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Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings

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World Journal of Cardiology 2022年第9期14卷 483-495页

作者： George Bazoukis Sebastian Garcia-Zamora GökselÇinier Sharen Lee Enes Elvin Gul JesúsÁlvarez-García Gabi Miana Mertİlker Hayıroğlu Gary Tse Tong Liu adrian baranchuk Department of Cardiology Larnaca General HospitalLarnaca 6036Cyprus Department of Basic and Clinical Sciences University of Nicosia Medical SchoolNicosia 2414Cyprus Department of Cardiology Delta ClinicSanta Fe 341Argentina Department of Cardiology Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research CenterIstanbul 34668Turkey Cardiovascular Analytics Group Laboratory of Cardiovascular PhysiologyHong Kong 999077China Division of Cardiac Electrophysiology Madinah Cardiac CentreMadinah 42351Saudi Arabia Department of Cardiology Ramon y Cajal University HospitalMadrid 28034Spain Telehealth Center of Hospital das Clínicas Hong Kong 999077China Kent and Medway Medical School CanterburyCanterbury CT27FSUnited Kingdom Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of TianjinTianjin Medical UniversityTianjin 300211China Department of Cardiology The Second Hospital of Tianjin Medical UniversityTianjin 300211China Department of Cardiology Queen's UniversityOntario K7L 3N6Canada

BACKGROUND Cardiac magnetic resonance(CMR)is a unique tool for non-invasive tissue characterization,especially for identifying fibrosis.AIM To present the existing data regarding the association of electrocardiographic(ECG)markers with myocardial fibrosis identified by CMR-late gadolinium enhancement(LGE).METHODS A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February 2021.In addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://***).RESULTS A total of 32 studies were included.In hypertrophic cardiomyopathy(HCM),fragmented QRS(fQRS)is related to the presence and extent of myocardial fibrosis.fQRS and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients,while fQRS has also been related to fibrosis in myocarditis.Selvester score,abnormal Q waves,and notched QRS have also been associated with LGE.Repolarization abnormalities as reflected by increased Tp-Te,negative Twaves,and higher QT dispersion are related to myocardial fibrosis in HCM patients.In patients with Duchenne muscular dystrophy,a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was observed.In atrial fibrillation patients,advanced inter-atrial block is defined as P-wave duration≥120 ms,and biphasic morphology in inferior leads is related to left atrial fibrosis.CONCLUSION Myocardial fibrosis,a reliable marker of prognosis in a broad spectrum of cardiovascular diseases,can be easily understood with an easily applicable ECG.However,more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR.

关键词： Myocardial fibrosis Late gadolinium enhancement Electrocardiogram Cardiac magnetic resonance

Diagnosis of interatrial block

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Journal of Geriatric Cardiology 2017年第3期14卷 161-165页

作者： Antoni Bay, s de Luna adrian baranchuk Luis Alberto Escobar Robledo Albert Masso van Roessel Manuel Martinez-Selles Catalan Institute of Cardiovascular Sciences St. Pau Hospital Barcelona Spain Heart Rhythm Service Kingston General Hospital Queen's University Kingston ON Canada Cardiology Department Hospital Universitario Gregorio Maranon Universidad Europea Universidad Complutense Madrid Spain

In the 70’s, we classified for the first time the blocks at the atrial level into interatrial blocks (IAB), partial and advanced, and other types of atrial blocks including the concept of atrial aberrancy, and atrial dissociation. The concept of IAB, the most frequent and relevant blocks at the atrial level mean that exist a delayed conduction between the right and left atrium (RA and LA). We also divided them using the same concept as at ventricular, sinoatrial, and atrioventricular (AV) level into 1~(st) degree or partial (P-IAB), 3~(rd) degree or advanced (A-IAB), and 2~(nd) degree or intermittent. The location of atrial fibrosis, that in the majority of cases is the responsible of delay of conduction involves much more part of the atria that just the isolated Bachmann bundle.

关键词：房间诊断心房

ST-Segment Depression in Leads I and aVL: Artifactual or Pathophysiological Findings ?

