Abstract:
OBJECTIVES:This study was conducted to evaluate the sensitivity and specificity of traditional electrocardiographic (ECG) criteria for right atrial enlargement and identify improve criteria, using quantitative two-dimensional echocardiography. BACKGROUND:Traditional ECG criteria for right atrial enlargement, such as P pulmonale, have been increasingly criticized as insensitive and nonspecific. Quantitative two-dimensional echo-cardiography has been shown to be a useful method for evaluating atrial size. METHODS:Hospitalized patients with mild, moderate and severe right atrial enlargement were selected from our laboratory's data base and compared with age- and gender-correlated hospitalized control subjects. After exclusions, 100 patients with right atrial enlargement and 25 control patients remained. Planimetric measurement of right atrial volumes was accomplished by two independent observers using the single-plane method of discs algorithm. Electrocardiograms were independently evaluated for current and newly proposed right atrial enlargement criteria. RESULTS:Fifty-two patients (52%) were in sinus rhythm, 41 were in atrial fibrillation, 5 were in atrial flutter, and 2 were in ectopic atrial rhythm. All control subjects were in sinus rhythm. The right atrial volume for the control group was 35.0 +/- 7.4 ml (mean +/- SD), with a narrow, roughly normal distribution. The right atrial volume for the patient group was 147.6 +/- 69.1 ml (median 127.2) in a wide, skewed distribution. The difference of mean values was highly significant (p = 0.0001). Right ventricular enlargement was found to some degree in all patients with right atrial enlargement. The most powerful predictors of right atrial enlargement were a QRS axis > 90 degrees, a P wave height in lead V2 > 1.5 mm and an R/S ratio > 1 in lead V1 in the absence of complete right bundle branch block. The combined sensitivity of these three criteria was 49%, with preservation of 100% specificity. P pulmonale detected only 6% of patients with right atrial enlargement. CONCLUSIONS:Using quantitative two-dimensional echocardiography, we found that most previously reported ECG criteria for right atrial enlargement have low predictive power. The best predictors of right atrial enlargement were a P wave height > 1.5 mm in lead V2 and, as new criteria, a QRS axis > 90 degrees and an R/S ratio > 1 in lead V1 in the absence of complete right bundle branch block. The combined sensitivity of these three criteria was 49%, with preservation of 100% specificity. Further studies are needed to prospectively validate these findings.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Kaplan JD,Evans GT Jr,Foster E,Lim D,Schiller NBdoi
10.1016/0735-1097(94)90763-3subject
Has Abstractpub_date
1994-03-01 00:00:00pages
747-52issue
3eissn
0735-1097issn
1558-3597pii
0735-1097(94)90763-3journal_volume
23pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVES:This study was designed to investigate whether the addition of N-terminal pro-B-type natriuretic peptide-guided, intensive patient management (BM) to multidisciplinary care (MC) improves outcome in patients following hospitalization due to heart failure (HF). BACKGROUND:Patients hospitalized due to HF exper...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2009.08.078
更新日期:2010-02-16 00:00:00
abstract:OBJECTIVES:We sought to determine whether the prescription of evidence-based medications at discharge after successful percutaneous coronary intervention (PCI) can predict long-term clinical outcome. BACKGROUND:The association of standard-of-care drug utilization and long-term mortality and morbidity after PCI is not ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.06.070
更新日期:2005-10-18 00:00:00
abstract:OBJECTIVES:The aim of this research was to determine whether presence of atrial fibrillation (AF) provides incremental prognostic information relative to myocardial perfusion single-photon emission computed tomography (MPS) with respect to risk of cardiac death (CD). BACKGROUND:The prognostic significance of AF in pat...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2004.05.076
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVES:This study sought to investigate the efficacy and safety of catheter ablation for atrial fibrillation (AF) in patients with heart failure with preserved ejection fraction (HFPEF). BACKGROUND:AF is a precipitating factor for clinical deterioration of HFPEF. METHODS:Catheter ablation for AF was performed in ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2013.07.020
更新日期:2013-11-12 00:00:00
abstract::An echocardiographic Doppler study in a patient with pulsus paradoxus of respiratory origin demonstrated a large inspiratory increase of tricuspid flow velocity and a corresponding decrease of mitral flow velocity. This "flow paradoxus" is therefore not specific for cardiac tamponade, and provides evidence that decrea...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(86)80205-4
