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Article ; Online: Major bleeding with vitamin K antagonist anticoagulants in pulmonary hypertension.

Henkens, Ivo R / Hazenoot, Thomas / Boonstra, Anco / Huisman, Menno V / Vonk-Noordegraaf, Anton

2013 Volume 41, Issue 4, Page(s) 872–878

Abstract: Vitamin K antagonists are advised in pulmonary arterial hypertension patients despite a lack of safety data. We reviewed major bleeding in three classes of pulmonary hypertension patients, all receiving vitamin K antagonists. Bleeding event rates were 5 ... ...

Abstract	Vitamin K antagonists are advised in pulmonary arterial hypertension patients despite a lack of safety data. We reviewed major bleeding in three classes of pulmonary hypertension patients, all receiving vitamin K antagonists. Bleeding event rates were 5.4 per 100 patient-years for patients with idiopathic pulmonary arterial hypertension, 19 per 100 patient-years for connective tissue disease related pulmonary arterial hypertension patients and 2.4 per 100 patient-years for chronic thromboembolic pulmonary hypertension patients. Life tables analysis showed that event-free survival was worse in patients with connective tissue disease related pulmonary hypertension than in patients with idiopathic pulmonary arterial hypertension (Wilcoxon=12.8; p<0.001), and patients with chronic thromboembolic pulmonary hypertension (Wilcoxon=23.2; p<0.001). Patients with idiopathic pulmonary arterial hypertension suffered more events than patients with chronic thromboembolic pulmonary hypertension (Wilcoxon=7.2; p<0.01). Major bleeding was independent of age, sex, target international normalised ratio (INR) range, documented INR, vitamin K antagonist type, or right atrial pressure, but was associated with use of prostacyclin analogues. Major bleeding risk during vitamin K antagonist therapy differs among groups of patients with pulmonary hypertension. Further research regarding optimal anticoagulant therapy is needed, as well as risk-benefit analyses for pulmonary hypertension patients with a higher bleeding propensity.
MeSH term(s)	Administration, Oral ; Adult ; Aged ; Anticoagulants/adverse effects ; Disease-Free Survival ; Female ; Fibrinolytic Agents/therapeutic use ; Hemorrhage/chemically induced ; Humans ; Hypertension, Pulmonary/complications ; Hypertension, Pulmonary/drug therapy ; International Normalized Ratio ; Male ; Middle Aged ; Platelet Count ; Retrospective Studies ; Vitamin K/antagonists & inhibitors
Chemical Substances	Anticoagulants ; Fibrinolytic Agents ; Vitamin K (12001-79-5)
Language	English
Publishing date	2013-04
Publishing country	England
Document type	Journal Article
ZDB-ID	639359-7
ISSN	1399-3003 ; 0903-1936
ISSN (online)	1399-3003
ISSN	0903-1936
DOI	10.1183/09031936.00039212
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Zs.A 2322: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 292: Show issues

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Article ; Online: Het syndroom van Austrian: een patiënt met meningitis, pneumonie en endocarditis.

Schimmelpenninck, Catrien A / Henkens, Ivo R / Duchateau, Christianne S J / van Buren, Marjolijn

Nederlands tijdschrift voor geneeskunde

2010 Volume 154, Page(s) A1480

Abstract: A 62-year-old man with a history of significant alcohol consumption presented with atypical neurological symptoms. Bacterial meningitis, caused by Streptococcus pneumoniae, was diagnosed with a 24-hour delay. Despite antibiotic treatment, the patient ... ...

