bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying the value of RVEF for the prediction of major cardiovascular outcomes: a study of 7,131 patients undergoing cardiovascular magnetic resonance imaging
Authors: Purmah Y , Lei L , Dykstra S , Labib D , Mikami Y , Satriano A , Feutcher P , Fine N , Gaztanaga J , Howarth A , Heydari B , Merchant N , Bristow M , Lydell C , White J
Published: November 2020

Background

Right ventricular (RV) function remains poorly recognized for its value in predicting cardiovascular events at a population level. Cardiovascular Magnetic Resonance (CMR) imaging is the gold standard for RV assessment.

Purpose

To define the independent prognostic value of RVEF for the prediction of major adverse cardiovascular events (MACE) as primary outcome in patients with known or suspected cardiovascular disease.

Methods

Data was obtained from the Cardiovascular Imaging Registry of Calgary (CIROC). Patients underwent standardized CMR imaging protocols and analysis. Clinical events were identified from administrative data.

Results

7,131 patients were included. 870 primary outcome events occurred over 2.5 years follow-up. RVEF provided equivalent predictive utility versus LVEF (Table 1). There was an increase in events with worsening severity of RVEF (Figure 1), with a significant “threshold-effect” at an RVEF of 40%.

Conclusions

RVEF is a strong and independent predictor of MACE at a population level.

Figure 1

Funding Acknowledgement

Type of funding source: None
Relationship between cardiac magnetic resonance derived extracellular volume fraction and myocardial strain in patients with non-ischemic dilated cardiomyopathy
Authors: Azuma M , Kato S , Kodama S , Hayakawa K , Kagimoto M , Iguchi K , Fukuoka M , Fukui K , Iwasawa T , Utsunomiya D , Kimura K , Tamura K
Published: November 2020

Background

The feature tracking (FT) technique has been proposed as a robust method to evaluate the myocardial strain using conventional cine magnetic resonance imaging (MRI) of the left ventricle. Data is limited regarding the relationship between FT-derived myocardial strain and diffuse myocardial fibrosis evaluated by T1 mapping in patients with non-ischemic dilated cardiomyopathy (NIDCM).

Purpose

The aim of this study was to evaluate the correlation between extracellular volume (ECV) by T1 mapping and myocardial strain by FT in patients with NIDCM.

Methods

A total of sixty-four patients with NIDCM (62±12 years) and 15 controls (62±11 years) were studied. Using a 1.5T MR scanner, pre- and post- T1 mapping images of LV wall at mid-ventricular level was acquired to calculate ECV by modified Look-Locker inversion recovery (MOLLI) sequence. Radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) was assessed by FT technique. ECV and myocardial strain were compared using a 6-segment model at mid-ventricular level.

Results

Compared to the controls, the NIDCM patients had a significantly higher ECV (0.30±0.02 vs. 0.24±0.01, p<0.001) and impaired myocardial strain (RS, 24.2±3.0 vs. 52.2±6.2, p<0.001; CS, −7.5±2.1 vs. −15.3±2.2, p<0.001; LS −10.4±3.5 vs. −20.2±4.7, p<0.001, respectively). Similar results were obtained when comparing all 6 myocardial segments (segment 7–12) (all p values <0.001). In a segment-based analysis, a significant positive correlation was found between the ECV and CS (r=0.26 to 0.41; all p values <0.05), a negative correlation was found between the ECV and RS (r=−0.31 to −0.41; all p values <0.05). In a patient-based analysis, there were significant positive correlations between the ECV and CS (r=0.45, p<0.001), ECV and LS from 2-chamber view (r=0.30, p=0.006), ECV and LS from 4-chamber view (r=0.37, p<0.001). There was a significant negative correlation between the ECV and RS (r=−0.43, p<0.001) (FIGURE)

Conclusions

In NIDCM patients, severity of myocardial fibrosis evaluated by T1 mapping is associated with impaired myocardial strain by FT technique.

Correlation between the ECV and strain

Funding Acknowledgement

Type of funding source: None
Comparison of cardiac MR feature tracking and myocardial MR tagging for assessment of regional ventricular function
Authors: Del Canto Serrano I , Tejero P , Lopez-Lereu M.P , Monmeneu J.V , Bodi V , Chorro F.J , Moratal D
Published: November 2020

Background

Quantification of regional myocardial function allows risk stratification in heart disease. CMR tagging (TAG) enables the evaluation of segmental cardiac deformation, but it has not reached clinical routine due to the long acquisition and post-processing times. Conversely, CMR feature-tracking (FT) is a post-processing method based on standard cine-MR imaging.

Purpose

To compare myocardial strain and torsion obtained with CMR-TAG and CMR-FT in healthy volunteers and myocardial infarction (MI).

Methods

42 subjects (18 healthy; 24 MI) underwent CMR (1.5T, cine/TAG sequences). Global and segmental (16-segment) circumferential strain (CS), and torsion were measured using FT (CVI42, Canada) and tagging (InTag, France). Inter-method agreement was assessed using 2-way-mixed intraclass correlation coefficient (ICC).

Results

The agreement for segmental and global CS measurements was good to excellent in both groups (Table). Torsion angle showed excellent (0.763) and good (0.697) agreement for healthy and MI.

