Search Results (22)

Background: Non-invasive biomarkers may facilitate early risk stratification in patients with coronary artery disease (CAD). Although the uric acid-to-HDL cholesterol ratio (UHR) has been identified as a novel marker associated with coronary atherosclerosis, the relationship between the uric acid-to-magnesium ratio (UA/Mg ratio) and the angiographic burden of coronary artery disease has not been sufficiently investigated. This study evaluated the association between the UA/Mg ratio and angiographic coronary artery disease burden in patients undergoing elective coronary angiography and compared its discriminative performance with that of the UHR and the frontal QRS-T angle. Methods: In this retrospective cross-sectional study, patients who underwent elective coronary angiography between 2022 and 2025 were evaluated. Patients with atrial fibrillation, left ventricular ejection fraction <50%, eGFR < 50 mL/min/1.73 m², severe valvular disease, uric acid-lowering therapy, or acute coronary syndrome were excluded. A total of 351 patients were included in the study and divided into three groups—low (n = 117), intermediate (n = 117), and high (n = 117)—based on their Gensini scores. Independent associations were evaluated using multivariable ordinal logistic regression analysis. Receiver operating characteristic (ROC) analysis was performed to evaluate discrimination of the high Gensini tertile. Results: The UA/Mg ratio was strongly correlated with the Gensini score (ρ = 0.699, p < 0.001), showing a correlation comparable to that of the UHR (ρ = 0.717, p < 0.001) and stronger than that of the frontal QRS-T angle (ρ = 0.546, p < 0.001). In the multivariable ordinal logistic regression analysis, the UA/Mg ratio remained independently associated with higher Gensini tertiles (OR = 2.34, 95% CI: 1.23–4.45; p = 0.009). In the ROC analysis, the UA/Mg ratio demonstrated excellent discriminative performance for identifying the high Gensini tertile (AUC = 0.907, 95% CI: 0.877–0.938). The AUC of the UA/Mg ratio was comparable to that of the UHR (DeLong p = 0.978), whereas it was significantly higher than that of the frontal QRS-T angle (DeLong p < 0.001). Conclusions: The uric acid-to-magnesium ratio was strongly and independently associated with the burden of angiographic coronary artery disease in patients undergoing elective coronary angiography. The UA/Mg ratio demonstrated discriminative performance comparable to that of the UHR and superior to the frontal QRS-T angle. These findings suggest that the UA/Mg ratio may serve as a complementary biomarker for assessing angiographic coronary artery disease burden. Further prospective studies are warranted to validate its clinical utility. Full article

Background/Objectives: Metabolic syndrome (MS) has been demonstrated to be associated with subclinical myocardial dysfunction, which develops in the early stages. It has been hypothesised that traditional echocardiographic parameters may be insufficient in detecting these changes. The frontal QRS-T angle is an electrocardiographic parameter that is easily obtained and that reflects ventricular electrical heterogeneity. This study aimed to examine the relationship between the frontal QRS–T angle and left ventricular myocardial deformation, as assessed by four-dimensional strain echocardiography (4DSE), in patients with MS. Methods: The present cross-sectional study comprised 70 patients diagnosed with MS and 61 healthy individuals matched for age and gender. All participants underwent standard transthoracic and 4DSE examination and 12-lead electrocardiography. The values of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and global area strain (GAS) were analysed. The frontal QRS-T angle was calculated as the absolute difference between the QRS and T axes. The interrelationships between the variables were assessed using correlation and multivariate linear regression analyses. Results: Despite comparable left ventricular ejection fraction (LVEF) between the groups, 4DSE-derived myocardial deformation parameters, including GLS, GCS, GAS, and GRS, were significantly impaired in the MS group. The frontal QRS-T angle was found to be significantly higher in patients diagnosed with MS in comparison to the control group (p < 0.001). A significant correlation was identified between the frontal QRS-T angle and GLS (r = 0.498, p < 0.001). In multivariable linear regression analysis, the frontal QRS–T angle was independently associated with GLS (standardized β = 0.501, p < 0.001). In exploratory receiver operating characteristic (ROC) analysis, the frontal QRS–T angle showed moderate discriminatory ability for GLS-defined impaired myocardial deformation area under the curve (AUC) = 0.720). Conclusions: An increased frontal QRS–T angle in individuals with metabolic syndrome was independently associated with subclinical LV dysfunction despite preserved ejection fraction (EF). These findings suggest that the frontal QRS–T angle may serve as a simple and readily available electrocardiographic marker associated with impaired myocardial deformation, warranting further validation in larger prospective studies. Full article

