Application of two indexes in the evaluation of carbon monoxide toxic heart disease / 中华急诊医学杂志

Objectives:To investigate the relationship between heart rate adjusted QT dispersion (QTcd) and soluble growth stimulating gene 2 protein (sST2) and the severity and prognosis of patients with acute carbon monoxide toxic heart disease.Methods:Retrospective analysis was performed on 135 patients with acute carbon monoxide toxic heart disease admitted to the Emergency Medical Department of our hospital from January 2017 to 2020. Blood sST2, creatine kinase isoenzyme (CK-MB) and troponin I(cTnI) concentrations were recorded at 3 h, 12 h, 2 d and 3 d immediately after admission.The patient was measured and calculated on the day of admission,2 d,3 d and QTcd at discharge.According to the toxicity of carbon monoxide in heart disease severity was divided into mild heart disease group (58 cases), moderate heart disease group (45 cases), severe heart disease group (32 cases), according to whether severe heart disease were divided into severe group (32 cases) and non severe group (103 cases), according to whether the patients death in patients with severe heart disease.Results:Thirty-two of the 135 patients had severe toxic heart disease, with an incidence of 23.7%.In the severe group, sST2, cTnI and CK-MB increased from 24 h and 2 d after admission, and the detected values were all higher than those of the non-severe group and the normal control group, with statistically significant differences ( P<0.05).Before treatment, there were statistically significant differences in sST2 and QTcd between the toxic group and the non-severe group and the normal control group ( P<0.05).After 2 d and 3 d poisoning, there were statistically significant differences between the two groups ( P<0.05). ROC curve analysis showed that the area under the sST2 curve was 0.726, 95% CI was 0.555-0.898, sensitivity was 56.3%, specificity was 94.1%, and truncation was 88.5 ng/mL.The area under the QTcd curve was 0.745, 95% CI was 0.602-0.889, sensitivity was 56.3%, specificity was 82.4%, and truncation value was 68.5 ms.The area under the combined detection curve was 0.939, 95% CI was 0.874-1.000, sensitivity was 81.3%, specificity was 91.2%. Conclusions:In patients with acute carbon monoxide toxic heart disease, the level of sST2 increased earlier than THAT of cTnI and CK-MB, and the combined observation of sST2 and QTcd can be used as an indicator for early prediction of acute carbon monoxide toxic heart disease and its severity.

Effects of lidocaine oropharyngeal spray applied before endotracheal intubation on qt dispersion in patients undergoing coronary artery bypass grafting: a prospective randomized controlled study

Abstract Objective: To investigate the effects of lidocaine oropharyngeal spray applied before endotracheal intubation on hemodynamic responses and electrocardiographic parameters in patients undergoing coronary artery bypass grafting. Methods: A total of 60 patients who underwent coronary artery bypass grafting surgery were included in this prospective randomized controlled study. Patients were randomly divided into two groups, the topical lidocaine group (administration of 10% lidocaine oropharyngeal spray, five minutes before laryngoscopy and endotracheal intubation) and the control group. Both groups were compared with each other in terms of main hemodynamic parameters including mean arterial pressure and heart rate, as well as P and QT wave dispersion durations, before and after endotracheal intubation. Results: The groups were similar in terms of age, gender, and other demographics and basic clinical characteristics. There was a statistically significant difference between the groups in terms of QT dispersion durations after laryngoscopy and endotracheal intubation. The increase in QT dispersion duration was not statistically significant in the topical lidocaine group, whereas the increase in QT dispersion duration was statistically significant in the control group. When the groups were compared in terms of P wave dispersion durations, there were significant decreases in both groups, but there was no significant difference between the groups. Conclusion: Our study revealed that the topical lidocaine administration before endotracheal intubation prevented increase of QT dispersion duration in patients undergoing coronary artery bypass grafting. Trial Registration: NCT03304431

QT Interval Dispersion Behavior in Patients With and Without Obstructive Coronary Artery Disease Undergoing Exercise Test

Abstract Background: Stress test is used to detect coronary artery disease (CAD). The QTc interval dispersion (dQTc) is an electrocardiographic index of ventricular repolarization heterogeneity. Some researchers have linked transient myocardial ischemia induced by physical exertion with increased heterogeneity of ventricular repolarization measured by dQTc. Objectives: To study the patterns of dQT in patients with and without chronic obstructive CAD and to define a reliable cutoff point for dQT that could become a diagnostic criterion for myocardial ischemia. Methods: We retrospectively analyzed the electrocardiogram in resting and in exercise of 63 patients submitted to exercise test and cardiac catheterization. We divided the patients into three groups: true negative (VN), true positive (VP) and false positive (FP). VN: patients with coronary lesion lower than 70% and exercise test without myocardial ischemia; VP: individuals with stenosis greater than 70% in coronary arteries and a test suggestive of myocardial ischemia; FP: people with stenosis lower than 70% in the coronary arteries and stress test with ischemia criteria. Values of p < 0.05 were considered statistically significant. Results: Resting dQTc was not different among the three groups. However, for the dispersion of the QTc interval in exercise was, respectively, 47 ± 17 ms, 72 ± 42 ms, and 61 ± 31 ms for VN, VP and FP (p = 0.003). Conclusions: Obstructive chronic coronary disease patients have an increase in dQTc during exercise. Measurement of dQTc may be helpful in the diagnosis of myocardial ischemia in the stress test.

