Results of surgical therapy in patients with left ventricular aneurysm

The clinical, angiographic and haemodynamic findings in 87 patientswith left ventricular aneurysm were investigated before andafter different surgical interventions. Thirty-four patientsunderwent aneurysmec-tomy alone (group I), 35 patients had additionalcoronary revascularization (group II), and 18 patients had revascularizationalone because of the findings during operation (group III).The size of aneurysm was not significantly different in thethree groups. Postoperatively, it decreased only in groups Iand II. The majority of the patients in group I (predominantlyone-vessel disease) had no angina pectoris, with no significantchange early and late (more than 12 months) after operation.The patients in groups II and III (with more two- and three-vesseldiseases) showed an improvement in angina pectoris. Preoper-atively,most patients had experienced exertional dyspnoea. Overall,there was no significant change after operation, but most patientsshowed an improvement in angina and dyspnoea when these symptomshad been the major indication for surgical therapy. Heart rate, systolic and end-diastolic pressures in the threegroups did not change significantly after surgery. End-diastolicand end-systolic volumes decreased and ejection fraction increasedsignificantly in groups I and II. In group III these variablesdid not change. Circumferential fibre shortening velocity inthe residual ventricle increased significantly only in groupI. Haemodynamic studies during exercise were performed in atotal of 32 patients. In group I the increase of mean pulmonarypressure was significantly lower postoperatively; there wasno significant change in groups II and III. At rest and during exercise only patients with aneurysmectomyshowed an improvement in global and residual left ventricularfunction. Patients with angiographically proven aneurysm butviable myocardium -found during operation - showed no improvementin left ventricular function at rest or during exercise, ifrevascularization alone was performed. The hospital mortality was 6%. Three patients died during thefollow-up period of cardiac causes. The high mortality of non-operatedpatients with clinical and haemodynamic findings similar tothese surgically treated patients, warrants aneurysmectomy quiteapart from the symptomatic and functional improvements aftersurgery     

Association of non‐invasive electrocardiographic risk factors with left ventricular systolic function in post‐myocardial infarction patients with mildly reduced or preserved ejection fraction: Insights from the PRESERVE‐EF study

BackgroundElectrocardiographic non‐invasive risk factors (NIRFs) have an important role in the arrhythmic risk stratification of post‐myocardial infarction (post‐MI) patients with preserved or mildly reduced left ventricular ejection fraction (LVEF). However, their specific relation to left ventricular systolic function remains unclear. We aimed to evaluate the association between NIRFs and LVEF in the patients included in the PRESERVE‐EF trial.MethodsWe studied 575 post‐MI ischemia‐free patients with LVEF≥40% (mean age: 57.0 ± 10.4 years, 86.2% men). The following NIRFs were evaluated: premature ventricular complexes, non‐sustained ventricular tachycardia (NSVT), late potentials (LPs), prolonged QTc, increased T‐wave alternans, reduced heart rate variability, and abnormal deceleration capacity with abnormal turbulence.ResultsThere was a statistically significant relationship between LPs (Chi‐squared = 4.975; p < .05), nsVT (Chi‐squared = 5.749, p < .05), PVCs (r= −.136; p < .01), and the LVEF. The multivariate linear regression analysis showed that LPs (p = .001) and NSVT (p < .001) were significant predictors of the LVEF. The results of the multivariate logistic regression analysis indicated that LPs (OR: 1.76; 95% CI: 1.02–3.05; p = .004) and NSVT (OR: 2.44; 95% CI: 1.18–5.04; p = .001) were independent predictors of the mildly reduced LVEF: 40%–49% versus the preserved LVEF: ≥50%.ConclusionLate potentials and NSVT are independently related to reduced LVEF while they are independent predictors of mildly reduced LVEF versus the preserved LVEF. These findings may have important implications for the arrhythmic risk stratification of post‐MI patients with mildly reduced or preserved LVEF.     

