Evaluation of Clinically Significant Cardiac Abnormalities in Patients with Normal Electrocardiogram using Transthoracic Electrocardiography
Hameed A. Alhibaly, Hameed Hussein Al-jameel, Ban Waheed Hussein Bdair , Satar Jabbar Rahi Al-Graittee
-
Hameed A. Alhibaly
,
Hameed Hussein Al-Jameel
,
Ban Waheed Hussein Bdair
,
Satar Jabbar Rahi Algraittee
Abstract
Abstract-Cardiac abnormalities have been suspected and identified using transthoracic echocardiography in patients with normal electrocardiographic results have been reported. It is however not clear whether these abnormalities are clinically significant or can lead to change in clinical management. The aim of this study was to evaluate the prevalence and clinical significance of cardiac abnormalities found in patients with normal electrocardiographic results. Transthoracic echocardiography was conducted on outpatients on referral despite having normal electrocardiographic results. Clinical symptoms were identified and parameters such as BMI, smoking status, blood pressure, blood glucose levels and hypercholesterolemia status were evaluated. The data obtained from these parameters were compared with findings of cardiac abnormalities in the patients. Out of 552 patients analysed with mean age of 50.53±15.04 years, 412 representing 74% had abnormalities in their transthoracic echocardiographic reports. Significant majority of active smoking patients (82.2%) had cardiac abnormalities. The major findings were valvular heart disease observed in 123 patients, grade I and II diastolic dysfunction in 85 patients, hypertensive heart disease in 76 patients and non-significant valve disease reported in 50 patients.
The common symptoms included atypical chest pain, shortness of breath and epigastric pain. Hypertension, hypercholesterolemia and diabetes mellitus were observed among patients with abnormal transthoracic echocardiographic reports. There is high prevalence of clinically significant cardiac abnormalities evaluated using transthoracic echocardiography in patients with normal electrocardiographic results. These cardiac abnormalities are associated with symptoms and cardio-metabolic disease, hence might warrant change in clinical management.
Keywords: Transthoracic, echocardiography, Cardiac abnormalities, Cardio-metabolic diseases, Structural heart disease.
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2. Otto CM, Schwaegler RG, Freeman RV, Linefsky J. Echocardiography Review Guide E-Book: Companion to the Textbook of Clinical Echocardiography: Elsevier Health Sciences; 2019.
3. Klein AL, Asher CR. Clinical echocardiography review: a self-assessment tool: Lippincott Williams & Wilkins; 2011.
4. AlGhatrif M, Lindsay J. A brief review: history to understand fundamentals of electrocardiography. Journal of community hospital internal medicine perspectives. 2012;2(1):14383.
5. Stone JR, Lee L, Ward JP, Ward RP. High prevalence of clinically important echocardiographic abnormalities in patients with a normal electrocardiogram referred for transthoracic echocardiography. Journal of the American Society of Echocardiography. 2018;31(8):926-32.
6. Dasgupta S, Anderson S, Kelleman M, Sachdeva R. Application of pediatric Appropriate Use Criteria for initial outpatient evaluation of asymptomatic patients with abnormal electrocardiograms. Congenital heart disease. 2019;14(2):230-5.
7. Tague L, Wiggs J, Li Q, McCarter R, Sherwin E, Weinberg J, et al. Comparison of left ventricular hypertrophy by electrocardiography and echocardiography in children using analytics tool. Pediatric cardiology. 2018;39(7):1378-88.
8. Buksińska-Lisik M, Litwin T, Pasierski T, Członkowska A. Cardiac assessment in Wilson’s disease patients based on electrocardiography and echocardiography examination. Archives of medical science: AMS. 2019;15(4):857.
9. Moustafa MM, Shredah AAR, Marghany KA, Zakaria AYS. Electrocardiography versus Echocardiography for assessment of left ventricular hypertrophy in ischemic heart disease patients with and without cardiovascular risk factors. The Egyptian Journal of Hospital Medicine. 2019;74(5):1165-73.
10. Baturova MA, Sheldon SH, Carlson J, Brady PA, Lin G, Rabinstein AA, et al. Electrocardiographic and Echocardiographic predictors of paroxysmal atrial fibrillation detected after ischemic stroke. BMC cardiovascular disorders. 2016;16(1):209.