Conclusion

CMR-FT strain and torsion measurements showed high agreement with CMR-tagging. Thus, CMR-FT provides a potential clinical alternative in the assessment of regional ventricular function.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute, Spanish Ministry of Economy and Competiveness; Agencia Valenciana de la Innovaciόn, Generalitat Valenciana
The role of right ventricular late gadolinium enhancement scoring by cardiac magnetic resonance imaging in cardiac sarcoidosis
Authors: Koyanagawa K , Naya M , Manabe O , Furuya S , Tsuneta S , Ohira H , Tsujino I , Oyama-Manabe N , Anzai T
Published: November 2020

Background

The right ventricular (RV) function is a significant predictor of the prognosis and exercises tolerance in patients with left ventricular dysfunction. The previous study reported that RV late gadolinium enhancements (LGE) as assessed by cardiac magnetic resonance (CMR) imaging were present in 16% of pulmonary sarcoidosis. Although RV LGE is associated with a poor prognosis, a semi-quantitative assessment of RV LGE was not been established so far. Moreover, the frequency of RV dysfunction (RVD) in cardiac sarcoidosis (CS) and predictors of RVD are unclear.

Purpose

Our aim of this study is to establish RV LGE semi-quantitative scores and to clarify the rate and predictors of RVD in CS.

Methods

Forty-four consecutive patients with CS who underwent CMR imaging (median age, 63 [IQR 54–71] years old; 10 males) were studied. They were diagnosed as definitive based on the Heart Rhythm Society expert consensus statement. Two patients were excluded due to no long axial view. Thus, a total of 42 patients were included in this study. RV LGE was semi-quantitatively evaluated using the original score developed by ours. RV was classified into RV outflow tract (OT), basal, middle and apex. RVOT and apex are assigned 1 segment for each, and basal and middle are assigned 4 segments include anterior, septal, inferior and lateral (Figure1). In total, 10 segments were evaluated. RV LGE scores were analysed independently by the two operators. The RV ejection fraction was assessed in a long axial view without an RVOT (20 phases, 12 slices). We divided the cohort into the non-RVD group (RVEF ≥45%) and the RVD group (RVEF <45%) and compared the RV scores between the two groups.

Results

The RVD was present in 31% of the entire cohort. The presence of RV LGE was significantly higher in the RVD group than the non-RVD group (83% vs. 43%, p=0.037). RV LGE score in the RVD group was significantly higher than that in the non-RVD group (2.83±1.95 vs. 0.83±1.21, p=0.001). The septal lesions in basal and middle levels accounted for 54% in all segments. RVEF showed a significant inverse correlation with RV LGE score (r=−0.57, p<0.0001). In the ROC curve for RVD, the RV LGE score of more than 2 and equal could discriminate RVD from non-RVD with AUC of 0.813 (Sensitivity = 0.77, Specificity = 0.76, p=0.003).

Conclusion

RVD was observed in 31% of patients with definitive CS. The septal lesions were the most frequent in the RV LGE site, which suggests that the longitudinal abnormal motion of RV is a significant predictor of the RVD in patients with CS. RV LGE score is a valuable method to assess RVD.

RV LGE score

Funding Acknowledgement

Type of funding source: None
Evaluation of ATTR-cardiac amyloidosis employing Tc-99m pyrophosphate scintigraphy using planar, SPECT and gated SPECT imaging on dedicated cardiac CZT camera
Authors: Tshori S , Livschitz S , Volodarsky I , Fabrikant J , George J
Published: November 2020

Background/Introduction

Recent recognition that ATTR cardiac amyloidosis (ATTR-CA) is not uncommon and the emergence of novel therapeutic opportunities resulted in the publication of “Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis”. However, almost all data were derived from general purpose NaI cameras, while new cardiac dedicated CZT cameras are becoming more widespread.

Purpose

To evaluate Tc-99m pyrophosphate (PYP) scintigraphy on D-SPECT cardio dedicated CZT camera (Spectrum Dynamics) in suspected ATTR-CA patients.

Methods

Seventy three consecutive patients suspected for ATTR-CA underwent planar (5 min), SPECT and gated SPECT (10 min, 8 bins) scintigraphy 89±26 min after injection of Tc99m-PYP 740 MBq, followed by late scintigraphy after 92±36 min in 65 consecutive patients. Perguini visual score, planar H/CL and SPECT derived H/CL ratio were evaluated by two blinded independent experienced readers. Diagnosis was based on visual interpretation after blood pool and monoclonal gammopathy were excluded.

Results

Very good to excellent planar and SPECT image quality was observed in almost all patients. PYP scintigraphy was positive in 6/73 patients, with left ventricular wall uptake clearly evident in the planar images of most patients. There was perfect agreement between readers regarding positive/negative interpretation. There was also substantial inter-observer agreement regarding the Perguini scoring (Cohen's k with linear weighting 0.819, 95% CI 0.701–0.937). Inter-observer agreement for H/CL ratio was also good (Pearson's correlation coefficient r(71)=0.873). SPECT and gated SPECT images were helpful only in one positive patient, and did not have an added value in any of the negative studies. Slightly better images were observed during late scintigraphy, but there was no change in interpretation, and H/CL ratio was not significantly changed (median difference −0.01, IQR 0.09). Alas, Inter-observer agreement of H/CL ratio was lower (Pearson's correlation coefficient r(64)=0.633). We also evaluated H/CL ratio derived from SPECT based application of the camera manufacturer. Agreement between early planar and early SPECT based H/CL ratio was good for both readers (r(69)=0.778 and r(66)=0.747), but inter-observer agreement was lower (r(66)=0.697).

Conclusions

ATTR PYP scintigraphy using cardiac dedicated CZT camera yielded excellent images in almost all patients, and uptake in the left ventricular wall could be easily identified in positive patients. Inter-observer agreement was excellent for both visual scoring and planar H/CL ratio. Early planar images were high quality, and limited additional diagnostic value was observed for both SPECT and gated SPECT scintigraphy and from later acquisition.

Funding Acknowledgement

Type of funding source: None
Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections: good for pocket, not so good for endocarditis
Authors: Jeronimo Baza A , Olmos C , Vilacosta I , Ortega-Candil A , Rodriguez-Rey C , Perez-Castejon M.J , Fernandez-Perez C , Perez-Garcia C.N , Garcia-Arribas D , Ferrera C , Carreras J.L
Published: November 2020

Introduction

The usefulness of 18F-FDG PET/CT in the diagnosis of infective endocarditis (IE) associated with cardiac implantable electronic devices (CIED) is not well established.

