Limits...
Electrocardiographic abnormalities in Trypanosoma cruzi seropositive and seronegative former blood donors.

Ribeiro AL, Sabino EC, Marcolino MS, Salemi VM, Ianni BM, Fernandes F, Nastari L, Antunes A, Menezes M, Oliveira CD, Sachdev V, Carrick DM, Busch MP, Murphy EL, NHLBI Retrovirus Epidemiology Donor Study-II (REDS-II), International Compone - PLoS Negl Trop Dis (2013)

Bottom Line: Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF)<0.50%.Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001).Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159,p<0.0003, and -0.142,p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001).

View Article: PubMed Central - PubMed

Affiliation: Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

ABSTRACT

Background: Blood donor screening leads to large numbers of new diagnoses of Trypanosoma cruzi infection, with most donors in the asymptomatic chronic indeterminate form. Information on electrocardiogram (ECG) findings in infected blood donors is lacking and may help in counseling and recognizing those with more severe disease.

Objectives: To assess the frequency of ECG abnormalities in T.cruzi seropositive relative to seronegative blood donors, and to recognize ECG abnormalities associated with left ventricular dysfunction.

Methods: The study retrospectively enrolled 499 seropositive blood donors in São Paulo and Montes Claros, Brazil, and 483 seronegative control donors matched by site, gender, age, and year of blood donation. All subjects underwent a health clinical evaluation, ECG, and echocardiogram (Echo). ECG and Echo were reviewed blindly by centralized reading centers. Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF)<0.50%.

Results: Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001). Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159,p<0.0003, and -0.142,p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001). Several ECG abnormalities were more commonly found in seropositive donors with depressed LVEF, including rhythm disorders (frequent supraventricular ectopic beats, atrial fibrillation or flutter and pacemaker), intraventricular blocks (right bundle branch block and left anterior fascicular block) and ischemic abnormalities (possible old myocardial infarction and major and minor ST abnormalities). ECG was sensitive (92%) for recognition of seropositive donors with depressed LVEF and had a high negative predictive value (99%) for ruling out LV dysfunction.

Conclusions: ECG abnormalities are more frequent in seropositive than in seronegative blood donors. Several ECG abnormalities may help the recognition of seropositive cases with reduced LVEF who warrant careful follow-up and treatment.

Show MeSH

Related in: MedlinePlus

Association between by left ventricular ejection fraction and ECG measurements.A – Left ventricular ejection fraction and QRS duration; B - Left ventricular ejection franction and QT corrected interval; and C: Diagnostic accuracy (area under the ROC curve) of QRS duration and QT corrected interval in the detection of reduced left ventricular ejection fraction.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3585012&req=5

pntd-0002078-g002: Association between by left ventricular ejection fraction and ECG measurements.A – Left ventricular ejection fraction and QRS duration; B - Left ventricular ejection franction and QT corrected interval; and C: Diagnostic accuracy (area under the ROC curve) of QRS duration and QT corrected interval in the detection of reduced left ventricular ejection fraction.

Mentions: LVEF was reduced in 36 out of 497 seropositive subjects with available data (prevalence of LV systolic dysfunction of 7.2%); in two patients LVEF measurement was not obtained due to technical reasons. Most seropositive subjects had LV systolic dysfunction considered mild (LVEF ranging between 40 and 49%, n = 17, 3.4%) or moderate (LVEF from 30–39%, n = 11, 2.2% of total); only 8 (1.6%) showed markedly depresses LVEF (<30%). Seropositive blood donors with and without LV dysfunction had comparable demographic and medical characteristics, although NT-proBNP levels were higher in those with LVEF below 50% (45 [25–76] vs351 [109–789], p<0.001).Seropositive donors with LV dysfunction showed longer PR, QRS and corrected QT intervals/durations (Figure 1), although both the heart rate and HRV indexes were not different between groups (data not shown). Both QRS and QTc duration were associated with LVEF values (rs: −0.159, p<0.0003, rs: −0.142, p: 0.002), and showed moderate accuracy in the detection of reduced LVEF (ROC AUC: 0.778 and 0.790, both p<0.0001, Figure 2). None of the other quantitative ECG variables showed significant correlation with measured LVEF.


