Carlos Pastore

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Non-invasive acquisition of the electrical heart activity through high density mapping might allow early diagnosis of heart diseases overcoming the limitations of the traditional ECG method. This study presents a BSPM system (hardware and platform) to allow users to analyze the characteristics of morphology in up to 64 simultaneous body surface potentials (BSPs) including the 12-lead ECG and vectocardiogram (VCG). The signals undergo a preprocessing step followed by the R peak detection using previously validated techniques for heart rate variability studies. In addition, embedded 3D isopotential, 3D isochrone maps and VCG planes allow researchers to investigate the heart's the electrical activity and its patterns under different heart rhythm disorders in clinical practice.

Background— Recent efforts have focused on improving the specificity of the European Society of Cardiology (ESC) criteria for ECG interpretation in athletes. These criteria are derived predominantly from white athletes (WAs) and do not account for the effect of Afro-Caribbean ethnicity or novel research questioning the relevance of several isolated ECG patterns. We assessed the impact of the ESC criteria, the newly published Seattle criteria, and a group of proposed refined criteria in a large cohort of black athletes (BAs) and WAs. Methods and Results— Between 2000 and 2012, 1208 BAs were evaluated with history, examination, 12-lead ECG, and further investigations as appropriate. ECGs were retrospectively analyzed according to the ESC recommendations, Seattle criteria, and proposed refined criteria which exclude several specific ECG patterns when present in isolation. All 3 criteria were also applied to 4297 WAs and 103 young athletes with hypertrophic cardiomyopathy. The ESC recom...

<jats:p> <jats:bold>Introduction.</jats:bold> The widely known electrocardiographic criteria for diagnosing left ventricular hypertrophy (LVH) use QRS complex voltages to define whether there is left ventricle enlargement or not. Mild myocardial hypertrophy is detected in many professional athletes and this is a consequence of their daily intensity of training. Thus it is not unusual that athlete's ECGs show large QRS voltages with normal hearts. </jats:p> <jats:p> <jats:bold>Objective.</jats:bold> To evaluate the applicability of the usual electrocardiographic criteria for LVH - Sokolow-Lyon, Romhilt-Estes, Cornell and Gubner - in a population of professional athletes. </jats:p> <jats:p> <jats:bold>Methods.</jats:bold> The four LVH criteria for diagnosing LVH were applied to analyse ECGs of 107 professional athletes (71% soccer players, 29% marathonists, all male, age 25± 10 years, training for 9± 8 years) by the same observer unaware of echocardiographic results. ECG was considered to be indicative of LVH if: Sokolow-Lyon ≥35mm (V <jats:sub>1or 2</jats:sub> S wave+V <jats:sub>5or 6</jats:sub> R wave); Romhilt-Estes score ≥5 points (frontal plane: R or S waves ≥ 20mm, horizontal plane: R or S waves ≥ 30mm, Morris indices, V <jats:sub>5or 6</jats:sub> strain pattern, left axis deviation ≥ − 30°, intrinsecoid deflection ≥ 0.04s, QRS duration ≥ 0.10s) ; Cornell ≥ 28mm (aV <jats:sub>L</jats:sub> R wave + V <jats:sub>3</jats:sub> S wave); Gubner ≥ 22mm (D <jats:sub>I</jats:sub> R wave + D <jats:sub>III</jats:sub> S wave). Hypertrophy was considered whenever: LV diastolic diameter ≥ 60mm and/or septum ≥ 13mm and/or LV posterior wall ≥ 13mm. Kruskal-Wallis was used to statistically analyse quantitative variables, corrected chi-square test for categorical variables. Significance level: p ≤ 0.05. </jats:p> <jats:p> <jats:bold>Results.</jats:bold> Romhilt-Estes showed the best results (75% sensitivity, 84% specificity, 16 false-positives, 1 false-negative), and was the only criteria with statistical significance (p = 0.047). Sokolow-Lyon showed 100% sensitivity, 15% specificity, p = 0.545, 88% false-positives, 0% false-negative. Cornell and Gubner showed 25% and 0% sensitivity, 95% and 99% specificity, p=0.205 and p = 0.449, respectively. </jats:p> <jats:p> <jats:bold>Conclusion.</jats:bold> In this male population of professional athletes, Romhilt-Estes score proved to be the best criterion for identifying left ventricular hypertrophy, while Sokolow-Lyon criterion did not discriminate normal from abnormal hearts. Cornell and Gubner criteria should not be used in this population because of their low sensitivity. </jats:p> <jats:p />

