bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic performance of advanced cardiac imaging for detection of cardiac sarcoidosis: a systematic review and meta-analysis
Authors: Ballo H , Saraste A , Doghman F , Knuuti J 
Published: November 2020

Abstract

Background
Advanced cardiac imaging techniques, 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) and cardiac magnetic resonance (CMR) imaging, have shown high accuracy for the detection of cardiac sarcoidosis (CS) in small studies. This meta-analysis was performed to evaluate the performance of FDG PET and CMR in the diagnosis of CS.

Methods
PubMed, Embase, and Cochrane Library were searched from the earliest available date of indexing to December 2019 for studies evaluating the accuracy of FDG-PET and CMR for the evaluation of possible CS defined mainly by the Japanese Ministry of Health, Labour and Welfare (JMHW) criteria. For robustness, only studies with a sample size of ≥20 patients were selected and sensitivity analysis excluding outliers was conducted. To calculate the overall performance of the diagnostic accuracy of FDG-PET and CMR, summary receiver operating curve (SROC) and area under the curve (AUC) analyses were done. Heterogeneity was evaluated with the Cochrane Q test and I2 test. Possible sources of heterogeneity were further explored by subgroup analyses.

Results
Fourteen studies used FDG-PET and six studies used CMR involving 1491 patients (mean age 53 years, 38% male) fulfilled the inclusion criteria. The pooled sensitivity of FDG-PET for diagnosis of CS was 76.7% (95% CI 71.6–81.2%; Q=4.4, P&lt;0.0001; I2=86.2%) and the pooled specificity was 86.0% (95% CI 82.8–88.8%; Q=37.4, P&lt;0.0001; I2=65.2%). For the CMR, the pooled sensitivity was 94.0% (95% CI 88.8–97.2%; Q=10.59, P=0.06; I2=52.8%) and the pooled specificity was 88.8 (95% CI 85.3–91.3%; Q=80.25, P&lt;0.0001; I2=93.8%). SROC analysis demonstrated good overall accuracy for FDG-PET (AUC value of 0.91, and Q* 0.85) and CMR (AUC value of 0.96, and Q* 0.9) (figure 1). The sensitivity analysis of FDG-PET (11 studies) demonstrated a pooled sensitivity of 86.2% (95% CI 81.3–90.2%; Q=35.3, P=0.0001; I2=71.6%) and pooled specificity of 87.9% (95% CI 84.3–90.9%; Q=16.7, P=0.08; I2=40.2%). Moreover, the sensitivity analysis of CMR (5 studies) showed a pooled sensitivity of 89.3% (95% CI 78.1–96%; Q=7.3, P=0.12; I2=44.9%) and pooled specificity of 77.9% (95% CI 72.1–82.9%; Q=2.5, P=0.6; I2=0%). Meta-regression showed that the age of the patients (coefficient 0.192; P=0.04) and the size of the studies (coefficient 0.035; P=0.028) were the sources of heterogeneity in FDG-PET and CMR, respectively. The subgroup analysis by the age ≥55 years (6 studies and 276 patients) showed improvement in the diagnostic accuracy of FDG-PET with sensitivity of 92.2% (95% CI 86.1–96.2%; Q=18.9, P&lt;0.01; I2=73.5%) and specificity of 85.1% (95% CI 78.4–90.4%; Q=4, P=0.553; I2=0%).

Conclusion
FDG-PET and CMR are useful adjunctive diagnostic tools in the evaluation of CS. Further large multi-center studies are warranted to validate the diagnostic accuracy of FDG-PET and CMR for diagnosis of CS.
Figure 1

Funding Acknowledgement
Type of funding source: None
Systematic Evaluation of KCNQ1 variant using ACMG/AMP Guidelines and Risk Stratification in Long QT Syndrome Type 1
Authors: Kashiwa A , Aiba T , Makimoto H , Yagihara N , Ohno S , Makiyama T , Hayashi K , Itoh H , Sumitomo N , Yoshinaga M , Morita H , Makita N , Kusano K , Horie M , Shimizu W 
Published: November 2020

Abstract

Background
Mutation/variant-site specific risk stratification in long-QT syndrome type 1 (LQT1) has been well investigated, but it is still challenging to adopt current enormous genomic information to clinical aspects caused by each mutation/variant. We assessed a novel variant-specific risk stratification in LQT1 patients.