Introduction: Prolongation of the QT interval and QRS duration, which are markers of ventricular repolarization and depolarization, has been reported in patients receiving flecainide therapy. However, the effects of flecainide on the QRS–T angle—a recognized indicator of transmural dispersion of repolarization—remain unclear. The aim of our study was to investigate the impact of flecainide therapy on the QRS–T angle. Method: In this study, 200 patients who were prescribed flecainide therapy due to atrial or ventricular arrhythmias were included. Prior to the initiation of flecainide treatment, all patients underwent a 12-lead electrocardiogram (ECG) in which heart rate (HR), PR and QRS durations, QT, QTc, JT, Tp–Te intervals and the frontal plane QRS–T angle were measured. At the 1-month follow-up, patients underwent repeat ECG recording and were evaluated for both cardiac and non-cardiac side effects of flecainide. The same ECG parameters were measured again using the follow-up recordings. Changes in ECG parameters between the baseline and 1-month post-treatment were analyzed. Results: Following flecainide administration, the drug was discontinued in 18 patients (9%) due to adverse effects (11 cases of cardiac and seven cases of non-cardiac). HR significantly decreased (78 ± 22 bpm to 74 ± 15 bpm and p < 0.05). PR interval and QRS duration significantly increased (148 ± 23 ms to 156 ± 9 ms and 89 ± 17 ms to 99 ± 19 ms, respectively p < 0.05 for each). Additionally, JT interval (326 ± 27 ms vs. 334 ± 6 ms), QT interval (416 ± 24 ms vs. 434 ± 24 ms), QTc interval (431 ± 24 vs. 447 ± 25 ms) and Tp–Te interval (84 ± 17 vs. 87 ± 18 ms) all showed statistically significant increases after flecainide treatment (p < 0.05 for-each). However, no significant change was observed in the frontal QRS–T angle. Discussion: In patients receiving flecainide therapy for atrial and ventricular arrhythmias, prolongation was observed in atrioventricular conduction, ventricular depolarization and repolarization parameters as measured by ECG. However, no significant change was detected in the frontal QRS–T angle. Full article

Background: Left ventricular systolic dysfunction (LVSD) is a major determinant of prognosis in patients with ischemic heart disease. Electrocardiography (ECG) is widely available, inexpensive, and may aid in identifying patients at risk. We hypothesized that a composite score derived from multiple established ECG markers could improve the detection of LVSD in patients with stable angina. Methods: In this single-center, cross-sectional study, 177 patients undergoing elective coronary angiography for stable angina were included. Patients were classified as LVSD-negative (n = 123) or LVSD-positive (n = 54) based on echocardiographic ejection fraction. ECG parameters, including fragmented QRS, pathologic Q waves, R-wave peak time, QRS duration, and frontal QRS–T angle, were assessed. Independent predictors of LVSD were identified using multivariate logistic regression. A composite ECG score was constructed by assigning one point to each abnormal parameter. Model robustness was evaluated using bootstrap resampling (1000 iterations) and 10-fold cross-validation. Results: Multivariable analysis identified prior stent implantation, fragmented QRS, pathological Q waves, R-wave peak time, frontal QRS–T angle (log-transformed), and QRS duration as independent predictors of LVSD. ROC analysis demonstrated good discriminatory performance for R-wave peak time (AUC 0.804), QRS duration (AUC 0.649), and frontal QRS–T angle (AUC 0.825) measurements. The composite ECG score showed a stepwise association with LVSD: a score of ≥2 yielded high sensitivity (88%) and negative predictive value (97%), whereas a score of ≥3 provided high specificity (100%) and positive predictive value (100%). Bootstrap resampling and cross-validation confirmed model stability and strong discriminatory performance (mean AUC, 0.964; accuracy, 0.91). Conclusions: A simple composite ECG score integrating multiple established ECG markers is associated with the robust detection of LVSD in patients with stable angina. Although not a substitute for echocardiography, this score may support early risk stratification and help identify patients who warrant further imaging evaluations. External validation in larger and more diverse populations is required before routine clinical implementation of this model. Full article

