Journal of electrocardiology最新文献

{"title":"Electrocardiographic LVH criteria: Poor diagnostic accuracy even with optimized cutoffs. Insights from MESA study","authors":"José Nunes de Alencar ,&nbsp;Sandro Pinelli Felicioni","doi":"10.1016/j.jelectrocard.2025.154138","DOIUrl":"10.1016/j.jelectrocard.2025.154138","url":null,"abstract":"<div><h3>Background</h3><div>Electrocardiographic (ECG) “left ventricular hypertrophy (LVH) criteria” are widely used as surrogates for increased LV mass but show limited sensitivity. We evaluated their diagnostic performance against cardiac magnetic resonance (CMR) in a large population cohort.</div></div><div><h3>Methods</h3><div>We analyzed 4849 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with standardized digital 12‑lead ECGs and CMR-derived LV mass indexed to body surface area (LVMi). LVH was defined as LVMi &gt;91 g/m² (men) and &gt; 77 g/m² (women). We assessed Sokolow-Lyon, Cornell voltage, Cornell product, Peguero–Lo Presti, Sokolow-aVL, and MESA-LVH (SV1 + SV2 + RV5). Diagnostic accuracy was calculated for classic (“pre-specified”) thresholds and for cutoffs optimized by the Youden index. We also tested whether combining indices via elastic-net penalized logistic regression improved discrimination.</div></div><div><h3>Results</h3><div>LVH prevalence was 30.2 %. Across classic thresholds, sensitivities were very low (3.7–15.2 %) with high specificities (&gt;94 %); likelihood ratios were modest (typical LR+ &lt;4; LR− ≈ 0.89–0.96). Youden-optimized cutoffs improved sensitivity (48.9–64.8 %) at the expense of specificity (54.4–74.3 %), yielding weak LR+ (1.42–1.94) and LR− (0.64–0.71). Pooled area under the ROC curve (AUC) for individual indices ranged 0.62–0.66. An elastic-net model combining all indices did not enhance discrimination beyond the best single measure (AUC 0.646).</div></div><div><h3>Conclusions</h3><div>In MESA, ECG voltage criteria—whether applied at classic or optimized thresholds—show poor diagnostic performance for CMR-defined LVH. Aggregating indices provides no material gain. These findings support reframing voltage positivity as an amplitude-based electrical phenotype with prognostic value rather than a reliable diagnostic surrogate for structural hypertrophy.</div></div><div><h3>Clinical trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifier <span><span>NCT00005487</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154138"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An integrated fractional stockwell transform with atrous convolutions aided vision transformer based capsule network for fetal ECG arrhythmia detection","authors":"P Siva Priya ,&nbsp;P Rajesh Kumar ,&nbsp;G. Srinivas ,&nbsp;Prasad Reddy PVGD","doi":"10.1016/j.jelectrocard.2025.154126","DOIUrl":"10.1016/j.jelectrocard.2025.154126","url":null,"abstract":"<div><div>One of the most difficult but important steps in assessing the fetus's health is the diagnosis of fetal cardiac abnormalities using fetal electrocardiograms (FECG). In order to provide accurate information regarding the fetus's condition, FECG monitoring is required. Severe fetal arrhythmia can cause heart failure or even death. This paper presents a Non-Causal Adaptive Filter that extracts the FECG through multiple error estimation. The maternal channel ECG in the chest will be used as the reference input, and the abdominal ECG will be used as the primary input for this filter. The clean FECG signals will be transformed into time-frequency (T-F) images using a fractional Stockwell transform after the FECG signals have been extracted. Using the Stockwell and fractional Fourier transforms, it can simultaneously display the time and fractional-frequency data in the time-fractional-frequency plane. The ability to detect fetal ECG arrhythmias with a clear physical interpretation is more significant. The resulting images are fed into the Atrous Convolutions aided Vision Transformer based Capsule Network (AConvVTCapNet) model, which detects fetal ECG arrhythmias. In this instance, Atrous convolutions efficiently compute dense feature maps, allowing the network to have wider receptive fields. The proposed model's parameters are adjusted using a new Opposition based Fire Hawk Optimization (OFHO) technique, which is carried out by the capsule network during the classification process. The proposed method obtained 98.23 % accuracy and 98.25 % specificity in the fetal ECG arrhythmia detection process.