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Cardiovascular Innovations and Applications 2021年第4期6卷 109-111页

作者： Sharen Lee Gary Tse Xin Wang adrian baranchuk Tong Liu Cardiovascular Analytics Group Laboratory of Cardiovascular PhysiologyHong KongChina Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina Department of Medicine Kingston General HospitalQueen’s UniversityKingstonOntarioCanada

The 12-lead electrocardiogram(ECG)is a routinely performed test but is susceptible to misinterpretation even by experienced physicians.We report a case of a 72-year-old lady with no prior cardiac history presented to our hospital with atypical chest pain.Her initial electrocardiogram shows an initial ST depression followed by positive defl ections leads I and aVL.Non-physiological ST segment and T-wave changes are also observed in the precordial leads V2 to V6.By contrast,these abnormalities are notably absent in lead II.A repeat of the ECG taken 30 minutes later reveals the resolution of most abnormalities seen in the initial ECG on a background of high-frequency noise in the limb leads.She was referred to the cardiology department for further management.An urgent echocardiogram revealed no regional wall motion abnormalities with preserved ejection fraction,and her coronary angiogram revealed no signifi cant coro-nary stenosis.This case illustrates the importance of understanding different factors that can cause ST segment abnor-malities,notably artifactual changes that can mimic ST segment myocardial infarction.

关键词： ST segment artifact

Telemonitoring and hemodynamic monitoring to reduce hospitalization rates in heart failure： a systematic review and meta-analysis of randomized controlled trials and real-world studies

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Journal of Geriatric Cardiology 2018年第4期15卷 298-309页

作者： Gary Tse Cynthia Chan Mengqi Gong Lei MENG Jian ZHANG Xiao-Ling SU Sadeq Ali-Hasan-Al-Saegh Abhishek C Sawant George Bazoukis Yun-Long XIA Ji-Chao Zhao Alex Pui Wai Lee Leonardo Roever Martin CS Wong adrian baranchuk Tong Liu Department of Medicine and Therapeutics Faculty of Medicine Chinese University of Hong Kong Hong Kong China Li Ka Shing Institute of Health Sciences Faculty of Medicine Chinese University of Hong Kong Hong Kong China Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of Cardiology Tianjin Institute of Cardiology the Second Hospital of Tianjin Medical University Tianjin China State Key Laboratory of Cardiovascular Disease Heart Failure Center Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Peking Union Medical College Beijing China Department of Cardiology Qinghai Provincial People's Hospital Xining China Cardiovascular Research Center Shahid Sadoughi University of Medical Sciences Yazd Iran Division of Cardiology State University of New York at Buffalo Buffalo NY USA The Second Department of Cardiology Laboratory of Cardiac Electrophystology Evangehsmos General Hospital of Athens Athens Greece Department of Cardiovascular Medicine the First Affiliated Hospital of Dalian Medical University Dalian China Auckland Bioengineering Institute the University of Auckland Auckland New Zealand Department of Clinical Research Federal University of Uberlandia Uberlandia MG Brazil JC School of Public Health and Primary Care Faculty of Medicine the Chinese University of Hong Kong Hong Kong China Division of Cardiology Kingston General Hospital Queen 's University Kingston Ontario Canada

BackgroundHeart 失败是导致重复住院的一个重要问题。Telemonitoring 并且血液动力学的监视在减少住院率表明了成功，然而并非所有研究报导了重要效果。系统的评论和元分析是在在心 failure.Methods 与 ResultsPubMed 和 Cochrane 图... 详细信息

BackgroundHeart 失败是导致重复住院的一个重要问题。Telemonitoring 并且血液动力学的监视在减少住院率表明了成功，然而并非所有研究报导了重要效果。系统的评论和元分析是在在心 failure.Methods 与 ResultsPubMed 和 Cochrane 图书馆减少住院检验 telemonitoring 和无线血液动力学的监视设备的有效性的这的目的被寻找直到 1 为调查了 telemonitoring 或在住院上的血液动力学的监视的效果的文章的 st 2017年5月评价在心失败。在 31,501 个病人(吝啬的年龄：68 #

关键词：血液动力学评论系统随机化世界试用控制评价

Does Minimizing Ventricular Pacing Reduce the Incidence of Atrial Fibrillation ? A Systematic Review and Meta-analysis of Randomized Controlled Trials

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Cardiovascular Innovations and Applications 2020年第3期5卷 1-7页

作者： Ishan Lakhani Mengqi Gong Cheuk Wai Wong George Bazoukis Konstantinos PLetsas Guangping Li Khalid bin Wahleed Yunlong Xia adrian baranchuk Gary Tse Keith Sai Kit Leung Tong Liu Dong Chang Laboratory of Cardiovascular Physiology Li Ka Shing Institute of Health SciencesHong Kong Special Administrative RegionPeople’s Republic of China Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjin 300211People’s Republic of China Li Ka Shing Faculty of Medicine The University of Hong KongHong KongSpecial Administrative RegionPeople’s Republic of China Second Department of Cardiology Laboratory of Cardiac ElectrophysiologyEvangelismos General Hospital of AthensAthensGreece Department of Cardiology First Affi liated Hospital of Dalian Medical UniversityDalianChina Division of Cardiology Kingston General HospitalQueen’s UniversityKingstonOntarioCanada Xiamen Cardiovascular Hospital Xiamen UniversityXiamenFujianPeople’s Republic of China Aston Medical School Aston UniversityBirminghamUnited Kingdom

Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial.Therefore,we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods:The PubMed,Embase,and Cochrane Library databases were searched up to August 1,2017,for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results:Eleven studies comprising 5705 participants(61%males,mean age 71 years[standard deviation 11 years])were fi nally included in the analysis.The mean follow-up duration was 24 months.Use of algorithms for minimizing ventricular pacing signifi cantly reduced the incidence of AF,with an odds ratio of 0.74(95%confi dence interval 0.55–1.00;P<0.05).There was moderate heterogeneity among studies(I 2=63%).Conclusions:The incidence of AF was reduced by 26%with use of algorithms for minimizing ventricular pacing.The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.

关键词： Atrial fibrillation minimizing ventricular pacing pacemaker

Meta-analysis of T-wave indices for risk stratification in myocardial infarction

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Journal of Geriatric Cardiology 2017年第12期14卷 776-779页

作者： Gary Tse Cheuk Wai Wong Meng-Qi GONG Lei MENG Konstantinos P Letsas Guang-Ping LI Paula Whittaker Aishwarya Bhardwaj Abhishek C Sawant William KK Wu Sunny Hei Wong Jayaprakash Shenthar Lap Ah Tse Martin CS Wong adrian baranchuk Gan-Xin YAN Tong LIU Department of Medicine and Therapeutics Faculty of Medicine Chinese University ofHong Kong Hong Kong China Li Ka Shing Institute of Health Sciences Faculty of Medicine Chinese University ofHong Kong Hong Kong China Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong China Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease Department of Cardiology Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University Tianjin China Second Department of Cardiology Laboratory of Cardiac Electrophysiology 'Evangelismos' General Hospital of Athens Athens Greece Division of Population Health Health Services Research and Primary Care School of Health Sciences University of Manchester United Kingdom Division of Cardiology Department of Internal Medicine State University of New York at Buffalo USA Department of Anaesthesia and Intensive Care State Key Laboratory of Digestive Disease LKS Institute of Health Sciences The Chinese University of Hong Kong Hong Kong China Electrophysiology Unit Sri Jayadeva Institute of Cardiovascular Sciences and Research B G Road 9th Block Jayanagar Bangalore India JC School of Public Health and Primary Care The Chinese University of Hong Kong Hong Kong China Division of Cardiology Kingston General Hospital Queen 's University Kingston Ontario Canada Lankenau Institute for Medical Research and Lankenau Medical Center Wynnewood Pennsylvania USA Beijing Anzhen Hospital Capital Medical University Beijing China

Ventricular tachy-arrhythmias are the commonest cause of sudden cardiac death in patients with ischemic heart disease. It is estimated that up to 20% patients with acute myocardial infarction suffer from these arrhythmias. There is a growing need for developing tools for risk assessment for sudden cardiac death (SCD) in this population. Several ECG indices have been proposed for risk stratification and for prognostication after myocardial infarction (MI). These can divided broadly into those based on repolarization, conduction or both, as reviewed recently. Repolarization indices include QT interval, QT dispersion, T_(peak)-T_(end) interval, T_(peak)-T_(end)/QT ratio, JT_(peak)/JT, (T_(peak)-T_(end))/JT_(peak) and T_(peak)/JT ratios. Conduction indices include QRS duration and QRS dispersion. Conduction-repolarization indices are exemplified by index of Cardiac Electrophysiological Balance (iCEB: QT/QRS), and QRS-T angle, amongst others.