Electrocardiographic abnormalities in Trypanosoma cruzi seropositive and seronegative former blood donors.

Ribeiro AL, Sabino EC, Marcolino MS, Salemi VM, Ianni BM, Fernandes F, Nastari L, Antunes A, Menezes M, Oliveira CD, Sachdev V, Carrick DM, Busch MP, Murphy EL, NHLBI Retrovirus Epidemiology Donor Study-II (REDS-II), International Compone - PLoS Negl Trop Dis (2013)

Association between by left ventricular ejection fraction and ECG measurements.A – Left ventricular ejection fraction and QRS duration; B - Left ventricular ejection franction and QT corrected interval; and C: Diagnostic accuracy (area under the ROC curve) of QRS duration and QT corrected interval in the detection of reduced left ventricular ejection fraction.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585012&req=5

pntd-0002078-g002: Association between by left ventricular ejection fraction and ECG measurements.A – Left ventricular ejection fraction and QRS duration; B - Left ventricular ejection franction and QT corrected interval; and C: Diagnostic accuracy (area under the ROC curve) of QRS duration and QT corrected interval in the detection of reduced left ventricular ejection fraction.
Mentions: LVEF was reduced in 36 out of 497 seropositive subjects with available data (prevalence of LV systolic dysfunction of 7.2%); in two patients LVEF measurement was not obtained due to technical reasons. Most seropositive subjects had LV systolic dysfunction considered mild (LVEF ranging between 40 and 49%, n = 17, 3.4%) or moderate (LVEF from 30–39%, n = 11, 2.2% of total); only 8 (1.6%) showed markedly depresses LVEF (<30%). Seropositive blood donors with and without LV dysfunction had comparable demographic and medical characteristics, although NT-proBNP levels were higher in those with LVEF below 50% (45 [25–76] vs351 [109–789], p<0.001).Seropositive donors with LV dysfunction showed longer PR, QRS and corrected QT intervals/durations (Figure 1), although both the heart rate and HRV indexes were not different between groups (data not shown). Both QRS and QTc duration were associated with LVEF values (rs: −0.159, p<0.0003, rs: −0.142, p: 0.002), and showed moderate accuracy in the detection of reduced LVEF (ROC AUC: 0.778 and 0.790, both p<0.0001, Figure 2). None of the other quantitative ECG variables showed significant correlation with measured LVEF.

Bottom Line: Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF)<0.50%.Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001).Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159,p<0.0003, and -0.142,p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001).

View Article: PubMed Central - PubMed

Affiliation: Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

ABSTRACT

Background: Blood donor screening leads to large numbers of new diagnoses of Trypanosoma cruzi infection, with most donors in the asymptomatic chronic indeterminate form. Information on electrocardiogram (ECG) findings in infected blood donors is lacking and may help in counseling and recognizing those with more severe disease.

Objectives: To assess the frequency of ECG abnormalities in T.cruzi seropositive relative to seronegative blood donors, and to recognize ECG abnormalities associated with left ventricular dysfunction.

Methods: The study retrospectively enrolled 499 seropositive blood donors in São Paulo and Montes Claros, Brazil, and 483 seronegative control donors matched by site, gender, age, and year of blood donation. All subjects underwent a health clinical evaluation, ECG, and echocardiogram (Echo). ECG and Echo were reviewed blindly by centralized reading centers. Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF)<0.50%.

Results: Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001). Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159,p<0.0003, and -0.142,p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001). Several ECG abnormalities were more commonly found in seropositive donors with depressed LVEF, including rhythm disorders (frequent supraventricular ectopic beats, atrial fibrillation or flutter and pacemaker), intraventricular blocks (right bundle branch block and left anterior fascicular block) and ischemic abnormalities (possible old myocardial infarction and major and minor ST abnormalities). ECG was sensitive (92%) for recognition of seropositive donors with depressed LVEF and had a high negative predictive value (99%) for ruling out LV dysfunction.

Conclusions: ECG abnormalities are more frequent in seropositive than in seronegative blood donors. Several ECG abnormalities may help the recognition of seropositive cases with reduced LVEF who warrant careful follow-up and treatment.

Show MeSH
Related in: MedlinePlus