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154126"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145389201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transient atypical advanced interatrial block in a pre-adolescent with sequelae of rheumatic fever","authors":"Andrés Ricardo Pérez-Riera MD PhD ,&nbsp;Raimundo Barbosa-Barros MD ,&nbsp;Maurício da Silva Rocha MD PhD ,&nbsp;Cynthia Aparecida da Silva Rocha MD ,&nbsp;Luciano Evaristo Pereira Rejálaga MD ,&nbsp;Kjell Nikus MD PhD","doi":"10.1016/j.jelectrocard.2025.154141","DOIUrl":"10.1016/j.jelectrocard.2025.154141","url":null,"abstract":"<div><div>We present a case of a pre-adolescent girl with mitral stenosis caused by rheumatic fever. The 12‑lead ECG showed prolonged P-wave duration indicating interatrial block. In addition, the P waves in the inferior leads showed a transient atypical interatrial block with a triphasic pattern in lead II. The appearance of the atypical interatrial block resulted in the attenuation of the P terminal force in lead V1. Atypical interatrial block is associated with atrial cardiomyopathy and is a potential risk factor for atrial fibrillation or stroke.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154141"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interatrial block and left atrial appendage thrombus: A manifestation of atrial cardiomyopathy rather than a direct association","authors":"Artur Dziewierz","doi":"10.1016/j.jelectrocard.2025.154132","DOIUrl":"10.1016/j.jelectrocard.2025.154132","url":null,"abstract":"","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154132"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular preexcitation in hypertrophic cardiomyopathy: Coincidence, clue, or concern?","authors":"Ahmet Korkmaz MD,&nbsp;Ozcan Ozeke MD,&nbsp;Serkan Topaloglu MD,&nbsp;Omac Tufekcioglu MD","doi":"10.1016/j.jelectrocard.2025.154130","DOIUrl":"10.1016/j.jelectrocard.2025.154130","url":null,"abstract":"<div><div>Unexplained LVH commonly prompts a diagnosis of hypertrophic cardiomyopathy (HCM), a sarcomeric protein gene disorder. While ventricular preexcitation is more frequently observed in patients with HCM its presence in a young patient with an HCM phenocopy should raise suspicion for an underlying storage, metabolic, or syndromic condition.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154130"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-conscious detection of ST-segment elevation during physician ECG interpretation","authors":"Gregory J. DiGirolamo Ph.D ,&nbsp;Nikolaos Kakouros M.D ,&nbsp;Federico Sorcini B.A ,&nbsp;Sofia Patrizi Sorcini ,&nbsp;Jenna Dupell ,&nbsp;Erin K. Sands B.A ,&nbsp;Max P. Rosen M.D","doi":"10.1016/j.jelectrocard.2025.154148","DOIUrl":"10.1016/j.jelectrocard.2025.154148","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate errors in the assessment of ST-elevation (STEs) myocardial infarctions on ECGs to determine if non-conscious processes successfully detect missed STEs, as evidenced by changes in how long and often physicians look at leads with STEs.</div></div><div><h3>Materials and method</h3><div>Eight experienced physicians interpreted 90 ECGs (45 STEs, 45 Normal) while eye movements were recorded. Physicians marked consciously recognized or considered STEs. No clinical context was provided.</div></div><div><h3>Results</h3><div>Physicians missed 18% of STEs. Eye-tracking showed longer (<em>P</em> = 0.02), more frequent (P = 0.02), and increased transitions (P = 0.02) to “missed” STE leads compared to Normal ECG leads.</div></div><div><h3>Discussion</h3><div>Non-conscious detection of STEs, including inter‑lead relationships, despite a lack of conscious recognition, suggests a sophisticated mechanism of wholistic detection, including culprit lesion sites by non-conscious processes.</div></div><div><h3>Conclusion</h3><div>Non-conscious detection of STEs supports non-conscious detection processing in medicine leading to more success than can be tracked by conscious report. Eye-tracking could enhance ECG interpretation and reduce diagnostic errors.