Electrocardiographic Time to Intrinsicoid Deflection and Heart Failure: The Multi‐Ethnic Study of Atherosclerosis

O’Neal, Wesley T.; Qureshi, Waqas; Nazarian, Saman; Kawel‐Boehm, Nadine; Bluemke, David A.; Lima, João A.C.; Soliman, Elsayed Z.

doi:10.1002/clc.22561

Cited by 15 publications

(22 citation statements)

References 17 publications

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“…Time to peak R wave (instrinsicoid deflection [ID]) was automatically measured from V5 and V6 (the left ventricular chest leads), and the maximum of both values was used in the main analysis. Time to ID values >50 ms were considered abnormal 23. Left ventricular hypertrophy was defined by the Cornell criteria (R wave amplitude AV L plus S wave amplitude V 3 ≥2.8 mV in men and ≥2.0 mV in women) 24.…”

Section: Methodsmentioning

confidence: 99%

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

O’Neal

Mazur

Bertoni

et al. 2017

JAHA

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BackgroundSeveral markers detected on the routine 12‐lead ECG are associated with future heart failure events. We examined whether these markers are able to separate the risk of heart failure with reduced ejection fraction (HFrEF) from heart failure with preserved ejection fraction (HFpEF).Methods and ResultsWe analyzed data of 6664 participants (53% female; mean age 62±10 years) from MESA (Multi‐Ethnic Study of Atherosclerosis) who were free of cardiovascular disease at baseline (2000–2002). A competing risks analysis was used to compare the association of several baseline ECG predictors with HFrEF and HFpEF detected during a median follow‐up of 12.1 years. A total of 127 HFrEF and 117 HFpEF events were detected during follow‐up. In a multivariable adjusted model, prolonged QRS duration, delayed intrinsicoid deflection, left‐axis deviation, right‐axis deviation, prolonged QT interval, abnormal QRS‐T axis, left ventricular hypertrophy, ST/T‐wave abnormalities, and left bundle‐branch block were associated with HFrEF. In contrast, higher resting heart rate, abnormal P‐wave axis, and abnormal QRS‐T axis were associated with HFpEF. The risk of HFrEF versus HFpEF was significantly differently for delayed intrinsicoid deflection (hazard ratio: 4.90 [95% confidence interval (CI), 2.77–8.68] versus 0.94 [95% CI, 0.29–2.97]; comparison P=0.013), prolonged QT interval (hazard ratio: 2.39 [95% CI, 1.55–3.68] versus 0.52 [95% CI, 0.23–1.19]; comparison P<0.001), and ST/T‐wave abnormalities (hazard ratio: 2.47 [95% CI, 1.69–3.62] versus 1.13 [95% CI, 0.72–1.77]; comparison P=0.0093).ConclusionsMarkers of ventricular repolarization and delayed ventricular activation are able to distinguish between the future risk of HFrEF and HFpEF. These findings suggest a role for ECG markers in the personalized risk assessment of heart failure subtypes.

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Section: Methodsmentioning

confidence: 99%

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

O’Neal

Mazur

Bertoni

et al. 2017

JAHA

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“…Prolongation of the ID time is frequently associated with diastolic dysfunction. In right ventricular hypertrophy, a prolonged ID time is frequently detected in leads V1 and V2 whereas it is not prolonged in lead V6 (11). Hence, we hypothesized that severe OSAS is associated with prolongation of ID time and P-wave discrimination (PWD), which might be helpful in clarifying the right ventricular hypertrophy and pulmonary hypertension in OSAS patients.…”

Section: O Bstructive Sleep Apnea Syndrome (Osas) Is a Common Sleep Dmentioning

confidence: 97%

“…This measure represents the time for excitation to spread from the endocardial to epicardial surface of the left ventricle (11). Prolongation of the ID time is frequently associated with diastolic dysfunction.…”

Section: O Bstructive Sleep Apnea Syndrome (Osas) Is a Common Sleep Dmentioning

confidence: 99%

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The effect of continuous positive airway pressure treatment on P-wave dispersion and intrinsicoid deflection time in severe obstructive sleep apnea syndrome