Title translation	Austrian syndrome: a patient with meningitis, pneumonia and endocarditis.
Abstract	A 62-year-old man with a history of significant alcohol consumption presented with atypical neurological symptoms. Bacterial meningitis, caused by Streptococcus pneumoniae, was diagnosed with a 24-hour delay. Despite antibiotic treatment, the patient developed heart failure and multiple organ failure. He also had endocarditis with insufficient mitral and aortic valves. Subsequently, we found signs of a pulmonary infection. Because of an unsustainable haemodynamic situation, double heart valve replacement was considered necessary, despite the extremely high surgical risk and the extracardial infection foci showed by leukocyte scintigraphy. The patient died shortly after surgery. The triad of meningitis, pneumonia and endocarditis caused by Streptococcus pneumoniae is called the Austrian syndrome. This syndrome is rare and often has a serious course. It is strongly associated with asplenia, functional asplenia or hyposplenism, as occurs with alcohol abuse. Early recognition and a combination of antibiotic and surgical treatment is essential.
MeSH term(s)	Endocarditis, Bacterial/complications ; Endocarditis, Bacterial/microbiology ; Fatal Outcome ; Heart Failure/etiology ; Heart Failure/microbiology ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Meningitis, Pneumococcal/complications ; Meningitis, Pneumococcal/microbiology ; Middle Aged ; Multiple Organ Failure/etiology ; Multiple Organ Failure/microbiology ; Streptococcal Infections/complications ; Streptococcal Infections/microbiology
Language	Dutch
Publishing date	2010
Publishing country	Netherlands
Document type	Case Reports ; English Abstract ; Journal Article
ZDB-ID	82073-8
ISSN	1876-8784 ; 0028-2162
ISSN (online)	1876-8784
ISSN	0028-2162
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Article ; Online: Diagnosis and mortality prediction in pulmonary hypertension: the value of the electrocardiogram-derived ventricular gradient.

Scherptong, Roderick W C / Henkens, Ivo R / Kapel, Gijs F L / Swenne, Cees A / van Kralingen, Klaas W / Huisman, Menno V / Schuerwegh, Annemie J M / Bax, Jeroen J / van der Wall, Ernst E / Schalij, Martin J / Vliegen, Hubert W

Journal of electrocardiology

2012 Volume 45, Issue 3, Page(s) 312–318

Abstract: Purpose: The aim of this study was to investigate the use of the electrocardiogram-derived ventricular gradient, projected on the x-axis (VGx), for detection of pulmonary hypertension (PH) and for prediction of all-cause mortality in PH patients.: ... ...

Abstract	Purpose: The aim of this study was to investigate the use of the electrocardiogram-derived ventricular gradient, projected on the x-axis (VGx), for detection of pulmonary hypertension (PH) and for prediction of all-cause mortality in PH patients. Methods: In patients referred for PH screening (n = 216), the VGx was calculated semiautomatically from the electrocardiogram and was defined as abnormal when less than 24 mV · ms. The VGx of PH patients was compared with the VGx of patients without PH. The association between a reduced VGx and mortality was investigated in PH patients. Results: Patients with PH (n = 117) had a significantly reduced VGx: 14 ± 27 vs 45 ± 23 mV · ms, P < .001. Furthermore, a severely reduced VGx (<0 mV · ms) was associated with increased mortality in PH patients: hazard ratio, 1.025 (95% confidence interval, 1.006-1.045; P = .012) per mV·ms VGx decrease. Conclusion: Reduced VGx is associated with the presence of PH and, more importantly, within PH patients, a severely reduced VGx predicts mortality.
MeSH term(s)	Comorbidity ; Electrocardiography/methods ; Electrocardiography/statistics & numerical data ; Female ; Humans ; Hypertension, Pulmonary/diagnosis ; Hypertension, Pulmonary/mortality ; Male ; Middle Aged ; Netherlands/epidemiology ; Prevalence ; Prognosis ; Reproducibility of Results ; Sensitivity and Specificity ; Survival Analysis ; Survival Rate ; Ventricular Dysfunction/diagnosis ; Ventricular Dysfunction/mortality
Language	English
Publishing date	2012-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	410286-1
ISSN	1532-8430 ; 0022-0736
ISSN (online)	1532-8430
ISSN	0022-0736
DOI	10.1016/j.jelectrocard.2011.12.001
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Article ; Online: Preoperative determinants of recovery time in adult Fallot patients after late pulmonary valve replacement.

