Journal of electrocardiology最新文献

英文中文

The association between ST-segment depressions and sudden cardiac deaths and arrests after acute coronary syndrome 急性冠状动脉综合征后st段压低与心源性猝死和骤停之间的关系

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-10-11 DOI: 10.1016/j.jelectrocard.2025.154145

Konsta Kivimäki , Hanna Pohjantähti , Jussi Hernesniemi , Leo-Pekka Lyytikäinen , Juho Tynkkynen , Jani Rankinen

Aims of the study

ST-segment depression in the electrocardiogram (ECG) of acute coronary syndrome (ACS) patients has been associated with higher mortality. But still, its association to sudden cardiac deaths (SCDs) or sudden cardiac arrests (SCAs) has not yet been investigated. We analyzed the association between ST-segment depression in the ECG after angiography and the long-term incidence of SCD and SCA among ACS patients.

Methods

Retrospective data of 8565 consecutive ACS patients with a median follow-up time of 7.1 years were analyzed retrospectively. Patients with (n = 1957) and without (n = 6608) ST-segment depression in ECG after angiography were compared after stratification according to the location of ST-segment depression. Incidents of SCDs and SCAs were adjudicated using various sources detailing the circumstances leading to the events. Subdistribution regression (Fine-Gray) models were used in the association analyses.

Results

Lateral, inferior, and inferolateral ST-segment depression were associated with the long-term risk for SCD and SCA in age- and sex-adjusted analyses (p-value <0.05). However, only lateral ST-segment depression was associated with a higher risk for SCD (HR 1.58, 95 % CI 1.13–2.20, p-value 0.007) and SCA (HR 1.48, 95 % CI 1.12–1.96, p-value 0.006) when additionally adjusted with several cardiovascular risk factors. The results remained significant in lateral and inferolateral ST-segment depression even after excluding patients with LVEF ≤35 % at baseline.

Conclusion

Lateral, inferolateral, and inferior ST-segment depressions in ECG after angiography in ACS patients are associated with a significantly higher long-term risk for SCD and SCA.

研究目的：急性冠脉综合征（ACS）患者心电图st段下降与较高的死亡率相关。但是，其与心源性猝死（SCDs）或心源性骤停（SCAs）的关系尚未被研究。我们分析了ACS患者血管造影后心电图st段下降与SCD和SCA长期发病率之间的关系。方法：回顾性分析8565例ACS患者的资料，中位随访时间为7.1年。根据st段凹陷的位置，分层后比较血管造影后心电图出现st段凹陷患者（n = 1957）和未出现st段凹陷患者（n = 6608）。scd和sca事件的裁决使用了各种来源，详细说明了导致事件的情况。关联分析采用亚分布回归（Fine-Gray）模型。结果：在年龄和性别调整分析中，侧、下、下st段压低与SCD和SCA的长期风险相关（p值）。结论：ACS患者血管造影后心电图显示的侧、下、下st段压低与SCD和SCA的长期风险显著升高相关。

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引用次数: 0

The value of P wave parameters in predicting proximal or distal right coronary artery occlusion in patients with inferior myocardial infarction P波参数预测下壁心肌梗死患者右冠状动脉近端或远端闭塞的价值。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-10-11 DOI: 10.1016/j.jelectrocard.2025.154143

Suleyman Cagan Efe MD , Murat Karacam MD , Ali Furkan Tekatli MD , Baver Bozan MD , Mustafa Furkan Kilicarslan MD , Mustafa Kara MD , Muhammet Bulut MD , Tuba Unkun MD , Enver Yucel MD , Cem Doğan MD , Gulumser Sevgin Halil MD , Ozgur Yasar Akbal MD , Ali Karagoz MD

Background

Electrocardiography (ECG) provides valuable information for early diagnosis of myocardial infarction. It is known that the atria receive their blood supply primarily from branches originating from the proximal segments of the coronary arteries. This study aimed to evaluate whether P wave parameters on admission ECG can help determine proximal versus distal right coronary artery (RCA) occlusion in patients presenting with inferior myocardial infarction (IMI).