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154148"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep inspiration as a diagnostic maneuver to differentiate accessory pathway-induced ST elevation from inferior myocardial infarction: A case report","authors":"Motahare Hatami ,&nbsp;Hamed Vahidi ,&nbsp;Arsalan Salari ,&nbsp;Asghar Mohamadi ,&nbsp;Somayeh Bashiri Aliabadi ,&nbsp;Fatemeh Baharvand","doi":"10.1016/j.jelectrocard.2025.154106","DOIUrl":"10.1016/j.jelectrocard.2025.154106","url":null,"abstract":"<div><div>The Wolff-Parkinson-White (WPW) pattern is an electrocardiographic finding resulting from conduction via an accessory pathway, which can mimic acute myocardial infarction (AMI), particularly when negative delta waves resemble Q waves and the repolarization abnormalities cause ST-segment elevations that mimic STEMI. We report the case of a 65-year-old woman who presented with acute retrosternal chest pain and an ECG showing both delta waves and inferior ST-segment elevations, raising concern for possible MI. However, a deep inspiration maneuver, known to influence autonomic tone, led to partial resolution of the delta waves and ST elevations, suggesting a non-ischemic etiology. Coronary angiography revealed normal coronary arteries, and upper endoscopy ultimately identified severe gastropathy and <em>Helicobacter pylori</em> infection as the cause of her symptoms. The patient was successfully treated with lansoprazole and antibiotics and remained symptom-free on follow-up. This case highlights the potential diagnostic utility of deep inspiration in differentiating accessory pathway-mediated ST changes from those of true myocardial infarction.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154106"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of P wave parameters in predicting proximal or distal right coronary artery occlusion in patients with inferior myocardial infarction","authors":"Suleyman Cagan Efe MD ,&nbsp;Murat Karacam MD ,&nbsp;Ali Furkan Tekatli MD ,&nbsp;Baver Bozan MD ,&nbsp;Mustafa Furkan Kilicarslan MD ,&nbsp;Mustafa Kara MD ,&nbsp;Muhammet Bulut MD ,&nbsp;Tuba Unkun MD ,&nbsp;Enver Yucel MD ,&nbsp;Cem Doğan MD ,&nbsp;Gulumser Sevgin Halil MD ,&nbsp;Ozgur Yasar Akbal MD ,&nbsp;Ali Karagoz MD","doi":"10.1016/j.jelectrocard.2025.154143","DOIUrl":"10.1016/j.jelectrocard.2025.154143","url":null,"abstract":"<div><h3>Background</h3><div>Electrocardiography (ECG) provides valuable information for early diagnosis of myocardial infarction. It is known that the atria receive their blood supply primarily from branches originating from the proximal segments of the coronary arteries. This study aimed to evaluate whether P wave parameters on admission ECG can help determine proximal versus distal right coronary artery (RCA) occlusion in patients presenting with inferior myocardial infarction (IMI).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed consecutive patients presenting with IMI to the emergency department between October 2022 and May 2023. After applying exclusion criteria, a total of 123 patients were included. Admission ECG parameters were analyzed in relation to the angiographically confirmed site of coronary occlusion.</div></div><div><h3>Results</h3><div>The study population was divided into two groups according to proximal or distal RCA occlusion. Demographic characteristics were similar between groups. Statistically significant differences were observed between groups in the following ECG parameters: QT dispersion, P wave terminal force, P wave peak time in leads V1 and V2, and ST elevation in lead V1.</div><div>In multivariable logistic regression analysis, ST elevation in lead V1 (OR 6.1; 95 % CI: 1.48–26.8; <em>p</em> = 0.013) and P wave peak time in lead V1 (OR 1.08; 95 % CI: 1.01–1.12; <em>p</em> = 0.008) were identified as independent predictors of proximal RCA occlusion. A added variable plot demonstrated that P wave peak time &gt; 56 ms was significantly associated with increased probability of proximal coronary occlusion.</div></div><div><h3>Conclusion</h3><div>In patients presenting with inferior myocardial infarction, P wave peak time in lead V1 on admission ECG may serve as a useful, non-invasive marker in predicting proximal RCA occlusion.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154143"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interatrial block predicts left atrial appendage thrombus in nonvalvular atrial fibrillation","authors":"Elmas Kaplan MD ,&nbsp;Firdevs Aysenur Ekizler MD ,&nbsp;Halenur Saribas MD ,&nbsp;Omac Tufekcioglu MD","doi":"10.1016/j.jelectrocard.2025.154112","DOIUrl":"10.1016/j.jelectrocard.2025.154112","url":null,"abstract":"<div><h3>Background</h3><div>Interatrial block (IAB) is an electrocardiographic manifestation of atrial conduction delay and structural remodeling. While it has been linked to atrial fibrillation (AF) and thromboembolic events, its potential role in predicting left atrial appendage (LAA) thrombus formation remains underexplored. This study aimed to investigate the association between IAB and the presence of LAA thrombus in patients with nonvalvular AF (NVAF) or atrial flutter referred for rhythm control procedures.