Seyis¹,

Usalan²

2017

Curr Res Cardiol

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OBJECTIVE: This study aims to evaluate the effects of continuous positive airway pressure (CPAP) treatment on intrinsicoid deflection time (R wave peak time) and P wave discrimination in severe obstructive sleep apnea syndrome (OSAS). METHODS:Fifty-five patients with severe OSAS (apnea-hypopnea index ≥ 30) and a healthy control group were included. Baseline electrocardiography (ECG), echocardiography (ECHO), and polysomnography parameters were recorded. All patients received CPAP treatment. ECG and ECHO echocardiography tests were repeated after one-year of CPAP therapy. RESULTS:A total of 55 OSAS patients (36 M, 19 F) with a mean age of 56.9 ± 7.6 years and 54 healthy controls (31 M, 23 F) with a mean age of 56.6 ± 5.7 years were included. There was a significant improvement in terms of intrinsicoid deflection time in lead V1 (76.2 ± 8.3 vs. 59.8 ± 7.2) and lead V6 (58.5 ± 8.0 vs. 49.8 ± 7.1), and P-wave dispersion (95.2 ± 12.8 vs. 39.8 ± 6.4) after one-year CPAP treatment (p<0.001). Cardiac volumes and diameters improved significantly.CONCLUSION: CPAP treatment significantly decreases intrinsicoid deflection time in leads V1 and V6, and improves P-wave dispersion. The results of this study indicate that long-term CPAP treatment had a strong protective effect on right or left cardiac functions in severe OSAS patients without any cardiac and pulmonary disease. KeyWords: CPAP; Intrinsicoid deflection time; OSAS; P-wave dispersion; PolysomnographyO bstructive sleep apnea syndrome (OSAS) is a common sleep disorder. It is caused by temporary collapse of the upper airway, which results in nocturnal hypoxia and sleep disturbance (1,2). Many vascular diseases including hypertension, coronary heart disease, heart failure, cardiac arrhythmias, and stroke have been found to be associated with OSAS (3). Cardiovascular morbidity and mortality have been reported as high as 70% in patients with OSAS (4).Many studies have shown that OSAS is associated with changes in cardiac structure such as myocardial hypertrophy or increased left ventricular mass, which can widen the QRS complex on the electrocardiogram (ECG) (5-7). On the other hand, prolonged QRS duration is an independent predictor of mortality and cardiovascular diseases (e.g., hypertension and heart failure) in OSAS patients. It has also been shown that severe OSAS patients (AHI ≥ 30) have a four-fold higher frequency of atrial fibrillation (AF) (8). Arrhythmia and its improvement with continuous positive airway pressure (CPAP) therapy in OSAS patients have been reported as well (8). However, the relationship between OSAS and intrinsicoid deflection (ID) (i.e., R-wave peak time) is unknown.Continuous positive airway pressure is used as first line treatment modality in patients with severe OSAS (9). Regular use of CPAP may lead to reduction in cardiovascular risk in patients with heart failure. A reduction of blood pressure, an increase in left ventricular ejection fraction, and a decrease in left ventricular hypertrophia, and an improvement in cardiovascular function h...

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“…Regarding the article “Electrocardiographic Time to Intrinsicoid Deflection and Heart Failure: the Multi‐Ethnic Study of Atherosclerosis,” the intrinsicoid deflection is one of the 6 electrocardiographic (ECG) components that comprise the Romhilt‐Estes score, proposed in 1968 for the ECG detection of left ventricular hypertrophy . This criterion achieved its place in this group because of its performance in a study of the correlation between various ECG components and heart weight, and left and right ventricular (RV) thickness, all controlled for body weight .…”

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confidence: 99%

Commentary on Electrocardiographic Time to Intrinsicoid Deflection and Heart Failure: the Multi‐Ethnic Study of Atherosclerosis

Estes

2017

Clinical Cardiology

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found that the intrinsicoid deflection time (which was called ventricular activation time in this study) had a higher correlation with total heart weight than the total QRS duration. Intrinsicoid deflection time had a higher correlation with RV thickness than left ventricular thickness, and it was more often found in those patients with symptoms suggesting heart failure (HF). The possibility that increased RV thickness (and increased intrinsicoid deflection time) were related to previous episodes of HF was considered but could not be established by this study.Much more recently, we have studied the ability of the same 6 ECG components, including the intrinsicoid deflection time, to predict all-cause mortality and new cardiovascular disease. 4,5 The overall Romhilt-Estes score is highly predictive of both mortality and new cardiovascular disease, but the surprising finding was that each of the 6 ECG components was independently predictive of these outcomes, and each was unique in its ability to predict specific cardiovascular outcomes. The intrinsicoid deflection time was among the most pow-

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Electrocardiographic Time to Intrinsicoid Deflection and Heart Failure: The Multi‐Ethnic Study of Atherosclerosis

Cited by 15 publications

References 17 publications

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

The effect of continuous positive airway pressure treatment on P-wave dispersion and intrinsicoid deflection time in severe obstructive sleep apnea syndrome

Commentary on Electrocardiographic Time to Intrinsicoid Deflection and Heart Failure: the Multi‐Ethnic Study of Atherosclerosis

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