Background: Ischemic heart disease is the primary contributor to global mortality. The QRS-T angle at the anterior aspect of the heart serves as a significant biomarker of the heterogeneity in myocardial repolarization and the electrophysiological instability of the cardiac myocytes. A wide frontal QRS-T angle is associated with proximal vascular disease, coexistence of three-vessel disease, and increased mortality. Hereby, we aimed to examine the relationship between collateral circulation and frontal QRS-T angle in patients with chronic total occlusion (CTO). Methods: A cohort comprising 120 patients (17 females, 14.1%) who received a diagnosis of chronic total occlusion (CTO) subsequent to the administration of coronary angiography conducted for the evaluation of stable angina pectoris was incorporated into the investigation. The electrocardiographs of the patients were evaluated in detail, and the frontal QRS-T angle was calculated. The patients were categorized into two groups: subjects exhibiting an increased frontal QRS-T angle (>110° for men, >90° for women) and those presenting with a normative frontal QRS-T angle. Coronary angiographies of the patients were analyzed, and coronary collateral circulation was classified according to Rentrop classification. Results: Serum albumin level (OR = 0.711, 95% CI 0.564–0.896; p = 0.004) and poor collateral flow (OR = 17.7, 95% CI 12.2–85.3; p < 0.001) were significant predictors of raised frontal QRS-T angle. Conclusions: The frontal QRS-T angle is a novel parameter that is more reliable, consistent, and less sensitive to miscalculation and misidentification than other conventional electrocardiographic myocardial repolarization parameters. Revealing the bad collateral relationship with the frontal QRS-T angle may enable physicians to take more stringent precautions and change the risk factors related to the increased QRS-T angle in advance. Full article

Background/Objectives: Coronary artery disease (CAD) is a leading cause of global mortality, necessitating effective risk stratification tools for optimal patient management. The electrical risk score (ERS) is a multi-parametric index incorporating various electrocardiographic (ECG) parameters, previously shown to predict unfavorable cardiovascular outcomes. However, the relationship between ERS and the presence and severity of CAD remains unclear. This study aimed to investigate the association of ERS with the presence and extent of CAD as assessed by coronary angiography. Methods: This retrospective study included 314 consecutive patients who underwent coronary angiography. ERS was calculated using six ECG parameters: heart rate > 75 bpm, left ventricular hypertrophy, delayed QRS transition zone, frontal QRS-T angle > 90°, prolonged QTc interval, and extended T peak to T end interval. Results: Of the study population (mean age 57.8 ± 11.4, 61.5% male), 158 were diagnosed with CAD, and 156 constituted the control group. The mean ERS was significantly higher in the CAD group than the control group (2.34 ± 1.35 vs. 1.78 ± 1.12, p = 0.006). Among ERS components, delayed QRS transition (p = 0.023), prolonged QTc (p = 0.004), and extended T peak to T end interval (p = 0.001) were notably more prevalent in the CAD group. ERS was independently associated with the presence of CAD on multivariate logistic regression analysis (p < 0.05). Conclusions: ERS is significantly associated with the presence and severity of CAD in stable patients. Elevated ERS, particularly due to delayed QRS transition, prolonged QTc, and extended T peak to T end interval, may serve as a valuable, non-invasive marker for prediction and early identification of CAD. Full article