</div></div><div><h3>Methods</h3><div>In this retrospective observational study, 750 patients with NVAF who underwent transesophageal echocardiography (TEE) prior to catheter ablation or cardioversion were evaluated. P-wave parameters were measured from digitally amplified 12‑lead ECGs, and IAB was defined according to current consensus criteria. Patients were stratified by the presence of LAA thrombus, and multivariate logistic regression was used to identify independent predictors.</div></div><div><h3>Results</h3><div>LAA thrombus was detected in 10.8 % of patients. Those with thrombus were older and had higher thromboembolic risk scores, more frequent history of stroke, and lower left ventricular ejection fraction (LVEF). Interatrial block was observed in 85.2 % and advanced IAB in 44.4 % of patients with thrombus. In multivariate analysis, IAB (OR: 2.698; <em>p</em> = 0.008), larger LA diameter, lower LVEF, and greater P-wave dispersion were independently associated with thrombus presence.</div></div><div><h3>Conclusion</h3><div>IAB is independently associated with LAA thrombus in NVAF patients and may serve as a noninvasive marker to identify individuals at higher thromboembolic risk, potentially guiding the need for TEE before rhythm control.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154112"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic changes in transgender patients on gender-affirming hormone replacement therapy","authors":"Heather M. Wang MD ,&nbsp;Meet S. Shah DO ,&nbsp;Rafael E. Toro-Manotas MD ,&nbsp;Shriya D. Patel DO ,&nbsp;Fady Botros BA ,&nbsp;Diana G. Finkel DO ,&nbsp;Christine M. Gerula MD ,&nbsp;Emad F. Aziz DO ,&nbsp;FHRS","doi":"10.1016/j.jelectrocard.2025.154137","DOIUrl":"10.1016/j.jelectrocard.2025.154137","url":null,"abstract":"<div><h3>Background</h3><div>Differences in electrocardiogram (EKG) measurements exist between cisgender men and cisgender women, with men typically exhibiting shorter QTc intervals, longer QRS durations, and longer PR intervals. Limited data describe the effects of gender-affirming hormone replacement therapy (HRT) on EKG parameters in transgender individuals.</div></div><div><h3>Objective</h3><div>To evaluate electrocardiographic changes associated with HRT in transgender patients.</div></div><div><h3>Methods</h3><div>This retrospective, single-institution cohort study included transgender women and transgender men receiving estrogen or testosterone HRT with available pre- and post-HRT EKGs. Demographics and EKG measurements were collected and compared using paired <em>t</em>-tests and Wilcoxon signed-rank tests.</div></div><div><h3>Results</h3><div>Thirty patients met inclusion criteria (17 transgender women, 13 transgender men). Among transgender women, QRS duration decreased from a median of 96.0 (92.0–106.0) ms pre-HRT to 94.0 (86.0–100.0) ms post-HRT (<em>p</em> = 0.022). P-wave amplitude decreased in leads V₃-V₄ (<em>p</em> = 0.024, <em>p</em> = 0.037), and R-wave amplitude decreased in leads V₄-V₆ (<em>p</em> = 0.008, <em>p</em> = 0.025, <em>p</em> = 0.011, respectively) post-HRT. T-wave amplitude was lower in transgender women in lead V₂ (<em>p</em> = 0.016) and higher in transgender men in leads V₂-V₃ post-HRT (<em>p</em> = 0.015, <em>p</em> = 0.024). Stratification by race showed an increase in heart rate in Black transgender women from 71.6 ± 12.8 to 84.9 ± 19.2 beats per minute post-HRT (p = 0.015). Similar differences in P-, R-, and T-wave amplitude were observed in Black transgender patients in select precordial leads.</div></div><div><h3>Conclusion</h3><div>HRT used for gender-affirming care is associated with electrocardiographic changes that trend toward patterns of the affirmed gender. Findings suggest baseline and follow-up EKGs should be standardized when initiating HRT. Larger studies are needed to clarify structural and arrhythmogenic implications.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"93 ","pages":"Article 154137"},"PeriodicalIF":1.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}