematic Review

Sarcopenic obesity (SO) is defined as co-occurrence of increased fat mass and sarcopenia and may predict adverse health outcomes in the pediatric population. However, the prevalence of SO and its association with adverse health outcomes have not been well defined in children and adolescents. We systematically reviewed data on the SO definition, prevalence, and adverse outcomes in the pediatric population. A total of 18 articles retrieved from PubMed or Web of Science databases were included. Overall, there was a wide heterogeneity in the methods and thresholds used to define SO. The prevalence of SO ranged from 5.66% to 69.7% in girls, with a range between 7.2% and 81.3% in boys. Of the 8 studies that evaluated outcomes related to SO, all showed a significant association of SO with cardiometabolic outcomes, non-alcoholic fatty liver disease (NAFLD) severity, inflammation, and mental health. In conclusion, this review found that SO is highly prevalent in children and adolescents and is associated with various adverse health outcomes. Findings of this review highlight the need for the development of a consensus regarding definition, standardized evaluation methods, and age and gender thresholds for SO for different ethnicities in the pediatric population. Further studies are needed to understand the relationship between obesity and sarcopenia and SO impact on adverse health outcomes in children and adolescents

Association of NT-proBNP and GDF-15 with markers of a prothrombotic state in patients with atrial fibrillation off anticoagulation

We investigated whether growth diferentiation factor-15 (GDF-15), also known as macrophage inhibitory cytokine-1 (MIC1), levels are associated with a prothrombotic state in atrial fbrillation (AF) as compared to N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (cTnI-hs). In 103 patients with AF assessed of anticoagulation (age: 71.0 [65.0–76.0] years; CHA2DS2-VASc score: 4.6±1.7), we measured endogenous thrombin potential (ETP), plasma fbrin clot permeability (Ks, a measure of clot density) and clot lysis time (CLT) and other hemostatic parameters, along with GDF-15, NT-proBNP, and cTnI-hs. GDF-15 positively correlated with ETP and CLT (r=0.25, P=0.01 and R=0.56, P<0.0001, respectively) but not with Ks, von Willebrand factor, thrombin-activatable fbrinolysis inhibitor, plasminogen, antiplasmin or tissue-type plasminogen activator antigen. NT-proBNP showed a stronger association with ETP (r=0.60, P<0.0001) and a similar correlation with CLT (R=0.53, P<0.0001), while cTnI-hs correlated solely with CLT (R=0.25, P=0.01). After adjustment for clinical and laboratory parameters, GDF-15 was a better independent predictor of CLT (unstandardized coefcient B 0.009; 95% confdence interval [CI] 0.006–0.012) than NT-proBNP (B 0.007; 95% CI 0.004–0.010, R (2)=0.51; P<0.0001); while among the three biomarkers, only NT-proBNP was an independent predictor of ETP. Elevated GDF-15 and NT-proBNP independently predict impaired fbrin clot lysability, while NT-proBNP is a key predictor of heightened thrombin formation in AF. Our fndings suggest that a predictive value of NT-proBNP and GDF-15 in AF could be in part attributed to their association with prothrombotic blood alterations

Inny scenariusz hamowania kardiostymulatora typu DDD. Czy zawsze winne są elektrody unipolarne?

We present 24-hour electrocardiography recording with observed DDD pacemaker pacing inhibition. Discussed Holter monitoring fi ndings are puzzling and may result from pacemaker sensing malfunction. However, its aetiology may be diverse. The detailed explanation of underlying mechanisms is provided and literature is reviewed.Przedstawiono zapis 24-godzinnego monitorowania elektrokardiografi cznego metodą Holtera z obserwowanymi zahamowaniami stymulacji kardiostymulatora typu DDD. Dyskutowane wyniki monitorowania holterowskiego są zagadkowe i mogą wynikać z zaburzeń wyczuwania kardiostymulatora. Ich etiologia może być jednak zróżnicowana. Zaprezentowano szczegółowe wytłumaczenie mechanizmów oraz przegląd literatury

Analiza parametrów częstotliwościowych zmienności rytmu serca po pomostowaniu aortalno-wieńcowym

Wstęp: Zmienność rytmu serca (HRV) jest uwarunkowana przez chwilowe zmiany czasu trwania kolejnych odstępów RR rytmu zatokowego. Parametry określające HRV odzwierciedlają wpływ obu składowych autonomicznego układu nerwowego na węzeł zatokowy i pozwalają na jego ilościową ocenę. Oznaczenie HRV może uwidocznić zaburzenia autonomicznej regulacji pracy serca. Celem pracy była ocena zmian wartości parametrów analizy częstotliwościowej zmienności rytmu zatokowego po pomostowaniu aortalno-wieńcowym (CABG). Materiał i metody: Badaniem objęto grupę 19 pacjentów (średni wiek 63,3 &#177; 9,8 roku), zakwalifikowanych po raz pierwszy do operacji CABG w trybie planowym. Z badania wykluczono osoby ze świeżym epizodem wieńcowym, schorzeniami organicznymi serca oraz zaburzeniami rytmu, pacjentów po ablacji i z rozrusznikiem. Każdego badanego poddano 3-krotnemu pomiarowi HRV metodą short time measurement (ok. 5 min) aparatem typu Holter. Pierwszy pomiar wykonywano w dobie przedoperacyjnej, a kolejne w 1. i 7. dobie po operacji. Po manualnym usunięciu z zapisu artefaktów i pobudzeń dodatkowych dokonano analizy HRV. Uwzględniono parametry analizy częstotliwościowej: moc widma w zakresie bardzo niskich częstotliwości (VLF), niskich częstotliwości (LF), wysokich częstotliwości (HF) oraz iloraz LF/HF. Wyniki: U wszystkich chorych wykazano znaczne zmniejszenie wartości parametrów VLF, LF, HF po operacji (dla wszystkich parametrów p < 0,001), które utrzymywało się do 7. doby (odpowiednio p < 0,02), choć obserwowano tendencję wzrostową od doby pooperacyjnej 1. do 7. Stwierdzono również tendencję do wzrostu LF/HF po operacji oraz wyższe wartości LF/HF w 7. dobie pooperacyjnej u mężczyzn niż u kobiet (p < 0,01). Obniżenie VLF w 7. dobie w stosunku do doby 1. zależało od wartości wskaźnika masy ciała (r = &#8211;0,47, p = 0,043). U chorych z dyslipidemią obserwowano istotnie niższe wartości HF przed zabiegiem (p < 0,05), podobnie przedoperacyjne wartości HF zależały od wieku (r = &#8211;0,58, p < 0,05). Wnioski: Zmienność rytmu serca zmniejsza się po pomostowaniu aortalno-wieńcowym. Obniżenie wartości parametrów częstotliwościowych utrzymuje się do co najmniej 7. doby pooperacyjnej. Pacjenci z dyslipidemią i starsi mają wyjściowo mniejszą zmienność rytmu zatokowego w zakresie częstotliwości odpowiadających czynności nerwu błędnego. Po operacji występuje tendencja do przesunięcia równowagi autonomicznej na korzyść układu współczulnego. (Folia Cardiologica Excerpta 2011; 6, 1: 76&#8211;81