Purpose

To assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, placing special emphasis on differentiating between pocket infection (PI) and CIED-IE.

Methods

From 2013 to 2018, all patients (n=63) admitted to a tertiary care hospital with suspected CIED infection were prospectively recruited, undergoing a thorough diagnostic work-up that included blood cultures extraction, transthoracic (TTE) and transoesophageal echocardiography (TEE) and a PET/CT. When device explantation was required, material from the pocket, generator and leads were also cultured. The gold standard for the diagnosis of CIED-IE was a positive lead culture in the absence of PI when percutaneous extraction was performed or a positive culture from a surgically removed lead. In spite of negative lead cultures, the presence of typical TEE images of vegetations in a clinical context of positive blood cultures was also considered as CIED-IE.

Results

After the whole diagnostic process, 14 (22.2%) cases corresponded to isolated PI and 13 (20.6%) were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, values of sensitivity, specificity and global diagnostic accuracy of PET/CT for CIED-IE were 38.5%, 98.0% and 85.7%, respectively. Positive and negative likelihood ratio values, 19.2 and 0.6 respectively, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis in case of a negative result. In the case of PI, fair sensitivity (72.2%) and good specificity values (95.6%) were obtained. Extracardiac lead SUVmax and SUVratio in PI were good, with an area under the ROC curve (AUC) of 0.870 and 0.879, respectively. However, semiquantitative analysis was not useful for the diagnosis of CIED-IE.

Conclusions

In patients with suspected CIED infection, the yield of 18F-FDG PET/CT differs depending on the site of infection, showing a very high specificity but poor sensitivity in CIED-IE; so negative studies must be interpreted with caution if the suspicion of CIED-IE is high.

ROC curves SUVmax and SUV ratio for PI

Funding Acknowledgement

Type of funding source: None
Splenic switch off as a novel marker for adenosine response in 13N-ammonia PET myocardial perfusion imaging – a pilot study
Authors: Bakula A , Patriki D , Von Felten E , Benetos G , Sustar A , Benz D.C , Wiedemann-Buser M , Treyer V , Pazhenkottil A.P , Graeni C , Gebhard C , Kaufmann P.A , Buechel R.R , Fuchs T.A
Published: November 2020

Background

Positron emission tomography myocardial perfusion imaging (PET MPI) is a robust and excellent tool for assessing ischemia. So far, however, no methodology has been established to distinguish truly reduced MFR due to microvascular dysfunction or three-vessel coronary disease (CAD) from seemingly impaired MFR due to inadequate adenosine response. Conversely, for cardiac stress magnetic resonance (CMR) the adenosine induced splenic switch-off (SSO) sign has been proposed as a potential marker for adequate adenosine response.

Purpose

We assessed the feasibility of detecting SSO in adenosine stress 13N-ammonia PET MPI using SSO in CMR as the standard of reference.

Methods

50 patients underwent simultaneous PET MPI and CMR on a hybrid PET/MR device with co-injection of 13N-ammonia and a gadolinium-based contrast agent during rest and adenosine-induced stress. In CMR, SSO was assessed qualitatively and quantitatively by calculating the ratio of the peak signal intensity of the spleen during stress over rest (SIR). Similarly, in PET MPI the splenic signal activity ratio (SAR) was calculated as the proportion of the maximal standard uptake value of the spleen in stress and rest. Additionally, MFR was quantified in PET MPI.

Results

Visual SSO in CMR was present in 37 (74%) patients, whereas 13 patients had no SSO. The median SIR in CMR was significantly lower in patients with visual SSO compared to patients without visual SSO (0.57 [IQR 0.49–0.62] vs. 0.89 [IQR 0.76–0.98]; p<0.001). Similarly, median SAR in PET was significantly lower in patients with visual SSO in CMR compared to patients without visual SSO (0.4 [IQR 0.32–0.45] vs. 0.8 [IQR 0.47–0.98]; p<0.001). SIR correlated significantly with SAR (r=0.4, p<0.05). Mean MFR was significantly higher in patients with visual SSO compared to patients without visual SSO (3.38±0.86 vs. 2.53±0.84; p<0.05).

Conclusion

Similarly to CMR, SSO can be detected in 13N-ammonia PET MPI. This might help distinguish adenosine non-responders from patients with truly impaired MFR due to microvascular dysfunction or multivessel CAD.

Figure 1. Splenic switch off (*) illustrated on transaxial 13N-ammonia PET MPI stress (A) compared to rest perfusion images (B) and similarly in stress (C) and rest (D) short axis CMR (**) in the same patient during adenosine induced stress and co-injection of 13N-ammonia and a gadolinium based contrast agent, acquired on a hybrid PET/MR device.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation (SNSF)
Qualitative and semiquantitative [18F]FDG-PET/CT analysis in patients with IE: a strategy to enhance specificity?
Authors: Boni R
Published: November 2020

Aim

The 2015 ESC Guideline for the diagnosis and management of infectious endocarditis (IE) included molecular imaging procedures such as radiolabeled leukocytes and [18F]FDG-PET/CT as major criteria to establish the diagnosis of IE. Whereas in case of radiolabeled leukocytes the criteria for defining positive and negative scan are well established, in case of [18F]FDG-PET/CT a consensus of the criteria that define a positive scan is still lacking.