Henkens, Ivo R / van Straten, Alexander / Hazekamp, Mark G / Schalij, Martin J / de Roos, Albert / van der Wall, Ernst E / Vliegen, Hubert W

International journal of cardiology

2007 Volume 121, Issue 1, Page(s) 123–124

MeSH term(s)	Age Factors ; Child ; Child, Preschool ; Female ; Heart Valve Prosthesis ; Humans ; Infant ; Male ; Pulmonary Valve/surgery ; Recovery of Function ; Tetralogy of Fallot/surgery
Language	English
Publishing date	2007-09-14
Publishing country	Netherlands
Document type	Letter
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2006.08.055
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Article ; Online: Relation of resting heart rate to prognosis in patients with idiopathic pulmonary arterial hypertension.

Henkens, Ivo R / Van Wolferen, Serge A / Gan, C Tji-Joong / Boonstra, Anco / Swenne, Cees A / Twisk, Jos W / Kamp, Otto / van der Wall, Ernst E / Schalij, Martin J / Vonk-Noordegraaf, Anton / Vliegen, Hubert W

The American journal of cardiology

2009 Volume 103, Issue 10, Page(s) 1451–1456

Abstract: Heart rate (HR) at rest is an important marker of prognosis in heart failure, but has not been addressed in pulmonary arterial hypertension (PAH). To determine the prognostic value of HR at rest in patients with PAH, we retrospectively analyzed 140 ... ...

Abstract	Heart rate (HR) at rest is an important marker of prognosis in heart failure, but has not been addressed in pulmonary arterial hypertension (PAH). To determine the prognostic value of HR at rest in patients with PAH, we retrospectively analyzed 140 consecutive patients with idiopathic PAH. Electrocardiogram (ECG)-derived HR at rest was evaluated as a potential predictor of adverse prognosis (death or lung transplantation), in addition to World Health Organization functional class, 6-minute walk distance, and hemodynamics before and approximately 1 year and 2 years after initiation of PAH treatment. During follow-up, 49 patients (35%) died, and 5 patients (4%) underwent lung transplantation. Before treatment initiation and after 1 year and 2 years of treatment, respectively, a higher HR at rest was an independent predictor of adverse prognosis (hazard ratios per 10-beats/min increase 1.76, 95% confidence interval 1.42 to 2.18, 2.31, 95% confidence interval 1.58 to 3.38, 2.1, 95% confidence interval 1.39 to 3.19, respectively, p <0.001 for all). Change in HR between the first and last ECG also independently predicted prognosis (hazard ratio per 1-beat/min increase 1.03, 95% confidence interval 1.01 to 1.06). In conclusion, a higher HR at rest and an important increase in HR at rest during follow-up signify a considerable risk of death in patients with PAH. ECG-derived HR at rest is an important marker of prognosis and should be assessed before and at frequent intervals after initiation of treatment for PAH.
MeSH term(s)	Adult ; Chi-Square Distribution ; Electrocardiography ; Exercise Test ; Female ; Heart Rate/physiology ; Hemodynamics ; Humans ; Hypertension, Pulmonary/mortality ; Hypertension, Pulmonary/physiopathology ; Hypertension, Pulmonary/therapy ; Lung Transplantation ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; ROC Curve ; Retrospective Studies ; Survival Rate
Language	English
Publishing date	2009-05-15
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2009.01.359
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Article: Right coronary artery flow impairment in patients with pulmonary hypertension.

van Wolferen, Serge A / Marcus, J Tim / Westerhof, Nico / Spreeuwenberg, Marieke D / Marques, Koen M J / Bronzwaer, Jean G F / Henkens, Ivo R / Gan, C Tji-Joong / Boonstra, Anco / Postmus, Pieter E / Vonk-Noordegraaf, Anton

European heart journal

2008 Volume 29, Issue 1, Page(s) 120–127

Abstract: ... to-diastolic flow ratio in the RCA, and mean flow per gram RV tissue, were inversely related to RV mass, R = -0 ... 61 (P = 0.009), and R = -0.73 (P < 0.001) and to RV pressure, R = -0.83 (P < 0.001), and R = -0.57 (P ...

