Left ventricular hypertrophy detection using electrocardiographic signal.

Left ventricular hypertrophy (LVH) indicates subclinical organ damage, associating with the incidence of cardiovascular diseases. From the medical perspective, electrocardiogram (ECG) is a low-cost, non-invasive, and easily reproducible tool that is often used as a preliminary diagnosis for the detection of heart disease. Nowadays, there are many criteria for assessing LVH by ECG. These criteria usually include that voltage combination of RS peaks in multi-lead ECG must be greater than one or more thresholds for diagnosis. We developed a system for detecting LVH using ECG signals by two steps: firstly, the R-peak and S-valley amplitudes of the 12-lead ECG were extracted to automatically obtain a total of 24 features and ECG beats of each case (LVH or non-LVH) were segmented; secondly, a back propagation neural network (BPN) was trained using a dataset with these features. Echocardiography (ECHO) was used as the gold standard for diagnosing LVH. The number of LVH cases (of a Taiwanese population) identified was 173. As each ECG sequence generally included 8 to 13 cycles (heartbeats) due to differences in heart rate, etc., we identified 1466 ECG cycles of LVH patients after beat segmentation. Results showed that our BPN model for detecting LVH reached the testing accuracy, precision, sensitivity, and specificity of 0.961, 0.958, 0.966 and 0.956, respectively. Detection performances of our BPN model, on the whole, outperform 7 methods using ECG criteria and many ECG-based artificial intelligence (AI) models reported previously for detecting LVH.

Serum uric acid is associated with incident metabolic syndrome independent of body shape index and body roundness index in healthy individuals.

BACKGROUND AND AIMS: Elevated serum uric acid (SUA) levels, body shape index (BSI) and body roundness index (BRI) were associated with incident metabolic syndrome (MetS). We aimed to investigate the relationship among the SUA level, BSI, and BRI on the incidence of MetS. METHODS AND RESULTS: We retrospectively included 6221 healthy individuals from annual health exams at our hospital between 2016/1/1 and 2016/12/31. We defined hyperuricemia as SUA levels greater than 7 mg/dl in men and 6 mg/dl in women and MetS according to the contemporary definition. The study cohort included 6221 healthy individuals with an overall incidence rate of MetS of 9.8%. Compared with the normouricemic group, the hyperuricemic group had a greater incidence of MetS (17.2% vs. 9.6%, P < 0.001). After full adjustment for confounders, the SUA level was significantly associated with incident MetS in addition to body mass index (BMI) (adjusted OR [aOR]: 1.161, 95% CI: 1.071-1.259, P < 0.001), BRI (aOR: 1.196, 95% CI: 1.104-1.296, P < 0.001), and BSI (aOR: 1.297, 95% CI: 1.200-1.403, P < 0.001). Regarding the anthropometric indices, BMI and BRI were independent predictors of incident MetS, but the BSI lost its significant association in multivariate logistic regression analyses. In sensitivity analyses, various thresholds of elevated SUA levels remained associated with incident MetS. CONCLUSION: We showed a dose-response effect of SUA on incident MetS independent of BMI, BRI and BSI in healthy individuals. Future studies can use SUA levels to stratify cardiometabolic risk in healthy individuals. CLINICAL TRIALS: ClinicalTrials.gov with the identification number NCT03473951.

Elevated serum uric acid is associated with incident hypertension in the health according to various contemporary blood pressure guidelines.

BACKGROUND AND AIMS: Elevated serum uric acid (SUA) is associated with hypertension according to its traditional definition. We investigated the association between SUA and incident hypertension according to the European Society of Cardiology (ESC) and American Society of Cardiology (ACC) guidelines. METHODS AND RESULTS: In this retrospective cohort study, we enrolled 10,537 healthy individuals ≥30 years old who underwent a routine annual health examination with office blood pressure recorded at our hospital in 2016; of the participants, 7349 repeated the exam in 2017. According to the ESC and ACC guidelines, hypertension was defined as office BP ≥ 140/90 mmHg or ≥130/80 mmHg. Hyperuricemia (HUA) was defined as SUA ≥7 mg/dL in men and ≥6 mg/dL in women. The hypertension incidence was 5.8% among 6378 individuals in the ESC cohort and 19% among 4330 individuals in the ACC cohort. Incident hypertension was significantly more common in the hyperuricemic group than in the normouricemic group (ESC: 8.6% vs. 4.7%, P < 0.001; ACC: 25.5% vs. 16.9%, P < 0.001). In the fully adjusted multivariate logistic regression analyses, each increase in SUA was associated with an increase in incident hypertension risk (ESC: adjusted OR: 1.167, 95% CI: 1.061-1.284, P = 0.001; ACC: adjusted OR: 1.125, 95% CI: 1.044-1.213, P = 0.002). The association can be explained by a significant correlation of baseline SUA with the BP in the following year (r = 0.24, P < 0.001 for baseline SUA and SBP in the following year; r = 0.239, P < 0.001 for baseline SUA and DBP in the following year). CONCLUSION: Elevated SUA was associated with incident hypertension in healthy individuals according to various contemporary BP guidelines (ClinicalTrials.gov: NCT03473951). CLINICAL TRIALS: ClinicalTrials.gov with the identification number of NCT03473951.

Serum Uric Acid may be Associated with Left Ventricular Diastolic Dysfunction in Military Individuals.