P-wave and QT Interval Dispersion Analysis in Children with End Stage Renal Disease on Regular Hemodialysis

Objectives: The consequences of hemodialysis on P-wave dispersion and QT dispersion have not been unequivocally documented and understood and may be complex. To investigate homogeneity disorders of atrial conduction and ventricular repolarization and tendency to develop various arrhythmias by demonstrating the effects of hemodialysis in children with end stage renal disease through assessment of P-wave dispersion and QT dispersion (By electrocardiograghy).Methods:Twenty end stage renal disease patients on conventional hemodialysis for at least 12 months and twenty healthy, age and sex matched volunteers were included. Patients underwent echocardiography to exclude any abnormalities of cardiac valves or muscle. A 12-lead electrocardiogram was undertaken in order to measure minimal and maximal (P wave and QT interval) durations, P wave dispersion and QT dispersion.Results:In patient group, males were 13, females were 7 with mean age of 11.9 ± 3.4 years, mean P wave dispersion and QT dispersion were significantly longer than control group. P wave dispersion was significantly shorter after dialysis (mean= 34 ± 13.1 ms) than before dialysis (mean=42.4 ± 14 ms), whereas QT dispersion was longer after dialysis (59 ± 19 ms) than before dialysis (55.5 ± 17 ms) but the differences in QT dispersion was not significant. Also, there was no correlation between neither P wave dispersion nor QT dispersion and the electrolytes.Conclusion:P wave dispersion and QT dispersion was found to be higher in end stage renal disease children on regular hemodialysis than healthy control subjects, indicating heterogeneity disorders of atrial conduction and ventricular repolarization in these patients and tendency to develop various arrhythmias

P-Wave and QT Dispersion in Children With βeta-Thalassemia

Aim:This study aimed atassessingP-wave and QT interval dispersion in children with β-thalassemia and to correlate them with various laboratory and echocardiographic data. Methodology:Subjects comprised of 30 children with β-thalassemia major as the patient group. 30 healthy children matched for age and sex served as the control group. All patients were evaluated clinically as well as by echocardiography and 12 leads ECG. The type of study isprospective case control study.Results:There was a statistically significant increase ofInterventricular Septal end diastole(IVSd),Interventricular Septal end systole(IVSs),Left Ventricular Internal Diameter end diastole (LVIDd), Left Ventricular Internal Diameter end systole(LVIDs) andLeft Ventricular Posterior Wall end diastole(LVPWd) in patients as compared to controls (Mean ±SD = 0.950±0.166, 0.863±0.103, 3.983±0.456, 2.947±0.535and 0.797±0.165 respectively) (P < 0.05). Moreover, there were a significant increase of LV mass (Mean ±SD = 107.267±26.736, P= 0.002) and LV mass index of the studied patients (Mean ±SD = 106.900±22.651, P = 0.005)compared to the controls. There were significant decrease ofejection fraction(EF%)(Mean ±SD = 60.373 ± 8.088, P = 0.032)and fractional shortening(FS%) (Mean ±SD = 29.495 ± 4.171, P = 0.026) of the studied patients compared to control group. Both P wave dispersion (PWd) (Mean ±SD = 33.667 ± 13.767, P = 0.029) and QT dispersion (QTd) (Mean ±SD = 53.000 ± 18.411, P = 0.001) were significantly higher in patients compared to controls. There was a significant positive correlation between PWd and serum ferritin(r =0.551,P-value=0.002), LVIDd (r =0.406,P-value=0.026), LVPWd(r =0.461,P-value=0.010), LV mass (r =0.412,P-value=0.024), and LV mass index(r = 0.379,P-value=0.039). While, there were a significant positive correlations between QTd and serum ferritin (r =0.654,P-value <0.001), LVIDd (r = 0.388,P-value =0.034), LV mass (r = 0.454,P-value =0.012)and LV mass index (r = 0.456,P-value =0.011). Conclusion:P wave dispersion and QT dispersion were prolonged in children with β-thalassemia major denoting cardiac autonomic dysfunction with homogeneity disorders of atrial conduction and ventricular repolarization in these patients

Evaluation of the QTc internal and QT dispersion in patients with newly detected clinical hypothyroidism

