Annals of Noninvasive Electrocardiology最新文献_第6页

Alcohol Intake and Cardiovascular Outcomes in Patients With Atrial Fibrillation: RE-LY AF Registry Analysis 房颤患者的酒精摄入和心血管预后：RE-LY AF登记分析

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-06-05 DOI: 10.1111/anec.70096

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.

背景：饮酒增加心房颤动（AF）的复发，但其与心血管预后的关系尚不清楚。我们的目的是研究全球房颤患者队列中不同水平的酒精摄入与心血管结局之间的关系。方法这是RE-LY房颤登记的横断面分析，包括47个国家的15400名房颤患者就诊急诊。患者分为不饮酒者、轻度饮酒者（7标准饮酒量[SD]/周）、中度饮酒者（7 - 13标准饮酒量[SD]/周）和重度饮酒者（≥14标准饮酒量/周）。1年随访结果为卒中/全身性栓塞、心力衰竭住院和大出血。采用Logistic混合效应回归模型计算多变量校正优势比（aOR），置信区间为95%。结果共有14058例患者（平均年龄= 65.9±14.7岁，其中48.0%为女性）具有可获得的酒精摄入水平数据。其中包括12091名（86.0%）戒酒者，1150名（8.2%）轻度饮酒者，458名（3.3%）中度饮酒者和359名（2.6%）重度饮酒者。与不饮酒者相比，轻度饮酒者（aOR = 0.88, 95% CI: 0.60-1.28）、中度饮酒者（aOR = 0.91, 95% CI: 0.53-1.57）或重度饮酒者（aOR = 0.79, 95% CI: 0.41-1.54）发生中风/全身栓塞的几率无显著差异。重度出血在数值上高于重度饮酒者，但无统计学意义（aOR = 1.52, 95% CI: 0.82-2.80）。与不饮酒者相比，酒精摄入与HF住院率降低相关(轻度：aOR = 0.73, 95% CI: 0.58-0.92；中度：aOR = 0.53, 95% CI: 0.35-0.78；重度：aOR = 0.63, 95% CI: 0.41-0.98)。然而，这种保护性关联仅在中高收入和高收入国家中观察到（p-相互作用<； 0.001）。结论：饮酒不太可能与房颤患者血栓栓塞事件增加相关，但可能与心衰住院风险降低相关。

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引用次数: 0

Late Gadolinium Enhancement and Electrocardiographic Associations in Hypertrophic Cardiomyopathy 肥厚性心肌病的晚期钆增强和心电图相关性

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-06-04 DOI: 10.1111/anec.70077

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。

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引用次数: 0

Seven-Day Patch ECG Monitoring During National Insurance Health Checkup Efficiently Detected Silent Atrial Fibrillation in Individuals Aged 75 Years and Older 国民保险健康检查期间7天贴片心电图监测可有效检测75岁及以上人群无症状心房颤动

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-06-03 DOI: 10.1111/anec.70092

Miho Miyoshi, Nozomi Kodama, Hiroki Sato, Kazuhiro Masutomo, Hitoshi Kamiunten, Tetsuji Shinohara, Naohiko Takahashi

Background

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.

背景目前尚不清楚未确诊房颤的无症状性心房颤动（AF）在多大程度上存在。最近流行的7天贴片心电图（ECG）监测可能有助于回答这个问题。方法在日本大分县的木月市和臼月市，对2023年6月至11月国民保险健康体检期间接受7天贴片心电图监测（Heartnote）进行无症状房颤筛查的受试者进行研究。受试者为：(1)65-74岁，有以下危险因素≥1项：高血压、糖尿病、中风、短暂性脑缺血发作和潜在心脏病（心力衰竭和/或既往心肌梗死）；(2)75岁及以上。结果共纳入571例患者，其中女性307例，男性264例，平均年龄75.3±5.4岁。571例受试者中有16例（2.8%）检测到无症状心房颤动。在75岁及以上的291名受试者中，有15名（5.2%）检测到无症状房颤。在多变量分析中，在年龄、体重指数（BMI）、高血压、糖尿病、中风和潜在心脏病中，只有年龄是无症状房颤检测的独立预测因子（优势比：1.16,95%可信区间：1.06-1.28,p < 0.01）。结论医保体检时7天贴片心电图监测对75岁及以上人群隐匿性房颤有较好的检测效果。

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引用次数: 0

Analysis of 4 Cases of Left Bundle Branch Block With Ventricular Preexcitation 左束支传导阻滞伴室前兴奋4例分析

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-06-01 DOI: 10.1111/anec.70091

M. M. Li Yi, B. M. Li Xingjie

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.

