MISSION STATEMENT o Dr Michael Merhige is a solo physician, General Cardiology practice, that provides heart disease patients with individualized, state of the art diagnosis, and aggressive medical management of the entire spectrum of cardiac disease. HDL indicates high-density lipoprotein. A total of 60 NIDCM patients (mean age 61 ± 12 years, mean left ventricular ejection fraction 37 ± 10%, mean QRS duration 110 ± 19 ms) were enrolled. Overall, it is conceivable that all 3 of the pathophysiological mechanisms contribute to the increased risk of CHF in individuals with longer QRS duration. However, the reproducibility of this measurement has not been studied thoroughly. Download figureDownload PowerPointFigure 2. Cardiovascular health was defined according to the AHA’s ideal CVH metrics (13). All of the covariates, including the QRS duration category, were modeled as time-dependent variables; values were updated every 2 years based on observations obtained at routine Heart Study examinations. In our large, community-based sample of middle-aged and elderly individuals free of prior CHF and MI, longer electrocardiographic QRS duration was associated with elevated risk of CHF. There are several mechanisms that may explain the observed association of longer QRS duration with CHF risk. Reliability and Reproducibility of QRS Duration. For this purpose, we used time-dependent analyses in which individuals with QRS <100 ms were categorized at each biennial examination into 2 groups: QRS ≤80 ms (referent) and QRS >80 ms. We also investigated whether CHF incidence varied according to the type of baseline BBB in Cox models (adjusting for baseline clinical covariates and MI on follow-up) that compared individuals with left, right, and indeterminate BBB (as defined above) with the referent group (QRS interval <100 ms). By continuing to browse this site you are agreeing to our use of cookies. The National Heart, Lung, and Blood Institute reviews all articles submitted for publication but it was not involved in the decision to publish. The duration of the course is two to three years long. Informed consent was obtained from all of the participants, and the study was approved by the Institutional Review Board at the Boston Medical Center. Criteria were attributed to CHF only in the absence of an alternative explanation for the symptoms and signs by other medical conditions (eg, cirrhosis, renal failure, or chronic pulmonary disease). This site uses cookies. ECG recordings were obtained on attendees over 2 consecutive cycles (from the middle of examination 16 to the initial part of examination 17). Examination of regression splines demonstrated an increase in CHF hazard with increasing baseline QRS duration that became steeper for QRS values ≥100 ms (Figure 2). Introduction. On stratification of our sample into 2 age groups (<70 versus ≥70 years), the association of QRS duration with CHF incidence remained statistically significant for individuals aged ≥70 years (HR per SD increment in log QRS, 1.26; 95% CI, 1.07 to 1.48; P=0.005) but was attenuated in those <70 years (HR per SD increment in log QRS, 1.13; 95% CI, 0.96 to 1.34; P=0.13). In these analyses, the association of complete BBB with greater CHF risk remained robust, but the relations of incomplete BBB to CHF risk were attenuated. Indian nationals can apply under the General category. A majority of CHF events occurred in individuals with a normal baseline QRS duration. Approximately one fourth of congestive heart failure (CHF) patients have a prolonged QRS interval (≥120 ms) on the surface ECG.1 On a parallel note, men with a complete bundle branch block (BBB) experience a higher incidence of CHF prospectively.2 In addition, prolonged electrocardiographic QRS interval is associated with increased echocardiographic left ventricular (LV) mass cross-sectionally in individuals without prior history of CHF or myocardial infarction (MI).3 These observations raise the possibility that prolongation of the QRS duration may be a marker of adverse ventricular remodeling. Attendees also underwent transthoracic 2D guided M-mode echocardiography at examination cycle 16. Doctor of Medicine in Cardiology is 3 years of course with a full-time postgraduate course. It is important to emphasize the limited generalizability of our results to other ethnicities given the overwhelmingly white Framingham sample. The presence of cardiovascular risk factors in patients with multiple sclerosis (MS) is associated with a greater degree of brain atrophy even in young patients who are unlikely to have small vessel disease, a new study has shown.. CHF event rates were calculated per 1000 person-years for each QRS category and also by type of BBB. †There were 1091 individuals with available data on echocardiographic FS; 21 with FS <0.29 were excluded. Candidates need to have completed MBBS or an equivalent qualification recognized by the Dental Council of India. Incomplete and complete BBB were associated with a 1.5- and 2-fold risk of CHF, respectively. Additional prospective studies of larger multiethnic samples size are warranted to confirm our findings and to elucidate the mechanisms underlying the observed association. When the QRS duration is >120 ms, there is delayed depolarisation of the lateral left ventricular (LV) wall causing dys-synchronous contraction. In contrast to QRS categories, we did not update continuous QRS duration values every 2 years, because the follow-up examinations did not use the same IBM program for QRS measurements; as noted previously, measurements at subsequent examinations were made to the nearest 10 ms, whereas measurements at the baseline examinations were made to the nearest 2 ms. To gain insights into potential nonlinearity of associations between QRS duration and CHF risk, we examined generalized additive Cox models using penalized splines.23 