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Title: Novel electrocardiographic techniques for diagnosis and risk stratification in patients with inherited and acquired cardiomyopathies
Author: Bastiaenen , Rachel
ISNI:       0000 0004 5372 4272
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2014
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Cardiomyopathies are heart muscle diseases associated with cardiac dysfunction and fibrosis. [1, 2] Formation of scar tissue increases the likelihood of ventricular arrhythmia (VT/VF), the final common pathway in the majority of sudden cardiac death (SCD). Diagnosis of inherited cardiomyopathies can be challenging particularly in the early stages of disease. Although implantable cardioverter defibrillator (ICD) therapy reduces SCD due to VT/VF, risk stratification in both acquired and inherited cardiomyopathies is imperfect. [3, 4,5,6] There are up to 100,000 SCDs each year in the UK.[7] Ventricular ectopic beats (VEB) are conducted through myocardium with limited participation of specialized conduction tissue and may therefore provide an index of the state of the myocardium, extent of fibrosis and risk of SCD.[8] Aims: to develop novel VEB electrocardiographic indices to aid cardiomyopathy diagnosis and risk stratification. Methods: 12 lead Holter monitoring to examine novel VEB indices: the ventricular ectopic QS interval (VEQSr); the number of VEB morphologies; and VEB fragmentation in cohorts of normal controls and patients with inherited and acquired cardiomyopathies. Relationship of the novel VEB indices with structural heart disease was assessed using echocardiographic and cardiac magnetic resonance imaging. Novel VEB indices were compared between cohorts and in patients with and without prior cardiac arrest. These indices were compared with conventional diagnostic and risk stratification criteria using multivariate analysis. Results: Normal ranges for novel VEB indices were defined in normal controls with good interobserver reproducibility. Novel VEB indices were significantly greater in patients with cardiomyopathy than normal controls and VEQSI in particular correlated with structural abnormalities. VEQSI appears more useful than VEB morphologies and VEB fragmentation in providing incremental information in the diagnosis of arrhythmogenic right ventricular cardiomyopathy and risk stratification of ischaemic cardiomyopathy. Novel VEB indices and myocardial deformation imaging suggest subtle underlying biventricular structural disease in Brugada syndrome. Conclusions: These novel VEB electrocardiographic indices are promising markers for diagnosis and risk stratification in inherited and acquired cardiomyopathies and require further assessment with larger patient numbers and prospective follow up.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available