急诊血运重建对急性心肌梗死左心室功能的影响

目的应用二维超声心动图及多普勒组织成像（Doppler tissue imaging,DTI）评价急诊血运重建（包括静脉溶栓或者急诊冠状动脉支架置入术）对急性心肌梗死（acute myocardial infarction,AMI）左心室收缩和舒张功能的影响。方法入院后根据AMI患者治疗方法分为常规组和治疗组。常规组30例给予内科常规治疗;治疗组20例在内科常规治疗基础上实施静脉溶栓或急诊冠状动脉支架置入术。应用DTI检测左心室射血分数、二尖瓣血流舒张早期流速峰值（peak velocity at early diastole,VE）和舒张晚期流速峰值（peak velocity at late diastole,VA）比值（VE／VA）,DTI成像模式检测二尖瓣环后间隔、侧壁、前壁、下壁、前间隔和后壁6个节段的收缩期运动速度峰值（peak velocity during systole,Sa）、舒张早期运动速度峰值（peak velocity at early diastole,Ea）和心房收缩期流速峰值（peak velocitv at atrial contraction,Aa）,并计算Ea／Aa比值。各取6个节段的平均值。结果所有AMI患者于发病后1周、3月末左心室射血分数、VE／VA、Sa、Ea和Ea／Aa均较对照组降低;予急诊血运重建的AMI患者于AMI发病后3个月S。和E。较本组发病后1周增高,并较未行急诊血运重建干预组（常规组）发病后3个月增高。结论AMI后左心室收缩和舒张功能受损,实施急诊血运重建可以有效改善心脏功能．应用DTI技术检测二尖瓣环运动速度可以精确反映AMI患者局部节段性心功能的恢复。     

Chronic biopsy proven post‐COVID myoendocarditis with SARS‐Cov‐2 persistence and high level of antiheart antibodies

PurposeTo study the clinical signs and mechanisms (viral and autoimmune) of myoendocarditis in the long‐term period after COronaVIrus Disease 2019 (COVID‐19).MethodsFourteen patients (nine male, 50.1 ± 10.2 y.o.) with biopsy proven post‐COVID myocarditis were observed. The diagnosis of COVID‐19 was confirmed by IgG seroconversion. The average time of admission after COVID‐19 was 5.5 [2; 10] months. An endomyocardial biopsy (EMB) of the right ventricle was obtained. The biopsy analysis included polymerase chain reaction diagnosis of viral infection, morphological, immunohistochemical (IHC) examination with antibodies to CD3, CD45, CD68, CD20, SARS‐Cov‐2 spike, and nucleocapsid antigens. Coronary atherosclerosis was ruled out in all patients over 40 years.ResultsThe new cardiac symptoms (congestive heart failure 3–4 New York Heart Association class with severe right ventricular involvement, various rhythm, and conduction disturbances) appeared 1–5 months following COVID‐19. Magnetic resonance imaging showed disseminated or focal subepicardial and intramyocardial late gadolinium enhancement, hyperemia, edema, and increased myocardial native T1 relaxation time. Antiheart antibodies levels were increased 3–4 times in 92.9% of patients. The mean left ventricular (LV) ejection fraction (EF) was 28% (24.5; 37.8). Active lymphocytic myocarditis was diagnosed in 12 patients, eosinophilic myocarditis in two patients. SARS‐Cov‐2 RNA was detected in 12 cases (85.7%), in association with parvovirus B19 DNA—in one. Three patients had also endocarditis (infective and nonbacterial, with parietal thrombosis). As a result of steroid and chronic heart failure therapy, the EF increased to 47% (37.5; 52.5).ConclusionsCOVID‐19 can lead to long‐term severe post‐COVID myoendocarditis, that is characterized by prolonged persistence of coronavirus in cardiomyocytes, endothelium, and macrophages (up to 18 months) in combination with high immune activity. Corticosteroids and anticoagulants should be considered as a treatment option of post‐COVID myoendocarditis.     