INTRODUCTION: We investigated the correlation and association between serum uric acid (SUA) and left ventricular diastolic dysfunction (LVDD) criteria in military individuals. MATERIAL AND METHODS: We prospectively enrolled military individuals who visited our hospital for evaluation of electrocardiographic abnormalities detected at an annual health exam between January 1, 2018 and December 31, 2019. Hyperuricemia was defined as an SUA level ≥7 mg/dL in men and ≥6 mg/dL in women. The definitions of LVDD criteria and LV hypertrophy were according to contemporary echocardiographic guidelines. RESULTS: The study included 268 individuals (89% male), with a mean age of 32.9 ± 7.6 years and SUA of 6.1 ± 1.3 mg/dL. The hyperuricemic (n = 74) and normouricemic (n = 194) groups had no significant differences in lifestyle choices and baseline characteristics. Serum uric acid correlated weakly with heart size parameters (r = 0.354, P < .001 for left atrial diameter and r = 0.146, P = .017 for left ventricular mass index (LVMI) and average E/e' >14 (r = 0.204, P = .001). The hyperuricemic group had higher LVMI (87.6 g/m2 vs. 81.8 g/m2, P = .022), septal e' velocity <7 cm/s (14.9% vs. 5.2%, P = .019), lateral e' velocity <10 cm/s (27.0% vs. 11.3%, P = .003), and average E/e' >14 (4.1% vs. 0%, P = .020) values than the normouricemic group. In multivariate logistic regression analyses, SUA was significantly associated with septal e' velocity <7 cm/s (adjusted HR: 2.398; 95% CI, 1.427-4.030; P = .001). CONCLUSION: Elevated SUA was significantly associated with the presence of LVDD criteria, namely, septal e' velocity <7, in military individuals. Maintaining SUA levels within normal limits may prevent the development of LVDD.

Association between Low-Grade Inflammation and Left Ventricular Diastolic Dysfunction in Patients with Metabolic Syndrome and Hyperuricemia.

BACKGROUND: Hyperuricemia (HUA) induces inflammation and insulin resistance and is reportedly associated with left ventricular hypertrophy (LVH) and possibly with left ventricular diastolic dysfunction (LVDD). OBJECTIVES: To investigate associations among HUA, inflammation, and insulin resistance with LVDD. METHODS: We enrolled patients with metabolic syndrome (MetS) between August 1, 2017, and December 31, 2017. All participants underwent fasting blood tests and transthoracic echocardiography. HUA was defined as an serum uric acid level ≥ 7 mg/dl in men or ≥ 6 mg/dl in women. MetS was defined as at least three of the following Taiwanese criteria: central obesity, prehypertension, fasting glucose impairment, hypertriglyceridemia, and lower values of high-density lipoprotein cholesterol. LVDD was defined according to contemporary guidelines. RESULTS: The study included 63 patients (60% male) with a mean age of 53 ± 14 years and body mass index (BMI) of 29.4 ± 4.0 kg/m2. Prevalence rates of HUA, LVH, LVDD were 40%, 18%, and 10%, respectively. Baseline characteristics were similar between the HUA and normouricemia groups, except that the HUA group had significantly higher serum high-sensitivity interleukin 6 and tumor necrosis factor-alpha (TNF-α) levels. LVDD occurred more frequently in the HUA group (20.0% vs. 2.6%, p = 0.032). HUA was associated with LVDD [crude odds ratio (OR): 9.25, 95% confidence interval (CI): 1.01-84.7, p = 0.049]. In multivariate analysis, the most relevant factor associated with LVDD was TNF-α after adjustments for age, male sex, and body mass index (adjusted OR for TNF-α: 4.1, 95% CI: 1.02-16.5, p = 0.047). CONCLUSIONS: The association between HUA and LVDD partially reflected a low-grade inflammation due to elevated TNF-α rather than increased insulin resistance in MetS patients.

Myopericarditis and exertional rhabdomyolysis following an influenza A (H3N2) infection.

BACKGROUND: Acute myopericarditis and exertional rhabdomyolysis, two uncommon but well-described diseases with potentially life-threatening effects, are generally considered as independent clinical entities. However, they may in fact be pathophysiologically related under certain circumstances. This is the first ever report of influenza myopericarditis provoked by exertional rhabdomyolysis to the best of our knowledge. CASE PRESENTATION: A 25-year-old immunocompetent Chinese man presented with bilateral leg pain, dizziness, and shortness of breath on admission soon after completing vigorous training comprising running drills. Exertional rhabdomyolysis was diagnosed with 44 fold high serum creatine phosphokinase. Then he developed chest pain, pericardial effusion, changes of electrocardiography and positive troponin I suggestive of myopericarditis. Influenza A (H3N2) virus infection was confirmed by polymerase chain reaction analysis of nasopharyngeal wash samples. Other possible infective and autoimmune causes were excluded. Patient recovered completely with anti-inflammatory therapy and the supportive care. CONCLUSION: This case suggests that clinicians who treat patients with exertional rhabdomyolysis should be aware of the potential vulnerability to acute myopericarditis, especially in the presence of recent influenza A infection.

Expanding refractory rectus sheath hematoma: a therapeutic dilemma.

Rectus sheath hematoma is an uncommon but well-described complication of a tussive paroxysm. It is an accumulation of blood within the sheath of the rectus abdominis secondary to disruption of the epigastric vessels or the rectus muscle and is often misdiagnosed as acute abdomen. Increases in the number of elderly patients and the use of therapeutic anticoagulation may increase the prevalence and severity of rectus sheath hematomas encountered in clinical practice. Expanding rectus sheath hematomas are occasionally refractory to conservative treatment and may require hemostatic intervention. Here, we describe the case of an 87-year-old woman who presented with two separate rectus sheath hematomas that were precipitated by a paroxysm of coughing. Repeated computed tomography showed two separate expanding rectus sheath hematomas, which were not accompanied by obvious contrast extravasation on angiography. Empiric left inferior epigastric artery embolization resulted in rapid hemodynamic stabilization, and the hematomas shrank gradually. Early empiric transcatheter arterial embolization may be appropriate for patients who are poor surgical candidates and have enlarging hematomas that are refractory to conservative treatment.