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Abstract Purpose: The Tpeak-Tend interval of the T wave has emerged as a new electrocardiographic marker of increased transmural dispersion of ventricular repolarization. We aimed to determine the presence of cardiac conduction system disorders in patients with systemic arterial hypertension (SAH) who have altered Tpeak-Tend interval of the T wave. Methods: The 67 patients with SAH were divided into two groups. Those with prolonged (≥ 77 ms) Tpeak-Tend intervals, 21 (31%) patients were in the study group. Those with normal (< 77 ms) Tpeak-Tend intervals, 46 (69%) patients were in the control group. Alteration of ventricular repolarization manifested as a prolongation of the Tpeak-Tend interval was detected by computerized electrocardiographic analysis tools. Results: The median value of QRS complex duration was significantly wider in the study group as compared to the control group (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). There was a significantly greater incidence of left anterior hemiblock in the study group (14% vs. 0% p < 0.04). The median value of the QTc interval was significantly greater in the study group (440 ± 26 vs. 422 ± 15 p < 0.01). There was a significantly greater incidence of patients with prolonged QTc interval in the study group (33% vs. 11% p < 0.02). The median value of the Tpeak-Tend interval was significantly greater in the study group (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), as well as, the Tpeak-Tend/QTc ratio in the study group (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusion: There is a significantly greater ventricular repolarization disorders and abnormalities of the cardiac conduction system in SAH patients who possess altered Tpeak-Tend interval of the T wave.
Resumen Objetivo: El intervalo Tpico-Tfinal de la onda T es un marcador electrocardiográfico de la dispersión transmural aumentada de la repolarización ventricular. Investigamos la presencia de trastornos del sistema de conducción cardíaca en pacientes con hipertensión arterial sistémica (HA) que poseen alterado el intervalo Tpico-Tfinal de la onda T. Métodos: Los 67 pacientes con HA fueron divididos en dos grupos. Aquellos con intervalos de Tpico-Tfinal prolongados (≥ 77 ms), 21 (31%) pacientes (grupo de estudio). Aquellos con intervalos normales (< 77 ms) Tpico-Tfinal, 46 (69%) pacientes (grupo control). Los intervalos Tpico-Tfinal fueron medidos por herramientas de análisis electrocardiográfico computarizado. Resultados: El valor mediano de la duración del complejo QRS fue significativamente más amplio en el grupo de estudio (110 ± 12 ms vs. 94 ± 8 ms p < 0.001). Hubo una incidencia significativamente mayor de hemibloqueo anterior izquierdo en el grupo de estudio (14% vs. 0% p < 0.04). El valor mediano del intervalo QTc fue significativamente mayor en el grupo de estudio (440 ± 26 vs. 422 ± 15 p < 0.01). Hubo una incidencia significativamente mayor de pacientes con intervalo QTc prolongado en el grupo de estudio (33% vs. 11% p < 0.02). El valor mediano del intervalo Tpico-Tfinal fue significativamente mayor en el grupo de estudio (84 ± 5 ms vs. 65 ± 4 ms p < 0.001), así como el cociente Tpico-Tfinal/QTc (0.19 ± 0.1 vs. 0.16 ± 0.1 p < 0.001). Conclusión: Existe una alteración de la repolarización ventricular significativamente mayor y anomalías del sistema de conducción cardíaca en pacientes con HA que poseen alteración del intervalo Tpico-Tfinal de la onda T.
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Objective To explore the changes and clinical significance of transmural dispersion of repolarization (TDR) in patients with hypertrophic cardiomyopathy (HCM). Methods Seventy-two patients with HCM (observation group) and 72 healthy subjects (control group) in Shengjing Hospital of China Medical University were selected from January 2015 to October 2017. The 12-lead conventional electrocardiogram was performed on enrolled personnel in 2 groups to measure T-peak T-end (TpTe), correct the QT interval (QTc), QT interval dispersion (QTd) and TpTe/QTc. The observation group underwent 24 h dynamic electrocardiography. The patients were divided into ventricular arrhythmia subgroup and non- ventricular arrhythmia subgroup according to the results of 24 h dynamic electrocardiography, and the TpTe, QTc, QTd and TpTe/QTc were compared. Results The TpTe, QTc, QTd and TpTe/QTc in observation groups were significantly higher than those in control group:(112.5 ± 11.2) ms vs. (105.6 ± 9.2) ms, (396.5 ± 13.5) ms vs. (385.3 ± 12.5) ms, (36.5 ± 6.4) ms vs. (32.4 ± 5.4) ms and 0.289 ± 0.016 vs. 0.262 ± 0.015, and there were statistical differences (P＜0.05). In observation group, the 24 h dynamic electrocardiogram result showed that 47 patients had ventricular arrhythmia (ventricular arrhythmia subgroup) and 25 patients had not ventricular arrhythmia (non-ventricular arrhythmia subgroup). The TpTe, QTc, QTd and TpTe/QTc in ventricular arrhythmia subgroup were significantly higher than those in non-ventricular arrhythmia subgroup: (114.4 ± 14.5) ms vs. (110.3 ± 12.2) ms, (402.5 ± 15.2) ms vs. (392.0 ± 12.1) ms, (37.5 ± 6.2) ms vs. (35.4 ± 6.5) ms and 0.292 ± 0.016 vs. 0.285 ± 0.015, and there were statistical differences (P＜0.05). Conclusions The values of TpTe, QTc, QTd and TpTe/QTc reflect the increase of transmural dispersion of repolarization in patients with HCM, and have a certain predictive effect on ventricular arrhythmia.