Methods

We retrospectively analyzed consecutive patients presenting with IMI to the emergency department between October 2022 and May 2023. After applying exclusion criteria, a total of 123 patients were included. Admission ECG parameters were analyzed in relation to the angiographically confirmed site of coronary occlusion.

Results

The study population was divided into two groups according to proximal or distal RCA occlusion. Demographic characteristics were similar between groups. Statistically significant differences were observed between groups in the following ECG parameters: QT dispersion, P wave terminal force, P wave peak time in leads V1 and V2, and ST elevation in lead V1.

In multivariable logistic regression analysis, ST elevation in lead V1 (OR 6.1; 95 % CI: 1.48–26.8; p = 0.013) and P wave peak time in lead V1 (OR 1.08; 95 % CI: 1.01–1.12; p = 0.008) were identified as independent predictors of proximal RCA occlusion. A added variable plot demonstrated that P wave peak time > 56 ms was significantly associated with increased probability of proximal coronary occlusion.

Conclusion

In patients presenting with inferior myocardial infarction, P wave peak time in lead V1 on admission ECG may serve as a useful, non-invasive marker in predicting proximal RCA occlusion.

背景：心电图（ECG）为早期诊断心肌梗死提供了有价值的信息。众所周知，心房的血液供应主要来自冠状动脉近段的分支。本研究旨在评估入院心电图P波参数是否有助于确定下段心肌梗死（IMI）患者近端与远端右冠状动脉（RCA）闭塞。方法：回顾性分析2022年10月至2023年5月期间急诊就诊的连续IMI患者。应用排除标准后，共纳入123例患者。分析入院心电图参数与造影确认的冠状动脉闭塞部位的关系。结果：根据RCA近端或远端咬合情况将研究人群分为两组。组间人口统计学特征相似。两组间心电图参数：QT离散度、P波末端力、V1导联和V2导联P波峰值时间、V1导联ST段抬高，差异均有统计学意义。在多变量logistic回归分析中，V1导联ST段抬高（OR 6.1; 95% CI: 1.48-26.8; p = 0.013）和V1导联p波峰值时间（OR 1.08; 95% CI: 1.01-1.12; p = 0.008）被确定为近端RCA闭塞的独立预测因子。增加的变量图显示，P波峰值时间bbb56ms与近端冠状动脉闭塞的可能性增加显著相关。结论：对于下位心肌梗死患者，入院心电图V1导联P波峰值时间可作为预测近端RCA闭塞的有效、无创指标。

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引用次数: 0

A novel multichannel sparse convolutional autoencoder for electrocardiogram signal compression 一种新的多通道稀疏卷积自编码器用于心电图信号压缩。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-10-10 DOI: 10.1016/j.jelectrocard.2025.154125

Tahir Bekiryazıcı, Mehmet Damkacı, Gürkan Aydemir, Hakan Gürkan

Electrocardiogram (ECG) signal compression is paramount in continuously monitoring cardiac patients, as it reduces data storage and transmission costs. Deep neural networks, particularly autoencoders, offer significant potential for compressing ECG signals by mapping them to lower-dimensional spaces. This paper presents a novel multichannel convolutional autoencoder model designed to compress ECG signals efficiently. The proposed approach encodes the ECG signal into a four-channel lower-dimensional space using a convolutional encoder, which is subsequently reconstructed by a deconvolutional decoder. Unlike traditional autoencoder-based methods, the first channel in the model remains unconstrained, while increasing levels of sparsity constraints are imposed on the remaining channels. Different quantization levels are applied to each channel to optimize compression further, reflecting the varying numerical ranges caused by the sparsity constraints. The quantized channels are then encoded using Huffman coding, resulting in a higher compression ratio. The model’s effectiveness is evaluated on a popular benchmark dataset, using normalized percent root mean square difference (PRDN) error and compression ratio as performance metrics. The proposed method achieves an average compression ratio of 20.23:1, with an average PRDN error of 9.86%, demonstrating its capability to compress ECG signals efficiently while maintaining reconstruction accuracy.

