A patient with episodic chest pain, diaphoresis, amaurosis, and dizziness, along with a history of hypertension, presented with electrocardiographic findings of ST elevation in aVR, diffuse T-wave inversion, and QTc prolongation. Initial diagnosis of NSTEMI was reconsidered after coronary angiography excluded significant stenosis, revealing myocardial bridging. Echocardiography and cardiac MRI showed preserved function without ischemia. Markedly elevated plasma renin and urinary normetanephrine, along with a retroperitoneal mass, suggested paraganglioma. Laparoscopic resection confirmed a 4.0 × 3.5 cm paraganglioma. This case highlights the importance of recognizing atypical ECG patterns that may mimic ischemia in catecholamine-secreting tumors to guide timely diagnosis and intervention.
{"title":"Extensive T-Wave Inversion Associated With Chest Pain: Elucidating the Underlying Truth","authors":"Jing-Xiu Li, Xin-Xin Di, Min Gao, Xue-Qi Li","doi":"10.1111/anec.70102","DOIUrl":"https://doi.org/10.1111/anec.70102","url":null,"abstract":"<p>A patient with episodic chest pain, diaphoresis, amaurosis, and dizziness, along with a history of hypertension, presented with electrocardiographic findings of ST elevation in aVR, diffuse T-wave inversion, and QTc prolongation. Initial diagnosis of NSTEMI was reconsidered after coronary angiography excluded significant stenosis, revealing myocardial bridging. Echocardiography and cardiac MRI showed preserved function without ischemia. Markedly elevated plasma renin and urinary normetanephrine, along with a retroperitoneal mass, suggested paraganglioma. Laparoscopic resection confirmed a 4.0 × 3.5 cm paraganglioma. This case highlights the importance of recognizing atypical ECG patterns that may mimic ischemia in catecholamine-secreting tumors to guide timely diagnosis and intervention.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart failure (HF) is a major driver of global morbidity and mortality. Early identification of patients at risk remains challenging due to complex, multivariate clinical relationships. Machine learning (ML) methods offer promise for more accurate prognostication.
Objective
We evaluated the predictive value of electrocardiogram (ECG)–derived features and developed an ML model to stratify HF risk.
Methods
We analyzed a public cohort of 1061 patients, of whom 589 (55.5%) developed HF. Records were randomly divided into training (70%, n = 742) and test (30%, n = 319) sets. After preprocessing, we trained a random forest (RF) classifier. Performance on the test set was assessed via accuracy, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC). Feature selection employed Gini importance and the Boruta algorithm, while SHAP values provided model interpretability.
Results
The RF model achieved an AUC of 0.969, with 91.8% accuracy, 93.8% sensitivity, 89.4% specificity, and a 92.7% F1-score. The top predictors included ST depression (Oldpeak), maximum heart rate (MaxHR), ST-segment slope, and serum cholesterol. Confusion matrix analysis confirmed robust discrimination between HF and non-HF cases. SHAP interpretation reinforced the dominant influence of ECG-related indices and cholesterol on individual risk estimates.
Conclusion
An RF model leveraging ECG features demonstrated excellent performance for HF risk prediction and highlighted key physiologic markers. Future work should integrate comorbidity profiles and detailed biochemical data to further enhance clinical applicability.
{"title":"Predictive Modeling of Heart Failure Outcomes Using ECG Monitoring Indicators and Machine Learning","authors":"Jia Liu, Dan Zhu, Lingzhi Deng, Xiaoliang Chen","doi":"10.1111/anec.70097","DOIUrl":"https://doi.org/10.1111/anec.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure (HF) is a major driver of global morbidity and mortality. Early identification of patients at risk remains challenging due to complex, multivariate clinical relationships. Machine learning (ML) methods offer promise for more accurate prognostication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We evaluated the predictive value of electrocardiogram (ECG)–derived features and developed an ML model to stratify HF risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed a public cohort of 1061 patients, of whom 589 (55.5%) developed HF. Records were randomly divided into training (70%, <i>n</i> = 742) and test (30%, <i>n</i> = 319) sets. After preprocessing, we trained a random forest (RF) classifier. Performance on the test set was assessed via accuracy, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC). Feature selection employed Gini importance and the Boruta algorithm, while SHAP values provided model interpretability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The RF model achieved an AUC of 0.969, with 91.8% accuracy, 93.8% sensitivity, 89.4% specificity, and a 92.7% F1-score. The top predictors included ST depression (Oldpeak), maximum heart rate (MaxHR), ST-segment slope, and serum cholesterol. Confusion matrix analysis confirmed robust discrimination between HF and non-HF cases. SHAP interpretation reinforced the dominant influence of ECG-related indices and cholesterol on individual risk estimates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An RF model leveraging ECG features demonstrated excellent performance for HF risk prediction and highlighted key physiologic markers. Future work should integrate comorbidity profiles and detailed biochemical data to further enhance clinical applicability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the guiding role of transesophageal echocardiography (TEE) intraoperatively and its evaluative function postoperatively during left atrial appendage occlusion (LAAO) in patients with non-organic heart disease (NOHD).