Abstract	Aims: This study investigates whether increased right ventricular (RV) pressure in pulmonary hypertension (PH) impairs right coronary artery (RCA) flow and RV perfusion. Methods: In 25 subjects, five patients with idiopathic pulmonary arterial hypertension, nine patients with chronic thromboembolic pulmonary arterial hypertension, and 11 healthy controls, flow of the RCA and left anterior descending (LAD) artery was measured with MR flow quantification. Results: In PH, RCA peak systolic and mean systolic flow were lower, 1.02 +/- 0.62 mL/s and 0.42 +/- 0.30 mL/s, than peak and mean diastolic flow, 2.99 +/- 1.97 mL/s (P < 0.001) and 1.73 +/- 0.97 mL/s (P < 0.001); a pattern similar to the LAD. In contrast, in controls, RCA peak and mean flow in systole, 1.63 +/- 0.58 mL/s and 0.72 +/- 0.23 mL/s, were comparable to peak and mean flow in diastole, 1.72 +/- 0.48 mL/s and 0.93 +/- 0.28 mL/s (NS). The systolic-to-diastolic flow ratio in the RCA, and mean flow per gram RV tissue, were inversely related to RV mass, R = -0.61 (P = 0.009), and R = -0.73 (P < 0.001) and to RV pressure, R = -0.83 (P < 0.001), and R = -0.57 (P = 0.033). Conclusion: Although in controls, RCA flow is similar in systole and diastole, in PH there is systolic flow impediment, which is proportional to RV pressure and mass. In patients with severe RV hypertrophy total mean flow is reduced.
MeSH term(s)	Blood Flow Velocity ; Blood Pressure/physiology ; Coronary Circulation/physiology ; Coronary Stenosis/complications ; Coronary Stenosis/physiopathology ; Diastole ; Female ; Humans ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/physiopathology ; Hypertrophy, Right Ventricular/complications ; Hypertrophy, Right Ventricular/physiopathology ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Systole ; Ventricular Dysfunction, Right/complications ; Ventricular Dysfunction, Right/physiopathology
Language	English
Publishing date	2008-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603098-1
ISSN	1522-9645 ; 0195-668X
ISSN (online)	1522-9645
ISSN	0195-668X
DOI	10.1093/eurheartj/ehm567
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Zs.A 1563: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Improved ECG detection of presence and severity of right ventricular pressure load validated with cardiac magnetic resonance imaging.

Henkens, Ivo R / Mouchaers, Koen T B / Vonk-Noordegraaf, Anton / Boonstra, Anco / Swenne, Cees A / Maan, Arie C / Man, Sum-Che / Twisk, Jos W R / van der Wall, Ernst E / Schalij, Martin J / Vliegen, Hubert W

American journal of physiology. Heart and circulatory physiology

2008 Volume 294, Issue 5, Page(s) H2150–7

Abstract: ... rsr' or rsR' in V1, R/S > 1 with R > 0.5 mV in V1, and QRS axis >90 degrees ) had a sensitivity of 89 ...