Introduction: The potentially fatal outcome related to J-point syndromes raises heated debate about the pathophysiology of Brugada syndrome (BrS) and early repolarization (ER). It has not been established yet if they carry a depolarization, a repolarization or both electrical problems. Hypothesis: The objective of this study was to define BrS and ER characteristic and distinctive electrical patterns, using aspects of the QRS complex loops, ST-segments and T-waves obtained from the classical vectorcardiogram (VCG). Methods: VCG loops of 29 BrS patients and 30 individuals with ER were analyzed qualitatively and quantitatively. Non-paired t-test and ROC curve statistics were used (p≤ 0.05 significance level). Results: Mean age: 47±15 vs 38±14y.o. (p=0.02), 66% vs 90% male (p=0.03); QRS duration: 102±10 vs 95±13ms (p=0.03), BrS vs ER, respectively. All QRS loops showed an end-conduction delay located in right posterior-anterior quadrant (BrS) or left posterior-anterior quadrant (ER). A ...

Microalternância da Onda T (TWA) x Repolarização Ventricular e Morte Súbita: novos conceitos, importância e aplicações Experiências Clínicas em populações saudáveis e cardiopatas Perspectivas para MAOT Excelente desempenho prognóstico : Valor Preditivo Negativo. Compara-se como método não invasivo de estratificação de risco cardíaco ao EEF em indivíduos portadores de cardiopatia isquêmica. MAOT MMM é mais acessível sob o ponto de vista de aplicação, realização e interpretação do que MAOT ME. Aumento da experiência clínica adquirida com o método (novos estudos) . Tornar-se importante ferramenta da avaliação da morte súbita cardíaca na população em geral (saudáveis e cardiopatas), em associação à métodos não-invasivos já consagrados como a monitorização ambulatorial (Holter) e o Teste Ergométrico.

Artigo recebido em 19/03/09; revisado recebido em 29/05/09; aceito em 18/03/10. Em geral, a maioria dos casos de morte súbita cardíaca (MSC) está relacionada a doença arterial coronariana e cardiomiopatia não isquêmica dilatada e hipertrófica 1 . Igualmente importantes são os casos de MSC registrados em sujeitos aparentemente saudáveis. Entre 1994 a 2003, no Reino Unido, foram realizadas autópsias de 453 indivíduos que sofreram MSC, todos entre 15 e 81 anos de idade. Nesse conjunto, foram encontrados 269 (59,3%) corações macroscópica e microscopicamente normais 2 . O reconhecimento preciso de indivíduos com maior risco imediato de MSC ainda é uma questão em aberto. Muitos fatores (adquiridos ou congênitos; estruturais, funcionais ou genéticos) estão relacionados a um aumento no risco de MSC, porém isoladamente eles não conseguem apontar quando uma pessoa estará no nível máximo desse tipo de risco. A atividade física vigorosa (6 METS ou mais) pode aumentar potencialmente o risco de e...

Introdução: Na microalternância da onda T (MAOT) artefatos no ECG prejudicam a análise dos resultados, sendo as derivações frontais mais susceptíveis ao problema. A Média Móvel Modificada (MMM) é uma nova metodologia que possibilita uso de protocolos de esforços consagrados na ergometria. Métodos: Estudo com 132 pacientes com cardiomiopatia hipertrófica divididos em dois grupos: alto risco (67 indivíduos - apresentavam pelo menos um fator de risco para morte súbita cardíaca: antecedente de ressuscitação por fibrilação ventricular ou taquicardia ventricular sustentada; história familiar de morte súbita; síncope inexplicada; espessura septal ≥ 30 mm; taquicardia ventricular não sustentada (TVNS); queda da pressão sistólica no teste de esforço) e baixo risco (65 indivíduos - sem fatores de risco). A MAOT foi avaliada pelo teste ergométrico com protocolo Naugthon modificado, sendo fator de atualização 8 e 32. Resultados analisados de 2 formas: 15 derivações do ECG (12 no plano frontal e...

Introdução: A cardiomiopatia hipertrófica (CMH) é principal causa de morte súbita (MSC) em adultos jovens, sendo única opção para tratamento desta complicação o cardiodesfibrilador implantável. A microalternância da onda T (MAOT) possui recomendação Classe IIa e nível de evidência A para diagnóstico e estratificação de arritmias ventriculares fatais na cardiomiopatia dilatada pelo Guideline da American Heart Association (2006). Métodos: Estudo realizado com 132 pacientes com diagnóstico de CMH divididos em dois grupos: alto risco (67 indivíduos) que apresentavam pelo menos um fator de risco para MSC (antecedente de ressuscitação por fibrilação ventricular ou taquicardia ventricular sustentada; história familiar de morte súbita; síncope inexplicada; espessura septal do miocárdio ≥ 30 mm; taquicardia ventricular não sustentada (TVNS); queda da pressão sistólica no teste de esforço) e baixo risco (65 indivíduos) sem fatores de risco. A MAOT foi avaliada com teste ergométrico com protoc...