Background/Objectives: Pregnancy is associated with profound physiological alterations that, together with anemia and spinal anesthesia, may influence myocardial repolarization. The frontal QRS-T [f(QRS-T)] angle has emerged as a reliable electrocardiographic parameter for evaluating repolarization heterogeneity. Materials and Methods: This observational prospective study included 100 term pregnant women [18–45 years, American Society of Anaesthesiologists (ASA) II] undergoing elective cesarean delivery under spinal anesthesia at Sanliurfa Training and Research Hospital between May and August 2025. Participants were divided into two groups: anemic (Hb < 10.5 g/dL, n = 50) and non-anemic (Hb ≥ 10.5 g/dL, n = 50). Standard monitoring and 12-lead ECGs were performed preoperatively and postoperatively. The f(QRS-T) angle was calculated as the absolute difference between QRS and T axes; values > 180° were adjusted by subtracting from 360°. Results: Demographic variables were comparable between groups. No significant differences were observed in mean arterial pressure or heart rate. Preoperative QTc and f(QRS-T) angle values did not differ significantly. However, postoperative QTc was prolonged in the anemic group compared with non-anemic women (426.3 ± 19.2 ms vs. 417.2 ± 20.7 ms, p = 0.026). Likewise, the postoperative f(QRS-T) angle was significantly higher in anemic patients (29.5 [16.0–45.3] vs. 20.5 [9.8–34.5], p = 0.017). Within-group analysis revealed significant postoperative increases in both QTc (p < 0.001) and f(QRS-T) angle (p < 0.001) in the anemic group, but not in controls. Hemoglobin levels correlated negatively with postoperative QTc (r = −0.267, p = 0.008) and f(QRS-T) angle (r = −0.264, p = 0.008). Conclusions: In anemic patients undergoing cesarean delivery under spinal anesthesia, the postoperative QTc interval and f(QRS-T) angle increased significantly compared with both baseline values and non-anemic counterparts. Assessment of the f(QRS-T) angle, a simple and inexpensive ECG-derived parameter, may aid in perioperative risk stratification and enhance patient safety. Full article

Background and Objectives: Obstructive sleep apnea syndrome (OSAS) and heart failure (HF) frequently coexist, amplifying cardiovascular risk through mechanisms involving chronic inflammation and autonomic dysfunction. This study investigates the impact of systemic inflammation, measured by the systemic immune-inflammation index (SII), and OSAS severity, assessed by the apnea–hypopnea index (AHI), on myocardial repolarization heterogeneity in patients with both conditions. Materials and Methods: In this retrospective study, 160 patients with HF and polysomnography-confirmed OSAS (AHI ≥ 5 events/h) were evaluated between January 2018 and November 2024. Patients were stratified by QT dispersion (QTd < 40 ms vs. ≥40 ms) to assess electrical heterogeneity. SII was calculated from neutrophil, platelet, and lymphocyte counts, and electrocardiographic markers (QTd, frontal QRS-T angle, T wave peak-to-end interval [TPEI]) were measured. Logistic regression and receiver operating characteristic (ROC) analyses were used to identify predictors of repolarization heterogeneity and ventricular arrhythmias. Results: Patients with QTd ≥ 40 ms (n = 78) exhibited higher SII (p < 0.001) and AHI (p < 0.001) compared to those with QTd < 40 ms (n = 82). SII and AHI independently predicted increased QTd in multivariate analysis (p = 0.01 and p < 0.001, respectively). ROC analysis identified SII ≥ 625.4 (sensitivity 73.1%, specificity 72%) and AHI ≥ 22.4 (sensitivity 79.5%, specificity 79.3%) as optimal cut-offs for predicting repolarization heterogeneity. SII, QTd, and TPEI were significantly associated with ventricular arrhythmias (p < 0.05). Patients with moderate-to-severe OSAS (AHI ≥ 15) had higher rates of ventricular tachyarrhythmias (17.8% vs. 5.7%, p = 0.03) and sudden cardiac death (9.3% vs. 1.9%, p = 0.05). Conclusions: Elevated SII and AHI are independent predictors of myocardial repolarization heterogeneity in patients with HF and OSAS, contributing to increased arrhythmic risk. These findings highlight the potential use of SII and AHI as accessible biomarkers for risk stratification, particularly in patients with a preserved ejection fraction, and underscore the need for targeted interventions to mitigate inflammation and OSAS severity. Full article