Abstract	The study aimed to assess whether the 12-lead ECG-derived ventricular gradient, a vectorial representation of ventricular action potential duration heterogeneity directed toward the area of shortest action potential duration, can improve ECG diagnosis of chronic right ventricular (RV) pressure load. ECGs from 72 pulmonary arterial hypertension patients recorded <30 days before onset of therapy were compared with ECGs from matched healthy control subjects (n = 144). Conventional ECG criteria for increased RV pressure load were compared with the ventricular gradient. In 38 patients a cardiac magnetic resonance (CMR) study had been performed within 24 h of the ECG. By multivariable analysis, combined use of conventional ECG parameters (rsr' or rsR' in V1, R/S > 1 with R > 0.5 mV in V1, and QRS axis >90 degrees ) had a sensitivity of 89% and a specificity of 93% for presence of chronic RV pressure load. However, the ventricular gradient not only had a higher diagnostic accuracy for chronic RV pressure load by receiver operating characteristic analysis [areas under the curve (AUC) = 0.993, SE 0.004 vs. AUC = 0.945, SE 0.021, P < 0.05], but also discriminated between mild-to-moderate and severe RV pressure load. CMR identified an inverse relation between the ventricular gradient and RV mass, and a trend toward a similar relation with RV volume. In conclusion, chronically increased RV pressure load is electrocardiographically reflected by an altered ventricular gradient associated with RV remodeling-related changes in ventricular action potential duration heterogeneity. The use of the ventricular gradient allows ECG detection of even mildly increased RV pressure load.
MeSH term(s)	Action Potentials ; Adult ; Aged ; Case-Control Studies ; Electrocardiography ; Female ; Humans ; Hypertension, Pulmonary/etiology ; Hypertension, Pulmonary/pathology ; Hypertension, Pulmonary/physiopathology ; Hypertrophy, Right Ventricular/etiology ; Hypertrophy, Right Ventricular/pathology ; Hypertrophy, Right Ventricular/physiopathology ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Predictive Value of Tests ; Pulmonary Artery/physiopathology ; ROC Curve ; Sensitivity and Specificity ; Severity of Illness Index ; Time Factors ; Vectorcardiography ; Ventricular Dysfunction, Right/complications ; Ventricular Dysfunction, Right/diagnosis ; Ventricular Dysfunction, Right/pathology ; Ventricular Dysfunction, Right/physiopathology ; Ventricular Pressure ; Ventricular Remodeling
Language	English
Publishing date	2008-02-29
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Validation Study
ZDB-ID	603838-4
ISSN	1522-1539 ; 0363-6135
ISSN (online)	1522-1539
ISSN	0363-6135
DOI	10.1152/ajpheart.01312.2007
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Article ; Online: ECG monitoring of treatment response in pulmonary arterial hypertension patients.

Henkens, Ivo R / Gan, C Tji-Joong / van Wolferen, Serge A / Hew, Miki / Boonstra, Anco / Twisk, Jos W R / Kamp, Otto / van der Wall, Ernst E / Schalij, Martin J / Vonk Noordegraaf, Anton / Vliegen, Hubert W

Chest

2008 Volume 134, Issue 6, Page(s) 1250–1257

Abstract: Background: The potential use of the ECG for monitoring treatment effects in patients with pulmonary arterial hypertension (PAH) has not been investigated. We evaluated whether the ECG is useful for monitoring treatment response based on changes in ... ...