The spline analysis permits the dose-response relation between QRS duration and CHF risk to be examined more accurately than by standard analyses using QRS categories, which may not adequately describe the trends in the data and do not make efficient use of within-category information.24. However, 2 recent meta-analyses by Sipahi et al6 The American Heart Association is qualified 501(c)(3) tax-exempt in Cardiothoracic Surgery is a 2- year long postgraduate course in medicine involving the surgical treatment of diseases affecting organs inside the thorax (the chest), and generally treatment of conditions of the heart (heart disease) and lungs (lung disease). Model 2: subgroup with available baseline echocardiogram and FS ≥0.29 (n=1070), Model 3: Subgroup with FS ≥0.29: additional adjustment for LV mass (n=1070), Model 4: subgroup with FS ≥0.29: additional adjustment for LV mass and FS (n=1070). Listed here are the minimum criteria of eligibility needed to be fulfilled for admission to the course. Local Info First, we observed a significant association of longer QRS duration with rising CHF risk. The curve with small dashes represents individuals with a normal QRS duration, that with large dashes indicates people with incomplete BBB, and the intact line corresponds to participants with complete BBB. Even if QRS duration were simply a marker (and a not a cause) of CHF risk, the ease of measurement and routine availability would render it a potentially useful indicator of risk. Aspiring candidates are expected to have demonstrated competence in all aspects of the discipline. In exploratory analyses, we evaluated 82 participants (25% of CHF cases) who underwent echocardiographic evaluation within 30 days of their first hospitalization for CHF (using estimates of LVEF from hospitalization records). Vertical lines represent upper and lower limits of QRS duration for incomplete BBB (100 to 119 ms). MD Cardiology Scope of Course. We hypothesized that CHF risk increases with longer QRS interval in individuals free of CHF. M.S. Second, baseline incomplete and complete BBB accounted for a modest proportion (30%) of CHF events on follow-up. Unauthorized In multivariable analyses, LBBB and indeterminate BBB were associated with a higher incidence of CHF (adjusted HR, 4.45; 95% CI, 2.33 to 8.51 for LBBB; P=0.0001; adjusted HR, 2.18; 95% CI, 1.13 to 4.20 for indeterminate BBB; P=0.02), whereas individuals with RBBB did not have a statistically significant increased risk of CHF (adjusted HR, 1.73; 95% CI, 0.93 to 3.21; P=0.08) when compared with those with a QRS duration <100 ms. We also tested for a trend for increasing CHF across the 3 QRS categories. A few recognized entrance examinations held in India for admission to the course are: Successful postgraduates of the course interested in higher studies in the discipline may go for pursuing Ph.D. in M.S., or pursue fellowship in a topic of choice thereupon, such as Pediatric Cardiac Surgery, Cardiac Transplantation, And Adult Acquired Heart Disease. Cumulative Incidence of CHF for Study Participants According to the Category of QRS Duration at Baseline. Outcome: cardiovascular health score. It is noteworthy, though, that QRS duration satisfies several of Hill’s criteria29 for causality of associations, including prolongation of QRS duration antedated CHF (temporal relations), observed dose-response relation, consistent findings in multiple models, and a biologically plausible causal association is (as detailed in the section above). Kaplan-Meier curves for survival free of CHF according to the categories of QRS duration at baseline. Sleep duration was categorized as <6 hours, 6 to <7 hours, 7 to <8 hours, 8 to <9 hours, and ≥9 hours. A 2-sided P value <0.05 was considered statistically significant. The prevalence of hypertension rose across the QRS duration categories. Course duration of MS in Cardiology? The design and selection criteria of Framingham Heart Study have been described previously.13 Individuals from the original cohort who attended the 16th (1979–1981) or the 17th (1982–1984) biennial examination cycles and had computerized ECG recordings available at these examinations were eligible (n=2081). The presence of cardiovascular risk factors in patients with multiple sclerosis (MS) is associated with a greater degree of brain atrophy even in young patients who are unlikely to have small vessel disease, a new study has shown.. Whereas primary analyses focused on the entire range of QRS values, we performed supplementary analyses to investigate whether a gradient of increasing CHF risk was present for QRS duration within the normal range (<100 ms). In a regular 3-year MD cardiology course, the medical program considers combined research with lab activities and clinical encounters wherein students work straightforwardly with patients in real healthcare settings. First, it is possible that the association of electrocardiographic QRS with CHF is confounded by the greater burden of risk factors, such as hypertension,8 diabetes2 or ischemic heart disease,27 in individuals with BBB. In cardiology, similar course is DM. Although Cardiothoracic is a specialized area in medical science, several sub-specialties have developed within it too, such as Nuclear Cardiothoracic Surgery which focuses on the pumping functions of the heart, or Electrophysiology, which specializes in the electrical function of the heart, or Interventional Cardiothoracic Surgery which includes invasive procedures such as stent insertion and angioplasty, or Pediatric Cardiothoracic Surgery which involves treatment of abnormalities and diseases of the heart in children who are still in- utero up to adulthood. Because the baseline examination anteceded use of 2D and Doppler echocardiography, we could not explore this possibility. 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