Methods
In this retrospective observational study, a total of 48 patients with NOHD who underwent LAAO in the Department of Cardiology at The First People's Hospital of Lanzhou City from April 2020 to September 2022 were recruited. TEE findings during and after the procedure, cardiac chamber size, and cardiac function parameters at different surgical stages, postoperative occlusion efficacy, and complications were recorded. The application value of TEE in LAAO for patients with NOHD was evaluated.
Results
Comparative analysis TEE-measured the maximum diameter of the LAAO (22.37 ± 3.86 mm) was significantly smaller than X-ray angiographic measurement (23.45 ± 4.22 mm; p < 0.05). One month after radiofrequency ablation, TTE revealed a statistically significant reduction in left atrial diameter (p < 0.05). Four cases (8%) exhibited minor peri-device leak (< 3 mm), and no major complications occurred.
Conclusion
TEE shows significant application value for monitoring anatomical changes, guiding device sizing, and detecting peri-device leaks during and after LAAO for patients with NOHD.
{"title":"Role of Transesophageal Echocardiography in Guiding and Evaluating Left Atrial Appendage Occlusion in Patients With Non-Organic Heart Disease","authors":"Xiaoli Long, Xiaohu Guo, Jiwen Xie, Xiaoyong Fan, Dongxia Yang, Xiaoting Mao, Jing Xie","doi":"10.1111/anec.70098","DOIUrl":"https://doi.org/10.1111/anec.70098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the guiding role of transesophageal echocardiography (TEE) intraoperatively and its evaluative function postoperatively during left atrial appendage occlusion (LAAO) in patients with non-organic heart disease (NOHD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective observational study, a total of 48 patients with NOHD who underwent LAAO in the Department of Cardiology at The First People's Hospital of Lanzhou City from April 2020 to September 2022 were recruited. TEE findings during and after the procedure, cardiac chamber size, and cardiac function parameters at different surgical stages, postoperative occlusion efficacy, and complications were recorded. The application value of TEE in LAAO for patients with NOHD was evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Comparative analysis TEE-measured the maximum diameter of the LAAO (22.37 ± 3.86 mm) was significantly smaller than X-ray angiographic measurement (23.45 ± 4.22 mm; <i>p <</i> 0.05). One month after radiofrequency ablation, TTE revealed a statistically significant reduction in left atrial diameter (<i>p <</i> 0.05). Four cases (8%) exhibited minor peri-device leak (< 3 mm), and no major complications occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TEE shows significant application value for monitoring anatomical changes, guiding device sizing, and detecting peri-device leaks during and after LAAO for patients with NOHD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute occlusion of the left main coronary artery (LMCA) is one of the most severe forms of acute coronary syndrome. Besides the typical electrocardiogram changes, it is important to promptly recognize atypical changes and hasten revascularization therapy without delays. By analyzing specific cases, this work revealed that ST-segment elevation in aVR and aVL leads, accompanied by newly developed bifascicular block that cannot be ruled out as pathological, but without ST-segment deviation in the chest leads, highly indicates a rare electrocardiographic manifestation of complete occlusion of the LMCA. On the other hand, subtotal occlusion represents an even rarer scenario.