11. Calò L, Martino A, Tranchita E, Sperandii F, Guerra E, Quaranta F, et al. Electrocardiographic and echocardiographic evaluation of a large cohort of peri-pubertal soccer players during pre-participation screening. European journal of preventive cardiology. 2019;26(13):1444-55.
12. Gibbons RJ, Carryer D, Liu H, Brady PA, Askew JW, Hodge D, et al. Use of echocardiography in outpatients with chest pain and normal resting electrocardiograms referred to Mayo Clinic Rochester. American heart journal. 2018;196:49-55.
13. Fernando RJ, Goeddel LA, Shah R, Ramakrishna H. Analysis of the 2019 ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS Appropriate Use Criteria for Multimodal Imaging in the Assessment of Structural Heart Disease. Journal of cardiothoracic and vascular anesthesia. 2020;34(3):805-18.
14. Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. European heart Journal-cardiovascular imaging. 2017;18(12):1301-10.
15. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2019;73(24):3168-209.
16. Garvey WT. The diagnosis and evaluation of patients with obesity. Current Opinion in Endocrine and Metabolic Research. 2019;4:50-7.
17. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical chemistry. 1972;18(6):499-502.
18. Ibrahim MA, Jialal I. Hypercholesterolemia. StatPearls [Internet]: StatPearls Publishing; 2019.
19. Aloia A-A. HBSc. Call to Standardize Diagnostic Practice for Type 2 Diabetes Mellitus World-Wide; A Review of Various Guidelines Used Internationally. Diabetes Complications. 2019;3(3):1-4.
20. Roth AR, Lazris A, Ganatra S. Overuse of cardiac testing. American family physician. 2018;98(10):561-3.
21. Gomez Polo J, Higueras Nafria J, Martinez Losas P, Godoy C, Palacios Rubio J, Vilchez Tschischke J, et al. Electrocardiogram interpretation at first medical contact in asymptomatic patients: The tip of the iceberg. 2016.
22. Kerkhof DL, Gleason CN, Basilico FC, Corrado GD. Is there a role for limited echocardiography during the Preparticipation physical examination? PM&R. 2016;8:S36-S44.
23. Kroenke K. Diagnostic testing and the illusory reassurance of normal results: comment on “Reassurance after diagnostic testing with a low pretest probability of serious disease”. JAMA internal medicine. 2013;173(6):416-7.
24. Tewelde SZ, Mattu A, Brady Jr WJ. Pitfalls in electrocardiographic diagnosis of acute coronary syndrome in low-risk chest pain. Western Journal of Emergency Medicine. 2017;18(4):601.
25. Hardy R, Maddock J, Ghosh AK, Hughes AD, Kuh D. the relationship between pubertal timing and markers of vascular and cardiac structure and function in men and women aged 60–64 years. Scientific reports. 2019;9(1):1-10.
26. Prajna GS, Rao SKM, Devi GS. A STUDY ON ECG CHANGES IN DIABETIC PATIENTS AND ITS RELATION TO CARDIAC DYSAUTONOMIA. International Journal of Scientific Research. 2019;8(11).
27. Dokuchaev A, Khamzin S, Solovyova O. A Population Modelling Approach to Studying Age-Related Effects on Excitation-Contraction Coupling in Human Cardiomyocytes. bioRxiv. 2019.
28. Rodicio MM, de Miguel VD, Jiménez MG, Guldrís SC, Franco MML, Gestal AE, et al. Early cardiac abnormalities in obese children and their relationship with adiposity. Nutrition. 2018;46:83-9.
29. Zhao H, Ma J, Zhou Q, Chen W, Zhu W, Cai Z, et al. Investigating the differences of body mass index and waist circumference in the follow-up assessment of patients to cardiac rehabilitation with acute coronary syndrome. Australasian physical & engineering sciences in medicine. 2016;39(4):1007-27.
30. Clark III D, Cain LR, Blaha MJ, DeFilippis AP, Mentz RJ, Kamimura D, et al. Cigarette smoking and subclinical peripheral arterial disease in blacks of the Jackson heart study. Journal of the American Heart Association. 2019;8(3):e010674.
31. Skranes JB, Claggett BL, Myhre PL, Lyngbakken MN, Solomon SD, Sabatine MS, et al. Current Smoking Is Associated With Lower Concentrations of High-Sensitivity Cardiac Troponin T in Patients With Stable Coronary Artery Disease: The PEACE Trial. Circulation. 2019;140(24):2044-6.