Methods
We classified a pathogenicity of 142 KCNQ1 variants among 927 LQT1 patients (536 probands and 391 family members) based on the American College of Medical Genetics and Genomics (ACMG) and Association for Molecular Pathology (AMP) guidelines and evaluated whether the ACMG/AMP-based classification was associated with arrhythmic risk in LQT1 patients.

Results
Among 142 KCNQ1 variants, 60 (42.3%), 58 (40.8%), and 24 (16.9%) variants were classified into pathogenic (P), likely pathogenic (LP), and variant of unknown significance (VUS), respectively. The ACMG/AMP guideline-based classification was significantly associated with syncopal events (particularly those during exercise) and LQT risk score (Schwartz score) in overall population. On the other hand, arrhythmic risk was completely different between probands and families even in the same variants. The baseline QTc interval and variant location could stratify the risk in family members but not in probands, however, the ACMG/AMP-based KCNQ1 variant classification stratified the risk in LQT1 probands as well as family members. Multivariate analysis showed that proband (HR=2.52; 95% CI: 1.93–3.30; p&lt;0.0001), longer QTc interval (≥500ms) (HR=1.41; 95% CI: 1.11–1.79; p&lt;0.0001), variants at membrane spanning (MS) (vs. those at N/C terminus) (HR=1.40; 95% CI: 1.07–1.85; p=0.02), C-loop (vs. N/C terminus) (HR=1.58; 95% CI: 1.11–2.24; p=0.01), and P variants [(vs. LP) (HR=1.71; 95% CI: 1.33–2.23; p&lt;0.0001), (vs. VUS) (HR=1.96; 95% CI: 1.19–3.46; p=0.007)] were significantly associated with syncopal events. A clinical score (0–4) based on the proband, QTc (≥500ms), variant location (MS or C-loop) and P variant by the ACMG/AMP guidelines allowed identification of patients more likely to have arrhythmic events (Figure A and B).

Conclusion
Comprehensive evaluation of clinical findings and pathogenicity of KCNQ1 variants based on the ACMG/AMP-based evaluation may stratify arrhythmic risk of congenital long-QT syndrome type 1.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Health Science Research Grant from the Ministry of Health,Labor and Welfare of Japan for Clinical Research on Measures for Intractable Diseases (H24-033, H26-040, H27-032) and a research grant from the Japan Agency for Medical Research and Development (AMED) (15km0305015h0101, 16ek0210073h0001)
The Admit-AF risk score: a clinical risk score for predicting hospital admissions in patients with atrial fibrillation
Authors: Meyre P , Aeschbacher S , Blum S , Coslovsky M , Beer J.H , Moschovitis G , Rodondi N , Baretella O , Kobza R , Sticherling C , Bonati L.H , Schwenkglenks M , Kuehne M , Osswald S , Conen D 
Published: November 2020

Abstract

Background
Patients with atrial fibrillation (AF) have a high risk of hospital admissions, but there is no validated prediction tool to identify those at highest risk.

Purpose
To develop and externally validate a risk score for all-cause hospital admissions in patients with AF.

Methods
We used a prospective cohort of 2387 patients with established AF as derivation cohort. Independent risk factors were selected from a broad range of variables using the least absolute shrinkage and selection operator (LASSO) method fit to a Cox regression model. The developed risk score was externally validated in a separate prospective, multicenter cohort of 1300 AF patients.

Results
In the derivation cohort, 891 patients (37.3%) were admitted to the hospital over a median follow-up 2.0 years. In the validation cohort, hospital admissions occurred in 719 patients (55.3%) during a median follow-up 1.9 years. The most important predictors for admission were age (75–79 years: adjusted hazard ratio [aHR], 1.33; 95% confidence interval [95% CI], 1.00–1.77; 80–84 years: aHR, 1.51; 95% CI, 1.12–2.03; ≥85 years: aHR, 1.88; 95% CI, 1.35–2.61), prior pulmonary vein isolation (aHR, 0.74; 95% CI, 0.60–0.90), hypertension (aHR, 1.16; 95% CI, 0.99–1.36), diabetes (aHR, 1.38; 95% CI, 1.17–1.62), coronary heart disease (aHR, 1.18; 95% CI, 1.02–1.37), prior stroke/TIA (aHR, 1.28; 95% CI, 1.10–1.50), heart failure (aHR, 1.21; 95% CI, 1.04–1.41), peripheral artery disease (aHR, 1.31; 95% CI, 1.06–1.63), cancer (aHR, 1.33; 95% CI, 1.13–1.57), renal failure (aHR, 1.18, 95% CI, 1.01–1.38), and previous falls (aHR, 1.44; 95% CI, 1.16–1.78). A risk score with these variables was well calibrated, and achieved a C-index of 0.64 in the derivation and 0.59 in the validation cohort.