本文报道4例室性预兴奋伴左束支传导阻滞（LBBB）。所有病例均间歇性出现WPW：病例1累及右侧副通路，而病例2-4累及左侧副通路。本文讨论了左、右两侧伴发LBBB的心电图特征。

引用次数: 0

Comparison of Two High-Power Ablation Strategies for Typical Atrial Flutter: Acute and Long-Term Outcome 两种高功率消融治疗典型心房扑动的比较：急性和长期结果

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-05-29 DOI: 10.1111/anec.70089

Wael Zaher, Lorenzo Marcon, Klaus-Richard Ebinger, Antonio Sorgente

Background

Ablation of the cavo-tricuspid isthmus (CTI) is the standard treatment for typical atrial flutter. High-power strategies have been described to improve lesion efficacy and durability.

Objective

To compare the acute success, safety, and long-term outcomes of two strategies of high-power CTI ablation using 8-mm gold-tip nonirrigated and 4-mm irrigated-tip catheters.

Methods

This single-center prospective cohort study included 253 patients who underwent CTI ablation. Patients were treated with either an 8-mm gold-tip nonirrigated catheter (60 W, ≥ 30 s) or a 4-mm irrigated catheter (45 W, ≥ 30 s). Procedural outcomes, safety, and long-term follow-up data were assessed.

Results

Using a propensity score matching, 180 patients were yielded with a 1:1 ratio. Acute bidirectional CTI block was achieved in 97.8% of the 4-mm group and 97.8% of the 8-mm group (p = 1.000). No major complications were reported. During a median follow-up of 27.7 ± 20.1 months, freedom from atrial arrhythmia was 93.3% in both groups (log rank p value 0.935). No significant differences were observed in atrial fibrillation incidence, pacemaker implantation, or cardiovascular mortality between the groups.

Conclusion

High-power CTI ablation with both 8-mm gold-tip nonirrigated and 4-mm irrigated catheters is highly effective and safe, providing durable outcomes over long-term follow-up.

背景：腔室-三尖瓣峡部消融是典型心房扑动的标准治疗方法。高功率策略已被描述为提高病变的疗效和持久性。目的比较使用8mm金头非冲洗导管和4mm冲洗导管的两种高功率CTI消融策略的急性成功、安全性和长期结果。方法该单中心前瞻性队列研究纳入253例行CTI消融术的患者。患者使用8毫米金尖非冲洗导管（60 W,≥30 s）或4毫米冲洗导管（45 W,≥30 s）。评估了手术结果、安全性和长期随访数据。结果采用倾向评分匹配法，以1:1的比例获得180例患者。4-mm组97.8%和8-mm组97.8%实现急性双向CTI阻断（p = 1.000）。无重大并发症报道。在27.7±20.1个月的中位随访期间，两组患者房性心律失常的发生率均为93.3% （log rank p值0.935）。两组间房颤发生率、起搏器植入或心血管死亡率均无显著差异。结论8mm金尖端非冲洗和4mm冲洗导管的高功率CTI消融是一种安全有效的方法，在长期随访中具有持久的疗效。

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引用次数: 0

QTc Interval Dispersion in Pediatric Epilepsy: A Case–Control Study From Iran 小儿癫痫QTc间期离散度：来自伊朗的病例对照研究

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-05-20 DOI: 10.1111/anec.70094

Ahmad Talebian, Ali Mohammad Shakiba, Adele Malekipoor, Fatemeh Hafezipour, Mohammad Mahdi Heidari, Fatemeh Talebian, Hamid Reza Gilasi

Introduction

QT interval corrected dispersion (QTcd) reflects the heterogeneity of ventricular repolarization and has been proposed as a marker for arrhythmic risk in various neurologic and cardiac conditions. The aim of this study was to evaluate QTcd differences between children with epilepsy and healthy controls, with attention to age and antiepileptic drug use.