32. Al Hariri M, Zibara K, Farhat W, Hashem Y, Soudani N, Al Ibrahim F, et al. Cigarette smoking-induced cardiac hypertrophy, vascular inflammation and injury are attenuated by antioxidant supplementation in an animal model. Frontiers in pharmacology. 2016;7:397.
33. Aune D, Schlesinger S, Norat T, Riboli E. Tobacco smoking and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies. Springer; 2018.
34. Anderson KL, Limkakeng A, Damuth E, Chandra A. Cardiac evaluation for structural abnormalities may not be required in patients presenting with syncope and a normal ECG result in an observation unit setting. Annals of emergency medicine. 2012;60(4):478-84. e1.
35. Chang N-L, Shah P, Bajaj S, Virk H, Bikkina M, Shamoon F. Diagnostic yield of echocardiography in syncope patients with normal ECG. Cardiology research and practice. 2016;2016.
36. Han S-K, Yeom S-R, Lee S-H, Park S-C, Kim H-B, Cho Y-M, et al. Transthoracic echocardiogram in syncope patients with normal initial evaluation. The American journal of emergency medicine. 2017;35(2):281-4.
37. Beltrame M, Compagnucci P, Maolo A. P-Waves Are the Main Clues for Correct ECG Interpretation. New Concepts in ECG Interpretation: Springer; 2019. p. 1-7.
38. Nestaas E, Shih J-Y, Smedsrud MK, Gjesdal O, Hopp E, Haugaa KH, et al. Comparison of Electrocardiography Markers and Speckle Tracking Echocardiography for Assessment of Left Ventricular Myocardial Scar Burden in Patients With Previous Myocardial Infarction. The American journal of cardiology. 2017;119(9):1307-12.
39. Yousef HA, Hamdan AE, Elminshawy A, Mohammed NA, Ibrahim AS. Corrected calculation of the overestimated ejection fraction in valvular heart disease by phase-contrast cardiac magnetic resonance imaging for better prediction of patient morbidity. Egyptian Journal of Radiology and Nuclear Medicine. 2020;51(1):1-11.
40. Nabeshima Y, Namisaki H, Teshima T, Kurashige Y, Kakio A, Fukumitsu A, et al. Impact of a training program incorporating cardiac magnetic resonance imaging on the accuracy and reproducibility of two-dimensional echocardiographic measurements of left ventricular volumes and ejection fraction. Cardiovascular ultrasound. 2019;17(1):23.
41. Nishimura RA, O’Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, et al. 2019 AATS/ACC/ASE/SCAI/STS expert consensus systems of care document: a proposal to optimize care for patients with valvular heart disease: a joint report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of the American College of Cardiology. 2019;73(20):2609-35.
42. Roslan A, Kamsani SH, Koh HB, Tey YS, Leong K, Tham CH, et al. Diastolic dysfunction grading, echocardiographic and electrocardiogram findings in 50 patients with apical hypertrophic cardiomyopathy. Med J Malaysia. 2019;74(6):521.
43. Khan HS, Iftikhar I, Khan Q. Validity of Electrocardiographic QT Interval in Predicting Left Ventricular Diastolic Dysfunction in Patients with Suspected Heart Failure. J Coll Physicians Surg Pak. 2016;26:353-6.
44. Khalique OK, Bello NA. Are We Getting Closer to the HEART of Hypertensive Heart Disease? : Am Heart Assoc; 2019.
45. Dubey T, Paithankar U, Yadav B. Correlation of echocardiographic left ventricular mass index and electrocardiographic left ventricular hypertrophy variables. Int J Contemp Med Res. 2016;3:1287-9.
46. Wilkinson IB, Raine T, Hall C, Wiles K, Goodhart A, O'Neill H. Oxford handbook of clinical medicine: Oxford University Press; 2017.
47. Esfehani RJ, Hosseini S, Ebrahimi M, Jalalyazdi M, Gharaee AM. Anomalous Left Coronary Artery from the Pulmonary Artery Presenting with Atypical Chest Pain in an Adult: A Case Report. The Journal of Tehran University Heart Center. 2017;12(3):128.
48. Sherazi MH. Common Cardiovascular Symptoms for the Objective Structured Clinical Examination. The Objective Structured Clinical Examination Review. 2018:111.
