Risk of Mortality in Individuals With Low QRS Voltage and Free of Cardiovascular Disease

Usoro, Andrew O.; Bradford, Natalie; Shah, Amit; Soliman, Elsayed Z.

doi:10.1016/j.amjcard.2014.02.006

Cited by 41 publications

(30 citation statements)

References 17 publications

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“…Assessments of diffuse fibrosis with ECG can be useful both as a diagnostic approach and for predicting outcomes. Recent studies have shown that low QRS voltage is associated with adverse outcomes in individuals free of cardiovascular disease (32) and cardiac amyloidosis (33). The present study may explain the underlying mechanism of the adverse outcome.…”

Section: Cardiac Imaging: Electrocardiographic Impact Of Myocardial Dmentioning

confidence: 59%

Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

et al. 2017

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Purpose:To examine the associations of myocardial diffuse fibrosis and scar with surface electrocardiographic (ECG) parameters in individuals free of prior coronary heart disease in four different ethnicities. Materials and Methods:This prospective cross-sectional study was approved by the institutional review boards, and all participants gave informed consent. A total of 1669 participants in the Multi-Ethnic Study of Atherosclerosis, or MESA, who were free of prior myocardial infarction underwent both ECG and cardiac magnetic resonance imaging. In individuals without a late gadolinium enhancement-defined myocardial scar (n = 1131), T1 mapping was used to assess left ventricular (LV) interstitial diffuse fibrosis. The associations of LV diffuse fibrosis or myocardial scar with ECG parameters (QRS voltage, QRS duration, and corrected QT interval [QTc]) were evaluated by using multivariable regression analyses adjusted for demographic data, risk factors for scar, LV end-diastolic volume, and LV mass. Results:The mean age of the 1669 participants was 67.4 years 6 8.7 (standard deviation); 49.8% were women. Lower postcontrast T1 time at 12 minutes was significantly associated with lower QRS Sokolow-Lyon voltage (b = 15.1 µV/10 msec, P = .004), lower QRS Cornell voltage (b = 9.2 µV/10 msec, P = .031), and shorter QRS duration (b = 0.16 msec/10 msec, P = .049). Greater extracellular volume (ECV) fraction was also significantly associated with lower QRS Sokolow-Lyon voltage (b = 235.2 µV/1% ECV increase, P , .001) and Cornell voltage (b = 223.7 µV/1% ECV increase, P , .001), independent of LV structural indexes. In contrast, the presence of LV scar (n = 106) was associated with longer QTc (b = 4.3 msec, P = .031). Conclusion:In older adults without prior coronary heart disease, underlying greater LV diffuse fibrosis is associated with lower QRS voltage and shorter QRS duration at surface ECG, whereas clinically unrecognized myocardial scar is associated with a longer QT interval.q RSNA, 2016

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Section: Cardiac Imaging: Electrocardiographic Impact Of Myocardial Dmentioning

confidence: 59%

Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

et al. 2017

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“…In addition to cardiac and pericardial disease low QRS voltage has also been observed in many non‐cardiac conditions such as pleural effusions, emphysema, pulmonary infiltrations, and hypothyroidism . In a study of 6440 individuals free of cardiovascular disease low QRS voltage was found in 1.4%, and was more common in the elderly, in women, non‐Hispanic blacks and those with pulmonary disease, and malignancies: during a median follow‐up of 14.1 years those with low QRS voltage were twice as likely to die …”

Section: Introductionmentioning

confidence: 99%

“…8 In a study of 6440 individuals free of cardiovascular disease low QRS voltage was found in 1.4%, and was more common in the elderly, in women, non-Hispanic blacks and those with pulmonary disease, and malignancies: during a median follow-up of 14.1 years those with low QRS voltage were twice as likely to die. 9 QRS amplitude can vary in the leads V1 to V6 because of artifact and errors in chest lead placement. Therefore, the combined amplitude of limb lead I and II has been recommended as the preferred method of measuring and monitoring QRS voltage.…”

Section: Introductionmentioning

confidence: 99%

QRS voltage is a predictor of in‐hospital mortality of acutely ill medical patients

Kellett

Opio

2018

Clinical Cardiology

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“…This study did not find significant association between QRS magnitude and DM. 68 In our population, HQRSA was higher in DM, compared with NDM. In multiple regression analysis adjusting for confounding factors, the regression coefficient of DM was 22.6 (95%CI 2.5 to 42.8, P = 0.03), suggesting that DM would significantly increase the HQRSA by 22.6 degrees, while triglyceride (increased by per 1mmol/L) reduced HQRSA by 7.9 degrees (regression coefficient −7.9, P = 0.02).…”

Section: Dm and Angle Of Horizontal Qrs Vectormentioning

confidence: 87%

Changes of Virtual Planar QRS and T Vectors Derived from Holter in the Populations with and without Diabetes Mellitus

Chen

Lin

et al. 2015

Ann Noninvasive Electrocardiol

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Aims: Research related to type 2 diabetes mellitus (DM) and parameters of electrocardiography (ECG) was limited. Patients with and without DM (NDM) were randomly enrolled in a study to exploit the influence of DM on planar QRS and T vectors derived from the Virtual Holter process.Methods: A total of 216 (NDM) and 127 DM patients were consecutively and randomly recruited. We selected a 1-minute length of ECG, which was scheduled for analysis at 4 AM. After a series of calculating algorisms, we received the virtual planar vector parameters.Results: Patients with DM were elderly (65.61 ± 12.08 vs 59.41 ± 16.86 years, P < 0.001); higher morbidity of hypertension (76.38% vs 58.14%, P < 0.001) and coronary artery disease (44.09% vs 32.41%, P = 0.03); thicker interventricular septum (10.92 ± 1.77 vs 10.08 ± 1.96 mm, P < 0.001) and left ventricular posterior wall (9.84 ± 1.38 vs 9.39 ± 1.66 mm, P = 0.03); higher lipid levels and average heart rate (66.67 ± 12.04 vs 61.87 ± 13.36 bpm, P < 0.01); higher angle of horizontal QRS vector (HQRSA, -2.87 ± 48.48 vs -19.00 ± 40.18 degrees, P < 0.01); lower maximal magnitude of horizontal T vector (HTV, 2.33 ± 1.47 vs 2.88 ± 1.89 mm, P = 0.01) and maximal magnitude of right side T vector (2.77 ± 1.55 vs 3.27 ± 1.92 mm, P = 0.03), and no difference in angle of frontal QRS-T vector (FQRSTA, 32.77 ± 54.20 vs 28.39 ± 52.87 degrees, P = 0.74) compared with patients having NDM. After adjusting for confounding factors, DM was significantly effective on FQRSTA (regression coefficient -40.0, 95%CI -66.4 to -13.6, P < 0.01), HQRSA (regression coefficient 22.6, 95%CI 2.5 to 42.8, P = 0.03), and HTV (regression coefficient 0.9, 95%CI 0.2 to 1.7, P = 0.01). Confounding

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Risk of Mortality in Individuals With Low QRS Voltage and Free of Cardiovascular Disease

Cited by 41 publications

References 17 publications

Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

Electrocardiographic Impact of Myocardial Diffuse Fibrosis and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

QRS voltage is a predictor of in‐hospital mortality of acutely ill medical patients

Changes of Virtual Planar QRS and T Vectors Derived from Holter in the Populations with and without Diabetes Mellitus

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