Materials and methods

In this work we prospectively evaluated a series of 90 patients (M:F=60:30, mean age 67±16 years, median age 72 years, range 18–88) that performed [18F]FDG-PET/CT for suspected IE between January 2016 and January 2019 in our center to define which pattern of uptake and semiquantitative parameters (SUVmax, SUVmean, valve/liver, valve/lung and valve/mediastinum uptake ratio) present the highest diagnostic accuracy for IE. PET/CT results were correlated with transthoracic (TTE) or transesophageal (TEE) echocardiography, blood culture, the Duke criteria. The new ESC criteria were also evaluated.

Results

Globally PET/CT presented sensitivity=96% and specificity=75%, NPV= 97% and PPV=68%. A focal pattern of uptake was found 17/30 patients with confirmed IE (mean SUVmax=5.29±1.8, median SUVmax=5.5) whereas whereas a diffuse pattern of uptake was found in 11 patients with confirmed IE (mean SUVmax=8.1±3.5, median SUVmax=7.6). No significant differences between the valve/liver ratio uptake and the valve/mediastinum uptake ratio were found between positive and negative patients with either focal or diffuse pattern of uptake. Interesting, in presence of diffuse valve uptake both SUVmax and the valve/lung uptake ratio were significantly higher in patients with a final diagnosis of IE, including the group of patients under antimicrobial treatment (>90%). PET/CT confirmed its ability to identify extracardiac sites of [18F]FDG uptake in presence of septic embolism (35%) and in patients with other diseases (vasculitis, vascular prosthesis infections, mediastinitis and cancer, particularly in patients with IE sustained by Streptococcus Gallolyticus).

Conclusions

Our results suggest pattern of [18F]FDG uptake more specific for valve infection is a focal uptake or a diffuse uptake with a SUVmax>5 and a valve/lung ratio >8.

Funding Acknowledgement

Type of funding source: None
Prognostic value of intracoronary imaging-derived measures for non-infarct related vessel revascularization throughout 7 years among patients with ST-elevation myocardial infarction
Authors: Ueki Y , Karagiannis A , Bar S , Yamaji K , Taniwaki M , Roffi M , Holmvang L , Maldonado R , Pedrazzini G , Kelbaek H , Radu M , Windecker S , Raber L
Published: November 2020

Background

Underlying plaque characteristics that lead to future revascularization during long-term follow-up remain poorly understood.

Purpose

We aimed to explore intracoronary imaging-derived measures as assessed by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) associated with non-infarct related vessel revascularization (non-TVR) arising from imaged segments during long-term (up to 7 years) follow-up among patients with ST-elevated myocardial infarction (STEMI).

Methods

A total of 94 STEMI patients enrolled into the IBIS-4 (Integrated Biomarker Imaging Study-4) study undergoing serial (baseline and 13 months) IVUS and OCT in 2 non-infarct-related coronary arteries under high-intensity statin therapy were analyzed in the present study. Patients were divided into 2 groups according to the occurrence of non-TVR within previously imaged vessel segments (non-TVR: n=14, no non-TVR: n=80).

Results

Baseline characteristics including LDL level were comparable between groups. At baseline, lesions with future non-TVR were associated with greater percent atheroma volume by IVUS (55.6±5.4% vs. 49.6±6.1%, P<0.001), minimum lumen area by OCT (3.4±1.7 mm2 vs. 6.0±3.3 mm2, P=0.004), and a higher prevalence of fibroatheroma (60.0% vs. 20.1%, P=0.007) by OCT compared with those without. Among patients with serial imaging, lesions with non-TVR had a trend towards a less reduction of percent atheroma volume (−0.2±3.8% vs. −2.4±4.2%, P=0.083).

Conclusion

Greater plaque burden, smaller lumen area, and higher prevalence of OCT-detected fibroatheroma at baseline were associated with non-infarct related vessel revascularization. Lesions with non-TVR tend to have less-pronounced regression of coronary atheroma despite intensive statin therapy and achieved LDL levels.

Non-TVR 7 years after index PCI

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation
Prediction of atrial fibrillation from normal ECG using artificial intelligence in patients with unexplained stroke
Authors: Baek Y.S , Lee S.C , Choi W.I , Kim D.H
Published: November 2020

Background

Stroke related to embolic and of undetermined source constitute 20 to 30% of ischemic strokes. Many of these strokes are related to atrial fibrillation (AF), which might be underdetected due to its paroxysmal and silent nature.

Purpose

The aim of our study was to predict AF during normal sinus rhythm in a standard 12-lead ECG to train an artificial intelligence to train deep neural network in patients with unexplained stroke (embolic stroke of undetermined source; ESUS).

Methods

We analyzed digital raw data of 12-lead ECGs using artificial intelligence (AI) recurrent neural network (RNN) to detect the electrocardiographic signature of atrial fibrillation present during normal sinus rhythm using standard 12-lead ECGs. We included 2,585 cases aged 18 years or older with multiple ECGs at our university hospital between 2005 and 2017 validated by crossover analysis of two electrophysiologists. We defined the first recorded AF ECG as the index ECG and the first day of the window of interest as 14 days before the date of the index ECG. We allocated ECGs to the training, internal validation, and testing datasets in a 7:1:2 ratio. We calculated recall, F1 score, and the area under the curve (AUC) of the receiver operatoring characteristic curve (ROC) for the internal validation dataset to select a probability threshold. We applied this developed AI program to 169 ESUS patients who has been diagnosed and had standard 12-lead ECGs in our hospital.

Results

We acquired 1,266 NSR ECSs from real normal subjects and 1,319 NSR ECGs form paroxysmal AF patients. RNN AI-enabled ECG identified atrial fibrillation with an AUC of 0.79, recall of 82%, specificity of 78%, F1 score of 75% and overall accuracy of 72.8% (Figure). ESUS patients were divided into three groups according to calculated probabilities of AF using AI guided RNN program: group 1 (35 patients with probability of 0–25% of paroxysmal AF), group 2 (86 patients with probability of 25–75% of paroxysmal AF) and group 3 (48 patients with probability of 75–100% of paroxysmal AF). In Kaplan-Meier estimates, Group 2 and 3 (more than 25% of PAF probabilities) tended to have higher AF incidence although it did not reach statistical significance (log-rank p 0.678) (Figure).