Background: Thyroid hormones play an important role in the orchestration of various metabolic functions in the body and thus thyroid dysfunction can produce dramatic cardiovascular effects. Electrocardiographic changes such as bradycardia, low voltage complexes, and varying degrees of heart block are commonly recognized in hypothyroid patients. Hypothyroidism has been found to be associated with increased cardiovascular morbidity and mortality. Hence, it is important to investigate the ECG profile in these patients. The present study was aimed at evaluating the QTc interval and QT dispersion, an indicator of inhomogeneity of ventricular repolarisation and cardiac autonomic modulation in patients with newly detected clinical hypothyroidism.Methods: 50 patients with newly detected clinical hypothyroidism and 50 healthy controls were included in the study. The ECG was recorded and the heart-rate, QTc interval and QT dispersion were calculated.Results: The mean heart-rate was found to be significantly (p <0.05) reduced in hypothyroid patients when compared to healthy controls. The mean QTc interval and QT dispersion were significantly increased in hypothyroid patients when compared to controls. QTmin and QTmax of cases and controls also showed a statistically significant difference.Conclusion: Thus, the present study confirms the role of thyroid hormones on the cardiovascular system, particularly on ventricular repolarisation and cardiac autonomic modulation. Hence, early and prompt therapy with levothyroxine may help to prevent the adverse events resulting from cardiovascular dysfunction.

QT dispersion in irritable bowel syndrome

Background: The pathogenesis of irritable bowel syndrome (IBS) has not been fully elucidated. The gastrointestinal tract have a well-differentiated intrinsic nervous system and also this system is connected with nervous system. The symptoms of IBS are related with autonomic nervous system (ANS). It was also possible to see cardiovascular symptoms due to this link. This link can influence QT dispersion (QTd). The aim of this case control study is to show the cardiac effects of IBS by changes in QTd.Methods: There were 56 newly diagnosed patients with IBS and 60 control subjects were included in this study. IBS was diagnosed using the new Roma IV Criterias. Standard 12-lead electrocardiogram (ECG) were taken in both two groups. QTd and corrected QTd (QTcd), QT max, QT min, QT avarage, Corrected QT (QTc) min, QTc max, QTc avarage values were calculated with Bazzet Formula from rest ECGs.Results: There were 56 newly diagnosed patients with IBS and 60 control subjects were included in the study (p:0.94). The mean age of the patients and control patients were 51.75±10.41 years and 48.41±9.72 (p: 0.53) years, respectively. QTd and corrected QTd (QTcd), QT max, QT min, QT mean, Corrected QT (QTc) min, QTc max, QTc mean values were calculated. QTd and QTcd values were found to be significantly higher in the patients with IBS (40.2±7.18; 34.1±6.18 / 52±9.8; 50.6±7.61 Msec, respectively). It is concluded that, QTd (p: 0.022) and QTcd (p: 0.032) were significantly incresased in the IBS.Conclusions: Activation of ANS in the patients with IBS can affect QT period in ECG.

An easy and reliable way to prevent electrocardiographic deteriorations of patients undergoing off-pump coronary artery bypass surgery: preoperative anxiolytic treatment

Abstract Objective: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. Methods: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. Results: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). Conclusion: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.

The effect of Huoxue-Yixin decoction combined with atorvastatin on NT-pro and QTd in patients with chronic heart failure / 国际中医中药杂志

Objective To observe the effect of Huoxue-Yixin decoction combined with atorvastatin on NT-pro and QTd in patients with chronic heart failure (CHF). Methods A total of 120 patients with chronic heart failure in our hospital from December 2016 to June 2017 were enrolled in this study. The subjects were randomly divided into the control group (n=60) and the treatment group (n=60). The control group were treated with conventional treatment,and the treatment group were treated with Huoxue-Yixin decoction combined with atorvastatin. The two groups were treated for 30 days. The NT-ProBNP, QTd, QTcd and LVESD, LVEDD, LVEF of the two groups before and after treatment were compared.Results The QTd at 2 d(45.6 ± 8.9 ms vs.64.0 ± 18.2 ms,t=-7.029),14 d(44.3 ± 6.8 ms vs.55.7 ± 12.8 ms,t=-6.092)in the experiment group were significantly lower than those of control group(P<0.01).The level of QTcd at 2 d(50.8 ± 10.1 ms vs.71.2 ± 19.8 ms,t=7.109), 14 d(48.1 ± 9.7 ms vs.63.1 ± 13.1 ms,t=7.128)of the experiment group were significantly lower than those of control group(P<0.01).After treatment,the NT-ProBNP(494.58 ± 331.61 ng/L vs.594.71 ± 382.65 ng/L,t=-1.532), LVESD(40.23 ± 3.13 mm vs.49.72 ± 3.99 mm,t=-14.495)and LVEDD(58.22 ± 3.30 mm vs.65.11 ± 3.95 mm, t=-10.720)of the treatment group were significantly lower than those of the control group(P<0.01).The LVEF (69.82% ± 4.72% vs. 50.34% ± 4.02%, t=-10.720) of the treatment group was significantly higher than the control group(P<0.01).Conclusions The Huoxue-Yixin decoction combined with atorvastatin can reduce the level of NT-ProBNP, QTd and QTcd in patients with CHF, can significantly improve cardiac function.