49. Li T, Han J, Li Y, Gao S, Hao X, He Y. Diagnosis of double‐chambered left ventricle by echocardiogram and cardiac magnetic resonance imaging: A rare case in an adult. Echocardiography. 2020.
50. Vijayalakshmi I. Pregnancy with Mitral Stenosis and Mitral Regurgitation and Cardiac Failure. Ward Rounds in Obstetrics & Gynecology. 2018:71.
51. Zhang W, Zhou Y, Bai B, Yu S, Xiong J, Chi C, et al. Consistency of left ventricular hypertrophy diagnosed by electrocardiography and echocardiography: the northern shanghai study. Clinical interventions in aging. 2019;14:549.
52. Waligóra M, Tyrka A, Miszalski-Jamka T, Urbańczyk-Zawadzka M, Podolec P, Kopeć G. Right atrium enlargement predicts clinically significant supraventricular arrhythmia in patients with pulmonary arterial hypertension. Heart & Lung. 2018;47(3):237-42.
53. Bacha F, Gidding SS. Cardiac abnormalities in youth with obesity and type 2 diabetes. Current diabetes reports. 2016;16(7):62.
54. Haley JE, Urbina EM. Insulin Resistance and Cardiovascular Disease. Insulin Resistance: Springer; 2020. p. 195-205.
55. Fumery M, Antakly Y, Garcon P, Abassade P, Boileve V, Rovani M, et al. Systematic echo-doppler screening identifies subtle structural and functional cardiac abnormalities in type 2 diabetes mellitus without documented cardio vascular disease: DIACAR a prospective study. Archives of Cardiovascular Diseases Supplements. 2020;12(1):159-60.
56. Jia G, Hill MA, Sowers JR. Diabetic cardiomyopathy: an update of mechanisms contributing to this clinical entity. Circulation research. 2018;122(4):624-38.
57. Luo Y, Zheng M, Zhang Y, He S, Zhang L, Sun H, et al. Familial hypercholesterolemia with early coronary atherosclerotic heart disease: A case report. Experimental and therapeutic medicine. 2019;18(2):981-6.
58. Ganjali S, Momtazi AA, Banach M, Kovanen PT, Stein EA, Sahebkar A. HDL abnormalities in familial hypercholesterolemia: Focus on biological functions. Progress in lipid research. 2017;67:16-26.
59. Akashi M, Matsumura R, Matsuo T, Kubo Y, Komoda H, Node K. Hypercholesterolemia causes circadian {Akashi, 2017 #718}dysfunction: A potential risk factor for cardiovascular disease. EBioMedicine. 2017;20:127-36.
60. Calborean V, Miscoci SA, Istratoaie O, Galceava O, Alexandru DO, Guta MM, et al. Correlation Between Liver Cirrhosis and Risk of Cardiac Arrhythmias. Rev Chim (Bucharest). 2018;69:1527-32.
2. Otto CM, Schwaegler RG, Freeman RV, Linefsky J. Echocardiography Review Guide E-Book: Companion to the Textbook of Clinical Echocardiography: Elsevier Health Sciences; 2019.
3. Klein AL, Asher CR. Clinical echocardiography review: a self-assessment tool: Lippincott Williams & Wilkins; 2011.
4. AlGhatrif M, Lindsay J. A brief review: history to understand fundamentals of electrocardiography. Journal of community hospital internal medicine perspectives. 2012;2(1):14383.
5. Stone JR, Lee L, Ward JP, Ward RP. High prevalence of clinically important echocardiographic abnormalities in patients with a normal electrocardiogram referred for transthoracic echocardiography. Journal of the American Society of Echocardiography. 2018;31(8):926-32.
6. Dasgupta S, Anderson S, Kelleman M, Sachdeva R. Application of pediatric Appropriate Use Criteria for initial outpatient evaluation of asymptomatic patients with abnormal electrocardiograms. Congenital heart disease. 2019;14(2):230-5.
7. Tague L, Wiggs J, Li Q, McCarter R, Sherwin E, Weinberg J, et al. Comparison of left ventricular hypertrophy by electrocardiography and echocardiography in children using analytics tool. Pediatric cardiology. 2018;39(7):1378-88.