Conclusion

AI may discriminate subtle changes between real and paroxysmal NSR and can also be helpful in patients with ESUS to identify if AF is the underlying cause of the stroke. Further studies are needed in order to evaluate their possible use in future prognostic models.

Funding Acknowledgement

Type of funding source: None
Spectrum of Cardiac Arrhythmias in children with left ventricular non-compaction
Authors: Vasichkina E.S , Kovalchuk T.S , Pervunina T.M , Myravyev A , Fomicheva Y , Vershinina T.L , Kostareva A.A
Published: November 2020

Left ventricular non-compaction (LVNC) represents a genetically heterogeneous primary cardiomyopathy which occurs in both children and adults, can be isolated or combined with other congenital heart diseases and reveals substantial clinical polymorphism. Isolated LVNC is a rare phenomenon more commonly being a part other cardiovascular phenotypes such as hypertrophic cardiomyopathy, restrictive cardiomyopathy or congenital heart disorders. Clinical features on LVNC include main triade: heart failure, ventricular arrhythmias (VA) and thromboembolism.

Purpose

The aim of this study was to analyze the clinical characteristics of arrhythmias in children with LVNC.

Methods

We enrolled 15 patients diagnosed with LVNC. For all patients enrolled the clinical examination included ECG, echocardiography, Holter monitoring, family history and neurological examination. The echocardiographic diagnosis for LVNC was based on the criteria of Stollberger and Jenni. Several patients additionally received MRI. Target sequencing and WES were performed using a targeted panel of 108 cardiomyopathy-associated genes. All patients had a written parental consent form for including in this study.

Results

The mean age oat presentation was 7.46±4.4 year (from 0.5 to 14 year old).

4 patients had ventricular arrhythmias, which manifested as isolated premature ventricular contractions (PVCs) in two patients; ventricular tachycardia (VT) in two patients, 3 – supraventricular arrhythmias, 2 – WPW syndrome/phenomenon, 5 - atrioventricular block (1 and 2 degrees), atrial fibrillation – 1.

Antiarrhythmic therapy received 7 patients (3 with VA; 3 with SVA).

In total 21 variants of interest were identified in all 15 patients in 18 different genes. All four patients with variants in ion channel genes had documented supraventricular and ventricular arrhythmias. In 3 out of 5 patients with AV block variants in contractile sarcomeric and related genes were detected.

Four patients reached endpoints such as cardiovascular death (2 patients) and heart transplantation (2 patients).

Conclusions

Arrhythmic manifestations in children with left ventricular non-compaction can vary from conduction disease to SVT and ventricular arrhythmias and these arrhythmias have been associated with prognosis and outcome.

Funding Acknowledgement

Type of funding source: None
Mortality in patients with atrial fibrillation with or without heart failure following hospital discharge
Authors: Kartas A , Samaras A , Vasdeki D , Dividis G , Fotos G , Paschou E , Forozidou E , Tsoukra P , Kotsi E , Goulas I , Karagiannidis E , Karvounis H , Tzikas A , Giannakoulas G
Published: November 2020

Background

The association of heart failure (HF) with the prognosis of atrial fibrillation (AF) remains unclear.

OBJECTIVES

To assess all-cause mortality in patients following hospitalization with comorbid AF in relation to the presence of HF.

Methods

We performed a cross-sectional analysis of data from 977 patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018 and followed for a median of 2 years. The association between HF and the primary endpoint of death from any cause was assessed using multivariable Cox regression.

Results

HF was documented in 505 (51.7%) of AF cases at discharge, including HFrEF (17.9%), HFmrEF (16.5%) and HFpEF (25.2%). A primary endpoint event occurred in 212 patients (42%) in the AF-HF group and in 86 patients (18.2%) in the AF-no HF group (adjusted hazard ratio [aHR] 2.27; 95% confidence interval [CI], 1.65 to 3.13; P<0.001). HF was associated with a higher risk of the composite secondary endpoint of death from any cause, AF or HF-specific hospitalization (aHR 1.69; 95% CI 1.32 to 2.16 p<0.001). The associations of HF with the primary and secondary endpoints were significant and similar for AF-HFrEF, AF-HFmrEF, AF-HFpEF.

Conclusions

HF was present in half of the patients discharged from the hospital with comorbid AF. The presence of HF on top of AF was independently associated with a significantly higher risk of all-cause mortality than did absence of HF, irrespective of HF subtype.

Funding Acknowledgement

Type of funding source: None
The role of epicardial fat tissue in atrial fibrillation onset in patients with hypertension
Authors: Tarzimanova A , Podzolkov V.I , Pisarev M.V , Gataulin R.G , Oganesian K.A
Published: November 2020

Aim

To study the influence of epicardial fat tissue (EFT) on atrial fibrillation (AF) occurrence in hypertensive patients.

Materials and methods

The study included 195 patients with hypertension aged from 38 to 72 years (mean age was 61.5±1.8 years). All patients were divided into two groups: group I included 95 hypertensive patients with paroxysmal AF; 100 patients with hypertension in sinus rhythm were enrolled into group II. Echocardiography was performed to evaluate the thickness of EFT in a parasternal long-axis view. The EFT volume was assessed with computed tomography (CT) scan. The plasma concentration of tissue inhibitor of metalloproteinase-1 (TIMP-1) and metalloproteinase-9 (MMP-9) was measured to evaluate the myocardial fibrosis process.