Methods

A case–control study was conducted on 50 children with epilepsy and 50 age- and sex-matched control children admitted to Shahid Beheshti Hospital in Kashan in 2019. QTcd was manually measured from 12-lead electrocardiograms (ECGs). Data were analyzed using SPSS version 22.

Results

No overall significant difference was observed in QTcd between groups (p > 0.05). However, children with epilepsy under 5 years of age had significantly higher QTcd than controls of the same age (p = 0.014). Moreover, QTcd was significantly lower in children with epilepsy receiving medication compared with those not on treatment (p = 0.026).

Conclusion

Although overall QTcd did not differ significantly between epileptic and control children, age under five and antiepileptic drug use significantly influenced QTcd. These findings suggest the importance of cardiac evaluation and early treatment in younger patients with epilepsy.

QT间期校正离散度（QTcd）反映了心室复极的异质性，并被认为是各种神经和心脏疾病中心律失常风险的标志。本研究的目的是评估癫痫患儿与健康对照之间的QTcd差异，并注意年龄和抗癫痫药物的使用。方法对2019年卡尚市沙希德·贝赫什蒂医院收治的50例癫痫患儿和50例年龄、性别匹配的对照组患儿进行病例对照研究。QTcd由12导联心电图（ECGs）人工测量。数据分析采用SPSS version 22。结果两组间QTcd总体差异无统计学意义（p > 0.05）。而5岁以下癫痫患儿的QTcd明显高于同龄对照组（p = 0.014）。此外，接受药物治疗的癫痫患儿的QTcd明显低于未接受药物治疗的癫痫患儿（p = 0.026）。结论癫痫患儿与对照组总体QTcd差异不显著，但5岁以下儿童和抗癫痫药物使用对QTcd有显著影响。这些发现提示对年轻癫痫患者进行心脏评估和早期治疗的重要性。

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引用次数: 0

The Role of Left Atrial Strain in Differentiating Embolic Stroke of Undetermined Source From Other Acute Ischemic Stroke Subtypes Related to Large-Vessel Occlusion 左心房应变在鉴别来源不明的栓塞性脑卒中与其他与大血管闭塞相关的急性缺血性脑卒中亚型中的作用

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-05-19 DOI: 10.1111/anec.70093

Yanjuan Zhang, Jincheng Jiao, Yingying Wang, Sheng Liu, Yuezhou Cao, Haibing Shi, Minglong Chen, Mingfang Li

Introduction

To evaluate left atrial (LA) function in patients with embolic stroke of undetermined source (ESUS) and other subtypes of acute ischemic stroke (AIS) related to large-vessel occlusion (LVO).

Methods

Consecutive patients with LVO-related AIS were prospectively enrolled from July 2019 to August 2022. To compare LA function with ESUS patients, a control group without prior stroke was sex- and age-matched with ESUS patients in a 1:1 ratio. LA strain was measured within 3 days after stroke. Multivariable logistic regression analysis was performed to assess associations between LA function and stroke subtypes.

Results

This study included 126 patients (mean age 67.7 ± 12.3 year, 39.7% women). Of these, 28 patients met the diagnostic criteria for ESUS, while the remaining were classified as large artery atherosclerosis (n = 49) and non-valvular AF-related cardioembolic stroke (n = 49). Patients with ESUS had lower left atrial reservoir strain (LASr) and left atrial conduit strain (LAScd) compared to those with large artery atherosclerosis (27.8 ± 7.1% vs. 32.0 ± 5.3%, p = 0.004, and 14.3 ± 3.8% vs. 17.3 ± 4.6%, p = 0.005, respectively) and the control group (27.8 ± 7.1% vs. 37.6 ± 7.2%, p < 0.001 and 14.3 ± 3.8% vs. 21.5 ± 7.9%, p < 0.001, respectively). A 5% reduction in LASr and LAScd was associated with a 1.92- and 2.45-fold increase, respectively, in the likelihood of having ESUS compared to large artery atherosclerosis. Lower LASr and LAScd in ESUS patients were prone to be associated with a higher likelihood of cardiovascular events during follow-up.

Conclusions

LA strain is associated with ESUS in stroke patients with LVO. Further studies are needed to explore its utility in identifying specific stroke etiologies.