Angiotensin‐converting enzyme inhibitors increase anti‐fibrotic biomarkers in African Americans with left ventricular hypertrophy

Angiotensin‐converting enzyme inhibitors (ACEi) are part of the indicated treatment in hypertensive African Americans. ACEi have blood pressure‐independent effects that may make them preferred for certain patients. We aimed to evaluate the impact of ACEi on anti‐fibrotic biomarkers in African American hypertensive patients with left ventricular hypertrophy (LVH). We conducted a post hoc analysis of a randomized controlled trial in which hypertensive African American patients with LVH and vitamin D deficiency were randomized to receive intensive antihypertensive therapy plus vitamin D supplementation or placebo. We selected patients who had detectable lisinopril (lisinopril group) in plasma using liquid‐chromatography/mass spectrometry analysis and compared them to subjects who did not (comparison group) at the one‐year follow‐up. The pro‐fibrotic marker type 1 procollagen C‐terminal propeptide (PICP) and the anti‐fibrotic markers matrix metalloproteinase‐1 (MMP‐1), tissue inhibitor of metalloproteinases 1 (TIMP‐1), telopeptide of collagen type I (CITP), and N‐acetyl‐seryl‐aspartyl‐lysyl‐proline (Ac‐SDKP) peptide were measured. Sixty‐six patients were included, and the mean age was 46.2 ± 8 years. No difference was observed in the number and intensity of antihypertensive medications prescribed in each group. Patients with detectable lisinopril had lower blood pressure than those in the comparison group. The anti‐fibrotic markers Ac‐SDKP, MMP‐1, and MMP‐1/TIMP‐1 ratio were higher in patients with detectable ACEi (all p < .05). In a model adjusted for systolic blood pressure, MMP‐1/TIMP‐1 (p = .02) and Ac‐SDKP (p < .001) levels were associated with lisinopril. We conclude that ACEi increase anti‐fibrotic biomarkers in hypertensive African Americans with LVH, suggesting that they may offer added benefit over other agents in such patients.     

急性心肌梗死血运重建术后远期预后的相关因素

目的:探讨急性心肌梗死（AM I）后接受血运重建术（PC I,CABG）的患者左室功能与病死率、心源性再住院率的关系,从而了解血运重建术是否能改善左室衰竭患者的预后。方法:分析我院1999-012003-02住院患者102例,根据左室射血分数（LVEF）值分成3组,LVEF≤40%（15例）,40%相似文献   

The duration of beta‐blocker therapy and outcomes in patients without heart failure or left ventricular systolic dysfunction after acute myocardial infarction: A multicenter prospective cohort study

BackgroundThe duration of beta‐blocker therapy in patients without heart failure (HF) or left ventricular systolic dysfunction after acute myocardial infarction (AMI) is unclear.HypothesisContinuous beta‐blocker therapy is associated with an improved prognosis.MethodsThis is a prospective, multicenter, cohort study. One thousand four hundred and eighty‐three patients eventually met the inclusion criteria. The study groups included the continuous beta‐blocker therapy group (lasted ≥6 months) and the discontinuous beta‐blocker therapy group (consisting of the no‐beta‐blocker therapy group and the beta‐blocker therapy <6 months group). The inverse probability treatment weighting was used to control confounding factors. The study tried to learn the role of continuous beta‐blocker therapy on outcomes. The median duration of follow‐up was 13.0 months. The primary outcomes were cardiac death and major adverse cardiovascular events (MACE). The secondary outcomes were all‐cause death, stroke, unstable angina, rehospitalization for HF, and recurrent myocardial infarction (MI).ResultsCompared with discontinuous beta‐blocker therapy, continuous beta‐blocker therapy was associated with a reduced risk of unstable angina, recurrent MI, and MACE (hazard ratio [HR]: 0.51; 95% CI: 0.32–0.82; p = 0.006); but this association was not available for cardiac death (HR: 0.57; 95% CI: 0.24–1.36; p = 0.206). When compared to the subgroups of no‐beta‐blocker therapy and beta‐blocker therapy <6 months, respectively, continuous beta‐blocker therapy was still observed to be associated with a reduced risk of unstable angina, recurrent MI, and MACE.ConclusionsContinuous beta‐blocker therapy was associated with a reduced risk of unstable angina or recurrent MI or MACE in patients without HF or left ventricular systolic dysfunction after AMI.     