Results

There was no significant difference between the studied groups of patients in body mass index: 34.43±1.2 kg/m2 in group I vs 31.97±1.67 kg/m2 in the group II. Waist circumference was significantly higher in group I in comparison with the group II patients: 118.9±3.3 cm vs 110.2±1.4 cm, respectively (p=0.038). EFT thickness was significantly higher in patients with paroxysmal AF (11.6±0.8 mm) in comparison with the patients in sinus rhythm (8.6±0.4 mm) (p<0.001). In group I patients a significant increase of EFT volume (4.6±0.4) in comparison with II group (3.5±0.25) (p=0.002) was noted. A significant positive correlation was revealed in hypertensive patients with paroxysmal AF between EFT volume and left atrial (LA) volume (r=0.7, p=0.022). Also, the plasma concentrations of TIMP-1 and MMP-1 were significantly higher in patients with paroxysmal AF and hypertension. There was a strong positive correlation between EFT volume and plasma concentration of TIMP-1 (r=0.72; p=0.01) and between the EFT volume and the LA volume (r=0.7, p=0.022) in group I patients. Multivariate regression analysis revealed the significant influence of increased EFT thickness more than 10 mm (prevalence ratio (PR) 4.1; 95% CI 1.1; 15.6) and EFT volume more than 6 ml (PR 3.7; 95% CI 1.0; 14.2) on AF occurrence.

Conclusion

Increased EFT thickness (more than 10 mm) and EFT volume (more than 6 ml) are predictors of AF onset in hypertensive patients.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): The complex subject of the Department
A novel diagnostic algorithm for the identification of different supraventircular tachycardias
Authors: Solis Cancino M , Pacheco Bouthillier A.D , Moreno Ruiz L.A
Published: November 2020

Background

Supraventricular arrhythmias represent a diagnostic challenge. Its prevalence and causes are not well established, given the impossibility to differentiate between all different types of supraventricular tachycardias (SVT). There are several supraventricular arrhythmias, but we focus on: 1) Atrial tachycardia (AT) 2) Junctional tachycardia (JT) 3) Atrial fibrillation (AF) 4) Atrial flutter (AA) 5) Atrioventricular nodal reentrant tachycardia (AVNRT), and 6) Atrioventricular reentrant tachycardia (AVRT). The electrocardiographic diagnosis is based on the presence of P-waves, its morphology and relationship with the QRS complex, and the relationship between the atrial and ventricular frequency.

Purpose

The purpose of this study was to create a helpful clinical tool that could serve the physician as a guide to determine a diagnosis and initial treatment. Additionally, we wanted to establish the sensitivity and specificity of the algorithm.

Methods

It is a diagnostic test study. We include 190 electrocardiograms of different SVT of patients undergoing electrophysiological studies. The data consists of 760 observations from two different readings of the electrocardiograms.

Results

104 of 112 AF, were correctly identified using the algorithm, with a sensitivity and specificity of 92.9% and 99.1%, respectively (95% CI: 0.86–0.96). 76 of 760 were AA, and 62 were correctly diagnosed, with a sensitivity and specificity of 81.6% and 95.5%, respectively (95% CI 0.71–0.88). 50 of the 72 AT were correctly classified, with a sensitivity of 69.4% and specificity of 97.4% (95% CI 0.58–0.78). 99 of 152 AVNRT were identified with a sensitivity and specificity of 64.5% and 87%, respectively (95% CI 0.84–0.89). 254 of 344 AVRT were diagnosed correctly with a sensitivity of 73.8% and specificity of 88.2% (95% CI 0.68–0.78). Finally, 1 of 4 JT were identified, with a sensitivity and specificity of 25% and 99.1% respectively (95% CI 0.04–0.69).

Conclusion

The algorithm is an excellent diagnostic tool to identify atrial flutter, atrial fibrillation and atrioventricular reentrant tachycardia.

SVT algorithm

Funding Acknowledgement

Type of funding source: None
Non Type-1 Brugada pattern, diagnostic yield of 5 ECG criteria in a young adult cohort
Authors: Carrington M , Creta A , Young W , Pais J , Rocha A.R , Santos A.R , Melo J , Henriques J , Teixeira R , Goncalves L , Lambiase P , Providencia R
Published: November 2020

Introduction

Distinguishing between non-Type 1 Brugada pattern (non-T1BrP) and an athlete's ECG remains challenging and may have important prognostic implications. We aimed to study prevalence and the diagnostic yield of experts and non-experts for the electrocardiographic non-T1BrP criteria in the young adults from the Sudden Cardiac Death-Screening Of risk factorS (SCD-SOS) cohort.

Methods

We performed a cross-sectional study in which we reviewed 14662 ECGs of SCD-SOS survey participants and selected 2494 that presented a rSr'-pattern in V1-V2. Among these, 98 were classified by experts in hereditary arrhythmic syndromes for the presence of non-T1BrP and by non-experts who performed manual measurements of the diagnostic criteria based on triangle formed by r'-wave. We estimated intra and interobserver concordance for each criterion, and used logistic regression and receiver operating characteristics (ROC) analysis and C-statistics for diagnostic accuracy and definition of the most appropriate cut-off values.

Results

We detected a rSr'-pattern in V1-V2 in 17% of the individuals and found that it was associated with higher PQ and QTc intervals, male gender and lower BMI. The manual measurements of non-T1BrP criteria were reproducible: we had high intraobserver concordance coefficients (CC) ranging from 0.90 to 0.94 (except for d(B) that had 0.66), but interobserver CC were lower (0.45–0.68). The measurements performed were highly correlated with non-T1BrP diagnosis and the criteria with higher discriminatory capacity were the distance d(B) (AUC 0.77; 95% CI0.69–0.84) and the degree of ST-ascent (AUC 0.79; 95% CI 0.72–0.86). The cut-offs defined by other authors had very low sensitivity (8–12%), despite high specificity (98%), so we defined new cut-offs: d(A) ≥2mm, d(B) ≥1.25mm, d(B)/h ≥0.38, β-angle ≥19° and ST-ascent ≥1mm. The addition of the degree of ST-ascent to a model with these 4 parameters presented an increase in C-statistics from 0.77 (95% CI: 0.68–0.86) to 0.83 (95% CI: 0.75–0.91) for the diagnosis of non-T1BrP by an expert in Sudden Arrhythmic Death and Channelopathies.