更新日期:1986-09-01 00:00:00
abstract::Myocardial ischemia of short duration (15 to 20 min) produces myocardial "stunning" during reperfusion. The vasoregulatory and contractile status of reperfused myocardium during normal and reduced perfusion pressures is of interest in the treatment of patients with unstable angina. In the present study the effects of ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(91)90813-o
更新日期:1991-09-01 00:00:00
abstract:OBJECTIVES:This study sought to evaluate the safety and feasibility of zotarolimus-eluting stent implantation in focal atherosclerotic lesions of the internal pudendal arteries among men with erectile dysfunction (ED) and a suboptimal response to phosphodiesterase-5 inhibitors. BACKGROUND:ED, a common condition, is of...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2012.08.1016
更新日期:2012-12-25 00:00:00
abstract:OBJECTIVES:The aim of this study was to identify the remodeling parameters cardiomyocyte (CM) damage or death, hypertrophy, and fibrosis that may be linked to outcomes in patients with advanced heart failure (HF) in an effort to understand the pathogenic mechanisms of HF that may support newer therapeutic modalities. ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2010.09.080
更新日期:2011-04-05 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2006.07.051
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2010.02.046
更新日期:2010-06-29 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.03.040
更新日期:2005-06-21 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2011.04.010
更新日期:2011-08-09 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(92)90138-d
更新日期:1992-07-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2015.05.020
更新日期:2015-07-21 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90178-4
更新日期:1993-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2014.10.048
更新日期:2015-01-27 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(90)90198-x
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
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更新日期:2014-08-19 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2008.01.028
更新日期:2008-04-29 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80020-7
更新日期:1987-08-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00305-2
更新日期:1998-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(91)90549-o
更新日期:1991-11-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2010.03.087
更新日期:2010-10-05 00:00:00
abstract:BACKGROUND:Long-term outcomes of Fontan patients who survive to age ≥16 years have not been well characterized. The Australian and New Zealand Fontan Registry (ANZFR) provides a unique opportunity to understand survival and complication rates in Fontan patients who transition to adult congenital heart disease centers. ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2017.12.054
更新日期:2018-03-06 00:00:00
abstract::The utility of using an endurance test as well as a maximal exercise test to assess the effect of amlodipine, a dihydropyridine calcium antagonist, was evaluated in 16 patients with angina pectoris. Amlodipine, 10 mg/day, was compared with placebo in a double blind crossover study. After a 2 week single blind placebo ...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1988-09-01 00:00:00
abstract:OBJECTIVES:We sought to examine the combined effect of hospital and physician volume of primary percutaneous coronary intervention (PCI) on in-hospital mortality. BACKGROUND:An inverse relationship between volume and outcome has been observed for both hospitals and physicians after primary PCI for acute myocardial inf...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2008.09.056
更新日期:2009-02-17 00:00:00
abstract::Cine nuclear magnetic resonance (NMR) imaging was used to serially measure cardiovascular function in 17 patients with New York Heart Association class II or III heart failure and left ventricular ejection fraction less than or equal to 45% who were treated for 3 months with benazepril hydrochloride, a new angiotensin...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(92)90337-m
更新日期:1992-05-01 00:00:00
abstract::Patients with chronic heart failure (CHF) have a resting restrictive ventilatory defect. Any type of exercise requires patients with CHF to markedly increase their minute ventilation. Patients with chronic obstructive pulmonary disease (COPD) have airflow obstruction that leads to dynamic lung hyperinflation and reduc...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2004.03.063
更新日期:2004-08-04 00:00:00
abstract:OBJECTIVES:The goal of this study was to examine the association between paraoxonase-1 (PON1) activity and concentration and the severity and extent of coronary artery disease (CAD). BACKGROUND:Paraoxonase-1, a high-density lipoprotein-associated enzyme, is proposed to have an antiatherogenic effect by protecting low-...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2006.01.074
更新日期:2006-06-20 00:00:00