8. Buksińska-Lisik M, Litwin T, Pasierski T, Członkowska A. Cardiac assessment in Wilson’s disease patients based on electrocardiography and echocardiography examination. Archives of medical science: AMS. 2019;15(4):857.
9. Moustafa MM, Shredah AAR, Marghany KA, Zakaria AYS. Electrocardiography versus Echocardiography for assessment of left ventricular hypertrophy in ischemic heart disease patients with and without cardiovascular risk factors. The Egyptian Journal of Hospital Medicine. 2019;74(5):1165-73.
10. Baturova MA, Sheldon SH, Carlson J, Brady PA, Lin G, Rabinstein AA, et al. Electrocardiographic and Echocardiographic predictors of paroxysmal atrial fibrillation detected after ischemic stroke. BMC cardiovascular disorders. 2016;16(1):209.
11. Calò L, Martino A, Tranchita E, Sperandii F, Guerra E, Quaranta F, et al. Electrocardiographic and echocardiographic evaluation of a large cohort of peri-pubertal soccer players during pre-participation screening. European journal of preventive cardiology. 2019;26(13):1444-55.
12. Gibbons RJ, Carryer D, Liu H, Brady PA, Askew JW, Hodge D, et al. Use of echocardiography in outpatients with chest pain and normal resting electrocardiograms referred to Mayo Clinic Rochester. American heart journal. 2018;196:49-55.
13. Fernando RJ, Goeddel LA, Shah R, Ramakrishna H. Analysis of the 2019 ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS Appropriate Use Criteria for Multimodal Imaging in the Assessment of Structural Heart Disease. Journal of cardiothoracic and vascular anesthesia. 2020;34(3):805-18.
14. Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. European heart Journal-cardiovascular imaging. 2017;18(12):1301-10.
15. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2019;73(24):3168-209.
16. Garvey WT. The diagnosis and evaluation of patients with obesity. Current Opinion in Endocrine and Metabolic Research. 2019;4:50-7.
17. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical chemistry. 1972;18(6):499-502.
18. Ibrahim MA, Jialal I. Hypercholesterolemia. StatPearls [Internet]: StatPearls Publishing; 2019.
19. Aloia A-A. HBSc. Call to Standardize Diagnostic Practice for Type 2 Diabetes Mellitus World-Wide; A Review of Various Guidelines Used Internationally. Diabetes Complications. 2019;3(3):1-4.
20. Roth AR, Lazris A, Ganatra S. Overuse of cardiac testing. American family physician. 2018;98(10):561-3.
21. Gomez Polo J, Higueras Nafria J, Martinez Losas P, Godoy C, Palacios Rubio J, Vilchez Tschischke J, et al. Electrocardiogram interpretation at first medical contact in asymptomatic patients: The tip of the iceberg. 2016.
22. Kerkhof DL, Gleason CN, Basilico FC, Corrado GD. Is there a role for limited echocardiography during the Preparticipation physical examination? PM&R. 2016;8:S36-S44.
23. Kroenke K. Diagnostic testing and the illusory reassurance of normal results: comment on “Reassurance after diagnostic testing with a low pretest probability of serious disease”. JAMA internal medicine. 2013;173(6):416-7.
24. Tewelde SZ, Mattu A, Brady Jr WJ. Pitfalls in electrocardiographic diagnosis of acute coronary syndrome in low-risk chest pain. Western Journal of Emergency Medicine. 2017;18(4):601.
25. Hardy R, Maddock J, Ghosh AK, Hughes AD, Kuh D. the relationship between pubertal timing and markers of vascular and cardiac structure and function in men and women aged 60–64 years. Scientific reports. 2019;9(1):1-10.
26. Prajna GS, Rao SKM, Devi GS. A STUDY ON ECG CHANGES IN DIABETIC PATIENTS AND ITS RELATION TO CARDIAC DYSAUTONOMIA. International Journal of Scientific Research. 2019;8(11).
27. Dokuchaev A, Khamzin S, Solovyova O. A Population Modelling Approach to Studying Age-Related Effects on Excitation-Contraction Coupling in Human Cardiomyocytes. bioRxiv. 2019.
28. Rodicio MM, de Miguel VD, Jiménez MG, Guldrís SC, Franco MML, Gestal AE, et al. Early cardiac abnormalities in obese children and their relationship with adiposity. Nutrition. 2018;46:83-9.