Changes of QT Dispersion in Hemodialysis Patients after Administrating Zhigancao Decoction () / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the alteration of QT dispersion (QTd) and QTc dispersion (QTcd) in hemodialysis patients after oral administration of Zhigancao Decoction (, Roasted Licorice Decoction, RLD).</p><p><b>METHODS</b>To investigate the alteration of QTd and QTcd in 68 routine hemodialysis patients before and after hemodialysis with 12-lead electrocardiogram (ECG) after orally administrated RLD for 4 weeks. Blood was also taken for measurement of plasma electrolytes, liver function, renal function, hemoglobin (Hgb) and hematocrit (HCT).</p><p><b>RESULTS</b>After hemodialysis, QTd and QTcd were prolonged evidently; the difference was significant between before and after hemodialysis (P<0.05). After RLD orally administrated for 4 weeks, QTd and QTcd only slightly increased after dialysis compared with pre-dialysis (P>0.05). The QTd and QTcd of the post-therapy-post-dialysis decreased significantly compared with the pre-therapy-post-dialysis (P<0.05). There were no other significant changes in other variables (post-therapy-pre-dialysis vs. pre-therapy-pre-dialysis, or post-therapy-post-dialysis vs. pre-therapy-post-dialysis;P>0.05). After therapy, the number of patients with supraventricular arrhythmia, occasional ventricular premature beat and multiple ventricular premature beat were decreased from 15 to 4, 10 to 2 and 7 to 1, respectively.</p><p><b>CONCLUSION</b>RLD therapy not only lowered the increased QTd and QTcd after hemodialysis, but also displayed a safety profile.</p>

Value of QT Dispersion in Myocardial Remodeling and Prognosis in Heart Failure Patient with Preserved Ejection Fraction / 医学研究杂志

Objective To evaluate the value of QT dispersion in myocardial remodeling and prognosis in patients with chronic heart failure with preserved ejection fraction (HFpEF).Methods Totally 76 patients admitted to hospital due to HFpEF in the period between years 2013-2015 were recruited.A 12-lead ECG,chest radiograph,echocardiogram,and serum for biochemical analysis were obtained at baseline.Patients were followed for 10.3 ± 2.6 months,the basic information of patients,medication details,laboratory examination,echocardiography and other clinical data,and the mortality rate and the incidence of the disease were collected and analyzed.Results During the follow-up,11 patients died (14.5％) with QT dispersion for 81.6 ± 25.7ms.65 patients survived,including 27 cases of readmission for cardiovascular events (35.5％) with QT dispersion for 73.8 ± 24.7ms.The remaining 38 patients without cardiovascular events (50％) with QT dispersion 64.8 ± 28.7ms.Univariate analysis showed that QTcmax and QTcd were the risk factors for death and cardiovascular events in HFpEF patients (P ＜ 0.05).Cox's proportional hazards regression model analysis found that QTcd was the independent risk factors for death and cardiovascular events in HFpEF patients (P ＜ 0.05).Pearson's correlation analysis showed that QTcd was significantly related with left ventricular end systolic diameter (P ＜ 0.05),left ventricular end diastolic diameter (P ＜ 0.05).Conclusion QT dispersion has clinical value in the diagnosis of myocardial remodeling and prognosis in patients with HFpEF.

Effect of different anti -platelet therapies on QT dispersion in patients with acute coronary syndrome after percutaneous coronary intervention / 中国基层医药

Objective To investigate the effect of anti -platelet therapy on QT dispersion(Qtd,QTcd)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods 80 patients with ACS and undergoing PCI were divided into the control group and the observation group by the random number table method,40 cases in each group.The control group was treated with routine antiplatelet therapy,oral administra-tion of aspirin and clopidogrel,while the observation group was treated with intensive antiplatelet therapy and tirofiban based on the treatment in the control group.The changes of platelet aggregation function and inflammation indices before and after treatment were compared between the two groups.The changes of QT dispersion in the two groups were monitored by electrocardiogram.Both two groups were followed up for 1 year,and the incidence rate of adverse events was analyzed statistically.Results Before treatment,there were no significant differences in platelet aggrega-tion indices (MPAR,PRU),levels of inflammatory factors (hs -CRP,sCD40L)and QT dispersion between the two groups (all P >0.05).After treatment,MPAR and PRU in the observation group were lower than those in the control group[(30.26 ±8.42)%,(114.36 ±10.26)U vs.(39.33 ±9.4)%,(143.86 ±12.65)U](t =4.542,11.454,all P <0.05),the levels of hs -CRP and sCD40L were lower than those in the control group[(2.12 ±0.62 )mg/L, (1.71 ±0.94)μg/L vs.(2.94 ±0.44)mg/L,(2.76 ±1.23)μg/L](t =6.748,4.289,all P <0.05),and QTd and QTcd were also lower than those in the control group [(25.41 ±3.32)ms,(26.12 ±4.26 )ms vs.(29.52 ± 2.98)ms,(30.51 ±3.97)ms](t =5.826,4.768,all P <0.05).During the follow -up,the incidence rate of rest-enosis or thrombosis in stent of the observation group was lower than that of the control group (2.50% vs.15.00%) (χ2 =3.913,P <0.05).Conclusion The application of tirofiban anti -platelet therapy in patients with ACS after PCI can reduce the inflammatory responses,reduce platelet aggregation rate,shorten QT dispersion and reduce the incidence of adverse events.