目的探讨不明来源栓塞性脑卒中（ESUS）及其他与大血管闭塞（LVO）相关的急性缺血性脑卒中（AIS）亚型患者的左心房（LA）功能。方法前瞻性纳入2019年7月至2022年8月连续的lvo相关AIS患者。为了比较ESUS患者的LA功能，将无卒中史的对照组与ESUS患者按1:1的比例进行性别和年龄匹配。脑卒中后3天内测量LA应变。采用多变量logistic回归分析评估左室功能与脑卒中亚型之间的关系。结果126例患者（平均年龄67.7±12.3岁，女性39.7%）。其中28例患者符合ESUS诊断标准，其余患者分为大动脉粥样硬化（n = 49）和非瓣膜性心房颤动相关心栓性卒中（n = 49）。ESUS患者左房储层应变（LASr）和左房导管应变（LAScd）低于大动脉粥样硬化患者（27.8±7.1%比32.0±5.3%,p = 0.004, 14.3±3.8%比17.3±4.6%,p = 0.005）和对照组（27.8±7.1%比37.6±7.2%,p <； 0.001和14.3±3.8%比21.5±7.9%,p < 0.001）。与大动脉粥样硬化相比，LASr和LAScd降低5%，发生ESUS的可能性分别增加1.92倍和2.45倍。ESUS患者LASr和LAScd较低，随访期间发生心血管事件的可能性较高。结论LA菌株与脑卒中合并LVO患者ESUS相关。需要进一步的研究来探索其在确定特定中风病因方面的效用。

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引用次数: 0

Simulation and Modeling Thrombotic Occlusion in Peripherally Inserted Central Catheters 外围置管中心血栓闭塞的模拟与建模

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-05-15 DOI: 10.1111/anec.70090

Feng-Xian Li, Qiao-hong Guo

Objective

To simulate thrombotic occlusion of catheters and develop a model for thrombotic occlusion in peripherally inserted central catheters (PICC), providing a framework for research on catheter occlusion and post-occlusion recanalization.

Methods

Following preparatory steps prior to modeling, sterile anticoagulant bovine blood was drawn and injected into the PICC. Subsequently, the catheter tip was clamped and left to stand for 72 h.

Results

A total of 140 catheter models were produced, all of which exhibited thrombosis, resulting in a 100% success rate for intra-catheter thrombus production. Of these, 118 models experienced no blood reflux when the syringe plunger was withdrawn and triggered an infusion pump alarm, achieving a catheter occlusion modeling success rate of 84.29%. There were 127 cases where syringe plunger withdrawal resulted in no blood reflux within the thrombotic catheter occlusion models, yielding an incidence rate of 90.71%, while 13 cases revealed blood reflux mixed with fine thrombosis, with an incidence rate of 9.29%. Additionally, 126 models triggered infusion pump alarms, with an incidence rate of 90%, while 14 models did not trigger alarms due to thrombus overflow at the catheter tip, with an incidence rate of 10%. The infusion pump alarm method and the syringe withdrawal method demonstrated a significant correlation in diagnosing thrombotic catheter occlusion.

Conclusion

The method for modeling thrombotic catheter occlusion used in this study is reliable, producing a model that accurately simulates the fundamental characteristics of thrombotic catheter occlusion. This model has the potential for application in clinical practice.

目的模拟导管血栓性闭塞，建立外周中心导管血栓性闭塞模型，为导管闭塞及闭塞后再通的研究提供框架。方法按照造模前的准备步骤，抽取无菌抗凝牛血液注射到PICC。随后夹住导管尖端，静置72小时。结果共制作140个导管模型，均出现血栓形成，导管内血栓生成成功率100%。其中118只模型在拔出注射器柱塞时无血液反流，并触发输液泵报警，导管闭塞建模成功率为84.29%。血栓性导管闭塞模型中，取下注射器柱塞无返血127例，发生率为90.71%，返血合并细血栓13例，发生率为9.29%。126个模型触发输液泵报警，发生率为90%，14个模型因导管尖端血栓溢出未触发报警，发生率为10%。输液泵报警法与注射器撤除法在诊断血栓性导管闭塞方面具有显著相关性。结论本研究中使用的血栓性导管闭塞建模方法是可靠的，生成的模型能够准确地模拟血栓性导管闭塞的基本特征。该模型具有临床应用的潜力。

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引用次数: 0

Evaluating the Role of Multimodal Imaging in the Diagnosis of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy 评价多模态成像在心脏淀粉样变性和肥厚性心肌病诊断中的作用

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-05-10 DOI: 10.1111/anec.70086

Zi-xin Yang, Rong-hui Zheng, Cui-yan Wang, Hai-tao Yuan, Yong-le Sun, Mei Zhu

Objective

The objective of this study is to examine the evolving cardiac characteristics of patients with cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) by integrating multimodal imaging techniques, including conventional echocardiography, strain echocardiography, and cardiac magnetic resonance imaging.

