Prognostic significance of electrocardiographic findings in patients with dilated cardiomyopathy

Koga, Yoshinori; Wada, Toyofumi; Toshima, Hironori; Akazawa, Kouhei; Nosé, Yukihiko

doi:10.1007/bf02630564

Cited by 30 publications

(12 citation statements)

References 14 publications

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“…Although all patients had normal preoperative coronary angiography, four of the nine patients who presented with postoperative ECG/VCG signs of MI already had such signs before the surgery. This is a common finding among patients suffering from dilated cardiomyopathy of idiopathic etiology with normal coronary angiography, and is consistent with data presented in the literature, [11][12][13][14] in which the presence of pathologic Q waves is shown in about 18.7 to 37% of patients of this type. All of these had QRS axis changes after ventriculectomy, with three presenting with extension to or new signs of MI within the lateral wall.…”

Section: Discussionsupporting

confidence: 92%

Electrocardiographic and vectorcardiographic findings of patients undergoing reductive ventriculectomy (Batista operation)

Pastore¹,

Tobias²,

Kaiser³

et al. 2003

Clinical Cardiology

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SummaryBackground: The Batista operation, or partial ventriculectomy, has been designed by the Brazilian surgeon Dr. Randas Batista as an alternative method for treating patients with idiopathic dilated cardiomyopathy.Hypothesis: This study aimed to analyze electro-and vectorcardiographic data obtained from patients who underwent such surgery, and to evaluate its electrical repercussions on the heart.Methods: Pre-and postoperative electrocardiography (ECG) and vectorcardiography (VCG) were performed 45 days apart in 15 patients undergoing reductive ventriculectomy.Results: All ECGs showed sinus rhythm, with unchanged QRS duration. Left atrial enlargement (86.6%) and left ventricular hypertrophy (100%) were the most common findings. Bundle-branch blocks (BBBs) were often demonstrated on preoperative studies, predominantly (46.7%) left BBBs. Left anterior fascicular blocks were seen in four patients (26.6%), one associated with right BBB. Electrocardiographic changes suggestive of myocardial infarction (MI) were seen in four patients preoperatively; postoperatively, all had extended to or within the lateral wall. Five additional patients developed lateral MIs postoperatively, for a total of 9 patients (60%) with postoperative signs of infarction (p < 0.05). Electro-and vec-

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Section: Discussionsupporting

confidence: 92%

Electrocardiographic and vectorcardiographic findings of patients undergoing reductive ventriculectomy (Batista operation)

Pastore¹,

Tobias²,

Kaiser³

et al. 2003

Clinical Cardiology

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“…However, patients with definite bundle branch or fascicular block were excluded because they increase the QRS duration, subsequently increasing the duration of wavelet transform regardless of regional conduction disturbances, and it has been already reported that these conduction disturbances are the major independent risk factor for cardiac death in patients with dilated cardiomyopathy. 26 Although it is likely that wavelet analysis can discriminate the characteristics of IDCM patients more definitely in the presence of any conduction disturbances, further investigation are needed to clarify these issues.…”

Section: Discussionmentioning

confidence: 99%

Detection of Abnormal High-Frequency Components in the QRS Complex by the Wavelet Transform in Patients With Idiopathic Dilated Cardiomyopathy