ECGEstudio: Herramienta para el diagnóstico de enfermedades cardiovasculares / ECGEstudio: Tool for the diagnosis of cardiovascular diseases

El objetivo del siguiente trabajo es exponer el diseño y las principales características de un sistema desarrollado para el análisis del ECG de reposo. Este está compuesto por: un módulo que adquiere el ECG y lo transmite vía USB, una computadora personal y una aplicación desarrollada sobre la tecnología .NET. Se realizan estudios de tendencia, no encontrados en los electrocardiógrafos tradicionales, para analizar la evolución de la Hipertrofia Ventricular, la tendencia a la Muerte Súbita y la recuperación posterior a un infarto cardiaco. Para el diseño del sistema, se siguió una estructura por capas con niveles de abstracción que faciliten su mantenimiento y actualización. Microsoft Visual Studio 2010 fue el entorno de desarrollo y SQL Server Compact el gestor de base de datos. El sistema fue evaluado con señales simuladas y provenientes de voluntarios con frecuencias cardíacas entre 30 y 240 latidos por minutos, obteniéndose una sensibilidad superior al 99 por ciento en la detección de complejos QRS(AU)

The aim of this paper is to discuss the main features of a system developed for the resting ECG analysis. The proposed system is composed of an electronic ECG module for signal acquisition and transmission via USB, a personal computer and a Windows application developed on .NET technology. Trend studies, based on several ECGs from a patient, are made to analyze the evolution of ventricular hypertrophy, the propensity to sudden death and the recovering degree after suffering a heart attack; this kind of study is not available in traditional electrocardiographs. The proposed was designed as a layered structure with levels of abstraction to facilitate their continued maintenance and updating. Microsoft Visual Studio 2010 was selected as the development environment and SQL Server Compact as the database manager. The system was tested with simulated ECGs and signals from volunteers with heart rates between 30 and 240 beats per minute, giving sensitivity in QRS complex detection over 99 percen(AU)

The effect of esmolol on corrected-QT interval, corrected-QT interval dispersion changes seen during anesthesia induction in hypertensive patients taking an angiotensin-converting enzyme inhibitor / Efeito de esmolol sobre o intervalo QT corrigido e alterações da dispersão do intervalo QT corrigido observadas durante a indução da anestesia em pacientes hipertensos que receberam um inibidor da enzima conversora de angiotensina / Efecto del esmolol sobre el intervalo QT corregido y alteraciones de la dispersión del intervalo QT corregido observadas durante la inducción de la anestesia en pacientes hipertensos que recibieron un inhibidor de la enzima convertidora de la angiotensina

BACKGROUND AND OBJECTIVES: The importance of minimizing the exaggerated sympatho-adrenergic responses and QT interval and QT interval dispersion changes that may develop due to laryngoscopy and tracheal intubation during anesthesia induction in the hypertensive patients is clear. Esmolol decreases the hemodynamic response to laryngoscopy and intubation. However, the effect of esmolol in decreasing the prolonged QT interval and QT interval dispersion as induced by laryngoscopy and intubation is controversial. We investigated the effect of esmolol on the hemodynamic, and corrected-QT interval and corrected-QT interval dispersion changes seen during anesthesia induction in hypertensive patients using angiotensin converting enzyme inhibitors. METHODS: 60 ASA I-II patients, with essential hypertension using angiotensin converting enzyme inhibitors were included in the study. The esmolol group received esmolol at a bolus dose of 500 mcg/kg followed by a 100 mcg/kg/min infusion which continued until the 4th min after intubation. The control group received 0.9% saline similar to the esmolol group. The mean blood pressure, heart rate values and the electrocardiogram records were obtained as baseline values before the anesthesia, 5 min after esmolol and saline administration, 3 min after the induction and 30 s, 2 min and 4 min after intubation. RESULTS: The corrected-QT interval was shorter in the esmolol group (p = 0.012), the corrected-QT interval dispersion interval was longer in the control group (p = 0.034) and the mean heart rate was higher in the control group (p = 0.022) 30 s after intubation. The risk of arrhythmia frequency was higher in the control group in the 4-min period following intubation (p = 0.038). CONCLUSION: Endotracheal intubation was found to prolong corrected-QT interval and corrected-QT interval dispersion, and increase the heart rate during anesthesia induction with propofol in hypertensive patients using angiotensin ...