29. Zhao H, Ma J, Zhou Q, Chen W, Zhu W, Cai Z, et al. Investigating the differences of body mass index and waist circumference in the follow-up assessment of patients to cardiac rehabilitation with acute coronary syndrome. Australasian physical & engineering sciences in medicine. 2016;39(4):1007-27.
30. Clark III D, Cain LR, Blaha MJ, DeFilippis AP, Mentz RJ, Kamimura D, et al. Cigarette smoking and subclinical peripheral arterial disease in blacks of the Jackson heart study. Journal of the American Heart Association. 2019;8(3):e010674.
31. Skranes JB, Claggett BL, Myhre PL, Lyngbakken MN, Solomon SD, Sabatine MS, et al. Current Smoking Is Associated With Lower Concentrations of High-Sensitivity Cardiac Troponin T in Patients With Stable Coronary Artery Disease: The PEACE Trial. Circulation. 2019;140(24):2044-6.
32. Al Hariri M, Zibara K, Farhat W, Hashem Y, Soudani N, Al Ibrahim F, et al. Cigarette smoking-induced cardiac hypertrophy, vascular inflammation and injury are attenuated by antioxidant supplementation in an animal model. Frontiers in pharmacology. 2016;7:397.
33. Aune D, Schlesinger S, Norat T, Riboli E. Tobacco smoking and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies. Springer; 2018.
34. Anderson KL, Limkakeng A, Damuth E, Chandra A. Cardiac evaluation for structural abnormalities may not be required in patients presenting with syncope and a normal ECG result in an observation unit setting. Annals of emergency medicine. 2012;60(4):478-84. e1.
35. Chang N-L, Shah P, Bajaj S, Virk H, Bikkina M, Shamoon F. Diagnostic yield of echocardiography in syncope patients with normal ECG. Cardiology research and practice. 2016;2016.
36. Han S-K, Yeom S-R, Lee S-H, Park S-C, Kim H-B, Cho Y-M, et al. Transthoracic echocardiogram in syncope patients with normal initial evaluation. The American journal of emergency medicine. 2017;35(2):281-4.
37. Beltrame M, Compagnucci P, Maolo A. P-Waves Are the Main Clues for Correct ECG Interpretation. New Concepts in ECG Interpretation: Springer; 2019. p. 1-7.
38. Nestaas E, Shih J-Y, Smedsrud MK, Gjesdal O, Hopp E, Haugaa KH, et al. Comparison of Electrocardiography Markers and Speckle Tracking Echocardiography for Assessment of Left Ventricular Myocardial Scar Burden in Patients With Previous Myocardial Infarction. The American journal of cardiology. 2017;119(9):1307-12.
39. Yousef HA, Hamdan AE, Elminshawy A, Mohammed NA, Ibrahim AS. Corrected calculation of the overestimated ejection fraction in valvular heart disease by phase-contrast cardiac magnetic resonance imaging for better prediction of patient morbidity. Egyptian Journal of Radiology and Nuclear Medicine. 2020;51(1):1-11.
40. Nabeshima Y, Namisaki H, Teshima T, Kurashige Y, Kakio A, Fukumitsu A, et al. Impact of a training program incorporating cardiac magnetic resonance imaging on the accuracy and reproducibility of two-dimensional echocardiographic measurements of left ventricular volumes and ejection fraction. Cardiovascular ultrasound. 2019;17(1):23.
41. Nishimura RA, O’Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, et al. 2019 AATS/ACC/ASE/SCAI/STS expert consensus systems of care document: a proposal to optimize care for patients with valvular heart disease: a joint report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of the American College of Cardiology. 2019;73(20):2609-35.
42. Roslan A, Kamsani SH, Koh HB, Tey YS, Leong K, Tham CH, et al. Diastolic dysfunction grading, echocardiographic and electrocardiogram findings in 50 patients with apical hypertrophic cardiomyopathy. Med J Malaysia. 2019;74(6):521.
43. Khan HS, Iftikhar I, Khan Q. Validity of Electrocardiographic QT Interval in Predicting Left Ventricular Diastolic Dysfunction in Patients with Suspected Heart Failure. J Coll Physicians Surg Pak. 2016;26:353-6.