Few studies have evaluated cardiac electrical activation dynamics after cardiac resynchronization therapy. Although this procedure reduces morbidity and mortality in heart failure patients, many approaches attempting to identify the responders have shown that 30% of patients do not attain clinical or functional improvement. This study sought to quantify and characterize the effect of resynchronization therapy on the ventricular electrical activation of patients using body surface potential mapping, a noninvasive tool. This retrospective study included 91 resynchronization patients with a mean age of 61 years, left ventricle ejection fraction of 28%, mean QRS duration of 182 ms, and functional class III/IV (78%/22%); the patients underwent 87-lead body surface mapping with the resynchronization device on and off. Thirty-six patients were excluded. Body surface isochronal maps produced 87 maximal/mean global ventricular activation times with three regions identified. The regional acti...

Body surface potential mapping assessed mean cardiac electrical activation times displayed by isochronal maps in the right ventricle (RV; right ventricle mean activation time [mRV]), anterior septal area (anterior septal area mean activation time [mAS]), and left ventricle (left ventricle mean activation time [mLV]) of 28 patients (mean, 61.07 years; congestive heart failure class III-IV; ejection fraction, < or =40%; left bundle-branch block [LBBB] QRS, 180.17 milliseconds), before and after biventricular pacemaker implantation, comparing them, using reference values from a control group of healthy individuals with normal hearts (GNL), in (1) baseline native LBBB, where mRV and mAS values were similar (40.99 vs 43.62 milliseconds), with mLV delayed (80.99 milliseconds, P < .01) and dyssynchronous with RV/anterior septal area; (2) single-site RV pacing, where mRV was greater than in GNL (86.82 milliseconds, P < .001), with greater mAS/mLV difference (63.41 vs 102.7 milliseconds; P < .001); and (3) biventricular pacing (BIV-PM), where mLV and mRV were similar (71.99 vs 71.58 milliseconds), mRV was greater than in GNL and native LBBB (71.58 vs 35.1 and 40.99 milliseconds; P < .001), and mAS approached values in GNL and native LBBB (51.28 vs 50.14 and 43.62 milliseconds). Body surface potential mapping showed that similar RV/left ventricle activation times during biventricular pacing, nearing mAS, indicate synchronized ventricular activation pattern in patients with congestive heart failure/LBBB.

Dentists of Lar São Francisco observed during dental treatment that children with cerebral palsy (CP) had increased heart rate (HR) and lower production of saliva. Despite the high prevalence of CP found in the literature (2.08-3.6/1000 individuals), little is known about the electrocardiographic (ECG) characteristics, especially HR, of individuals with CP. This study aimed to investigate the hypothesis that individuals with CP have a higher HR and to define other ECG characteristics of this population. Ninety children with CP underwent clinical examination and 12-lead rest ECG. Electrocardiographic data on rhythm, HR, PR interval, QRS duration, P/QRS/T axis, and QT, QTc and T(peak-end) intervals (minimum, mean, maximum, and dispersion) were measured and analyzed then compared with data from a control group with 35 normal children. Fisher and Mann-Whitney U tests were used, respectively, to compare categorical and continuous data. Groups cerebral palsy and control did not significantly differ in age (9 ± 3 × 9 ± 4 years) and male gender (65% × 49%). Children with CP had a higher HR (104.0 ± 20.6 × 84.2 ± 13.3 beats per minute; P < .0001), shorter PR interval (128.8 ± 15.0 × 138.1 ± 15.1 milliseconds; P = .0018), shorter QRS duration (77.4 ± 8.6 × 82.0 ± 8.7 milliseconds; P = .0180), QRS axis (46.0° ± 26.3° × 59.7° ± 24.8°; P = .0024) and T-wave axis (34.3° ± 28.9° × 42.9° ± 17.1°; P = .034) more horizontally positioned, and greater mean QTc (418.1 ± 18.4 × 408.5 ± 19.4 milliseconds; P = .0110). All the electrocardiogram variables were within the reference range for the age group including those with significant differences. Children with CP showed increased HR and other abnormal ECG findings in the setting of this investigation. Further studies are needed to explain our findings and to correlate the increased HR with situations such as dehydration, stress, and autonomic nervous disorders.