Abstract	Background: The potential use of the ECG for monitoring treatment effects in patients with pulmonary arterial hypertension (PAH) has not been investigated. We evaluated whether the ECG is useful for monitoring treatment response based on changes in pulmonary vascular resistance (PVR). Methods: An ECG was recorded in 81 PAH patients at the time of diagnostic right heart catheterization and after 1 year of treatment. Patients were treated according to the guidelines. Patients were divided into two groups based on PVR (ie, < 500 or > 500 dyne x s x cm(-5)). A positive treatment response was defined as a > 25% decrease in PVR to an absolute PVR of < 500 dyne x s x cm(-5). Results: At baseline, the 19 patients with a PVR of < 500 dyne x s x cm(-5) had a significantly lower P amplitude in lead II, a less rightward oriented QRS axis, and a more rightward T axis than the 62 patients with a PVR of > 500 dyne x s x cm(-5). Overall (n = 81), the mean (+/- SD) change in PVR was -143 +/- 360 dyne x s x cm(-5) after 1 year of treatment (p < 0.001). Twelve patients (19%) with a baseline PVR of > 500 dyne x s x cm(-5) were classified as responders. Receiver operating characteristic analysis determined that the P amplitude in lead II (area under the curve [AUC], 0.80; 95% confidence interval [CI], 0.67 to 0.94; p < 0.01), QRS axis (AUC, 0.70; 95% CI, 0.52 to 0.89; p = 0.03), and T axis (AUC, 0.90; 95% CI, 0.82 to 0.97; p < 0.001) were important determinants of treatment response. The presence of a P amplitude in lead II of < 0.175 mV and a T axis of >or= 25 degrees combined had a positive and negative predictive value for treatment response of 0.81 (95% CI, 0.37 to 0.96) and 0.94 (95% CI, 0.86 to 0.99), respectively. Conclusions: Routine ECG evaluation can be an important contribution in the assessment of treatment response in PAH patients.
MeSH term(s)	Adult ; Antihypertensive Agents/therapeutic use ; Cardiac Catheterization ; Cohort Studies ; Electrocardiography ; Female ; Humans ; Hypertension, Pulmonary/drug therapy ; Hypertension, Pulmonary/physiopathology ; Male ; Middle Aged ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Treatment Outcome ; Vascular Resistance/physiology
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2008-12
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1378/chest.08-0461
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Zs.MO 349: Show issues

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Article ; Online: Pulmonary valve replacement in tetralogy of Fallot improves the repolarization.

Hooft van Huysduynen, Bart / Henkens, Ivo R / Swenne, Cees A / Oosterhof, Thomas / Draisma, Harmen H M / Maan, Arie C / Hazekamp, Mark G / de Roos, Albert / Schalij, Martin J / van der Wall, Ernst E / Vliegen, Hubert W

International journal of cardiology

2008 Volume 124, Issue 3, Page(s) 301–306

Abstract: Objective: To assess the effect of pulmonary valve replacement (PVR) on the repolarization of patients with tetralogy of Fallot.: Background: Pulmonary valve regurgitation may cause right ventricular failure in adult patients with Fallot's tetralogy. ...

Abstract	Objective: To assess the effect of pulmonary valve replacement (PVR) on the repolarization of patients with tetralogy of Fallot. Background: Pulmonary valve regurgitation may cause right ventricular failure in adult patients with Fallot's tetralogy. In these patients, prolonged depolarization and disturbed repolarization are associated with ventricular arrhythmias and sudden cardiac death. Methods: Thirty Fallot patients (age 32+/-9 years, 19 male) eligible for PVR were studied with cardiac magnetic resonance imaging (CMR) before and 6 months after PVR. Electrocardiograms obtained during initial and follow-up CMR were analyzed and occurrence of ventricular arrhythmias was studied. Results: Right ventricular end-diastolic volume (RV EDV) decreased from 322+/-87 to 215+/-57 ml after PVR (P<0.0001). The spatial QRS-T angle normalized from 117+/-34 to 100+/-35 degrees , P=0.0004 (normal angle <105 degrees). QT dispersion and T-wave complexity did not change significantly. T-wave amplitude decreased from 376+/-121 to 329+/-100 microV (P=0.01). T-wave area decreased from 43+/-15 to 38+/-13 microV s (P=0.02). Decreases in T-wave amplitude and area were most prominent in the right precordial leads overlying the RV. Three patients had sustained ventricular arrhythmias and one patient died suddenly. These patients had a QRS duration >160 ms. No severe ventricular arrhythmias were found in patients with a RV EDV <220 ml, QRS-T angle <100 degrees , QT dispersion <60 ms or T-wave complexity <0.30. Conclusion: Normal repolarization indices may be associated with the absence of severe ventricular arrhythmias. PVR in Fallot patients with dilated right ventricles has a beneficial effect on electrocardiographic indices of repolarization heterogeneity.
MeSH term(s)	Adult ; Electrocardiography ; Female ; Heart Conduction System/physiopathology ; Heart Valve Prosthesis Implantation/methods ; Humans ; Magnetic Resonance Imaging ; Male ; Pulmonary Valve/surgery ; Pulmonary Valve Insufficiency/diagnosis ; Pulmonary Valve Insufficiency/physiopathology ; Pulmonary Valve Insufficiency/surgery ; Tachycardia, Ventricular/prevention & control ; Tetralogy of Fallot/diagnosis ; Tetralogy of Fallot/physiopathology ; Tetralogy of Fallot/surgery ; Treatment Outcome
Language	English
Publishing date	2008-03-14
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	779519-1
ISSN	1874-1754 ; 0167-5273
ISSN (online)	1874-1754
ISSN	0167-5273
DOI	10.1016/j.ijcard.2007.02.006
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Article ; Online: Normal limits of the spatial QRS-T angle and ventricular gradient in 12-lead electrocardiograms of young adults: dependence on sex and heart rate.