{"title":"A Rare Case of Atypical Electrocardiogram Changes in Subtotal Occlusion of the Left Main Coronary Artery","authors":"Honglin Ni, Zhicheng Gao, Jun Yao","doi":"10.1111/anec.70100","DOIUrl":"https://doi.org/10.1111/anec.70100","url":null,"abstract":"<p>Acute occlusion of the left main coronary artery (LMCA) is one of the most severe forms of acute coronary syndrome. Besides the typical electrocardiogram changes, it is important to promptly recognize atypical changes and hasten revascularization therapy without delays. By analyzing specific cases, this work revealed that ST-segment elevation in aVR and aVL leads, accompanied by newly developed bifascicular block that cannot be ruled out as pathological, but without ST-segment deviation in the chest leads, highly indicates a rare electrocardiographic manifestation of complete occlusion of the LMCA. On the other hand, subtotal occlusion represents an even rarer scenario.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lilli C. Wiedenmann, Joachim R. Ehrlich, Ilan Goldenberg
Background
Female LQTS patients are at high risk for arrhythmogenic events during the postpartum period due to hormonal influence on cardiac repolarization.
Methods
We observed an LQT1 patient with previous cardiac events during pregnancy and 3 weeks postpartum. We obtained ECG recordings and quantified sex hormone levels.
Estradiol and Progesterone decline rapidly after birth, correlating to QTc prolongation and elevated risk for arrhythmogenic events. Therefore, modification of pharmacological or device therapy may be considered.
{"title":"Postpartum QT Prolongation in a Long QT Syndrome Type 1 Patient","authors":"Lilli C. Wiedenmann, Joachim R. Ehrlich, Ilan Goldenberg","doi":"10.1111/anec.70079","DOIUrl":"https://doi.org/10.1111/anec.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Female LQTS patients are at high risk for arrhythmogenic events during the postpartum period due to hormonal influence on cardiac repolarization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We observed an LQT1 patient with previous cardiac events during pregnancy and 3 weeks postpartum. We obtained ECG recordings and quantified sex hormone levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Peak pregnancy: QTc: 420 ± 7 ms, Estradiol: 24.18 ng/mL, Progesterone: 218 ng/mL. Seven days postpartum: QTc prolongation to 455 ± 5 ms. 22 days postpartum: QTc: 452 ± 5, Estradiol: 0.013 ng/mL, Progesterone: 0.25 ng/mL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Estradiol and Progesterone decline rapidly after birth, correlating to QTc prolongation and elevated risk for arrhythmogenic events. Therefore, modification of pharmacological or device therapy may be considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alireza Oraii, David Conen, Linda S. Johnson, William F. McIntyre, Faith Kirabo, Kumar Balasubramanian, Alexander P. Benz, Jonas Oldgren, Jens Cosedis Nielsen, Jeff Healey
Background
Alcohol intake increases recurrence of atrial fibrillation (AF), but its relationship with cardiovascular outcomes is less well characterized. We aimed to study the association between different levels of alcohol intake and cardiovascular outcomes in a global cohort of patients with AF.
Methods
This is a cross-sectional analysis of the RE-LY AF registry, including 15,400 patients with AF who visited emergency departments in 47 countries. Patients were categorized into abstainers, light (< 7 standard drinks [SD]/week), moderate (7–13 SD/week), and heavy drinkers (≥ 14 SD/week). Outcomes were stroke/systemic embolism, heart failure (HF) hospitalization, and major bleeding at 1-year follow-up. Logistic mixed-effects regression models were used to calculate multivariable-adjusted odds ratios (aOR) with a 95% confidence interval (CI).
Results
In total,14,058 patients (mean age = 65.9 ± 14.7 years, 48.0% women) with available alcohol intake level data were included. This consisted of 12,091 (86.0%) abstainers, 1150 (8.2%) light, 458 (3.3%) moderate, and 359 (2.6%) heavy drinkers. The odds of stroke/systemic embolism were not significantly different in light (aOR = 0.88, 95% CI: 0.60–1.28), moderate (aOR = 0.91, 95% CI: 0.53–1.57) or heavy drinkers (aOR = 0.79, 95% CI: 0.41–1.54) compared to abstainers. Major bleedings were numerically, but not statistically significantly, higher among heavy drinkers (aOR = 1.52, 95% CI: 0.82–2.80). Compared to abstainers, alcohol intake was associated with fewer HF hospitalizations (light: aOR = 0.73, 95% CI: 0.58–0.92; moderate: aOR = 0.53, 95% CI: 0.35–0.78; heavy: aOR = 0.63, 95% CI: 0.41–0.98). However, this protective association was observed only in upper-middle and high-income countries (p-interaction < 0.001).