et al. 1999

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eft ventricular mechanical dysfunction estimated by ejection fraction (EF) and complex ventricular premature beats are independent prognostic predictors in patients with idiopathic dilated cardiomyopathy (IDCM). [1][2][3][4] From the histological viewpoint, it is likely that myocardial fiber degeneration and fibrotic replacement, resulting in the disruption of cell-to-cell connections, 5,6 would not only reduce left ventricular mechanical performance but would also produce electrophysiological abnormalities, such as disruptions of the depolarization wavefront and regional conduction delays, that would provide an appropriate substrate for arrhythmogenicity. The incidence of sudden cardiac death presumably due to fatal ventricular tachyarrhythmia increases with the progression of heart failure and the reduction of the left ventricular EF, 7,8 which suggests that the potential for fatal ventricular arrhythmia due to electrophysiological derangement may progress insidiously with left ventricular mechanical dysfunction, whether or not there is a history of symptomatic malignant ventricular tachycardia.Disruptions of the depolarization wavefront and regional conduction delays, which could provide a substrate for a reentrant pathway and subsequent ventricular tachyarrhythmia, produce fine, fragmented signals in the QRS complex Japanese Circulation Journal Vol.63, January 1999 of the electrocardiogram (ECG). 9-11 Fine, delayed, fragmented signals in the terminal QRS/ST segment of the signal-averaged ECG, which are defined as late potentials, have been related to slowly activated tissue responsible for sustained ventricular arrhythmia and sudden cardiac death. However, late potentials are only some of the pathological signals that extend into the terminal QRS/ST segment; others might be hidden in the QRS complex, 12 and the presence of late potentials has not been thought to indicate a decrease in the left ventricular ejection fraction in patients with IDCM. 1,9,13,14 Wavelet analysis is a new time-frequency technique that enables the detection and localization of small, transient signals in the QRS complex. [15][16][17][18][19][20][21][22] Thus, this study was conducted to clarify whether fine, fragmented signals in the QRS complex detected by the wavelet transform are related to the severity of ventricular arrhythmia, cardiac mortality, the appearance of late potentials, and left ventricular mechanical dysfunction in patients with IDCM. For this purpose, we modified the original equation of wavelet analysis for a quantification of fine fragmented signals, and the relations of 4 quantitative indices; that is, the number and the density of local maxima, and the duration and the root mean square amplitude of wavelet transform, derived from wavelet transform to these issues, were evaluated. Methods SubjectsThis study involved 26 Japanese subjects with IDCM, identified according to criteria of the World Health Organization. 23 All were in sinus rhythm without bundle branch or fascicular block, or any symptoms at rest. The J...

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“…One analysis of the relationship used the QRS duration as a continuous variable and another used QRS prolongation as a categorical variable. QRS prolongation was defined as QRS interval >120 ms, given that previous studies have demonstrated worse outcomes in HF patients with QRS ≥120 ms . Covariates were prespecified based on a minimum of 10 events per variable.…”

Section: Methodsmentioning

confidence: 99%

Race and Sex Differences in QRS Interval and Associated Outcome Among Patients with Left Ventricular Systolic Dysfunction

Randolph

Broderick

Shaw

et al. 2017

JAHA

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BackgroundProlonged QRS duration is associated with increased mortality among heart failure patients, but race or sex differences in QRS duration and associated effect on outcomes are unknown.Methods and ResultsWe investigated QRS duration and morphology among 2463 black and white patients with heart failure and left ventricular ejection fraction ≤35% who underwent coronary angiography and 12‐lead electrocardiography at Duke University Hospital from 1995 through 2011. We used multivariable Cox regression models to assess the relationship between QRS duration and all‐cause mortality and investigate race‐QRS and sex‐QRS duration interaction. Median QRS duration was 105 ms (interquartile range [IQR], 92–132) with variation by race and sex (P<0.001). QRS duration was longest in white men (111 ms; IQR, 98–139) followed by white women (108 ms; IQR, 92–140), black men (100 ms; IQR, 91–120), and black women (94 ms; IQR, 86–118). Left bundle branch block was more common in women than men (24% vs 14%) and in white (21%) versus black individuals (12%). In black patients, there was a 16% increase in risk of mortality for every 10 ms increase in QRS duration up to 112 ms (hazard ratio, 1.16; 95% CI, 1.07, 1.25) that was not present among white patients (interaction, P=0.06).ConclusionsBlack individuals with heart failure had a shorter QRS duration and more often had non‐left bundle branch block morphology than white patients. Women had left bundle branch block more commonly than men. Among black patients, modest QRS prolongation was associated with increased mortality.

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Prognostic significance of electrocardiographic findings in patients with dilated cardiomyopathy

Cited by 30 publications

References 14 publications

Electrocardiographic and vectorcardiographic findings of patients undergoing reductive ventriculectomy (Batista operation)

Electrocardiographic and vectorcardiographic findings of patients undergoing reductive ventriculectomy (Batista operation)

Detection of Abnormal High-Frequency Components in the QRS Complex by the Wavelet Transform in Patients With Idiopathic Dilated Cardiomyopathy

Race and Sex Differences in QRS Interval and Associated Outcome Among Patients with Left Ventricular Systolic Dysfunction

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