Chagas disease is one of the most important endemic parasitic diseases in Latin America. In its chronic phase, progression to cardiomyopathy has high morbidity and mortality. The persistence of a ...normal electrocardiogram (ECG) provides a similar prognosis to that of a non-diseased population. Benznidazole (BNZ) is the only drug with trypanocidal action available in Brazil.
A group of 310 patients with chronic Chagas disease who had normal ECGs at the first medical visit performed before 2002 were included. There were 263 patients treated with BNZ and 47 untreated. The follow-up period was 19.59 years. Univariate analyses showed that those treated were younger and predominantly male. As many as 79.08% of those treated and 46.81% of those untreated continued with normal electrocardiograms (p <0.0001). The occurrence of electrocardiographic abnormalities and relevant clinical events (heart failure, stroke, total mortality, and cardiovascular death) was less prevalent in treated patients (p <0.001, p: 0.022, p: 0.047 respectively). In multivariate analyses, the parasiticide treatment was an independent variable for persistence of a normal ECG pattern, which was an independent variable in the prevention of significant clinical events. The immunofluorescence titers decreased with the parasitological treatment. However, the small number of tests in untreated patients did not allow the correlation of the decrease of these titers with electrocardiographic alterations.
These data suggest that treatment with benznidazole prevents the occurrence of electrocardiographic alterations. On the other hand, patients who develop ECG abnormalities present with more significant clinical events.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Electrocardiogram is the initial test in the investigation of heart disease. Electrocardiographic changes in hypertrophic cardiomyopathy have no set pattern, and correlates poorly with ...echocardiographic findings. Cardiac magnetic resonance imaging has been gaining momentum for better assessment of hypertrophy, as well as the detection of myocardial fibrosis.
To correlate the electrocardiographic changes with the location of hypertrophy in hypertrophic cardiomyopathy by cardiac magnetic resonance.
This descriptive cross-sectional study evaluated 68 patients with confirmed diagnosis of hypertrophic cardiomyopathy by cardiac magnetic resonance. The patients' electrocardiogram was compared with the location of the greatest myocardial hypertrophy by cardiac magnetic resonance. Statistical significance level of 5% and 95% confidence interval were adopted.
Of 68 patients, 69% had septal hypertrophy, 21% concentric and 10% apical hypertrophies. Concentric hypertrophy showed the greatest myocardial fibrosis mass (p < 0.001) and the greatest R wave size in D1 (p = 0.0280). The amplitudes of R waves in V5 and V6 (p = 0.0391, p = 0.0148) were higher in apical hypertrophy, with statistical significance. Apical hypertrophy was also associated with higher T wave negativity in D1, V5 and V6 (p < 0.001). Strain pattern was found in 100% of the patients with apical hypertrophy (p < 0.001).
The location of myocardial hypertrophy by cardiac magnetic resonance can be correlated with electrocardiographic changes, especially for apical hypertrophy.
FUNDAMENTOS: O bloqueio do ramo esquerdo (BRE) e a presença de disfunção sistólica são as principais indicações de terapia de ressincronização cardíaca (TRC). A dissincronia ventricular mecânica pela ...ecocardiografia pode ajudar a identificar pacientes responsivos à TRC. O BRE pode mostrar diferentes padrões em sua morfologia. OBJETIVO: Comparar a prevalência de dissincronia mecânica em diferentes padrões de BRE em pacientes com disfunção sistólica esquerda. MÉTODOS: Analisaram-se 48 pacientes com fração de ejeção (FE) < 40% e BRE referidos consecutivamente para análise de dissincronia. Foram realizados ecocardiograma convencional e análise da dissincronia mecânica, interventricular e intraventricular, por 10 conhecidos métodos, usando modo M, Doppler e Doppler tecidual, sozinhos ou combinados. A morfologia do BRE foi categorizada pelo desvio esquerdo do eixo no plano frontal e duração de QRS > 150 ms. RESULTADOS: Eram 24 homens, com idade 60 ± 11 anos e FEVE de 29 ± 7%. Trinta e dois apresentavam QRS > 150 ms, e 22, ECG eixo entre -30º e +90º. A dissincronia interventricular foi identificada em 73% dos pacientes e a intraventricular em valores entre 37-98%. Portadores de QRS > 150 ms apresentaram maiores dimensões do átrio e ventrículo esquerdos, e menor FE (p < 0,05), e o desvio esquerdo do eixo associou-se a pior função diastólica e maior diâmetro atrial. A presença de dissincronia mecânica interventricular e intraventricular (10 métodos) foi semelhante entre os diferentes padrões de BRE (p = ns). CONCLUSÃO: Nos dois diferentes padrões eletrocardiográficos de BRE analisados, não foram observadas diferenças em relação à presença de dissincronia mecânica.