Conclusion
Alcohol drinking is unlikely to be associated with increased thromboembolic events in patients with AF, but may be associated with a lower risk of HF hospitalizations.
{"title":"Alcohol Intake and Cardiovascular Outcomes in Patients With Atrial Fibrillation: RE-LY AF Registry Analysis","authors":"Alireza Oraii, David Conen, Linda S. Johnson, William F. McIntyre, Faith Kirabo, Kumar Balasubramanian, Alexander P. Benz, Jonas Oldgren, Jens Cosedis Nielsen, Jeff Healey","doi":"10.1111/anec.70096","DOIUrl":"https://doi.org/10.1111/anec.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Alcohol intake increases recurrence of atrial fibrillation (AF), but its relationship with cardiovascular outcomes is less well characterized. We aimed to study the association between different levels of alcohol intake and cardiovascular outcomes in a global cohort of patients with AF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a cross-sectional analysis of the RE-LY AF registry, including 15,400 patients with AF who visited emergency departments in 47 countries. Patients were categorized into abstainers, light (< 7 standard drinks [SD]/week), moderate (7–13 SD/week), and heavy drinkers (≥ 14 SD/week). Outcomes were stroke/systemic embolism, heart failure (HF) hospitalization, and major bleeding at 1-year follow-up. Logistic mixed-effects regression models were used to calculate multivariable-adjusted odds ratios (aOR) with a 95% confidence interval (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total,14,058 patients (mean age = 65.9 ± 14.7 years, 48.0% women) with available alcohol intake level data were included. This consisted of 12,091 (86.0%) abstainers, 1150 (8.2%) light, 458 (3.3%) moderate, and 359 (2.6%) heavy drinkers. The odds of stroke/systemic embolism were not significantly different in light (aOR = 0.88, 95% CI: 0.60–1.28), moderate (aOR = 0.91, 95% CI: 0.53–1.57) or heavy drinkers (aOR = 0.79, 95% CI: 0.41–1.54) compared to abstainers. Major bleedings were numerically, but not statistically significantly, higher among heavy drinkers (aOR = 1.52, 95% CI: 0.82–2.80). Compared to abstainers, alcohol intake was associated with fewer HF hospitalizations (light: aOR = 0.73, 95% CI: 0.58–0.92; moderate: aOR = 0.53, 95% CI: 0.35–0.78; heavy: aOR = 0.63, 95% CI: 0.41–0.98). However, this protective association was observed only in upper-middle and high-income countries (<i>p</i>-interaction < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Alcohol drinking is unlikely to be associated with increased thromboembolic events in patients with AF, but may be associated with a lower risk of HF hospitalizations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144213970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Issa Asfour, Shahid Karim, Sair A. Tabraiz, Anwar Chahal, Mohammed Y. Khanji, Akil A. Sherif, Steve R. Ommen, Virend K. Somers, Grace Lin, Peter A. Brady
Background
Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging is a well-established indicator of myocardial fibrosis in hypertrophic cardiomyopathy (HCM). However, its association with electrocardiographic (ECG) abnormalities and the risk of atrial fibrillation (AF) remains uncertain.
Objectives
To investigate the association between the presence and burden of LGE with ECG characteristics, including precordial voltage, depolarization and repolarization abnormalities, and the incidence of AF in adults with HCM.
Methods
We conducted a retrospective cohort study of 144 adults with HCM with CMR and 12-lead ECG within 30 days of each other. LGE was quantified as a percentage of LV mass and categorized as absent, < 5%, or ≥ 5%. ECG parameters, including QRS voltage, repolarization abnormalities, and LVH criteria, were analyzed. Incident AF was assessed during a median follow-up of 6.6 years.