JUSTIFICATIVA E OBJETIVO: É óbvia a importância de minimizar as respostas simpatoadrenérgicas exageradas e o intervalo QT e a dispersão do intervalo QT que podem ocorrer por causa de laringoscopia e intubação traqueal durante a indução da anestesia em pacientes hipertensos. Esmolol diminui a resposta hemodinâmica à laringoscopia e à intubação. Porém, o efeito de esmolol sobre a redução do intervalo QT prolongado e a dispersão do intervalo QT induzida pela laringoscopia e intubação é controverso. Pesquisamos o efeito de esmolol sobre a hemodinâmica e o intervalo QT corrigido e as alterações da dispersão do intervalo QT observadas durante a indução da anestesia em pacientes hipertensos que receberam inibidores da enzima conversora de angiotensina (IECA). MÉTODOS: Foram incluídos no estudo 60 pacientes, estado físico ASA I-II, com hipertensão arterial essencial e que receberam IECA. O grupo esmolol recebeu uma dose em bolus de 500 mcg kg-1, seguida por infusão contínua de 100 mcg kg-1 min-1 até o quarto minuto após a intubação. O grupo controle recebeu solução salina a 0,9%, semelhantemente ao grupo esmolol. Os valores da pressão arterial média e da frequência cardíaca e os registros do eletrocardiograma foram obtidos durante a fase inicial pré-anestesia, cinco minutos após a administração de esmolol e solução salina, três minutos após a indução e 30 segundos, dois minutos e quatro minutos após a intubação. RESULTADOS: O intervalo QT corrigido foi menor no grupo esmolol (p = 0,012), o intervalo de dispersão do intervalo QT corrigido foi maior no grupo controle (p = 0,034) e a frequência cardíaca média foi maior no grupo controle (p = 0,022) 30 segundos após a intubação. O risco da frequência de arritmia foi maior no grupo controle no quarto minuto após a intubação (p = 0,038). CONCLUSÃO: Descobrimos que a intubação traqueal prolonga o intervalo e a dispersão do intervalo QT corrigido e aumenta a frequência cardíaca durante a indução da ...

JUSTIFICACIÓN Y OBJETIVO: Es evidente la importancia que tiene minimizar las respuestas simpatoadrenérgicas exageradas y el intervalo QT y la dispersión del intervalo QT que pueden ocurrir a causa de la laringoscopia e intubación traqueal durante la inducción de la anestesia en pacientes hipertensos. El esmolol disminuye la respuesta hemodinámica a la laringoscopia y a la intubación. Sin embargo, su efecto sobre la reducción del intervalo QT prolongado y la dispersión del intervalo QT inducida por la laringoscopia e intubación es controvertido. Investigamos el efecto del esmolol sobre la hemodinámica y el intervalo QT corregido, y las alteraciones de la dispersión del intervalo QT observadas durante la inducción de la anestesia en pacientes hipertensos que recibieron inhibidores de la enzima convertidora de la angiotensina. MÉTODOS: Fueron incluidos en el estudio 60 pacientes, estado físico ASA I-II, con hipertensión arterial esencial y que recibieron inhibidores de la enzima convertidora de la angiotensina. El grupo esmolol recibió una dosis en bolos de 500 mcg/kg, seguida de infusión continua de 100 mcg/kg/min hasta el cuarto minuto después de la intubación. El grupo control recibió una solución salina al 0,9%, de forma similar al grupo esmolol. Los valores de la presión arterial media y de la frecuencia cardíaca y los registros del electrocardiograma fueron obtenidos durante la fase inicial preanestésica, 5 min después de la administración del esmolol y la solución salina, 3 min después de la inducción, y 30 s, 2 min y 4 min después de la intubación. RESULTADOS: El intervalo QT corregido fue menor en el grupo esmolol (p = 0,012), el intervalo de dispersión del intervalo QT corregido fue mayor en el grupo control (p = 0,034) y la frecuencia cardíaca media fue mayor en el grupo control (p = 0,022) 30 s después de la intubación. El riesgo de la frecuencia de arritmia fue mayor en el grupo control en el cuarto minuto después de la intubación ...