44. Khalique OK, Bello NA. Are We Getting Closer to the HEART of Hypertensive Heart Disease? : Am Heart Assoc; 2019.
45. Dubey T, Paithankar U, Yadav B. Correlation of echocardiographic left ventricular mass index and electrocardiographic left ventricular hypertrophy variables. Int J Contemp Med Res. 2016;3:1287-9.
46. Wilkinson IB, Raine T, Hall C, Wiles K, Goodhart A, O'Neill H. Oxford handbook of clinical medicine: Oxford University Press; 2017.
47. Esfehani RJ, Hosseini S, Ebrahimi M, Jalalyazdi M, Gharaee AM. Anomalous Left Coronary Artery from the Pulmonary Artery Presenting with Atypical Chest Pain in an Adult: A Case Report. The Journal of Tehran University Heart Center. 2017;12(3):128.
48. Sherazi MH. Common Cardiovascular Symptoms for the Objective Structured Clinical Examination. The Objective Structured Clinical Examination Review. 2018:111.
49. Li T, Han J, Li Y, Gao S, Hao X, He Y. Diagnosis of double‐chambered left ventricle by echocardiogram and cardiac magnetic resonance imaging: A rare case in an adult. Echocardiography. 2020.
50. Vijayalakshmi I. Pregnancy with Mitral Stenosis and Mitral Regurgitation and Cardiac Failure. Ward Rounds in Obstetrics & Gynecology. 2018:71.
51. Zhang W, Zhou Y, Bai B, Yu S, Xiong J, Chi C, et al. Consistency of left ventricular hypertrophy diagnosed by electrocardiography and echocardiography: the northern shanghai study. Clinical interventions in aging. 2019;14:549.
52. Waligóra M, Tyrka A, Miszalski-Jamka T, Urbańczyk-Zawadzka M, Podolec P, Kopeć G. Right atrium enlargement predicts clinically significant supraventricular arrhythmia in patients with pulmonary arterial hypertension. Heart & Lung. 2018;47(3):237-42.
53. Bacha F, Gidding SS. Cardiac abnormalities in youth with obesity and type 2 diabetes. Current diabetes reports. 2016;16(7):62.
54. Haley JE, Urbina EM. Insulin Resistance and Cardiovascular Disease. Insulin Resistance: Springer; 2020. p. 195-205.
55. Fumery M, Antakly Y, Garcon P, Abassade P, Boileve V, Rovani M, et al. Systematic echo-doppler screening identifies subtle structural and functional cardiac abnormalities in type 2 diabetes mellitus without documented cardio vascular disease: DIACAR a prospective study. Archives of Cardiovascular Diseases Supplements. 2020;12(1):159-60.
56. Jia G, Hill MA, Sowers JR. Diabetic cardiomyopathy: an update of mechanisms contributing to this clinical entity. Circulation research. 2018;122(4):624-38.
57. Luo Y, Zheng M, Zhang Y, He S, Zhang L, Sun H, et al. Familial hypercholesterolemia with early coronary atherosclerotic heart disease: A case report. Experimental and therapeutic medicine. 2019;18(2):981-6.
58. Ganjali S, Momtazi AA, Banach M, Kovanen PT, Stein EA, Sahebkar A. HDL abnormalities in familial hypercholesterolemia: Focus on biological functions. Progress in lipid research. 2017;67:16-26.
59. Akashi M, Matsumura R, Matsuo T, Kubo Y, Komoda H, Node K. Hypercholesterolemia causes circadian {Akashi, 2017 #718}dysfunction: A potential risk factor for cardiovascular disease. EBioMedicine. 2017;20:127-36.
60. Calborean V, Miscoci SA, Istratoaie O, Galceava O, Alexandru DO, Guta MM, et al. Correlation Between Liver Cirrhosis and Risk of Cardiac Arrhythmias. Rev Chim (Bucharest). 2018;69:1527-32.
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| Issue | Vol 59, No 2 (2021) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v59i2.5576 | |
| Keywords | ||
| Keywords: Transthoracic echocardiography Cardiac abnormalities Cardio-metabolic diseases Structural heart disease. | ||
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How to Cite
1.
A. Alhibaly H, Hussein Al-Jameel H, Hussein Bdair BW, Jabbar Rahi Algraittee S. Evaluation of Clinically Significant Cardiac Abnormalities in Patients with Normal Electrocardiogram using Transthoracic Electrocardiography. Acta Med Iran. 2021;59(2):97-107.