Background: Despite the survival benefit of ICDs in patients with HFrEF, most recipients do not receive appropriate therapy during follow-up. Existing risk models based on echocardiographic and clinical parameters show limited predictive accuracy for arrhythmic events. This study aimed to assess whether ECG-derived markers outperform conventional measures in predicting appropriate ICD shocks. Methods: This retrospective observational study included 375 patients with HFrEF who underwent ICD implantation for primary prevention at least six months before study enrollment. Twelve-lead surface ECGs were analyzed for a QTc interval, Tp-e/QT ratio, frontal QRS-T angle, and maximum deflection index (MDI). Clinical, echocardiographic, and arrhythmic event data obtained from device interrogations were evaluated. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were performed to identify independent predictors of appropriate ICD shocks. Results: Patients who experienced appropriate ICD shocks had significantly higher rates of a complete bundle branch block, digoxin use, QRS duration, QTc, Tp-e/QT ratio, frontal QRS-T angle, MDI, and right-ventricular pacing ratio. Conversely, beta-blocker use was significantly lower in this group. In multivariate analysis, independent predictors of appropriate shocks included the patient’s digoxin use (OR = 2.931, p = 0.003), beta-blocker use (OR = 0.275, p = 0.002), frontal QRS-T angle (OR = 1.009, p < 0.001), QTc interval (OR = 1.020, p < 0.001), and Tp-e/QT ratio (OR = 4.882, p = 0.050). The frontal QRS-T angle had a cutoff value of 105.5° for predicting appropriate ICD shocks (sensitivity: 73.6%, specificity: 85.2%, AUC = 0.758, p < 0.001). Conclusions: Electrocardiographic markers, particularly the frontal QRS-T angle, QTc interval, and Tp-e/QT ratio, demonstrated superior predictive power for appropriate ICD shocks compared to conventional echocardiographic and clinical measures. These easily obtainable, non-invasive ECG parameters may improve current risk stratification models and support more individualized ICD implantation strategies. Full article

Background/Objectives: Obesity is a major cause of repolarisation defects of the heart. The frontal QRS-T angle is a new parameter used for cardiac evaluation. This study aimed to evaluate the effects of a laparoscopic cholecystectomy and anaesthetic agents on the frontal QRS-T angle in individuals with obesity. Methods: A total of 91 patients who underwent a laparoscopic cholecystectomy surgery were included in this study. The patients were divided into two groups according to body mass index (BMI) < 30 (n = 68) and ≥30 (n = 23). The frontal QRS-T angle (FQRST), QT interval (QT), corrected QT, and other electrocardiography (ECG) findings were recorded at different time points. Results: In the BMI ≥ 30 group, the frontal QRS-T angle and QT interval measured during the intraoperative period were statistically higher than those of the BMI < 30 group (p < 0.001, p < 0.001). Additionally, the frontal QRS-T angle value was statistically higher in all patients postoperatively compared with the preoperative and intraoperative periods (p < 0.001). Furthermore, there was a positive correlation between the BMI and the frontal QRS-T angle. Our study found that the QRS-T angle and the QT interval duration measured during surgery in the BMI ≥ 30 group who underwent a laparoscopic cholecystectomy were significantly higher than in the BMI < 30 group. Conclusions: We recommend close haemodynamic monitoring during and after surgery for patients with obesity undergoing a laparoscopic cholecystectomy. Full article

Aim: The frontal QRS-T (fQRS-T) angle serves as an electrocardiography indicator that visually represents the disparity between the frontal QRS axis and the T axis. The heterogeneity between cardiac depolarization and repolarization rises with an increase in the fQRS-T angle. Prior research has demonstrated a relationship between the fQRS-T angle and the extent of atherosclerosis, along with the risk of cardiovascular mortality. The non-alcoholic fatty liver disease fibrosis score (NFS) is a non-invasive scoring tool used to quantify the degree of liver fibrosis in individuals with non-alcoholic fatty liver disease (NAFLD). Non-alcoholic fatty liver disease increases the risk of atherosclerotic cardiovascular disease, which can be predicted using the NFS. The objective of this study is to examine the potential correlation between the fQRS-T angle and NFS in patients with stable angina pectoris. Materials and Methods: This cross-sectional study included 177 (48 women) non-alcoholic patients who underwent coronary angiography due to stable angina pectoris. Individual NFS values were calculated using clinical and laboratory data. Patients were categorized into two groups based on a NFS threshold value of 0.67. Following a minimum fasting period of 12 h, biochemical laboratory parameters were acquired using a peripheral venous sample, and electrocardiographic data were recorded. Results: The univariate logistic regression analysis revealed significant associations between hypertension (p = 0.018), coronary artery disease (p = 0.014), neutrophil (p = 0.024), hemoglobin (p = 0.038), and low-density lipoprotein (LDL, p = 0.007) with the NFS. The electrocardiographic variables related to the score included the QRS duration (p = 0.015), Pmax (p = 0.026), QTC interval (p = 0.02), and fQRS-T angle (p < 0.001). In the multivariate logistic regression analysis, NFS was independently associated with LDL (OR: 0.984, 95% CI: 0.970–0.998, p = 0.024) and fQRS-T angle (OR: 3.472, 95% CI: 1.886–6.395, p < 0.001). Conclusions: The FQRS-T angle may exhibit a distinct correlation with NAFLD. Extensive investigations should validate this link, since the fibrosis score can serve as an effective tool for monitoring patients prior to the onset of clinical symptoms associated with liver fibrosis. Full article