Scherptong, Roderick W C / Henkens, Ivo R / Man, Sum Che / Le Cessie, Saskia / Vliegen, Hubert W / Draisma, Harmen H M / Maan, Arie C / Schalij, Martin J / Swenne, Cees A

Journal of electrocardiology

2008 Volume 41, Issue 6, Page(s) 648–655

Abstract: Background and purpose: Normal limits of the spatial QRS-T angle and spatial ventricular gradient (SVG) are only available from Frank vectorcardiograms (VCGs) of male subjects. We determined normal limits for these variables derived from standard 12- ... ...

Abstract	Background and purpose: Normal limits of the spatial QRS-T angle and spatial ventricular gradient (SVG) are only available from Frank vectorcardiograms (VCGs) of male subjects. We determined normal limits for these variables derived from standard 12-lead electrocardiograms (ECGs) of 660 male and female students aged 18 to 29 years. Methods: A computer algorithm was used that constructed approximated VCG leads by inverse Dower matrix transformation of the 12-lead ECG and subsequently calculated the spatial QRS-T angle, SVG magnitude, and orientation. Results: In female subjects, the QRS-T angle was more acute (females, 66 degrees +/- 23 degrees; normal, 20 degrees-116 degrees; males, 80 degrees +/- 24 degrees; normal, 30 degrees-130 degrees; P < .001), and the SVG magnitude was smaller (females, 81 +/- 23 mV x ms; normal, 39-143 mV x ms; males, 110 +/- 29 mV x ms; normal, 59-187 mV x ms; P < .001) than in male subjects. The male SVG magnitude in our study was larger than that computed in Frank VCGs (79 +/- 28 mV.ms; P < .001). Conclusions: The spatial QRS-T angle and SVG depend strongly on sex. Furthermore, normal limits of SVG derived from Frank VCGs differ markedly from those derived from VCGs synthesized from the standard ECG. As nowadays, VCGs are usually synthesized from the 12-lead ECG; normal limits derived from the standard ECG should preferably be used.
MeSH term(s)	Adult ; Diagnosis, Computer-Assisted/methods ; Diagnosis, Computer-Assisted/statistics & numerical data ; Electrocardiography/methods ; Electrocardiography/statistics & numerical data ; Female ; Heart Rate/physiology ; Humans ; Male ; Netherlands/epidemiology ; Reference Values ; Reproducibility of Results ; Sensitivity and Specificity ; Sex Factors ; Young Adult
Language	English
Publishing date	2008-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	410286-1
ISSN	1532-8430 ; 0022-0736
ISSN (online)	1532-8430
ISSN	0022-0736
DOI	10.1016/j.jelectrocard.2008.07.006
Database	MEDical Literature Analysis and Retrieval System OnLINE

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