We constructed an intracardiac vectorcardiogram from 3 configurations of intracardiac cardioverto... more We constructed an intracardiac vectorcardiogram from 3 configurations of intracardiac cardiovertor defibrilator (ICD) electrograms (EGMs). Six distinctive 3 lead combinations were selected out of five leads: can to right ventricular coil (RVC); RVC to superior vena cava coil (SVC); atrial lead tip (A-tip) to right ventricular (RV)-ring; can to RV-ring; RV-tip to RVC, in a patient with dual chamber ICD. Surface spatial QRS-T angle (119.8°) was similar to intracardiac spatial QRS-T angle derived from ICD EGMs combination A (101.3°), B (96.1°), C (92.8°), D (95.2), E (99.0), F (96.2) and median (101.5). Future validation of the novel method is needed.
ABSTRACT T-wave alternans (TWA) and mechanical alternans (MA) can be coupled. The goal of this st... more ABSTRACT T-wave alternans (TWA) and mechanical alternans (MA) can be coupled. The goal of this study was to compare outcomes in patents with MA and TWA. A prospective cohort study was conducted in the intensive cardiac care unit and enrolled 133 patients (59.6 ± 15.7 years; 65% men) admitted with acute heart failure (HF). Surface ECG and peripheral arterial blood pressure waveform via arterial line were recorded continuously. MA and TWA were measured by enhanced modified moving average method. All-cause death or heart transplant served as a combined primary endpoint. MA was observed in 28 patients (25%), whereas TWA was detected in 33 patients (33%). If present, MA was tightly coupled with TWA. Mitral flow deceleration time was shorter (127 ± 61 ms vs 172 ± 80 ms, P = .030), and left atrial systolic diameter was larger (5.1 ± 1.3 mm vs 4.4 ± 0.9 mm, P = .020) in patients with MA compared to those without. Mean TWA amplitude was larger in patients with both TWA and MA compared to patients with lone TWA (median 37 [interquartile range 26-61] µV vs 22 [21-23] µV, P = .045). After adjustment for New York Heart Association HF class, MA was associated with the primary endpoint (HR 2.3, 95% confidence interval 1.15-4.59, P = .018), whereas all lone TWA patients remained alive. Univariate Kaplan-Meier survival analysis showed the worst survival in patients with both MA and TWA at baseline, whereas patients without alternans had an intermediate probability of survival (Figure 1). All patients with lone TWA remained free from the primary endpoint. HF patients with MA are characterized by restrictive diastolic dysfunction. The predictive value of TWA without simultaneous assessment of MA is inconclusive.
Repolarization abnormality in bundle branch blocks (BBB) is traditionally ignored. This study eva... more Repolarization abnormality in bundle branch blocks (BBB) is traditionally ignored. This study evaluated the prognostic value of QRS/T angle for mortality in the presence and absence of BBB. Total 15,408 participants (mean age 54years, 55.2% women, 26.9% blacks, 2.8% with BBB) were from the Arteriosclerosis Risk in Communities Study. Sex stratified Cox regression models were used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) for coronary heart disease (CHD) and all-cause mortality for wide spatial QRS/T angle with and without BBB including right BBB (RBBB), left BBB (LBBB) and indetermined-type ventricular conduction defect (IVCD) and RBBB combined with left anterior fascicular block. During a median 22-year follow-up, 4767 deaths occurred, 728 of them CHD deaths. Using the No-BBB with QRS/T angle below median value as gender-specific reference groups, the mortality risk increase was significant for both women and men with No-BBB and QRS/T angle above the median ...
We constructed an intracardiac vectorcardiogram from 3 configurations of intracardiac cardioverto... more We constructed an intracardiac vectorcardiogram from 3 configurations of intracardiac cardiovertor defibrilator (ICD) electrograms (EGMs). Six distinctive 3 lead combinations were selected out of five leads: can to right ventricular coil (RVC); RVC to superior vena cava coil (SVC); atrial lead tip (A-tip) to right ventricular (RV)-ring; can to RV-ring; RV-tip to RVC, in a patient with dual chamber ICD. Surface spatial QRS-T angle (119.8°) was similar to intracardiac spatial QRS-T angle derived from ICD EGMs combination A (101.3°), B (96.1°), C (92.8°), D (95.2), E (99.0), F (96.2) and median (101.5). Future validation of the novel method is needed.
ABSTRACT T-wave alternans (TWA) and mechanical alternans (MA) can be coupled. The goal of this st... more ABSTRACT T-wave alternans (TWA) and mechanical alternans (MA) can be coupled. The goal of this study was to compare outcomes in patents with MA and TWA. A prospective cohort study was conducted in the intensive cardiac care unit and enrolled 133 patients (59.6 ± 15.7 years; 65% men) admitted with acute heart failure (HF). Surface ECG and peripheral arterial blood pressure waveform via arterial line were recorded continuously. MA and TWA were measured by enhanced modified moving average method. All-cause death or heart transplant served as a combined primary endpoint. MA was observed in 28 patients (25%), whereas TWA was detected in 33 patients (33%). If present, MA was tightly coupled with TWA. Mitral flow deceleration time was shorter (127 ± 61 ms vs 172 ± 80 ms, P = .030), and left atrial systolic diameter was larger (5.1 ± 1.3 mm vs 4.4 ± 0.9 mm, P = .020) in patients with MA compared to those without. Mean TWA amplitude was larger in patients with both TWA and MA compared to patients with lone TWA (median 37 [interquartile range 26-61] µV vs 22 [21-23] µV, P = .045). After adjustment for New York Heart Association HF class, MA was associated with the primary endpoint (HR 2.3, 95% confidence interval 1.15-4.59, P = .018), whereas all lone TWA patients remained alive. Univariate Kaplan-Meier survival analysis showed the worst survival in patients with both MA and TWA at baseline, whereas patients without alternans had an intermediate probability of survival (Figure 1). All patients with lone TWA remained free from the primary endpoint. HF patients with MA are characterized by restrictive diastolic dysfunction. The predictive value of TWA without simultaneous assessment of MA is inconclusive.
Repolarization abnormality in bundle branch blocks (BBB) is traditionally ignored. This study eva... more Repolarization abnormality in bundle branch blocks (BBB) is traditionally ignored. This study evaluated the prognostic value of QRS/T angle for mortality in the presence and absence of BBB. Total 15,408 participants (mean age 54years, 55.2% women, 26.9% blacks, 2.8% with BBB) were from the Arteriosclerosis Risk in Communities Study. Sex stratified Cox regression models were used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) for coronary heart disease (CHD) and all-cause mortality for wide spatial QRS/T angle with and without BBB including right BBB (RBBB), left BBB (LBBB) and indetermined-type ventricular conduction defect (IVCD) and RBBB combined with left anterior fascicular block. During a median 22-year follow-up, 4767 deaths occurred, 728 of them CHD deaths. Using the No-BBB with QRS/T angle below median value as gender-specific reference groups, the mortality risk increase was significant for both women and men with No-BBB and QRS/T angle above the median ...
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Papers by L. Tereshchenko