Electrocardiographic and echocardiographic correlations in patients with pulmonary arterial hypertension

Abstract / Journal of Electrocardiology 46 (2012) e1–e37 ECG QT interval in mitral valve prolapse syndrome patients in Taiwan C.H. Hsu a, Y.C. Chen a, L.W. Tsai b, I.F. Yang c, C.K. Tseng d, T.F. Yang a,b a National Chiao Tung University b Taipei Medical University and Hospital, Taipei, Taiwan c Jen Chi General Hospital, Taipei, Taiwan d China Medical University Hospital, Taichung, Taiwan Introduction: Until recently, there has been no study to assess the difference of QT interval between patients with mitral valve prolapse syndrome (MVPS) and normal Taiwanese. The QT interval is dependent on the heart rate (the faster the heart rate the shorter the QT interval) and corrected QT (QTc) can be easily calculated by computer-based ECG machines to improve the detection of ventricular arrhythmia(VA) and Sudden Cardiac Death (SCD). Different correction formulae such as Bazett, Fridericia, Framingham, Hodges etc have been adopted. MVPS has been reported to produce significantly more repolarization abnormalities and VA than normal. The aim of this study was to evaluate whether there was any differences in QT between MVPS and normal Taiwanese. Methods: ECG data were recorded with a BURDICK Atria 6100® and analyzed in 581 normal subjects (239 males (26 ± 10 years) and 342 females (36 ± 14 years)) as well as in 86 echocardiographically documented MVP patients (8 males (33 ± 15 years) and 78 females (43 ± 14 years)) at a cardiology clinic. All the ECG signals were collected to a desktop PC for further SPSS-19 software statistical analysis. The two tail student-t test was adopted to differentiate the QT corrected formulae. P b 0.05 was regarded as statistically significant. Results: Table 1

QT and QTc (derived from 4 formulae) in normal subjects and patients with MVPS. Number QTint (ms) Normal 581 MVPS P

86

QTcBaz (ms)

392.23 424.06 ± 36.68 402.60 433.96 ± 25.16 b0.01 b0.01

QTcFri (ms)

QTcFra (ms)

QTcHod (ms)

412.92 ± 42.25 423.03 ± 37.62 b0.01

364.32 ± 53.13 375.68 ± 47.23 b0.05

378.10 ± 43.12 388.65 ± 35.18 b 0.05

Conclusions: 1. There is no significant difference in QTc between MVPS and normal in women. 2. In men, there was a significant difference in QTc Bazett and Fridericia. 3. There are not enough males with MVPS in this study, which might introduce some bias. http://dx.doi.org/10.1016/j.jelectrocard.2013.05.034

Gender differences of heart rate variability between symptomatic mitral valve prolapse syndrome and normal Taiwanese Y.C. Chen a, C.H. Hsu a, L.W. Tsai b, I.F. Yang c, C.K. Tseng d, T.F. Yang a,b a National Chiao Tung University, Hsin Chu, Taiwan b Taipei Medical University and Hospital, Taipei, Taiwan c Jen Chi General Hospital, Taipei, Taiwan d China Medical University Hospital, Taichung, Taiwan Introduction: Short term heart rate variability (HRV) can provide non-invasive information on the autonomic nervous system (ANS), including its vagal and sympathetic components, which has a strong association with the pathogenesis of ventricular arrhythmias and sudden cardiac death (SCD) in the general population. Short term HRV is claimed to be similar to 24 hour HRV in men and can provide predictive information similar in strength to an entire 24 hour record. Mitral Valve Prolapse Syndrome (MVPS) was reported to be associated with significant ANS dysfunction in Caucasians. Gender variation of HRV was also

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previously reported. The aim of this study was to evaluate the effect of gender on HRV parameters in Taiwanese symptomatic MVPS patients. Methods: A total of 118 MVP patients (7 males and 111 females) who had been echocardiographically documented at a cardiology clinic and 148 healthy university students (54 males and 94 females) were recruited for the study. A local HRV system with modified lead II ECG was used. HRV was performed during the daytime to avoid diurnal effects. The subjects were asked to rest at least 5 minutes before recording HRV with lying, sitting and standing posture. The paired Student t test was used to characterize changes in HRV variables between MVPS patients and the normal control group. All HRV variables were expressed as mean ± SD. All statistical analyses were performed using Microsoft Excel 2007. A P value b0.05 was determined as statistically significant. Results: For MVPS, no difference was found in time domain measures between male and female except in the lying position. For the normals, all frequency domain parameters were statistically significantly different between male and female, except total power. Conclusion: 1. Gender specific HRV diagnostic MVPS criteria should be established in Taiwanese. 2. One limitation of the study is the relatively small number of males with MVPS. http://dx.doi.org/10.1016/j.jelectrocard.2013.05.035

Electrocardiographic and echocardiographic correlations in patients with pulmonary arterial hypertension E. Blinova, T. Sakhnova, M. Saidova, A. Loskutova, Z. Dadacheva, O. Archipova, T. Martynyuk, I. Chazova Cardiology Research Complex Objective: To study the interrelations of electrocardiographic (ECG) and echocardiographic parameters in patients with pulmonary arterial hypertension (PAH). Methods: We examined 30 PAH patients (4 males and 26 females; age (mean ± SE) 38.0 ± 2.0 years). Systolic pulmonary artery pressure (SPAP), right ventricular (RV) dimensions, systolic and diastolic function were assessed using comprehensive echocardiographic examination, including Tissue Doppler Imaging and two-dimensional Speckle Tracking. ECG parameters under investigation were: QRS and T axes, frontal plane QRS-T angle (QRS-Tf), QRS duration (QRSd), R and S wave amplitudes in leads V1 and V5. Results: QRS-Tf, QRSd and RV1 correlated positively with RV anterior-posterior, basal and middle dimensions (r = 0.6; p b 0.01 for QRSd; r from 0.4 to 0.7; p b 0.05 for QRS-Tf; r from 0.4 to 0.5; p b 0.05 for RV1). QRS-Tf and RV1 correlated with RV anterior wall thickness (r = 0.5; p b 0.05) and SPAP (r = 0.6; p b 0.01). QRS-Tf and QRSd correlated negatively with parameters of RV systolic function: RV fractional area change (FAC), TAPSE, RV and interventricular septum systolic velocities (r from − 0.4 to − 0.7; p b 0.05). QRS-Tf and QRSd correlated positively with parameters of RV diastolic function: RV and interventricular septum diastolic velocities (r from 0.4 to 0.6; p b 0.05). QRS-Tf and QRSd correlated positively with RV longitudinal strain (r = 0.5; p b 0.05). Conclusion: In patients with PAH, ECG parameters QRS-Tf and QRSd correlate with RV dimensions and parameters of RV systolic and diastolic function. http://dx.doi.org/10.1016/j.jelectrocard.2013.05.036

Decartographic detection of presence and severity of right ventricular overload in patients with pulmonary hypertension T. Sakhnova a, E. Blinova a, V. Trunov b, E. Aidu b, E. Yurasova a, M. Saidova a, T. Martynyuk a, I. Chazova a a Cardiology Research Complex b Institute for Information Transmission Problems RAS Introduction: The aim of this study was to examine the value of decartographic parameters of repolarization for the assessment of right