Results
LGE was present in 96 (67%) patients, with 21 (22%) having ≥ 5% LGE. There were no significant differences in precordial voltage between patients with and without LGE across Sokolow-Lyon, Cornell, and Romhilt-Estes criteria. However, T-wave inversion was more common in leads I (41% vs. 19%, p = 0.009), aVL (50% vs. 31%, p = 0.033), and V4 (41% vs. 23%, p = 0.035) in patients with LGE. Patients with ≥ 5% LGE had a significantly lower median LVEF (64% vs. 74%, p = 0.003). Additionally, LGE presence was not associated with an increased risk of incident AF (HR 1.8, 95% CI 0.6–5.3, p = 0.308).
Conclusion
In contrast to pediatric HCM, LGE is associated with specific ECG repolarization abnormalities, particularly T-wave inversion in lateral leads, but does not significantly affect precordial voltage in adults.
背景：心血管磁共振（CMR）成像的晚期钆增强（LGE）是肥厚性心肌病（HCM）心肌纤维化的一个公认指标。然而，其与心电图（ECG）异常和房颤（AF）风险的关系仍不确定。目的探讨成人HCM患者LGE的存在和负担与心电特征（包括心前电压、去极化和复极化异常）以及房颤发生率的关系。方法对144例HCM成人CMR和12导联心电图在30天内进行回顾性队列研究。将LGE量化为左室质量的百分比，并将其分为未见、<； 5%或≥5%。分析心电图参数，包括QRS电压、复极异常和LVH标准。在中位随访6.6年期间评估偶发性房颤。结果96例（67%）患者存在LGE，其中21例（22%）患者LGE≥5%。通过Sokolow-Lyon、Cornell和Romhilt-Estes标准，LGE患者和非LGE患者的心前电压无显著差异。然而，在LGE患者中，t波倒置在导联I （41% vs. 19%, p = 0.009）、aVL （50% vs. 31%, p = 0.033）和V4 （41% vs. 23%, p = 0.035）更常见。LGE≥5%的患者中位LVEF显著降低（64% vs. 74%, p = 0.003）。此外，LGE的存在与AF发生风险增加无关（HR 1.8, 95% CI 0.6-5.3, p = 0.308）。结论与儿童HCM相比，LGE与特定的ECG复极异常有关，特别是侧导联t波反转，但对成人心前电压无显著影响。
{"title":"Late Gadolinium Enhancement and Electrocardiographic Associations in Hypertrophic Cardiomyopathy","authors":"Issa Asfour, Shahid Karim, Sair A. Tabraiz, Anwar Chahal, Mohammed Y. Khanji, Akil A. Sherif, Steve R. Ommen, Virend K. Somers, Grace Lin, Peter A. Brady","doi":"10.1111/anec.70077","DOIUrl":"https://doi.org/10.1111/anec.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging is a well-established indicator of myocardial fibrosis in hypertrophic cardiomyopathy (HCM). However, its association with electrocardiographic (ECG) abnormalities and the risk of atrial fibrillation (AF) remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the association between the presence and burden of LGE with ECG characteristics, including precordial voltage, depolarization and repolarization abnormalities, and the incidence of AF in adults with HCM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of 144 adults with HCM with CMR and 12-lead ECG within 30 days of each other. LGE was quantified as a percentage of LV mass and categorized as absent, < 5%, or ≥ 5%. ECG parameters, including QRS voltage, repolarization abnormalities, and LVH criteria, were analyzed. Incident AF was assessed during a median follow-up of 6.6 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LGE was present in 96 (67%) patients, with 21 (22%) having ≥ 5% LGE. There were no significant differences in precordial voltage between patients with and without LGE across Sokolow-Lyon, Cornell, and Romhilt-Estes criteria. However, T-wave inversion was more common in leads I (41% vs. 19%, <i>p</i> = 0.009), aVL (50% vs. 31%, <i>p</i> = 0.033), and V4 (41% vs. 23%, <i>p</i> = 0.035) in patients with LGE. Patients with ≥ 5% LGE had a significantly lower median LVEF (64% vs. 74%, <i>p</i> = 0.003). Additionally, LGE presence was not associated with an increased risk of incident AF (HR 1.8, 95% CI 0.6–5.3, <i>p</i> = 0.308).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In contrast to pediatric HCM, LGE is associated with specific ECG repolarization abnormalities, particularly T-wave inversion in lateral leads, but does not significantly affect precordial voltage in adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144206853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is unclear to what extent silent atrial fibrillation (AF) is present in subjects previously undiagnosed with AF. The recently popular 7-day patch electrocardiography (ECG) monitoring may help answer this question.
