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Background: T-wave alternans (TWA) is usually performed at accelerated heart rates (HR) during exercise, while recovery TWA is typically not analyzed. Consequently, it is still unknown if TWA shows a HR-dependent hysteresis or not. Thus, the aim of the present study was to investigate TWA dependency on HR during both the exercise and recovery phases of an ergometer test, and to evaluate if recovery TWA may contribute to identify subjects at increased risk of arrhythmic events.Methods: Our HR adaptive match filter was used to identify TWA from electrocardiographic recordings acquired during a bicycle ergometer test in 266 patients with implanted cardio-defibrillator. During the 4-year follow-up, 76 patients developed tachycardia or ventricular fibrillation (ICD_Cases) and 190 did not (ICD_Controls).Results: TWA was statistically lower during exercise than recovery for HRs between 75 and 110 bpm (16-21 μV vs 20-27 μV; P < 0.05), and reverse for HRs between 120 and 130 bpm (41-51 μV vs 28 μV; P < 0.05). ICD_Cases and ICD_Controls showed significantly different TWA at 80 bpm (20 μV vs 15 μV; P < 0.05) and 140 bpm (15 μV vs 22 μV; P < 0.05) during exercise, and at 90 bpm (38 μV vs 21 μV; P < 0.05) and 95 bpm (33-24 μV vs 28 μV; P < 0.05) during recovery.Conclusions: TWA shows a HR-dependent hysteresis and there is a different behavior of TWA in ICD_Cases and ICD_Controls groups. Consequently, beside exercise TWA also recovery TWA may contribute to identify subjects at increased risk of arrhythmic events. [ABSTRACT FROM AUTHOR]

Background: Defects of cardiac repolarization, noninvasively identifiable by analyzing the electrocardiographic (ECG) ST segment and T wave, are among the major causes of sudden cardiac death. Still, no repolarization-based index has so far shown sufficient sensitivity and specificity to justify preventive treatments. Thus, the aim of this work was to evaluate the predictive power of our recently proposed f99 index for the occurrence of ventricular arrhythmias.Methods: Our study populations included 170 patients with implanted cardiac defibrillator (ICD), 44 of which developed ventricular tachycardia and/or fibrillation during the 4-year follow-up (ICD_Cases) and 126 did not (ICD_Controls). The f99 index, defined as the frequency at which the repolarization normalized cumulative energy reaches 99%, was computed in each of the 15 (I to III, aVl, aVr, aVf, V1 -V6 , X, Y, Z) available ECG leads independently, and then maximized over the 6 precordial leads (f99_MaxV1 -V6 ), 12 standard leads (f99_Max12STD) and three orthogonal leads (f99_MaxXYZ) to avoid dispersion-related issues. Each index predictive power was quantified as the area under the receiving operating characteristic curve (AUC).Results: Median f99_MaxV1 -V6 , f99_Max12STD and f99_MaxXYZ values were significantly higher in the ICD_Cases than in the ICD_Controls (48 Hz vs. 35 Hz, P<0.05; 51 Hz vs. 43 Hz, P<0.05; 45 Hz vs. 31 Hz, P<10(-3) ; respectively), indicating a more fragmented repolarization in the former group. The AUC values were 0.62, 0.63 and 0.68, respectively.Conclusions: The f99 represents a promising risk index for the occurrence of ventricular arrhythmias, especially when maximized over the three orthogonal leads. [ABSTRACT FROM AUTHOR]

Background Noninvasive fetal electrocardiography (fECG), obtained positioning electrodes on the maternal abdomen, is important in safeguarding the life and the health of the unborn child. This study aims to provide a review of the state of the art of fECG, and includes a description of the parameters useful for fetus clinical evaluation; of the fECG recording procedures; and of the techniques to extract the fECG signal from the abdominal recordings. Methods The fetus clinical status is inferred by analyzing growth parameters, supraventricular arrhythmias, ST-segment variability, and fetal-movement parameters from the fECG signal. This can be extracted from an abdominal recording obtained using one of the following two electrode-types configurations: pure-abdominal and mixed. Differently from the former, the latter also provides pure maternal ECG tracings. From a mathematical point of view, the abdominal recording is a summation of three signal components: the fECG signal (i.e., the signal of interest to be extracted), the abdominal maternal ECG (amECG), and the noise. Automatic extraction of fECG includes noise removal by abdominal signal prefiltration (0.5-45 Hz bandpass filter) and amECG cancellation. Conclusions Differences among methods rely on different techniques used to extract fECG. If pure abdominal electrode configurations are used, fECG is extracted directly from the abdominal recording using independent component analysis or template subtraction. Eventually, if mixed electrode configurations are used, the fECG can be extracted using the adaptive filtering fed with the maternal ECG recorded by the electrodes located in the woman thorax or shoulder. [ABSTRACT FROM AUTHOR]