心电图（ECG）信号压缩在心脏病患者的连续监测中至关重要，因为它降低了数据存储和传输成本。深度神经网络，特别是自编码器，通过将心电信号映射到低维空间，为压缩心电信号提供了巨大的潜力。本文提出了一种新的多通道卷积自编码器模型，用于有效地压缩心电信号。该方法使用卷积编码器将心电信号编码到四通道低维空间中，然后通过反卷积解码器对其进行重构。与传统的基于自编码器的方法不同，模型中的第一个通道保持不受约束，而对其余通道施加越来越多的稀疏性约束。为了进一步优化压缩，对每个信道应用了不同的量化水平，以反映稀疏性约束引起的数值范围的变化。然后使用霍夫曼编码对量化信道进行编码，从而获得更高的压缩比。该模型的有效性在一个流行的基准数据集上进行了评估，使用归一化的百分比均方根差（PRDN）误差和压缩比作为性能指标。该方法的平均压缩比为20.23:1，平均PRDN误差为9.86%，能够在保持重构精度的前提下有效压缩心电信号。

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引用次数: 0

Narrow QRS tachycardia? What is the diagnosis? 窄QRS心动过速？诊断结果是什么？

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-10-08 DOI: 10.1016/j.jelectrocard.2025.154146

Victoria Fanucci B.S. , Utkarsh Kohli M.D

引用次数: 0

Transient atypical advanced interatrial block in a pre-adolescent with sequelae of rheumatic fever 青少年前风湿热后遗症的一过性非典型晚期房间传导阻滞。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-10-08 DOI: 10.1016/j.jelectrocard.2025.154141

Andrés Ricardo Pérez-Riera MD PhD , Raimundo Barbosa-Barros MD , Maurício da Silva Rocha MD PhD , Cynthia Aparecida da Silva Rocha MD , Luciano Evaristo Pereira Rejálaga MD , Kjell Nikus MD PhD

We present a case of a pre-adolescent girl with mitral stenosis caused by rheumatic fever. The 12‑lead ECG showed prolonged P-wave duration indicating interatrial block. In addition, the P waves in the inferior leads showed a transient atypical interatrial block with a triphasic pattern in lead II. The appearance of the atypical interatrial block resulted in the attenuation of the P terminal force in lead V1. Atypical interatrial block is associated with atrial cardiomyopathy and is a potential risk factor for atrial fibrillation or stroke.

我们提出的情况下，青春期前的女孩二尖瓣狭窄引起的风湿热。12导联心电图显示p波持续时间延长，提示房间传导阻滞。下导联P波表现为短暂性非典型房间传导阻滞，II导联呈三相型。非典型房间传导阻滞的出现导致V1导联P端力的衰减。非典型房间传导阻滞与心房心肌病有关，是心房颤动或中风的潜在危险因素。

引用次数: 0

Normal electrocardiographic patterns in school-aged children: Data from a sports cardiology screening program 学龄儿童的正常心电图模式：来自运动心脏病学筛查项目的数据。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-10-08 DOI: 10.1016/j.jelectrocard.2025.154142

Nouran Mostafa Mansour MD, Asmaa Ramadan Abdelnaby MD, Noran Ibrahim Khalil MD

Background and purpose of the study

Assessing pediatric ECG variations to enhance screening accuracy, thus helps address challenges in distinguishing normal developmental changes from potential cardiac pathology. This study aims to establish age- and sex-specific ECG reference patterns in healthy young athletes to improve clinical interpretation during pre-participation screening, thereby reducing false positives and optimizing referral practices.