This study explores the potential of unsupervised machine learning algorithms to identify latent cardiac risk profiles by analyzing ECG-derived parameters from two general groups: clinically healthy individuals (Norm dataset, n = 14,863) and patients hospitalized with heart failure (patients’ dataset, n = 8220). Each dataset includes 153 ECG and heart rate variability (HRV) features, including both conventional and novel diagnostic parameters obtained using a Universal Scoring System. The study aims to apply unsupervised clustering algorithms to ECG data to detect latent risk profiles related to heart failure, based on distinctive ECG features. The focus is on identifying patterns that correlate with cardiac health risks, potentially aiding in early detection and personalized care. We applied a combination of Uniform Manifold Approximation and Projection (UMAP) for dimensionality reduction and Hierarchical Density-Based Spatial Clustering (HDBSCAN) for unsupervised clustering. Models trained on one dataset were applied to the other to explore structural differences and detect latent predispositions to cardiac disorders. Both Euclidean and Manhattan distance metrics were evaluated. Features such as the QRS angle in the frontal plane, Detrended Fluctuation Analysis (DFA), High-Frequency power (HF), and others were analyzed for their ability to distinguish different patient clusters. In the Norm dataset, Euclidean distance clustering identified two main clusters, with Cluster 0 indicating a lower risk of heart failure. Key discriminative features included the “ALPHA QRS ANGLE IN THE FRONTAL PLANE” and DFA. In the patients’ dataset, three clusters emerged, with Cluster 1 identified as potentially high-risk. Manhattan distance clustering provided additional insights, highlighting features like “ST DISLOCATION” and “T AMP NORMALIZED” as significant for distinguishing between clusters. The analysis revealed distinct clusters that correspond to varying levels of heart failure risk. In the Norm dataset, two main clusters were identified, with one associated with a lower risk profile. In the patients’ dataset, a three-cluster structure emerged, with one subgroup displaying markedly elevated risk indicators such as high-frequency power (HF) and altered QRS angle values. Cross-dataset clustering confirmed consistent feature shifts between groups. These findings demonstrate the feasibility of ECG-based unsupervised clustering for early risk stratification. The results offer a non-invasive tool for personalized cardiac monitoring and merit further clinical validation. These findings emphasize the potential for clustering techniques to contribute to early heart failure detection and personalized monitoring. Future research should aim to validate these results in other populations and integrate these methods into clinical decision-making frameworks. Full article

Background and Objectives: Major depressive disorder (MDD) is a prevalent psychiatric illness increasingly recognized as a systemic condition with implications for cardiovascular diseases. Growing evidence indicates that individuals with MDD have an elevated risk of cardiovascular mortality, underscoring the need for reliable, non-invasive biomarkers to assess cardiac risk. While underlying mechanisms remain unclear, electrocardiogram (ECG)-based markers offer a promising, non-invasive means of evaluation. Among these, the electrical risk score (ERS), a composite derived from specific ECG parameters, has emerged as a predictor of adverse cardiac outcomes. This study aimed to investigate the association between ERS and MDD, and whether ERS correlates with depression severity and illness duration. Materials and Methods: In this retrospective cross-sectional study, 12-lead ECGs were evaluated to calculate the ERS based on six ECG parameters: heart rate, corrected QT interval, Tp-e interval, frontal QRS-T angle, QRS transition zone, and presence of left ventricular hypertrophy according to Sokolow–Lyon criteria. The Hamilton Depression Rating Scale (HAM-D) was utilized. Results: The study included 102 patients with MDD and 62 healthy controls. No significant differences were observed in baseline or laboratory parameters between the groups. However, heart rate, Tp-e interval, frontal QRS-T angle, and ERS were significantly higher in the depression group. ROC analysis identified ERS as the strongest predictor of depression. ERS was significantly higher in patients with severe depression compared to those with mild symptoms and showed a positive correlation with both disease duration and HAM-D score. Conclusions: Here, we show that the ECG-derived ERS is significantly elevated in patients with MDD and is associated with increased cardiac risk. ERS outperformed conventional ECG parameters in identifying individuals with depression and demonstrated positive associations with both illness duration and symptom severity. These findings suggest that ERS may serve as a practical, non-invasive biomarker for assessing cardiovascular vulnerability in this population. Full article