Alteraciones electrocardiográficas en anorexia nervosa: revisión crítica de la literatura / Electrocardiographic abnormalities in anorexia nervosa: a critical review of the literature

Introducción: La anorexia nervosa (AN) es un trastorno de la conducta alimentaria y, entre sus causas de mortalidad, las arritmias cardiacas y la muerte súbita son frecuentes, por lo que es indispensable la monitorización electrocardiográfica. Se han descrito muchos hallazgos con resultados contradictorios, por lo que es necesaria una revisión crítica de la literatura científica. Metodología: Revisión de los estudios relevantes sobre cambios electrocardiográficos en AN, consultados en PubMed desde 1974 hasta febrero de 2014, utilizando los términos MeSH: Eating disorders, nervosa anorexia, sinusal bradycardia, QT prolongation, QT dispersion, electrocardiography, EKG, electrocardiogram. Resultados y discusión: Las dos alteraciones más comunes reportadas incluyen la bradicardia sinusal y los cambios en la repolarización evidenciados en prolongación del QT e incremento de su dispersión. Los trastornos electrolíticos parecen ser la causa de estas alteraciones en algunos pacientes, pero otras razones se discuten en detalle, como la desviación del eje del QRS a la derecha, la alteración en variabilidad de la frecuencia cardiaca, R en derivación V6 de bajo voltaje, disminución de la amplitud del QRS y onda T y alargamiento del QRS. La mayoría de los autores hablan de reversibilidad de los cambios después del tratamiento. Conclusiones: Estos resultados siguen apoyando la necesidad de valorar a los pacientes con AN con electrocardiogramas inicial y de seguimiento, para el diagnóstico temprano y tratamiento de alteraciones cardiovasculares relacionadas con alta morbimortalidad. También apoyan la necesidad del uso racional de psicofármacos para no aumentar el riesgo de arritmias cardiacas y muerte súbita.

Background: Anorexia nervosa is an eating disorder in which cardiac arrhythmias and sudden death are frequent causes of mortality, which makes electrocardiographic monitoring indispensable in these patients. There are many suggestive findings but results are contradictory, making a critical review of the scientific literature is necessary. Methods: The most relevant studies on electrocardiographic (EKG) changes in patients with AN, found in PubMed from 1974 to February 2014, were reviewed using the MeSH terms: eating disorders, nervosa anorexia, sinus bradycardia, QT prolongation, QT dispersion, electrocardio graphy, EKG, and electrocardiogram. Findings and discussion: The two most common EKG findings reported in the literature are sinus bradycardia and changes in depolarization, as shown by prolongation and increased dispersion of the QT interval. Electrolyte disturbances seem to be the cause of these disturbances in some patients, but other reasons are also discussed in detail, such as QRS right axis deviation, disturbances of heart rate variability, low R wave voltage in V6, amplitude decrease of the QRS and T wave, and QRS prolongation. The majority of authors report that these changes are reversible after treatment of AN. Conclusions: These findings support the need for initial and follow-up EKGs in patients with AN and for early diagnosis and treatment of cardiovascular disturbances that are associated with morbidity and mortality. They also support the need for the rational use of psychop harmacology, and that does not increase the risk of arrhythmias and sudden death in these patients.

Influence of interventional treatment of ventricular septal defect on QT dispersion, corrected QT dispersion and the left ventricular voltage / 解放军医学杂志

Objective To investigate the influence of interventional treatment of ventricular septal defect (VSD) on QT dispersion (QTd), corrected QT dispersion (QTcd) and the left ventricular voltage. Methods Fifty patients with VSD, admitted from May 2010 to October 2011 for interventional occlusion therapy, were included in the present study. The electrocardiograms and echocardiography of the patients were analyzed before and 1 day and 6 months after interventional treatment, including QTd, QTcd, RV5, SV1, RaVL, SV3, left ventricular ejection fraction (EF) and fractional shortening (FS). The changes in QTd, QTcd and the left ventricular voltage (RV5+SV1, RaVL+SV3) were observed after interventional occlusion therapy. Results Compared with preoperative electrocardiogram, the QTd and QTcd were obviously shortened (P<0.05), and the left ventricular voltage (RV5+SV1, RaVL+SV3) declined significantly after interventional occlusion therapy (P<0.05). Conclusions The QTd and QTcd are shortened and left ventricular voltage lowered significantly after interventional occlusion treatment in VSD patients. Transcatheter interventional occlusion therapy can obviously improve electrical remodeling.