关键词：风险梗塞心肌索引波浪开发工具死亡心脏

Brugada phenocopy: A new electrocardiogram phenomenon

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World Journal of Cardiology 2014年第3期6卷 81-86页

作者： Daniel D Anselm Jennifer M Evans adrian baranchuk Division of Cardiology Electrophysiology and PacingQueen's UniversityKingston General Hospital

Brugada phenocopies(BrP) are clinical entities that are etiologically distinct from true congenital Brugada syndrome. BrP are characterized by type 1 or type 2 Brugada electrocardiogram(ECG) patterns in precordial leads V1-V3. However, BrP are elicited by various un-derlying clinical conditions such as myocardial ischemia, pulmonary embolism, electrolyte abnormalities, or poor ECG filters. Upon resolution of the inciting underlying pathological condition, the BrP ECG subsequently nor-malizes. To date, reports have documented BrP in the context of singular clinical events. More recently, recur-rent BrP has been demonstrated in the context of re-current hypokalemia. This demonstrates clinical repro-ducibility, thereby advancing the concept of this new ECG phenomenon. The key to further understanding the pathophysiological mechanisms behind BrP requires experimental model validation in which these phenom-ena are reproduced under strictly controlled environ-mental conditions. The development of these validation models will help us determine whether BrP are tran-sient alterations of sodium channels that are not repro-ducible with a sodium channel provocative test or al-ternatively, a malfunction of other ion channels. In this editorial, we discuss the conceptual emergence of BrP as a new ECG phenomenon, review the progress made to date and identify opportunities for further investiga-tion. In addition, we also encourage investigators that are currently reporting on these cases to use the term BrP in order to facilitate literature searches and to help establish this emerging concept.

关键词： Brugada phenocopy Brugada syndrome Electrolytes Myocardial ischemia Pulmonary embo-lism Cardiomyopathy Electrocardiogram filters

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Brugada拟表型:一个新的临床实体

江苏实用心电学杂志 2015年第4期24卷 245-255,260页

作者： Byron H Gottschalk Daniel D Anselm adrian baranchuk 蒋祖勋加拿大金斯顿综合医院 Libin Cardiovascular Institute of Alberta Foothills Medical CentreUniversity of Calgary 广东省人民医院心功能科

Brugada拟表型(Brugada phenocopy,BrP)是临床实体,它与真正的Brugada综合征(Brugada syndrome,BrS)具有相同的心电图波形,但前者是由各种临床状况诱发的。在某种相关的潜隐状况下,BrP的特征表现为心前区导联V1~V3呈1型或2型Brugada心... 详细信息

Brugada拟表型(Brugada phenocopy,BrP)是临床实体,它与真正的Brugada综合征(Brugada syndrome,BrS)具有相同的心电图波形,但前者是由各种临床状况诱发的。在某种相关的潜隐状况下,BrP的特征表现为心前区导联V1~V3呈1型或2型Brugada心电图波形。随着潜隐状况的纠正,这些心电图波形恢复正常。本研究中,我们回顾了BrP的分类、与BrS鉴别的方法及有关BrP病因的最新研究结果。此外,我们提供了BrP国际在线注册的更新数据,并讨论了BrP未来的研究方向。

关键词： Brugada心电图波形 Brugada拟表型 Brugada综合征

Hypertrophic cardiomyopathy: Can the noninvasive diagnostic testing identify high risk patients?

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World Journal of Cardiology 2014年第8期6卷 764-770页

作者： Li Zhang Obinna Mmagu Liwen Liu Dayuan Li Yuxin Fan adrian baranchuk Peter R Kowey Center for Clinical Cardiology Lankenau Institute for Medical ResearchLankenau Medical CenterJefferson Medical CollegePhiladelphiaPA 19096United States Department of Ultrasound Xijing HospitalForth Military Medical University HeartEast Heart Care HealthEast Care SystemSt.PaulMN 55102United States John Welsh Cardiovascular Diagnostic Laboratory Department of Pediatrics-CardiologyBaylor College of MedicineHoustonTX 77030United States Arrhythmia Service Kingston General HospitalQueen’s UniversityK7L 2V7OntarioCanada

Hypertrophic cardiomyopathy(HCM) is the most common cause of sudden cardiac death(SCD) in the young, particularly among athletes. Identifying high risk individuals is very important for SCD prevention. The purpose of this review is to stress that noninvasive diagnostic testing is important for risk assessment. Extreme left ventricular hypertrophy and documented ventricular tachycardia and fibrillation increase the risk of SCD. Fragmented QRS and T wave inversion in multiple leads are more common in high risk patients. Cardiac magnetic resonance imaging provides complete visualization of the left ventricular chamber, allowing precise localization of the distribution of hypertrophy and measurement of wall thickness and cardiac mass. Moreover, with late gadolinium enhancement, patchy myocardial fibrosis within the area of hypertrophy can be detected, which is also helpful in risk stratification. Genetic testing is encouraged in all cases, especially in those with a family history of HCM and SCD.

关键词： Hypertrophic cardiomyopathy Sudden cardiac death Noninvasive diagnostic testing