Effect of Increased Left Ventricle Mass on Ischemia Assessment in Electrocardiographic Signals: Rabbit Isolated Heart Study

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2017 Aug 6

PMID 28778146

Citations 2

Authors

Marina Ronzhina

Veronika Olejnickova

Tibor Stracina

Marie Novakova

Oto Janousek

Jakub Hejc

Jana Kolarova

Miroslava Hlavacova

Hana Paulova

Affiliations

Soon will be listed here.

Abstract

Background: Detailed quantitative analysis of the effect of left ventricle (LV) hypertrophy on myocardial ischemia manifestation in ECG is still missing. The associations between both phenomena can be studied in animal models. In this study, rabbit isolated hearts with spontaneously increased LV mass were used to evaluate the effect of such LV alteration on ischemia detection criteria and performance.

Methods: Electrophysiological effects of increased LV mass were evaluated on sixteen New Zealand rabbit isolated hearts under non-ischemic and ischemic conditions by analysis of various electrogram (EG) parameters. To reveal hearts with increased LV mass, LV weight/heart weight ratio was proposed. Standard paired and unpaired statistical tests and receiver operating characteristics analysis were used to compare data derived from different groups of animals, monitor EG parameters during global ischemia and evaluate their ability to discriminate between unchanged and increased LV as well as non-ischemic and ischemic state.

Results: Successful evaluation of both increased LV mass and ischemia is lead-dependent. Particularly, maximal deviation of QRS and area under QRS associated with anterolateral heart wall respond significantly to even early phase (the 1-3 min) of ischemia. Besides ischemia, these parameters reflect increased LV mass as well (with sensitivity reaching approx. 80%). However, the sensitivity of the parameters to both phenomena may lead to misinterpretations, when inappropriate criteria for ischemia detection are selected. Particularly, use of cut-off-based criteria defined from control group for ischemia detection in hearts with increased LV mass may result in dramatic reduction (approx. 15%) of detection specificity due to increased number of false positives. Nevertheless, criteria adjusted to particular experimental group allow achieving ischemia detection sensitivity of 89-100% and specificity of 94-100%, respectively.

Conclusions: It was shown that response of the heart to myocardial ischemia can be successfully evaluated only when taking into account heart-related factors (such as LV mass) and other methodological aspects (such as recording electrodes position, selected EG parameters, cut-off criteria, etc.). Results of this study might be helpful for developing new clinical diagnostic strategies in order to improve myocardial ischemia detection in patients with LV hypertrophy.

Citing Articles

Golden Standard or Obsolete Method? Review of ECG Applications in Clinical and Experimental Context.

Stracina T, Ronzhina M, Redina R, Novakova M Front Physiol. 2022; 13:867033.

PMID: 35547589 PMC: 9082936. DOI: 10.3389/fphys.2022.867033.

Di-4-ANEPPS Modulates Electrical Activity and Progress of Myocardial Ischemia in Rabbit Isolated Heart.

Ronzhina M, Stracina T, Lacinova L, Ondacova K, Pavlovicova M, Marsanova L Front Physiol. 2021; 12:667065.

PMID: 34177617 PMC: 8222999. DOI: 10.3389/fphys.2021.667065.

References

Nadruz W . Myocardial remodeling in hypertension. J Hum Hypertens. 2014; 29(1):1-6. DOI: 10.1038/jhh.2014.36. View

Hejc J, Vitek M, Ronzhina M, Novakova M, Kolarova J . A Wavelet-Based ECG Delineation Method: Adaptation to an Experimental Electrograms with Manifested Global Ischemia. Cardiovasc Eng Technol. 2015; 6(3):364-75. DOI: 10.1007/s13239-015-0224-z. View

Zhao Z, Chen L, Xiao Y, Hao J, Tang C, Zheng D . A rabbit model to study regression of ventricular hypertrophy. Heart Lung Circ. 2013; 22(5):373-82. DOI: 10.1016/j.hlc.2012.11.021. View

Okin P, Roman M, Devereux R, Pickering T, Borer J, Kligfield P . Time-voltage QRS area of the 12-lead electrocardiogram: detection of left ventricular hypertrophy. Hypertension. 1998; 31(4):937-42. DOI: 10.1161/01.hyp.31.4.937. View