Short‐term repeatability of the peguero‐lo presti electrocardiographic left ventricular hypertrophy criteria

BackgroundElectrocardiographic left ventricular hypertrophy (ECG‐LVH) represents preclinical cardiovascular disease and predicts cardiovascular disease morbidity and mortality. While the newly developed Peguero‐Lo Presti ECG‐LVH criteria have greater sensitivity for LVH than the Cornell voltage and Sokolow–Lyon criteria, its short‐term repeatability is unknown. Therefore, we characterized the short‐term repeatability of Peguero‐Lo Presti ECG‐LVH criteria and evaluate its agreement with Cornell voltage and Sokolow–Lyon ECG‐LVH criteria.MethodsParticipants underwent two resting, standard, 12‐lead ECGs at each of two visits one week apart (n = 63). We defined a Peguero‐Lo Presti index as a sum of the deepest S wave amplitude in any single lead and lead V₄ (i.e., S_D + SV₄) and defined Peguero‐Lo Presti LVH index as ≥ 2,300 µV among women and ≥ 2,800 µV among men. We estimated repeatability as an intraclass correlation coefficient (ICC), agreement as a prevalence‐adjusted bias‐adjusted kappa coefficient (κ), and precision using 95% confidence intervals (CIs).ResultsThe Peguero‐Lo Presti index was repeatable: ICC (95% CI) = 0.94 (0.91–0.97). Within‐visit agreement of Peguero‐Lo Presti LVH was high at the first and second visits: κ (95% CI) = 0.97 (0.91–1.00) and 1.00 (1.00–1.00). Between‐visit agreement of the first and second measurements at each visit was comparable: κ (95% CI) = 0.90 (0.80–1.00) and 0.93 (0.85–1.00). Agreement of Peguero‐Lo Presti and Cornell or Sokolow–Lyon LVH on any one of the four ECGs was slightly lower: κ (95% CI) = 0.71 (0.54–0.89).ConclusionThe Peguero‐Lo Presti index and LVH have excellent repeatability and agreement, which support their use in clinical and epidemiological studies.     

Relationship between signal-averaged electrocardiography and dangerous ventricular arrhythmias in patients with left ventricular aneurysm after myocardial infarction

We performed signal-averaged electrocardiography (SAECG) andHolter monitoring, and subsequently followed-up 53 ambulatorypatients with left ventricular aneurysm (LVA) after myocardialinfarction (MI). A history of spontaneous episodes of sustainedventricular tachycardia (VT) v also analysed. Out of 53 patients, 25 (47%) had an abnormal SAECG. AbnormalSAECG correctly identified nine out of 10 cases with a historyof sustained VT. Complex ventricular arrhythmias were detectedon Holler monitoring in 23 patients: in five out of 28 withnormal SAECG (18%) and in 18 out of 25 with abnormal SAECG (72%)(P<0001). During follow-up (mean 19 months) sustained VTand/or sudden cardiac death (SCD) occurred in eight cases, outof which seven had an abnormal SAECG. The negative predictivevalue of SAECG (no VT or SCD during follow-up) was very high,96%. similar to the negative predictive value of a history ofsustained VT (93%). Using multivariate analysis only a historyof sustained VT twas an independent factor in predicting theoutcome of patients in this study. We conclude that an abnormal SAECG identifies those post infarctionpatients with LVA who are prone to complex ventricular arrhvthmias.A normal SAECG and an absence of a history of sustained VT stronglyindicate that the risk of developing arrhythmic events is verylow.     

Mid‐ventricular obstruction is associated with non‐sustained ventricular tachycardia in patients with hypertrophic obstructive cardiomyopathy