Conclusion

A rSr'-pattern in precordial leads V1-V2 is a frequent finding and the detection of non-T1BrP by using the aforementioned 5 measurements is reproducible and accurate. In this study, we describe new cut-off values that may help untrained clinicians to identify young individuals who should be referred for provocative drug testing for Brugada Syndrome.

Accuracy of non-T1 BrP criteria

Funding Acknowledgement

Type of funding source: None
Changes of QT interval in the acute phase after pulmonary vein isolation for paroxysmal atrial fibrillation
Authors: Chikata A , Kato T , Ududa K , Fujita S , Otowa K , Maruyama M , Tsuda T , Hayashi K , Takamura M
Published: November 2020

Introduction

Pulmonary vein isolation (PVI) affects ganglionated plexi (GP) around the atrium, leading to a modification of the intrinsic cardiac autonomic system (ANS). In animal models, GP ablation has a potential risk of QT prolongation and ventricular arrhythmias. However, the impact of PVI on QT intervals in humans remains unclear.

Purpose

This study aims to evaluate the Impact of PVI on QT interval in patients with paroxysmal atrial fibrillation.

Methods

We analyzed consecutive 117 PAF patients for their first PVI procedures. 12-lead ECG was evaluated at baseline, 4 hr, day 1, 1 month, and 3 months after ablation. Only patients with sinus rhythm on 12-lead ECG at each evaluation point without antiarrhythmic drugs were included.

Results

Heart rate significantly increased at 4 hr, day 1, and 1 month. Raw QT interval prolonged at 4 hr (417.1±41.6 ms, P<0.001) but shortened at day 1 (376.4±34.1 ms, P<0.001), 1 month (382.2±31.5 ms, P<0.001), and 3 months (385.1±32.8 ms, P<0.001) compared to baseline (391.6±31.4 ms). Bazett- and Fridericia- corrected QTc intervals significantly prolonged at 4hr (Bazett: 430.8±27.9 ms, P<0.001; Fridericia: 425.8±27.4 ms, P<0.001), day1 (Bazett: 434.8±22.3 ms, P<0.001; Fridericia: 414.1±23.7 ms, P<0.001), 1M (Bazett: 434.8±22.3 ms, P<0.001; Fridericia: 408.2±21.0 ms, P<0.05), and 3M (Bazett: 420.1±21.8 ms, P<0.001; Fridericia: 407.8±21.1 ms, P<0.05) compared to baseline (Bazett: 404.9±25.2 ms; Fridericia: 400.0±22.6 ms). On the other hand, Framingham- and Hodges- corrected QTc interval significantly prolonged only at 4hr (Framingham: 424.1±26.6 ms, P<0.001; Hodges: 426.8±28.4 ms, P<0.001) and at day1 (Framingham: 412.3±29.3 ms, P<0.01; Hodges: 410.6±40.2 ms, P<0.05) compared to baseline (Framingham: 399.2±22.7 ms; Hodges: 400.7±22.8 ms). At 4 hr after ablation, raw QT and QTc of all formulas significantly prolonged than baseline. Raw QT and QTc prolongation at 4hr after ablation were more frequently observed in female patients. Multiple regression analysis revealed that female patient is a significant predictor of raw QT and QTc interval prolongation of all formulas 4hr after PVI.

Conclusions

Raw QT and QTc prolonged after PVI, especially in the acute phase. Female patient is a risk factor for QT prolongation in the acute phase after PVI.

Funding Acknowledgement

Type of funding source: None
Near zero fluoroscopy cryoballoon catheter ablation in patients with atrial fibrillation using a novel dielectric imaging system
Authors: Schillaci V , Stabile G , Arestia A , Shopova G , Agresta A , Solimene F
Published: November 2020

Background

Fluoroscopy is commonly used in cryoballoon catheter ablation for pulmonary vein (PV) isolation procedures in patients with atrial fibrillation (AF).

Purpose

The purpose of this study was to verify the feasibility of a new dielectric imaging system in reducing the radiation exposure during cryoballoon ablation in patients with AF.

Methods

We enrolled 40 consecutive patients with paroxysmal AF: 20 patients underwent the procedure under fluoroscopy guidance before the new system introduction, while 20 patient underwent the procedure under fluoroscopy and a new dielectric imaging system guidance with its occlusion tool software. After transseptal access a detailed image reconstruction of left atrium and PVs was achieved with an octapolar circular mapping catheter and the cryoablation was performed with a cryoballoon catheter.

Results

Total time of the procedure was comparable between the two groups (90.15±28.67 vs 80.77±17.17 using the dielectric imaging system, p=0.34), while fluoroscopy time was significantly lower in the group using the new dielectric imaging system (16.92±8.96 vs 5.54±2.06, p<0.01). Acute isolation was achieved in all PVs. No 30 days complication was observed.

Conclusion

This is the first study that demonstrates the feasibility of a reduce fluoroscopy workflow using the novel dielectric imaging system in a cryoballoon procedure.