Methods

A retrospective study was conducted, comprising 38 patients with CA, 20 patients with HCM, and 16 healthy individuals in the control group. Statistical analyses were conducted to assess conventional and strain echocardiography parameters across these groups. Furthermore, cardiac magnetic resonance imaging data from 15 patients with CA and 15 patients with HCM were analyzed and compared, focusing on correlations between imaging parameters and myocardial amyloid load.

Results

Analysis of conventional and strain echocardiography revealed that left ventricular ejection fraction, E/e′, relative apical longitudinal sparing, and the ejection fraction-to-longitudinal strain ratio were strongly associated with the diagnosis of CA and served as key differentiators between the CA and HCM groups. The combination of these four parameters yielded optimal diagnostic efficiency, with an area under the curve of 0.916.

Conclusion

The integration of conventional and strain multiparametric echocardiography demonstrated superior diagnostic efficacy in differentiating CA from HCM. Furthermore, the analysis of cardiac magnetic resonance parameters indicated that an increase in cardiac amyloid load is associated with changes in cardiac indices, with parameters such as E/e′, basal longitudinal strain, global longitudinal strain, and ejection fraction-to-strain ratio effectively reflecting the extent of amyloid infiltration in the myocardium.

本研究的目的是通过整合多模态成像技术，包括常规超声心动图、应变超声心动图和心脏磁共振成像，研究心脏淀粉样变性（CA）和肥厚性心肌病（HCM）患者心脏特征的演变。方法回顾性研究38例CA患者、20例HCM患者和16例健康人作为对照组。统计分析评估各组的常规和应变超声心动图参数。分析比较15例CA患者和15例HCM患者的心脏磁共振成像数据，重点分析成像参数与心肌淀粉样蛋白负荷的相关性。结果常规超声心动图和应变超声心动图分析显示，左心室射血分数、E/ E′、相对根尖纵向余量和射血分数/纵向应变比与CA的诊断密切相关，是区分CA组和HCM组的关键指标。4个参数联合使用诊断效率最佳，曲线下面积为0.916。结论常规超声心动图与应变多参数超声心动图结合对鉴别CA和HCM具有较好的诊断价值。此外，心脏磁共振参数分析表明，心脏淀粉样蛋白负荷的增加与心脏指标的变化有关，E/ E′、基底纵向应变、总纵向应变、射血分数-应变比等参数能有效反映淀粉样蛋白在心肌中的浸润程度。

{"title":"Evaluating the Role of Multimodal Imaging in the Diagnosis of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy","authors":"Zi-xin Yang, Rong-hui Zheng, Cui-yan Wang, Hai-tao Yuan, Yong-le Sun, Mei Zhu","doi":"10.1111/anec.70086","DOIUrl":"https://doi.org/10.1111/anec.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to examine the evolving cardiac characteristics of patients with cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) by integrating multimodal imaging techniques, including conventional echocardiography, strain echocardiography, and cardiac magnetic resonance imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted, comprising 38 patients with CA, 20 patients with HCM, and 16 healthy individuals in the control group. Statistical analyses were conducted to assess conventional and strain echocardiography parameters across these groups. Furthermore, cardiac magnetic resonance imaging data from 15 patients with CA and 15 patients with HCM were analyzed and compared, focusing on correlations between imaging parameters and myocardial amyloid load.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analysis of conventional and strain echocardiography revealed that left ventricular ejection fraction, E/e′, relative apical longitudinal sparing, and the ejection fraction-to-longitudinal strain ratio were strongly associated with the diagnosis of CA and served as key differentiators between the CA and HCM groups. The combination of these four parameters yielded optimal diagnostic efficiency, with an area under the curve of 0.916.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The integration of conventional and strain multiparametric echocardiography demonstrated superior diagnostic efficacy in differentiating CA from HCM. Furthermore, the analysis of cardiac magnetic resonance parameters indicated that an increase in cardiac amyloid load is associated with changes in cardiac indices, with parameters such as E/e′, basal longitudinal strain, global longitudinal strain, and ejection fraction-to-strain ratio effectively reflecting the extent of amyloid infiltration in the myocardium.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"30 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143930238","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}