Results

Of 320 patients evaluated at a cardio sports clinic, 243 healthy participants (114 aged 5–9 years; 129 aged 10–16 years) were included. No significant sex-based differences were found in age or weight within either age group. In the 10–16-year group, females had significantly higher heart rates (p = 0.020), while males had longer PR intervals (p = 0.011); no significant differences were observed in QTc or QRS durations. All participants demonstrated normal sinus rhythm and QRS axis. T-wave inversion patterns, commonly seen in leads V1–V3 among 5–9-year-olds and isolated to V1 in 10–16-year-olds. ECG abnormalities such as prolonged QTc or Wolff-Parkinson-White (WPW) pattern were infrequent, with only respiratory sinus arrhythmia being significantly more common in older females (p = 0.035).

Conclusion

The findings highlight the clinical implication of considering age and sex when interpreting pediatric ECGs, particularly in the context of sports screening. While most parameters showed no significant differences, the observed variations in heart rate and PR interval in older children suggest that sex-specific reference values may be beneficial in clinical practice.

研究背景和目的：评估儿童心电图变化以提高筛查准确性，从而有助于解决区分正常发育变化和潜在心脏病理的挑战。本研究旨在建立健康年轻运动员的年龄和性别特异性心电图参考模式，以改善参与前筛查时的临床解释，从而减少假阳性并优化转诊实践。结果：在一家心脏运动诊所评估的320例患者中，包括243名健康参与者（114名5-9岁；129名10-16岁）。在两个年龄组中，年龄和体重都没有明显的性别差异。在10-16岁组中，女性的心率明显较高（p = 0.020），而男性的PR间隔较长（p = 0.011）；QTc和QRS持续时间无显著差异。所有受试者均显示窦性心律和QRS轴正常。t波倒置型，常见于5-9岁儿童V1- v3导联，10-16岁儿童仅见V1导联。心电图异常，如延长QTc或Wolff-Parkinson-White （WPW）模式并不常见，只有呼吸窦性心律失常在老年女性中更为常见（p = 0.035）。结论：研究结果强调了在解释儿童心电图时考虑年龄和性别的临床意义，特别是在运动筛查的背景下。虽然大多数参数显示没有显著差异，但在年龄较大的儿童中观察到的心率和PR间期的变化表明，性别特异性参考值可能在临床实践中是有益的。

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引用次数: 0

A hemodynamically stable wide complex tachycardia: What is the diagnosis? 血流动力学稳定的宽复合心动过速：诊断是什么？

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-10-08 DOI: 10.1016/j.jelectrocard.2025.154144

Hannah E. Wey MD , Timothy W. Smith DPhil, MD

引用次数: 0

Increased fragmented QRS and decreased basophil in earthquake-related post-traumatic stress disorder 地震相关创伤后应激障碍中碎片化QRS增加和嗜碱性粒细胞减少。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-10-03 DOI: 10.1016/j.jelectrocard.2025.154140

Dilek Örüm , Yaşar Kapıcı , Sabri Abuş

Aims

Many people died or were injured in two consecutive huge earthquakes in Turkey in February 2023. The earthquakes caused serious psychiatric disorders including post-traumatic stress disorder (PTSD). This study aimed to compare various electrocardiography (ECG) parameters including fragmented QRS (fQRS) and complete blood count (CBC) parameters including basophil to lymphocyte ratio (BLR) of earthquake-exposed with and without post-traumatic stress disorder (PTSD) subjects.

Methods

ECG and CBC parameters were obtained from 47 earthquake-exposed with PTSD subjects and 51 earthquake-exposed without PTSD subjects. Additional psychiatric and general medical conditions that might affect ECG and CBC were excluded. The PTSD severity scale (PCL-5) and the Symptom Checklist-90-Revised (SCL-90-R) were used.

