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  • 1
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Clinical and experimental observations indicate that reduced beat-to-beat changes in the cycle length of nonsustained ventricular tachycardia (NSVT) may portend malignant ventricular tachyarrhythmias and sudden cardiac death. The purpose of the study was to test the hypothesis that measures of ventricular rate variability during NSVT (VRV-NSVT) may be useful in identifying patients at high risk of life-threatening arrhythmic events.Methods: The study group consisted of 326 patients who had NSVT on 24-hour ECG recordings. Temporal changes in up to 10 beat-to-beat intervals of NSVT runs (V-V) were assessed. The following parameters of VRV-NSVT were calculated: (1) average value of successive differences in V-V intervals (ADVV); and (2) normalized average value of successive differences in V-V intervals (nADVV).Results: During a mean follow-up of 4 years, 52 (16%) patients had a documented episode of sustained VT or ventricular fibrillation. Patients with these arrhythmic events had significantly (P 〈 0.001) lower values of ADVV and nADVV variables in comparison to patients without arrhythmic events. The relative risk of malignant arrhythmic events for patients with ADW 〈 40 ms was 4.9 (P 〈 0.001), for patients with nADVV 〈 6%, the risk was 3.9 (P 〈 0.001).Conclusions: The results of this study indicate a strong and significant relationship between NSVT and the risk of subsequent malignant ventricular tachycardia. The assessment of VRV-NSVT may be useful for identifying patients at high and low risk for subsequent arrhythmic events.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: The diagnostic value of ambulatory ECG monitoring in screening for coronary artery disease has been studied in diverse and usually small groups of patients. There are no studies evaluating the diagnostic value of Holter recorded ST depression using the Bayes' theorem of probability, which accounts for the prevalence of the disease in prespecified populations.Purpose: Applying the Bayes' theorem, this study aimed to examine the diagnostic value of Holterrecorded 1-mm ST depression in patients screened for coronary artery disease (CAD) and to identify groups of patients who may benefit from diagnostic ST segment monitoring in ambulatory ECG recordings.Methods: The ST segment analysis was performed in 24-hour ambulatory ECG monitoring of 460 subjects (375 males; aged 35–65, mean 48.6 years), who were screened for CAD and had coronary angiography. The Bayes' formulae were used to calculate the predictive value of ST segment monitoring (posttest likelihood of CAD) in comparison to pretest likelihood of the disease based on age, gender, and symptoms.Results: The 1-mm ST depression was identified in the ambulatory ECG monitoring in 203 (44%) patients. CAD was angiographically confirmed in 279 (61%) patients. The 1-mm ST depression had 54% sensitivity, 71% specificity, 74% positive predictive value, and 50% negative predictive value for CAD. The Bayes' theorem analysis with adjustment for pretest likelihood of the disease in relation to age, gender, and symptoms showed that 1-mm ST segment depression is significant diagnostically in patients with pretest likelihood of the disease exceeding 75%, i.e., in males aged 35–45 years and females aged 56–65 years, both with typical angina. In other groups of patients regardless of the symptoms, age, and gender, detection of ST segment depression does not improve the diagnostic process. A negative result (absence of ST segment depression) can be helpful, confirming the absence of CAD in patients with 15%–25% pretest likelihood of the disease, i.e., in females aged 35–45 years with atypical angina pains and in males aged 46–55 years with nonanginal chest pains.Conclusions: Based on our observations, the 1-mm ST segment depression detected on 24-hour ambulatory ECG monitoring indicates a high likelihood of CAD in patients with 〈 75% pretest likelihood of the disease. ST segment analysis in other age and gender relative groups of patients, regardless of the nature of their symptoms, does not significantly improve diagnosis process.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    350 Main Street , Malden , MA 02148 , USA , and 9600 Garsington Road , Oxford OX4 2XG , UK . : Blackwell Publishing, Inc.
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Seismocardiography (SCG) is a useful method for the detection of exercise-induced changes in cardiac muscle contractility which may occur during myocardial ischemia. The aim of this study was to compare the diagnostic accuracy of SCG with electrocardiographic exercise test (ETT) for diagnosis of ischemia in patients with angiographically proved coronary artery disease (CAD). Methods: Seventy-seven male patients with CAD without myocardial infarction (MI), mean age 51 ± 9 years, were subjected to SCG and ETT. A gender-matched control group consisted of 30 healthy volunteers aged 34 ± 7 years. SCG was done simultaneously with resting supine 12-lead electrocardiography before and immediately after a symptom-limited ETT. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of SCG were compared with ETT. Moreover, the diagnostic accuracy of both the methods was compared, with coronary angiography being the reference for the analysis. Results: SCG was more sensitive (61.1% vs 44.2%, P 〈 0.05) and accurate (70% vs 61%, P 〈 0.05) method for detecting ischemia caused by coronary stenosis ≥50%, at least in one coronary artery compared to the ETT. However, ETT had better specificity than SCG (82.4% vs 76%, P 〈 0.05). The PPV and NPV of SCG were significantly better than those obtained with ETT (77.9% vs 76%, P 〈 0.05 and 63.4% vs 53.8%, P 〈 0.05, respectively). Moreover, the concordant results of SCG and ETT improved the diagnostic accuracy of both methods. Conclusions: SCG appeared to be more sensitive for detecting ischemia caused by more than ≥50% stenosis of the main coronary artery compared to an electrocardiographic stress test. SCG was a useful ETT adjunct for selecting patients requiring coronary angiography.
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