Funding Acknowledgement

Type of funding source: None
Impact of catheter ablation for atrial flutter on mortality and hospital readmission rates in patients with heart failure and reduced ejection fraction
Authors: Arora S , P Patel H , Jani C , Thakkar S , Gonzalez J , Deshmukh A , Patel R , D'Hoit B
Published: November 2020

Background

The effectiveness of catheter ablation as a management modality amongst patients with coexisting atrial flutter (AFL) and heart failure with reduced ejection fraction (HFrEF) is scarcely studied.

Methods

Appropriate ICD 10 codes were applied to the 2016 and 2017 National Readmission Database (NRD) to isolate patients having coexistent AFL and HFrEF including who had undergone an ablation. All-cause mortality at the end of 1 year was used as a primary outcome. Readmission due to AFL, heart failure (HF) and other causes were secondary outcomes. The hazard ratios were generated using Cox regression analysis while the time to event analysis was demonstrated with the Kaplan Meier curves.

Results

Out of a total of 9966 patients with AFL and HFrEF, 1980 (24.79%) patients underwent catheter ablation. The primary outcome, all-cause mortality (2.8% vs. 4.6%, HR: 0.610, 95% CI: 0.460–0.808, p=0.001) at the end of 1 year was significantly lower. Significant difference was also noted amongst two groups when it came to secondary outcomes such as readmissions due to AFL (1.6% vs. 6.3%, HR: 0.247, 95% CI: 0.173–0.354, p<0.001), HF (8.2% vs. 11.4%, HR: 0.693, 95% CI: 0.587–0.819, p<0.001) and other causes (29.4% vs. 37.1%, HR: 0.735, 95% CI: 0.673–0.804, p<0.001)

Conclusion

Ablative intervention amongst AFL patients with concomitant HFrEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to AFL, HF and other causes at the end of one year.

Outcomes of AFL and HFrEF

Funding Acknowledgement

Type of funding source: None
Hospital readmissions after catheter ablation for atrial fibrillation among patients with heart failure in the United States
Authors: Lima F , Kennedy K , Parulkar A , Sheikh W , Sharma E , Chu A
Published: November 2020

Background

Catheter ablation for atrial fibrillation may improve quality of life and long-term mortality among patients with heart failure.

Purpose

The rates of hospital readmission after catheter ablation for atrial fibrillation among patients with an established diagnosis of heart failure are largely unknown. We aimed to assess the rates and causes of 30-day readmission among patients with heart failure undergoing catheter ablation vs. medical therapy for atrial fibrillation in the United States.

Methods

The 2016 Nationwide Readmissions Database was screened for patients with diagnosis of heart failure and atrial fibrillation using the 10th Revision of International Classification of Diseases codes. Patients undergoing catheter ablation for atrial fibrillation were grouped separately from those treated medically for atrial fibrillation. Thirty-day readmissions were assessed for both groups.

Results

The analytical cohort included 749,776 (national estimate of 1,421,673) patients with heart failure and atrial fibrillation. This included 2,204 patients that underwent catheter ablation. Patients treated with catheter ablation had lower 30-day readmissions compared to the medical therapy group (16.8% vs 20.1%, p<0.001). Fifty-five percent of all readmissions among the catheter ablation cohort were related to cardiac events. Heart failure exacerbation (40%) and arrhythmia (36%) were the most common cardiac causes for readmission after catheter ablation (Figure).

Conclusions

In a contemporary nationwide analysis of patients with heart failure and atrial fibrillation, compared to medical therapy those treated with catheter ablation for atrial fibrillation had fewer 30-day readmissions after index hospital discharge. The most common cause for readmission among patients treated with catheter ablation was heart failure exacerbation and arrhythmia.

Causes of readmission

Funding Acknowledgement

Type of funding source: None
Acute detection of optical tissue changes in real-time during pulsed field ablation (PFA)
Authors: Hong K.L , Amirana O , Ransbury T , Glover B
Published: November 2020

Background

It has been established in previous animal and human studies that it is possible to assess lesion formation in real-time using optical means during the application of radiofrequency (RF) energy in cardiac ablation procedures. The optical interrogation was accomplished using a novel catheter and instrument system whereby the catheter has embedded optical fibers that transmit and receive light from the instrument.

Purpose

The aim of this study was to see if there are similar indications of lesion formation, detected by the same optical means, during the application of pulsed field ablation (PFA) energy to cause lesions through electroporation.

Methods

A series of 3 anesthetized pigs underwent PFA in the right atrium. An 8-electrode circular catheter was placed high in the right atrium, near the superior vena cava, to simulate pulmonary vein isolation as part of an AF ablation procedure. The optical catheter was placed adjacent to the circular catheter between stimulation electrode pairs. A bolus of adenosine was administered to create a window of asystole to avoid stimulation on the T-wave. Bipolar PFA was delivered immediately post drug infusion and the optical signature from the catheter was recorded and displayed in real-time. Electrograms were recorded and the mapping of the lesion was performed with the optical catheter at the following time intervals post PFA delivery: 0 min, 15 min, 1 hour, and 3 hours. Necropsy and histology followed the procedure.

Results

The optical signal is distinctly higher in intensity during the PFA pulse train. The optical signal showed an immediate significant decrease and a slow but steady decay over the mapping interval. Electrogram reduction accompanied PFA application and also showed a marked reduction over the mapping interval. The optical signal amplitudes were markedly lower when on the lesion compared to healthy non-ablated myocardium as predicted.

Conclusions

Preliminary results indicate that optical mapping detects immediate tissue changes during PFA at these energy levels and hence could be is a viable method of evaluating lesion formation during and after PFA energy application. The optical signal indicates that cell damage occurs immediately at these energy levels and continues to progress slowly in lesions made by PFA energy compared to those made by RF energy. The findings also suggest that optical mapping can identify acute lesions made with PFA energy in real-time implying that optical mapping could evolve as a PFA gap detector.

Funding Acknowledgement

Type of funding source: None