Otterstad J . Ischaemia and left ventricular hypertrophy. Eur Heart J. 1993; 14 Suppl F:2-6. DOI: 10.1093/eurheartj/14.suppl_f.2. View

Adams M, Drew B . Body position effects on the ECG: implication for ischemia monitoring. J Electrocardiol. 1997; 30(4):285-91. DOI: 10.1016/s0022-0736(97)80040-4. View

Bers D . Cardiac Na/Ca exchange function in rabbit, mouse and man: what's the difference?. J Mol Cell Cardiol. 2002; 34(4):369-73. DOI: 10.1006/jmcc.2002.1530. View

Kang C, Brennan J, Kuzmiak-Glancy S, Garrott K, Kay M, Efimov I . Technical advances in studying cardiac electrophysiology - Role of rabbit models. Prog Biophys Mol Biol. 2016; 121(2):97-109. DOI: 10.1016/j.pbiomolbio.2016.05.006. View

Camici P, Olivotto I, Rimoldi O . The coronary circulation and blood flow in left ventricular hypertrophy. J Mol Cell Cardiol. 2011; 52(4):857-64. DOI: 10.1016/j.yjmcc.2011.08.028. View

10.

Bacharova L, Szathmary V, Kovalcik M, Mateasik A . Effect of changes in left ventricular anatomy and conduction velocity on the QRS voltage and morphology in left ventricular hypertrophy: a model study. J Electrocardiol. 2009; 43(3):200-8. DOI: 10.1016/j.jelectrocard.2009.07.014. View

11.

Armstrong A, Gidding S, Gjesdal O, Wu C, Bluemke D, Lima J . LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging. 2012; 5(8):837-48. PMC: 3501209. DOI: 10.1016/j.jcmg.2012.06.003. View

12.

Kohya T, Kimura S, Myerburg R, BASSETT A . Susceptibility of hypertrophied rat hearts to ventricular fibrillation during acute ischemia. J Mol Cell Cardiol. 1988; 20(2):159-68. DOI: 10.1016/s0022-2828(88)80029-4. View

13.

McIntosh M, Hicks M, Kane K, Rankin A, Cobbe S . A characterized model of left ventricular hypertrophy in the rabbit. Cardioscience. 1994; 5(2):95-100. View

14.

Fantinelli J, Perez Nunez I, Arbelaez L, Schinella G, Mosca S . Participation of mitochondrial permeability transition pore in the effects of ischemic preconditioning in hypertrophied hearts: role of NO and mitoKATP. Int J Cardiol. 2011; 166(1):173-80. DOI: 10.1016/j.ijcard.2011.10.103. View

15.

Bell R, Mocanu M, Yellon D . Retrograde heart perfusion: the Langendorff technique of isolated heart perfusion. J Mol Cell Cardiol. 2011; 50(6):940-50. DOI: 10.1016/j.yjmcc.2011.02.018. View

16.

Weber H, Van der Walt J . Cardiomyopathy in crowded rabbits. A preliminary report. S Afr Med J. 1973; 47(35):1591-5. View

17.

Hancock E, Deal B, Mirvis D, Okin P, Kligfield P, Gettes L . AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association.... J Am Coll Cardiol. 2009; 53(11):992-1002. DOI: 10.1016/j.jacc.2008.12.015. View

18.

Hlavacova M, Olejnickova V, Ronzhina M, Stracina T, Janousek O, Novakova M . Tolerance of isolated rabbit hearts to short ischemic periods is affected by increased LV mass fraction. Physiol Res. 2017; 66(4):581-589. DOI: 10.33549/physiolres.933333. View

19.

Zehender M, Faber T, Koscheck U, Meinertz T, Just H . Ventricular tachyarrhythmias, myocardial ischemia, and sudden cardiac death in patients with hypertensive heart disease. Clin Cardiol. 1995; 18(7):377-83. DOI: 10.1002/clc.4960180705. View

20.

Schillaci G, Battista F, Pucci G . A review of the role of electrocardiography in the diagnosis of left ventricular hypertrophy in hypertension. J Electrocardiol. 2012; 45(6):617-23. DOI: 10.1016/j.jelectrocard.2012.08.051. View