引用次数: 0

CHA2DS2-VASc Score as a Predictor for Atrial Fibrillation Recurrence and Clinical Outcomes Following Pulmonary Vein Isolation CHA2DS2-VASc评分作为肺静脉隔离后房颤复发和临床结果的预测因子

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology

Pub Date : 2025-05-08 DOI: 10.1111/anec.70088

Mustafa Gabarin, Mahmoud Suleiman, Adi Elias, Ibrahim Marai, Roy Beinart, Eyal Nof, Yoav Michowitz, Michael Glikson, Yuval Konstantino, Moti Haim, David Luria, David Pereg, Avishag Laish-Farkash, Alexander Omelchenko, the Israeli Working Group on Pacing Electrophysiology

Background

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, associated with serious cardiovascular complications such as ischemic stroke, heart failure, and myocardial infarction. Pulmonary vein isolation (PVI) is an established rhythm-control strategy for AF. Although the CHA₂DS₂-VASc score is primarily used to estimate stroke risk in patients with AF, its potential utility in predicting AF recurrence after PVI has not been fully explored in contemporary, real-world multicenter settings.

Aim

To evaluate the association between the CHA₂DS₂-VASc score and both AF recurrence and adverse clinical outcomes following PVI.

Methods

We conducted a retrospective cohort study using the Israeli Catheter Ablation Registry (ICAR), including 860 patients undergoing their first PVI for AF. Patients were grouped by CHA₂DS₂-VASc score (0–1, 2–4, > 5). The primary endpoint was AF recurrence within 12 months. Secondary endpoints included re-hospitalization, major adverse cardiovascular events (MACE), and all-cause mortality.

Results

AF recurrence occurred in 32% of patients. Recurrence rates were 25.7%, 31.4%, and 51% across the low, intermediate, and high CHA₂DS₂-VASc score groups, respectively. A higher score was independently associated with increased recurrence risk (HR = 2.88; 95% CI, 1.75–4.74; p < 0.001). Elevated CHA₂DS₂-VASc scores also correlated with higher MACE and re-hospitalization rates. No significant difference in all-cause mortality was observed.

Conclusion

The CHA₂DS₂-VASc score is an independent predictor of AF recurrence and adverse outcomes after PVI. Its simplicity, availability, and routine use make it a clinically useful tool to support preprocedural risk stratification in AF patients undergoing ablation.

背景房颤（AF）是成人中最常见的持续性心律失常，并伴有严重的心血管并发症，如缺血性卒中、心力衰竭和心肌梗死。肺静脉隔离（PVI）是房颤的心律控制策略。尽管CHA2DS2-VASc评分主要用于估计房颤患者的卒中风险，但其在预测PVI后房颤复发方面的潜在效用尚未在当代多中心环境中得到充分探索。目的探讨CHA2DS2-VASc评分与PVI后房颤复发及不良临床结局的关系。方法采用以色列导管消融登记（ICAR）进行回顾性队列研究，纳入860例房颤首次PVI患者。患者按CHA2DS2-VASc评分（0 - 1,2 - 4,> 5）分组。主要终点为房颤12个月内复发。次要终点包括再住院、主要不良心血管事件（MACE）和全因死亡率。结果房颤复发率为32%。低、中、高CHA2DS2-VASc评分组复发率分别为25.7%、31.4%和51%。较高的评分与复发风险增加独立相关(HR = 2.88；95% ci, 1.75-4.74；p < 0.001)。升高的CHA2DS2-VASc评分也与较高的MACE和再住院率相关。两组全因死亡率无显著差异。结论CHA2DS2-VASc评分是预测PVI术后AF复发和不良结局的独立指标。它的简单性、可用性和常规使用使其成为支持房颤消融患者手术前风险分层的临床有用工具。

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引用次数: 0