BackgroundMid‐ventricular obstruction (MVO) is a rare subtype of hypertrophic cardiomyopathy (HCM) but it is associated with ventricular arrhythmia. The relationship between MVO and non‐sustained ventricular tachycardia (NSVT) in HCM patients is unknown.HypothesisThe severity of MVO increases the incidence of NSVT in patients with hypertrophic obstructive cardiomyopathy (HOCM).MethodsFive hundred and seventy‐two consecutive patients diagnosed with HOCM in Fuwai Hospital between January 2015 and December 2017 were enrolled in this study. Holter electrocardiographic and clinical parameters were compared between HOCM patients with and without MVO.ResultsSeventy‐six (13.3%) of 572 patients were diagnosed with MVO. Compared to patients without MVO, those with MVO were much younger, and had a higher incidence of syncope, greater left ventricular (LV) posterior wall thickness, a higher percentage of LV late gadolinium enhancement, and higher prevalence of NSVT. Furthermore, the prevalence of NSVT increased with the severity of MVO (without, mild, moderate or severe: 11.1%, 18.2%, 25.6%, respectively, p for trend < .01). Similarly, the prevalence of NSVT differed among patients with isolated LV outflow tract (LVOTO), both MVO and LVOTO, and isolated MVO (11.1%, 21.3%, 26.6%, respectively, p for trend = .018). In addition to age, diabetes, left atrial diameter, and maximal wall thickness, multivariate analysis revealed the presence of MVO as an independent risk factor for NSVT (Odds ratio 2.69; 95% confidence interval 1.41 to 5.13, p = .003).ConclusionsThe presence and severity of MVO was associated with higher incidence of NSVT in HOCM patients.     

Relationship between signal-averaged electrocardiography and dangerous ventricular arrhythmias in patients with left ventricular aneurysm after myocardial infarction.

We performed signal-averaged electrocardiography (SAECG) and Holter monitoring, and subsequently followed-up 53 ambulatory patients with left ventricular aneurysm (LVA) after myocardial infarction (MI). A history of spontaneous episodes of sustained ventricular tachycardia (VT) was also analysed. Out of 53 patients, 25 (47%) had an abnormal SAECG. Abnormal SAECG correctly identified nine out of 10 cases with a history of sustained VT. Complex ventricular arrhythmias were detected on Holter monitoring in 23 patients: in five out of 28 with normal SAECG (18%) and in 18 out of 25 with abnormal SAECG (72%) (P less than 0.001). During follow-up (mean 19 months) sustained VT and/or sudden cardiac death (SCD) occurred in eight cases, out of which seven had an abnormal SAECG. The negative predictive value of SAECG (no VT or SCD during follow-up) was very high, 96%, similar to the negative predictive value of a history of sustained VT (93%). Using multivariate analysis only a history of sustained VT was an independent factor in predicting the outcome of patients in this study. We conclude that an abnormal SAECG identifies those post infarction patients with LVA who are prone to complex ventricular arrhythmias. A normal SAECG and an absence of a history of sustained VT strongly indicate that the risk of developing arrhythmic events is very low.     

Infection of cardiac mural thrombus associated with left ventricular aneurysm

Infection is a rare complication of cardiac mural thrombus andmay prove difficult to diagnose and treat. We describe a patientwith infected thrombus associated with a left ventricular aneurysm,involving Salmonella typhimurium. Cross-sectional echocardiographyproved helpful in establishing the diagnosis.     

The expression of myeloperoxidase in thrombi is associated with reduced heme oxygenase‐1 induction and worse left ventricular remodeling in patients with acute ST‐elevation myocardial infarction

BackgroundMyeloperoxidase (MPO) secreted by neutrophils is the enzyme that kills bacteria and other pathogens. Acute myocardial infarction (AMI) is usually caused by thrombosis in response to vulnerable plaque rupture. Circulating MPO was found to be associated with increased mortality in AMI patients. However, the relationship between MPO in thrombi and the prognosis of AMI patients remains unknown.HypothesisMPO expression in thrombi is associated with the prognosis of patients who underwent primary percutaneous coronary intervention (PCI) after AMI.MethodsThis study included 41 consecutive patients with acute ST‐elevation myocardial infarction, who successfully underwent primary PCI, during which we collected thrombi remaining in the culprit artery using aspiration catheters. These thrombus samples were fixed, and immunohistochemical staining against MPO and heme oxygenase‐1 (HO‐1) was conducted. Enrolled patients were divided into two groups based on the induction of thrombotic MPO, which was quantified using Image J software.MethodsWe observed that increased MPO was associated with lower left ventricular ejection fraction (LVEF) and worse LV remodeling in AMI patients. Instead, patients with decreased thrombotic MPO induction had a considerable improvement in LVEF 1 month after discharge (54.4 ± 2.0% vs. 61.1 ± 2.3%, p < 0.01). In the MPO group, a reduction in the thrombotic HO‐1 level contributed to the development of adverse LV remodeling. Logistic regression showed that MPO was a considerable risk factor for adverse LV remodeling (adjusted OR 3.70, p < 0.05).ConclusionMPO expression in thrombi is associated with reduced LVEF and deteriorated LV remodeling in AMI patients, which may be due to HO‐1 suppression in thrombi.     