The study of the changes of QT dispersion and heart rate variability in children with ventricular contraction / 实用医学杂志

Objective To investigate the changes of QT dispersion and heart rate variability in children with ventricular contraction. Methods 50 healthy children who came for medical examinations at Chengdu Women′s and Children′s Central Hospital from January 2012 to January 2014 were selected as control group. 147 children with ventricular contraction admitted in Pediatric Intracardiac Department of Chengdu Women′s and Children′s Central Hospital from January 2012 to January 2014 were divided them into Benign Group (LownⅠ&LownⅡ) and Malignant Group(LownⅢ, LownⅣA, LownⅣB&LownⅤ) according to the results of Lown classification. Benign Group contained 90 cases while Malignant Group contained 57 cases. Difference in QT dispersion and indices of heart rate variability of the three groups were compared. Results There were no statistically differences between control group and benign group in QT dispersion (P > 0.05). QT dispersion of malignant group was much longer than that of control group and the differences had statistically meaning(P50 ms) of malignant group was much shorter than that of control group and benign group and the differences had statistically meaning (P< 0.01). SDNN, SDANN and SDNN index of benign group was shorter than that of control group and the differences had statistically meaning (P<0.05). Conclusions Heart rate variability of children with malignant ventricular contraction becomes significantly shorter and QT dispersion becomes significantly longer. Detection of QT dispersion and heart rate variability can effectively predict the risky degree of ventricular contraction in children.

QT Interval Abnormalities in Korean Women with Anorexia Nervosa / 대한정신약물학회지

OBJECTIVE: Anorexia nervosa carries the highest mortality of any psychiatric disorder with largely attributed to a cardiovascular etiology. The aim of this study was to evaluate QT alteration and the factors to influence the QT alteration. METHODS: We evaluated a hospital cohort of patients with anorexia nervosa (n=78) and age-matched healthy women (n=89). The QT, QT dispersion and U wave were measured from electrocardiograms in both patients and controls, and QT was corrected for heart rate using Bazett's formula. We also gathered the data for serum electrolytes, cholesterol, uric acid, creatinine, thyroid hormone, and bone mineral density. RESULTS: QT dispersion was significantly greater in patients with anorexia nervosa whereas corrected QT interval did not differ between groups. U wave tended to appear more frequently in patients with anorexia nervosa. QT dispersion was influenced by lowest ever body mass index and serum thyroid hormone. CONCLUSION: QT dispersion and U wave look to be more reliable index than heart rate-corrected QT, which may reflect arrhythmia potential in patients with anorexia nervosa. Lowest ever body mass index and current metabolic status could be predictive factors to cardiac arrhythmia in anorexia nervosa. Longitudinal follow-up study to evaluate risk as well as protective factors to cardiac mortality is warranted.

The influence of amiodarone on serum hs-CRP and QTd in patients with ventricular arrhythmia of coronary heart disease / 中国基层医药

Objective To observe the influence of amiodarone on serum high-sensitivity C-reactive protein (hs-CRP) and QT dispersion (QTd) in patients with ventricular arrhythmia of coronary heart disease.Methods 92 patients with ventricular arrhythmia of coronary heart disease were randomly divided into the observation group(n =50 cases) and the control group (n =42 cases).The patients in the observation group were treated through the conventional treatment plus amiodarone,while the patients in the control group were treated through the conventional treatment plus metoprolol.They were treated for two weeks.Serum hs-CRP and QTd were detected before and after treatment.Results The total effective rate of the observation group was 94％ and that was 83％ in the control group.There was significant difference between two groups (x2 =4.790,P ＜ 0.05).After treatment,the serum hs-CRP and QTd were decreased(t =2.009,2.019,11.020,4.975,P ＜ 0.05),those in the observation group were significandy lower than in the control group(t =2.018,5.102,P ＜ 0.05).Conclusion Amiodarone can decrease serum hs-CRP and QTd in patients with ventricular arrhythmia of coronary heart disease and improve patients' condition.

Conduction Abnormalities and Associated Factors in Korean Patients with Eating Disorders

OBJECTIVES: QT interval prolongation and dispersion known as indicators of an increased risk for ventricular arrhythmias and sudden death have been reported to be prolonged in patients with anorexia nervosa. The aims of this study were to compare conduction abnormalities in Korean patients with anorexia nervosa and bulimia nervosa, and to examine its relation with clinical and laboratory factors. METHODS: We retrospectively examined 45 women with anorexia nervosa and 75 women with bulimia nervosa who were assessed by 12-lead electrocardiogram at baseline. QT interval and corrected QT interval, QT dispersion of the difference between the longest and shortest QT intervals, and abnormal U wave were measured for conduction abnormalities. RESULTS: QT interval was significantly longer in patients with anorexia nervosa compared with those with bulimia nervosa. There were no differences in QTc (Corrected QT), QTd (QT dispersion) and abnormal U wave between patients with anorexia nervosa and those with bulimia nervosa. QTd was significantly correlated with the lowest ever lifetime body mass index (kg/m2) as well as the serum amylase level in patients with anorexia nervosa. CONCLUSIONS: These results suggest some conduction abnormalities reported in patients with anorexia nervosa are also found in patients with bulimia nervosa. It appears that severity of weight loss and purging behavior could affect the cardiac arrhythmia in patients with eating disorders. Appropriate attention should be paid to cardiac involvement in patients with eating disorders.