Cardiac resynchronization therapy (CRT) is an adjunct treatment for heart failure (HF) which associates with left bundle-branch block (LBBB) and is refractory to medical therapy. However, nearly 1/3 of the patients still do not respond, the reasons for which have yet to be determined. Additionally, experimental studies proved that epicardial left ventricle (LV) pacing yields reversed electrical activation sequence, increasing QT interval duration and dispersion of the ventricular repolarization, and leaving patients at greater risk for ventricular arrhythmias. In this study, a series of 60 patients (61.7% male, mean age 59.2+/-11.54 years) in NYHA functional class III-IV heart failure and LBBB, who received CRT through implantation of atrial-biventricular pacemakers, were assessed by 87-lead body surface potential mapping (BSPM). The BSPM, noninvasive technique with semi-automatic readings, allowed analysis of variables associated with the cardiac ventricular repolarization QT intervals, maximal, minimum and mean Tpeak-end, and QT dispersion (QTmax - min), in addition to transmural dispersion of repolarization (Tpeak-end max - Tpeak-end min), in two different moments: baseline rhythm and during atrial-biventricular pacing. QT dispersion showed a significant 19.6% reduction (p=0.0009) under CRT, as compared with baseline measurements (85.58+/-26.63 msec vs. 68.83+/-25.16 msec). The transmural dispersion of repolarization (Tpeak-end max - Tpeak-end min) showed smaller statistical significance (p=0.0343); however, its values were similarly decreased (55.50+/-15.45 msec vs 49.41+/-14.11 msec) during CRT. These results may corroborate findings from major randomized clinical trials. We consider that the electrocardiographic variables obtained with the use of the BSPM, namely, the QT and Tpeak-end intervals, are appropriate for analysis and study of the effects of cardiac resynchronization therapy on the improved electrical dispersion as characterizing the improvement of homogeneity of cardiac ventricular repolarization.

The controversial effects promoted by cardiac resynchronization therapy (CRT) on the ventricular repolarization (VR) have motivated VR evaluation by body surface potential mapping (BSPM) in CRT patients. Fifty-two CRT patients, mean age 58.8 ± 12.3 years, 31 male, LVEF 27.5 ± 9.2, NYHA III-IV heart failure with QRS181.5 ± 14.2 ms, underwent 87-lead BSPM in sinus rhythm (BASELINE) and biventricular pacing (BIV). Measurements of mean and corrected QT intervals and dispersion, mean and corrected T peak end intervals and their dispersion, and JT intervals characterized global and regional (RV, Intermediate, and LV regions) ventricular repolarization response. Global QTm (P < 0.001) and QTc(m) (P < 0.05) were decreased in BIV; QTm was similar across regions in both modes (P = ns); QTc(m) values were lower in RV/LV than in Intermediate region in BASELINE and BIV (P < 0.001); only RV/Septum showed a significant difference (P < 0.01) in the BIV mode. QTD values both of BASELINE (P < 0.01) and BIV (P < 0.001) were greater in the Intermediate than in the LV region. CRT effect significantly reduced global/regional QTm and QTc(m) values. QTD was globally decreased in RV/LV (Intermediate: P = ns). BIV mode significantly reduced global T peak end mean and corrected intervals and their dispersion. JT values were not significant. Ventricular repolarization parameters QTm, QTc(m), and QTD global/regional values, as assessed by BSPM, were reduced in patients under CRT with severe HF and LBBB. Greater recovery impairment in the Intermediate region was detected by the smaller variation of its dispersion.

Different methodologies for electrocardiographic acquisition in horses have been used since the first ECG recordings in equines were reported early in the last century. This study aimed to determine the best ECG electrodes positioning method and the most reliable calculation of mean cardiac axis (MEA) in equines. We evaluated the electrocardiographic profile of 53 clinically healthy Thoroughbreds, 38 males and 15 females, with ages ranging 2-7 years old, all reared at the São Paulo Jockey Club, in Brazil. Two ECG tracings were recorded from each animal, one using the Dubois lead positioning system, the second using the base-apex method. QRS complex amplitudes were analyzed to obtain MEA values in the frontal plane for each of the two electrode positioning methods mentioned above, using two calculation approaches, the first by Tilley tables and the second by trigonometric calculation. Results were compared between the two methods. There was significant difference in cardiac axis valu...

... Id: 29688. Autor: Pastore, Carlos Alberto; Moffa, Paulo Jorge; Tobias, Nancy MM de Oliveira;Moraes, Aguinaldo Pereira de; Nishioka, Silvana A. D; Chierighini, José Emilio C; Cruz, Maria do Carmo Carvalho; Nero Júnior, Ermelindo del; Bellotti, Giovanni; Pileggi, Fúlvio. ...