Results

Gender, age, education level, marital and smoking status, PTSD history, location at the time of earthquakes, and residence damage were similar between groups (p > 0.05). The SCL-90-R score of the earthquake-exposed with PTSD group was higher than the earthquake-exposed without PTSD group (p < 0.001). The fQRS count (p = 0.041), presence of fQRS (p = 0.024) and frontal QRS-T angle (p = 0.004) were significantly higher in the earthquake-exposed with PTSD group. This significance persisted for frontal QRS-T angle (adjusted p = 0.049) after controlling for the effects of age, gender, smoking status, post-earthquake migration, and body mass index (BMI) as covariance. After controlling for the effect of age, gender, and BMI in the earthquake-exposed with PTSD group, a significant correlation was detected between fQRS count and PCL-5 (r = 0.764, p < 0.001). The area under the ROC curve of basophil count was 0.857 (p < 0.001; 95 % CI (0.779–0.936)). In the binary logistic regression analysis, BLR contributed significantly to the model (p < 0.001).

Conclusions

This study suggests that there may be significant differences between surface ECG and CBC parameters of individuals with and without earthquake-related PTSD.

目的：2023年2月，土耳其连续两次大地震造成多人死亡或受伤。地震造成了严重的精神疾病，包括创伤后应激障碍（PTSD）。本研究旨在比较有和无创伤后应激障碍（PTSD）的地震暴露受试者的各种心电图（ECG）参数，包括碎片性QRS （fQRS）和全血细胞计数（CBC）参数，包括嗜碱性粒细胞与淋巴细胞比值（BLR）。方法：对47例地震暴露伴PTSD者和51例地震暴露无PTSD者进行心电图和CBC参数测定。排除了可能影响ECG和CBC的其他精神和一般医疗条件。采用PTSD严重程度量表（PCL-5）和症状量表（SCL-90-R）。结果：性别、年龄、文化程度、婚姻及吸烟状况、创伤后应激障碍（PTSD）史、地震发生地点、房屋受损情况组间差异无统计学意义（p < 0.05）。地震暴露后PTSD组的SCL-90-R评分高于地震暴露后无创伤后应激障碍组(p)。结论：本研究提示有无地震相关PTSD个体的体表心电图和CBC参数可能存在显著差异。

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引用次数: 0

Novel presentation of CACNA1C variant as neonatal complete atrioventricular block, heart failure and non-compaction cardiomyopathy with oligogenic influences 新生儿完全性房室传导阻滞、心力衰竭和非压实性心肌病伴少源性影响的CACNA1C变异的新表现。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-30 DOI: 10.1016/j.jelectrocard.2025.154139

Sydney R. Rooney MD , Brock Karolcik MD , Shawn West MD , Christopher Follansbee MD , Mousumi Moulik MD , Gaurav Arora MD

Pathogenic CACNA1C variants are associated with long QT syndrome, cardiac conduction disorders (CCD), short QT or Brugada syndromes, sudden cardiac death, and rarely hypertrophic cardiomyopathy. Neonatal complete AV block (CAVB) has not been previously reported in patients with CACNA1C-mutations. We present a neonate with CAVB, severe heart failure, and non-compaction cardiomyopathy, found to have a de novo, likely pathogenic, heterozygous CACNA1C variant and heterozygous variants of uncertain significance (VUS) in TNNI3K, GATA6, and PDHK1 genes. This case expands the CACNA1C-associated phenotype to include neonatal CAVB and suggests a potential oligogenic contribution to severe neonatal cardiac disease.