Left bundle-branch block (LBBB) and the presence of systolic dysfunction are the major indications for cardiac resynchronization therapy (CRT). Mechanical ventricular dyssynchrony on echocardiography ...can help identify patients responsive to CRT. Left bundle-branch block can have different morphologic patterns.
To compare the prevalence of mechanical dyssynchrony in different patterns of LBBB in patients with left systolic dysfunction.
This study assessed 48 patients with ejection fraction (EF) < 40% and LBBB consecutively referred for dyssynchrony analysis. Conventional echocardiography and mechanical dyssynchrony analysis were performed, interventricular and intraventricular, with ten known methods, using M mode, Doppler and tissue Doppler imaging, isolated or combined. The LBBB morphology was categorized according to left electrical axis deviation in the frontal plane and QRS duration > 150 ms.
The patients' mean age was 60 ± 11 years, 24 were males, and mean EF was 29% ± 7%. Thirty-two had QRS > 150 ms, and22, an electrical axis between -30º and +90º. Interventricular dyssynchrony was identified in 73% of the patients, while intraventricular dyssynchrony, in 37%-98%. Patients with QRS > 150 ms had larger left atrium and ventricle, and lower EF (p < 0.05). Left electrical axis deviation associated with worse diastolic function and greater atrial diameter. Interventricular and intraventricular mechanical dyssynchrony (ten methods) was similar in the different LBBB patterns (p = ns).
In the two different electrocardiographic patterns of LBBB analyzed, no difference regarding the presence of mechanical dyssynchrony was observed.
IntroductionMasquerading bundle branch block (MBBB) is a rare cardiac conduction anomaly characterized in the Electrocardiogram (EKG) by Right Bundle Branch Block in the precordial leads and Left ...Bundle Branch Block in frontal leads. The available evidence indicates that it carries poor prognosis and that it is often underdiagnosed. We studied epidemiological peculiarities, electrocardiographic features and prognosis of this rare kind of ventricular conduction delay.MethodsIn a review of over 600,000 EKGs from the database of Tele-Electrocardiography department of Dante Pazzanese Institute of Cardiology during the last seven years, we found twenty-five cases of MBBB. Diagnostic criteria were presence of QRS ≥ 0.12 s, dominant positive waves in V1, left axis deviation and absent or minimal S wave in DI and aVL. Epidemiological data was collected for each EKG and the follow-up of patient′s health status was assessed by telephone contact. Kaplan-Meier survival curves were based on the following endpointsmortality, pacemaker implantation and the composite of both.ResultsWe identified twenty-five cases (21 males and 4 females) of MBBB. The average age was 69 (±14) years. Sinus rhythm was present in 17 patients (68%), atrial fibrillation in 7 (28%) and atrial flutter in one (4%). Average heart rate, PR interval, QRS length, QTc and QRS axis were, respectively70 (±17) bpm, 205 (±50) ms, 159 (±24) ms, 463 (±37) ms and -76° (±6) degrees. Follow-up data was successfully obtained from 15 patients4 (26.6%) had a pacemaker implanted, 7 (46.6%) died and 9 had combined endpoints (60%). According to the Kaplan-Meier survival curve, at 48 months, the estimated ratios of death, pacemaker implantation or combined endpoints were 41.4%, 38.9% and 80.2%, respectively.ConclusionsMBBB represents a high-risk condition and, although rare, this EKG pattern should be taken into consideration due to the poor prognosis associated with its presence.
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