Methods
In the Kitsuki and Usuki cities in Oita Prefecture, Japan, a study was conducted among subjects who underwent 7-day patch ECG monitoring (Heartnote) for silent AF screening during the national insurance health checkup between June and November 2023. Subjects were (1) 65–74 years old and have ≥ 1 of the following risk factors: hypertension, diabetes mellitus, stroke, transient ischemic attack, and underlying heart disease (heart failure and/or previous myocardial infarction) and (2) 75 years and older.
Results
A total of 571 subjects (307 females and 264 males, mean age 75.3 ± 5.4 years) were analyzed. Silent AF was detected in 16 out of 571 subjects (2.8%). Among those aged 75 years or older, silent AF was detected in 15 out of 291 subjects (5.2%). In multivariate analysis, among age, body mass index (BMI), hypertension, diabetes, stroke, and underlying heart disease, only age was the independent predictor of silent AF detection (odds ratio: 1.16, 95% confidence interval: 1.06–1.28, p < 0.01).
Conclusions
Seven-day patch ECG monitoring during the national insurance health checkup efficiently detected silent AF in individuals aged 75 years and older.
{"title":"Seven-Day Patch ECG Monitoring During National Insurance Health Checkup Efficiently Detected Silent Atrial Fibrillation in Individuals Aged 75 Years and Older","authors":"Miho Miyoshi, Nozomi Kodama, Hiroki Sato, Kazuhiro Masutomo, Hitoshi Kamiunten, Tetsuji Shinohara, Naohiko Takahashi","doi":"10.1111/anec.70092","DOIUrl":"https://doi.org/10.1111/anec.70092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>It is unclear to what extent silent atrial fibrillation (AF) is present in subjects previously undiagnosed with AF. The recently popular 7-day patch electrocardiography (ECG) monitoring may help answer this question.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the Kitsuki and Usuki cities in Oita Prefecture, Japan, a study was conducted among subjects who underwent 7-day patch ECG monitoring (Heartnote) for silent AF screening during the national insurance health checkup between June and November 2023. Subjects were (1) 65–74 years old and have ≥ 1 of the following risk factors: hypertension, diabetes mellitus, stroke, transient ischemic attack, and underlying heart disease (heart failure and/or previous myocardial infarction) and (2) 75 years and older.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 571 subjects (307 females and 264 males, mean age 75.3 ± 5.4 years) were analyzed. Silent AF was detected in 16 out of 571 subjects (2.8%). Among those aged 75 years or older, silent AF was detected in 15 out of 291 subjects (5.2%). In multivariate analysis, among age, body mass index (BMI), hypertension, diabetes, stroke, and underlying heart disease, only age was the independent predictor of silent AF detection (odds ratio: 1.16, 95% confidence interval: 1.06–1.28, <i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Seven-day patch ECG monitoring during the national insurance health checkup efficiently detected silent AF in individuals aged 75 years and older.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144197074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper reports 4 cases of ventricular preexcitation (WPW) accompanied by left bundle branch block (LBBB). WPW appeared intermittently in all cases: Case 1 involved a right-sided accessory pathway, while Cases 2–4 involved left-sided accessory pathways. The electrocardiographic characteristics of both right-sided and left-sided accessory pathways coexisting with LBBB are discussed.
{"title":"Analysis of 4 Cases of Left Bundle Branch Block With Ventricular Preexcitation","authors":"M. M. Li Yi, B. M. Li Xingjie","doi":"10.1111/anec.70091","DOIUrl":"https://doi.org/10.1111/anec.70091","url":null,"abstract":"<p>This paper reports 4 cases of ventricular preexcitation (WPW) accompanied by left bundle branch block (LBBB). WPW appeared intermittently in all cases: Case 1 involved a right-sided accessory pathway, while Cases 2–4 involved left-sided accessory pathways. The electrocardiographic characteristics of both right-sided and left-sided accessory pathways coexisting with LBBB are discussed.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 4","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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