Continuous multi‐day tracking of post‐myocardial infarction recovery of cardiac electrical stability and autonomic tone using electrocardiogram patch monitors

BackgroundSudden cardiac death (SCD) risk is elevated following acute myocardial infarction (MI). The time course of SCD susceptibility post‐MI requires further investigation.MethodsIn this observational cohort study, we employed state‐of‐the‐art noninvasive ECG techniques to track the daily time course of cardiac electrical instability and autonomic function following ST‐segment elevation myocardial infarction (STEMI) and non‐STEMI (NSTEMI). Preventice BodyGuardian MINI‐EL Holters continuously recorded ECGs for 7 days at hospital discharge and at 40 days for STEMI (N = 5) or at 90 days for NSTEMI patients (N = 5). Cardiac electrical instability was assessed by T‐wave alternans (TWA) and T‐wave heterogeneity (TWH); autonomic tone was determined by rMSSD‐heart rate variability (HRV).ResultsTWA was severely elevated (≥60 μV) in STEMI patients (80 ± 10.3 μV) at discharge and throughout the first recording period but declined by 50% to 40 ± 2.3 μV (p = .03) by Day 40 and remained in the normal range (<47 μV). TWH, a related phenomenon analyzed from 12‐lead ECGs, was reduced by 63% in the five STEMI patients from discharge to normal (<80 μV) at follow‐up (105 ± 27.3 to 39 ± 3.3 μV, p < .04) but increased by 65% in a STEMI case (89 to 147 μV), who received a wearable defibrillator vest and later implantable cardioverter defibrillator. In NSTEMI patients, TWA was borderline abnormal (47 ± 3.3 μV) at discharge and declined by 19% to normal (38 ± 1.2 μV) by Day 90 (p = .05). An overall reciprocal increase in rMSSD‐HRV suggested recovery of vagal tone.ConclusionsThis study provides proof‐of‐principle for tracking post‐MI SCD risk in individual patients with implications for personalized therapy.     

Nighttime mean arterial pressure is associated with left ventricular hypertrophy in white‐coat hypertension

White‐coat hypertension (WCH) is associated with increased cardiovascular risks. To investigate the relationship between WCH and left ventricular hypertrophy (LVH), the authors recruited 706 participants who underwent anthropometric measurements, blood laboratory analysis, 24h ambulatory blood pressure monitoring (ABPM), and echocardiography. The authors defined WCH as elevated office BP but normal ABPM over 24h, daytime, and nighttime periods. The authors compared the proportion of LVH between the true normotension (NT) and the WCH population, and further assessed the associations between BP indexes and LVH in the two groups, respectively. The proportion of LVH was significantly higher in the WCH group than in NT participants (19.70% vs. 13.12%, P = .036). In the NT group, 24h SBP, 24h PP, daytime SBP, daytime PP and SD of nighttime SBP were associated with LVH after adjustment for demographic and blood biochemical data (all P < .05). In the WCH population, LVH was associated with 24h SBP, nighttime SBP, nighttime MAP, and office SBP after adjustment (all P < .05). However, on forward logistic regression analysis with all the BP indexes listed above, only 24h SBP (OR = 1.057, 1.017–1.098, P < .001) in the NT group, and nighttime MAP (OR = 1.114, 1.005–1.235, P < .05) and office SBP (OR = 1.067, 1.019–1.117, P < .001) in the WCH group were still significantly associated with LVH. Our study suggests that the proportion of LVH is higher in WCH patients than in the NT population. Furthermore, elevated nighttime MAP and office SBP may play critical roles in the development of LVH in the WCH population.     