Background T-wave alternans (TWA) is a noninvasive index of risk for the occurrence of ventricular arrhythmias. It is known that TWA amplitude (TWAA) increases with heart rate (HR) but how the TWA predictive power varies with HR remains unknown. Thus, the aim of this study was to evaluate the dependency of exercise-induced TWA predictive power for the occurrence of ventricular arrhythmias from HR. Methods TWA was identified using our HR adaptive match filter in exercise ECGs from 248 patients with implanted cardiac defibrillator (ICD), of which 72 developed ventricular tachycardia and/or fibrillation during the 4 year follow-up (ICD_Cases) and 176 did not (ICD_Controls). TWA predictive power was evaluated at HRs from 80 to 120 bpm by computing the area under the receiver operating characteristic curve (AUC) obtained using the maximum TWAA (maxTWAA) and the TWAA ratio (TWAAratio; i.e., the ratio between TWAA at a specific HR and at 80 bpm). Results TWAA increased with HR. At 80 bpm maxTWAA was lower than at 120 bpm in both ICD_Cases (22 μV vs 41 μV; P < 10−2) and ICD_ Controls (16 μV vs 36 μV; P < 10−4). However, only at 80 bpm ICD_Cases showed significantly higher maxTWAA than ICD_Controls (AUC = 0.6486; P = 0.0080). TWAAratio was higher in ICD_Controls than ICD_Cases for all HR but 120 bpm, and its predictive power was maximum at 115 bpm (AUC = 0.6914; P < 0.05). Conclusions Exercise-induced TWA predictive power for the occurrence of ventricular arrhythmias, quantified using both maxTWAA and TWAAratio, was higher at low rather than at high HR. [ABSTRACT FROM AUTHOR]

The evolution with ageing of insulin resistance, body weight (BW) and mean arterial pressure (MAP) was studied in a group of Zucker fatty rats (ZFRs, n= 22), between 7 and 16 weeks of age, compared with an age-matched control group of Zucker lean rats (ZLRs, n= 22). The minimal model of glucose kinetics was applied to estimate glucose effectiveness, SG, and insulin sensitivity, SI, from insulinaemia and glycaemia measured during a 70 min intravenous glucose tolerance test. No correlation was found between SG and age in both ZFR and ZLR groups. No significant changes in mean SG between the two groups indicated no alteration of glucose-mediated glucose disposal. Estimates of SI from individual ZFRs were independent of age and, on average, showed 83% reduction ( P < 0.001) compared with the ZLR group. Despite the lack of alteration of SI with age, the ZFR group showed an age-related increase of MAP, which correlated with increasing BW (r = 0.71 and P < 0.001). These results support the hypothesis that in our ZFRs, as a suitable genetic model of obesity and hypertension, insulin resistance is fully established at the age of 7 weeks and remains practically unaltered until at least the sixteenth week. An age-related increase in arterial pressure, observed in this strain, relates more properly to increasing BW, rather than insulin resistance. Development of hypertension with increasing age and BW may result from an enhanced insulin-mediated activity of the sympathetic nervous system, as observed in our previously reported study. [ABSTRACT FROM AUTHOR]

Background: Obesity is known to induce a deterioration of insulin sensitivity (SI), one of the insulin‐dependent components of glucose tolerance. However, few studies investigated whether obesity affects also the insulin‐independent component, that is glucose effectiveness (SG). This cross‐sectional study aimed to analyse SG and its components in different body mass index (BMI) categories. Materials and methods: Three groups of subjects spanning different BMI (kg m−2) categories underwent a 3‐h frequently sampled intravenous glucose tolerance test: Lean (LE; 18.5 ≤ BMI < 25, n = 73), Overweight (OW; 25 ≤ BMI < 30, n = 90), and Obese (OB; BMI ≥ 30, n = 41). OB has been further divided into two subgroups, namely Obese I (OB‐I; 30 ≤ BMI < 35, n = 27) and Morbidly Obese (OB‐M; BMI ≥ 35, n = 14). Minimal model analysis provided SG and its components at zero (GEZI) and at basal (BIE) insulin. Results: Values for SG were 1.98 ± 1.30 × 10−2·min−1 in all subjects grouped and 2.38 ± 1.23, 1.84 ± 0.82, 1.59 ± 0.61 10−2·min−1 in LE, OW and OB, respectively. In all subjects grouped, a significant inverse linear correlation was found between the log‐transformed values of SG and BMI (r = −0.3, P < 0.0001). SG was significantly reduced in OW and OB with respect to LE (P < 0.001) but no significant difference was detected between OB and OW (P = 0.35) and between OB‐I and OB‐M (P = 0.25). Similar results were found for GEZI. BIE was not significantly different among NW, OW and OB (P = 0.11) and between OB‐I and OB‐M (P ≥ 0.07). Conclusions: SG and its major component GEZI deteriorate in overweight individuals compared to those in the normal BMI range, without further deterioration when BMI increases above 30 kg m−2. [ABSTRACT FROM AUTHOR]