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Objective To analyze the changes of Tpeak-Tend interval (Tp-Te) in patients with type 2 diabetes mellitus (T2DM),and to explore the relationship between the changes of Tp-Te and ventricular arrhythmias. Methods A total of 112 patients with T2DM were selected from the Department of endocrinology of our hospital from June 2014 to May 2016 (T2DM group),and 65 subjects underwent healthy physical examination in our hospital were selected as the normal control group (NC group) during the same period.The general data,fasting plasma glucose (FPG),glycosylated hemoglobin (HbA1c),Tp-Te,Tp-Te dispersion (Tp-Ted) were compared between the two groups.The changes of Tp-Te in patients with or without ventricular arrhythmia in T2DM group were also analyzed. Results The FPG,HbA1c,LDL-C,TC and heart rate were significantly higher in T2DM group than in the NC group (P<0.05).Compared with the control group,V5 lead Tp-Te and Tp-Ted in T2DM group was significantly prolonged (P<0.05).IN T2DM group,V5 lead Tp-Te and Tp-Ted were significantly longer in patients with ventricular arrhythmias than in patients without ventricular arrhythmia (P<0.05).Multiple logistic regression analysis showed that the increase of HbA1c and FPG were independent risk factors for prolonged Tp-Ted,and Tp-Ted was an independent risk factor for ventricular arrhythmia. Conclusion Patients with T2DM are more likely to have prolonged Tp-Ted.The prolonged Tp-Te and Tp-Ted could increase the incidence of ventricular arrhythmias.
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Background: Risk stratification of patients with acute pulmonary embolism (PE) allows assessment of individual prognosis and guides therapeutic decision making. Several electrocardiographic (ECG) markers measuring the arrhythmogenic substrate(s) in ventricular myocardium are used to identify the high-risk patients with acute PE. However studies on Tp-e/QT ratio in patients with acute PE are lacking therefore the present study is aimed to evaluate the in hospital prognostic significance (death and in hospital adverse clinical events [ACE]) of Tp-e/QT ratio at admission in acute PE patients. Materials and methods: This was a retrospective study that included adult patients who had been diagnosed with acute PE and were treated at our hospital between January 2012 and March 2016. After considering inclusion and exclusion criteria, data was collected from eligible patients. All ECG recordings were digitalized and evaluated by a computer based program. Tp-e and QT intervals were measured from all precordial leads and mean value is calculated. Statistical analysis was performed using SPSS 17.0. Receiver operator characteristic (ROC) curves were computed for the Tp-e/QT ratio to assess the optimal cutoff values for predicting mortality and ACE. Univariate logistic regression analysis for the predictors of in hospital events (death and in hospital ACE) in the study population was done. The statistical significance was considered for a p-value <0.05. Results: A total of 48 patients were included in the study with mean age of 37.95 years (±13.86) and male: female ratio of 1.18:1. Patients with pulmonary embolism have mean Tp-e/QT ratio of 0.25 and the range of Tp-e/QT ratio was 0.18 to 0.29. In regression analysis, a Tp-e/QT ratio ≥0.26 increased the risk of death (P = 0.03) and a Tp-e/QT ratio ≥0.25 increased the risk of ACE (P = 0.01) significantly.