Accuracy of the novel Peguero Lo‐Presti criterion for electrocardiographic detection of left ventricular hypertrophy in a black African population

The diagnostic accuracy of the electrocardiogram for left ventricular hypertrophy (LVH) is limited. Recently, Peguero and collaborators proposed a novel voltage criterion for its detection with reportedly higher accuracy than the commonly used Cornell and Sokolow‐Lyon criteria. While studies done in various populations have confirmed it, there are no available data from black African populations. We conducted a cross‐sectional study in a population from Cameroon to compare the Peguero‐Lo Presti criterion to the older Cornell, Sokolow‐Lyon, and Cornell product criteria, pertaining to their sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), with echocardiography as the reference standard. The study population consisted of 238 participants (54.2% female) with a mean age of 58 (SD 13) years. On echocardiography, the prevalence of LVH was 45.3% (n = 108). The sensitivity was 48.14%, 63.89%, 63.89%, and 67.29% for the Sokolow‐Lyon, Peguero‐Lo Presti, Cornell, and Cornell product criteria, respectively. The specificity was 73.84%, 75.97%, 79.23%, and 82.31% for the Peguero‐Lo Presti, Cornell product, Cornell, and Sokolow‐Lyon criteria, respectively. The overall accuracy of the Peguero‐Lo Presti (AUC = 0.689) was not significantly different from that of the Cornell (AUC = 0.714), the Cornell product (AUC = 0.717), and the Sokolow‐Lyon (AUC = 0.652) (all p ˃ .05). Hypertension and gender influenced the agreement between ECG criteria and echocardiography in the detection of LVH. In conclusion, in this black African population, Peguero‐Lo Presti was not significantly more or less accurate than Cornell or Sokolow‐Lyon.     

Chronic intrapericardial bleeding from a left ventricular aneurysm

A case of an aneurysm of the left ventricle associated withrecurrent hemorrhagic pericardial effusion is described. A smallconduit connecting the left ventricle to the pericardial cavitywas identified by left ventri-culography. The mechanisms whichprevented sudden cardiac tamponade and death are discussed.     

Automatically assessed P‐wave predicts cardiac events independently of left atrial enlargement in patients with cardiovascular risks: The Japan Morning Surge‐Home Blood Pressure Study

A prolonged P‐wave in electrocardiography (ECG) reflects atrial remodeling and predicts the development of atrial fibrillation (AF). The authors enrolled 810 subjects in the Japan Morning Surge Home Blood Pressure (J‐HOP) study who had ≥1 cardiovascular (CV) risk factor. The duration of P‐wave was automatically analyzed by standard 12‐lead electrocardiogram. Left atrial (LA) enlargement and left ventricular hypertrophy (LVH) were measured on echocardiography. The primary end points were fatal/nonfatal cardiac events: myocardial infarction, sudden death, and hospitalization for heart failure. The maximum P‐wave duration (Pmax) from the 12 leads was selected for analysis. The authors compared four prolonged P‐wave cutoffs (Pmax = 120, 130, 140, 150 ms) and cardiac events. LA diameter and left ventricular mass index (LVMI) were significantly associated with Pmax (r = 0.08, P = .02 and r = 0.17, P < .001, respectively). When the cutoff level was Pmax 120 or 130 ms, prolonged P‐wave was not associated with cardiac events (P = .45 and P = .10), but when a prolonged P‐wave was defined as Pmax ≥ 140 ms (n = 50) or Pmax ≥ 150 ms (n = 19), the patients in those groups had significantly higher incidence of cardiac events than others (P < .001 and P = .03). A Cox proportional hazards model including age, gender, body mass index, smoking, regular drinker, hypertension, dyslipidemia, diabetes, office systolic blood pressure, heart rate, LA enlargement, and LVH revealed that prolonged P‐wave defined as Pmax ≥ 140 ms was independently associated with cardiac events (hazard ratio: 4.23; 95% confidence interval: 1.30–13.77; P = .02). In conclusion, the automatically assessed prolonged P‐wave was associated with cardiac events independently of LA enlargement and LVH in Japanese patients with CV risks.