Background and Objectives: Post-term pregnancies are associated with increased risks of perinatal complications. This study aimed to evaluate potential cardiac electrophysiological changes in pregnant women by comparing the QRS duration, interval of corrected QT (QTc), and frontal QRS-T angle [f(QRS-T)] between term and post-term pregnancies. Materials and Methods: In this observational prospective study, 120 pregnant women were enrolled—60 term (37–41 weeks) and 60 post-term (≥42 weeks). All participants underwent standard 12-lead electrocardiography (ECG) and caesarean section with spinal anaesthesia. The QTc interval, QRS duration, and frontal QRS-T angle were measured. Demographic parameters such as age, gestational week, height, and weight were recorded. The SPSS software was used to analyse the data with p < 0.05 as the threshold for significance. Results: Post-operative QTc interval (417.3 ± 20.5 vs. 410.2 ± 14.5, p = 0.032) and f(QRS-T) (28 [16–55] vs. 22 [14–34], p = 0.042) were significantly higher in the post-term group than in the term group. When the change in the f(QRS-T) angle was analysed, there was a significant widening of this angle in the post-term group (from 21 [11–37] to 28 [16–55], p = 0.002). The increased f(QRS-T) angle reflects greater heterogeneity in ventricular depolarisation and repolarisation, which may indicate sub-clinical myocardial stress or altered autonomic regulation in the post-term period. Although no overt arrhythmias were observed, subtle changes in P-wave morphology and QT dispersion were more prevalent in the post-term group. Conclusions: Prolonged QRS duration and an increased f(QRS-T) angle in post-term pregnancies can reflect the underlying changes in cardiac electrophysiology related to prolonged gestation. These ECG parameters may serve as non-invasive indicators of sub-clinical cardiac stress, which could be relevant for anaesthetic risk assessment and perinatal management. Full article

Background: The impact of Celiac Disease (CD) is not only limited to the intestinal system, but extraintestinal manifestations may also be seen. In this context, cardiac manifestations have recently been the focus of attention. This study aimed to evaluate myocardial repolarization properties in CD patients by assessing the frontal QRS-T Angle (fQRS-T) on electrocardiography (ECG). Methods: A total of 302 patients, including 150 CD patients and 152 control group patients, were included in the study. ECG parameters, including fQRS-T, QRS interval, and QTc interval, were calculated for each patient and compared between the groups. In addition, the relationship of these ECG parameters with disease duration was also analyzed. Results: The median disease duration was 38.5 (16 to 96) months in the CD group. Significantly wider QRS interval (92 (86 to 96) vs. 83 (76.3 to 93), p < 0.001) and fQRS-T (23 (13 to 37) vs. 18 (6.3 to 27), p < 0.001) values were observed in the CD group. Among CD patients, those with longer disease duration (>38.5 months) exhibited significantly wider QRS intervals (94 (88 to 98) vs. 88 (84 to 94), p < 0.001) and frontal QRS-T angles (29 (14 to 47) vs. 16 (10 to 25), p < 0.001) compared to those with shorter disease duration. A positive correlation between the disease duration and fQRS-T was also demonstrated (r = 0.478, p < 0.001). Multivariable logistic regression identified QRS interval (OR: 1.060, 95% CI: 1.032–1.088, p < 0.001) and frontal QRS-T angle (OR: 1.028, 95% CI: 1.013–1.043, p < 0.001) as independent predictors of CD. Additionally, the QRS interval (OR: 1.066, 95% CI: 1.012–1.124, p = 0.016) and frontal QRS-T angle (OR: 1.021, 95% CI: 1.003–1.038, p = 0.021) were significant predictors of longer disease duration. A linear regression analysis confirmed that disease duration was a stronger predictor of frontal QRS-T angle widening (B: 0.389, 95% CI: 0.102–0.677, p < 0.001) compared to age (B: 0.184, 95% CI: 0.123–0.245, p = 0.008). Conclusions: In this study, we demonstrated that chronic inflammation secondary to CD may have negative effects on cardiac repolarization and that this effect is closely related to disease duration. Full article