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Objective: To explore the effect of trimetazidine (TMZ) on T-peak (Tp) to T-end (Te) interval of resting ECG in patients with unstable angina pectoris (UAP) after percutaneous coronary intervention (PCI). Methods: We investigated 94 UAP patients with PCI and 76 of them ifnished the study as 2 groups. Control group,n=42, the patients received conventional treatment, and TMZ group,n=34, in addition to conventional treatment, the patients received TMZ 60 mg at 0.5 to 1 hour before PCI. The changes of Tp to Te interval before and after PCI were calculated, serum levels of creatine kinase (CK), creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) at before and at 6, 24 hours after PCI were compared between 2 groups. Ventricular arrhythmia was recorded during PCI. Results: Both groups had shortened Tp to Te intervals after PCI, and TMZ group had more shortened Tp to Te interval, bothP0.05. The occurrence rate of ventricular arrhythmia in Control group was higher than that in TMZ group (12.52% vs 5.16%) during PCI,P<0.05. Compared with Control group, TMZ group had lower levels of CK, CK-MB and cTnI at 6, 24 hours after PCI, allP<0.05. Conclusion: TMZ could decrease Tp to Te interval of resting ECG, prevent ventricular arrhythmia and reduce the relevant myocardial injury in UAP patients after PCI.
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Objective To evaluate the outcome of incomplete revasculariszation by percutaneous coronary intervention (PCI) in elderly patients with coronary artery disease.Methods Data of 48 patients (age≥75 years old) underwent incomplete coronary revascularization during the period from 2008 to 2011 were collected.Their data before PCI and the 6 months follow-up results were comparatively analyzed.Results Six months after incomplete coronary revascularization,the LVEF was higher than that before revascularization ((48.10 ± 7.19)％ vs (39.82 ± 8.23)％) and BNP declined significantly ((575.17 ± 67.27) ng/L vs (793.57 ± 87.53)ng/L).T peak-T end (Tp-Te) √RR and Tp-Te/QT also declined significantly (Tp-Te √RR:(96.38 ± 10.79)ms vs (147.81 ± 17.32)ms;Tp-Te/QT:(0.25 ±0.05) vs (0.30 ±0.07)) (P ＜0.05).Six months after PCI,LVEDV and LVESV were higher than those before surgery,but there was no significant difference(P ＞ 0.05).Conclusion Incomplete coronary revascularization can improve heart function and stability of cardiac electrophysiology in elderly patients with coronary artery disease,but it can not prevent the development of left ventricular remodeling.
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Torsade de pointes (TdP) is a devastating form of polymorphic ventricular arrhythmia associated with corrected QT (QTc) interval prolongation. TdP usually terminates spontaneously but frequently recurs and may degenerate to ventricular fibrillation. The present report describes a case of TdP in a patient being transferred to the postanesthetic care unit following an emergency laparoscopic appendectomy. The patient had undergone open heart surgery 1 week before. Retrospective electrocardiogram analysis revealed the patient had QTc and Tpeak-Tend interval prolongation that had gone unrecognized. We believe TdP may have been induced by accentuation of sympathetic nervous system during emergence from general anesthesia.
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Humans , Anesthesia, General , Appendectomy , Arrhythmias, Cardiac , Electrocardiography , Emergencies , Long QT Syndrome , Retrospective Studies , Sympathetic Nervous System , Thoracic Surgery , Torsades de Pointes , Ventricular FibrillationABSTRACT
The finger flexor injuries are very difficult to treat satisfactorily. It is usually said that the earlier the treatment performed, the better result obtained. But the delicasy of the hand anatomy and its function as well as the absence of the hand surgeon in the first aid care make the problem more complex. Even if we made the primary treatment to the flexor tendon injuries, some disabilities are often remained. We have treated fifty eight cases of old flexor tendon injuries in forty eight patients, the results can be summarized as follows. 1. The cause of the tendon damage is due to the laceration injury in the majorities of the cases. T,he tendon injuries are especially common between the late second and the early third decade. 2. In the injury of the Zone II with pulley distortion, the pulley reconstruction using palmaris longus or fascia from other sites will prevent bowstring and help the tendon function. 3. The Zone II can be subdivided into two subspecific areas. The proximal area is from the distal palmar crease to the midoprtion of porximal phalanx and the distal one is from the midportion of the proximal phalanx to the insertion of the sublimis tendon. In the proximal area one can repair the injured tendon directly after removal of the A1 and about proximal half of the A2 pulley without any subsequent bowstring if the tendon and its tunnel is relatively well preserved. Thus one can convert this proximal portion of Zone II to Zone III. So the proximal area of the Zone II should be differentiated from the remaining distal part of the Zone II. 4. At six months after the operation the result of the operation was analyzed by the percentage of the recovery, which was calculated by the postoperative active range of the interphalangeal joints divided by one hundred seventy five degrees that means the available total range of motion of normal interphalangeal joints. Excluding the cases with the tenodesis or arthrodesis, the total result revealed good or excellent in about ninty percentages with this method. 5. There were two fingers that showed a postoperative lumbrical plus state in Zone II, which were recovered spontaneously within three to four months postoperatively. So it is considered that the relative shortening of the lumbrical muscles can be treated and overcome conservatively by the active use of the fingers, and there is no need to perform an lumbrical tenotomy to correct this kind of muscle imbalance.