致病性CACNA1C变异与长QT综合征、心传导障碍（CCD）、短QT综合征或Brugada综合征、心源性猝死以及肥厚性心肌病有关。新生儿完全AV阻滞（CAVB）在cacna1c突变患者中尚未报道。我们报告了一个患有CAVB、严重心力衰竭和非压实性心肌病的新生儿，发现其在TNNI3K、GATA6和PDHK1基因中具有新发的、可能致病的杂合CACNA1C变异和不确定意义的杂合变异（VUS）。本病例将cacna1c相关表型扩展到包括新生儿CAVB，并提示可能的低基因性对严重新生儿心脏病的贡献。

引用次数: 0

Electrocardiographic LVH criteria: Poor diagnostic accuracy even with optimized cutoffs. Insights from MESA study 心电图LVH标准：即使使用优化的截止值，诊断准确性也较差。来自MESA研究的见解。

IF 1.2 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology

Pub Date : 2025-09-26 DOI: 10.1016/j.jelectrocard.2025.154138

José Nunes de Alencar , Sandro Pinelli Felicioni

Background

Electrocardiographic (ECG) “left ventricular hypertrophy (LVH) criteria” are widely used as surrogates for increased LV mass but show limited sensitivity. We evaluated their diagnostic performance against cardiac magnetic resonance (CMR) in a large population cohort.

Methods

We analyzed 4849 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with standardized digital 12‑lead ECGs and CMR-derived LV mass indexed to body surface area (LVMi). LVH was defined as LVMi >91 g/m² (men) and > 77 g/m² (women). We assessed Sokolow-Lyon, Cornell voltage, Cornell product, Peguero–Lo Presti, Sokolow-aVL, and MESA-LVH (SV1 + SV2 + RV5). Diagnostic accuracy was calculated for classic (“pre-specified”) thresholds and for cutoffs optimized by the Youden index. We also tested whether combining indices via elastic-net penalized logistic regression improved discrimination.

Results

LVH prevalence was 30.2 %. Across classic thresholds, sensitivities were very low (3.7–15.2 %) with high specificities (>94 %); likelihood ratios were modest (typical LR+ <4; LR− ≈ 0.89–0.96). Youden-optimized cutoffs improved sensitivity (48.9–64.8 %) at the expense of specificity (54.4–74.3 %), yielding weak LR+ (1.42–1.94) and LR− (0.64–0.71). Pooled area under the ROC curve (AUC) for individual indices ranged 0.62–0.66. An elastic-net model combining all indices did not enhance discrimination beyond the best single measure (AUC 0.646).

Conclusions

In MESA, ECG voltage criteria—whether applied at classic or optimized thresholds—show poor diagnostic performance for CMR-defined LVH. Aggregating indices provides no material gain. These findings support reframing voltage positivity as an amplitude-based electrical phenotype with prognostic value rather than a reliable diagnostic surrogate for structural hypertrophy.

Clinical trial registration

ClinicalTrials.gov Identifier NCT00005487.

背景：心电图（ECG）“左室肥厚（LVH）标准”被广泛用作左室重量增加的替代指标，但其敏感性有限。我们在一个大型人群队列中评估了它们对心脏磁共振（CMR）的诊断性能。方法：我们分析了4849名来自多民族动脉粥样硬化研究（MESA）的参与者，使用标准化的数字12导联心电图和cmr衍生的左室质量与体表面积（LVMi）指数。LVH的定义为LVMi >91 g/m2（男性）和> 77 g/m2（女性）。我们评估了Sokolow-Lyon、Cornell voltage、Cornell product、Peguero-Lo Presti、Sokolow-aVL和MESA-LVH （SV1 + SV2 + RV5）。根据经典（“预先指定的”）阈值和由约登指数优化的截止值计算诊断准确性。我们还测试了通过弹性网络惩罚逻辑回归组合指数是否能改善歧视。结果：LVH患病率为30.2%。在经典阈值上，敏感性非常低（3.7- 15.2%），特异性很高（bb0 - 94%）；结论：在MESA中，ECG电压标准——无论是应用于经典阈值还是优化阈值——对cmr定义的LVH的诊断性能较差。汇总指数不会带来实质收益。这些发现支持将电压阳性重构为具有预后价值的基于振幅的电表型，而不是结构肥大的可靠诊断替代品。临床试验注册：ClinicalTrials.gov标识符NCT00005487。

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引用次数: 0

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