Conclusions
Multiple risk factors were associated with hospital admissions in AF patients. This prediction tool selects high-risk patients who may benefit from preventive interventions.
The Admit-AF risk score

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swiss National Science Foundation (Grant numbers 33CS30_1148474 and 33CS30_177520), the Foundation for Cardiovascular Research Basel and the University of Basel
Three year incidence and duration of atrial fibrillation episodes among a large, real-world population of cryptogenic stroke patients with insertable cardiac monitors
Authors: Ziegler P.D , Rogers J.D , Richards M , Nichols A.J , Ferreira S.W , Koehler J.L , Sarkar S 
Published: November 2020

Abstract

Background/Introduction
The primary goal of monitoring for atrial fibrillation (AF) after cryptogenic stroke (CS) is secondary stroke prevention. Therefore, long-term monitoring of CS patients with insertable cardiac monitors (ICMs) is likely important to ensure appropriate secondary stroke prevention therapy, regardless of when AF is detected after the index event. However, long-term data on the incidence and duration of AF from real-world populations are sparse.

Purpose
To investigate the long-term incidence and duration of AF episodes in real-world clinical practice among a large population of patients with ICMs placed for AF detection following CS.

Methods
We included patients from a large device manufacturer's database who received an ICM for the purpose of AF detection following CS and were monitored for up to 3 years. All detected AF episodes (≥2 minutes) were adjudicated. We quantified the AF detection rate for various episode duration thresholds using Kaplan-Meier survival estimates, analyzed the maximum duration of AF episodes, and measured the time to initial AF detection.

Results
A total of 1247 patients (65.3±13.0 years, 53% male) were included and followed for 763±362 days. AF episodes (n=5456) were detected in 257 patients, resulting in a median frequency of 5 episodes [IQR 2–19] per patient. At 3 years, the AF detection rate for episodes ≥2 minutes was 24.2%. The AF detection rates at 3 years for episodes ≥6 minutes, ≥30 minutes, and ≥1 hour were 22.4%, 20.6%, and 19.1%, respectively. The median duration of the longest detected AF episode was 4.4 [IQR 1.2–13.9] hours and the median time to AF detection was 129 [IQR 45–354] days.

Conclusion
AF episodes were detected via ICMs in approximately one-quarter of CS patients within 3 years of follow-up. More than 75% of patients with AF detected had episodes lasting ≥1 hour and half had episodes lasting ≥4 hours. Detection of the first AF episode typically occurred beyond the range of conventional ambulatory monitors. Long-term surveillance of CS patients is likely important given the appreciable incidence, frequency, and duration of these AF episodes.

Funding Acknowledgement
Type of funding source: None
Dronedarone vs placebo in patients with atrial fibrillation or atrial flutter across a range of renal function: a post hoc analysis of the ATHENA trial
Authors: Vamos M , Oldgren J , Nam G.-B , Lip G , Calkins H , Zhu J , Ueng K.-C , Ludwigs U , Wieloch M , Stewart J , Hohnloser S.H 
Published: November 2020

Abstract

Background
The use of antiarrhythmic drugs in patients with chronic kidney disease (CKD) is challenging due to issues with renal clearance, drug accumulation and increased proarrhythmic risks. Since CKD is a common comorbidity with atrial fibrillation (AF), it is important to establish the efficacy and safety for antiarrhythmic drug treatment in patients with CKD.

Purpose
To evaluate the efficacy and safety of dronedarone in patients with AF or atrial flutter (AFL) across different stages of renal impairment.

Methods
In this post-hoc analysis of ATHENA (NCT00174785), a randomised, double-blind trial of dronedarone 400 mg BID vs placebo in patients with AF or AFL plus additional risk factors for death and a calculated glomerular filtration rate ≥10 mL/min, the primary outcome was time to first cardiovascular (CV) hospitalisation or death. Renal function (estimated glomerular filtration rate [eGFR]) was assessed using CKD Epidemiology Collaboration equation and patients were grouped by eGFR (10–44, 45–59, ≥60 mL/min). Log-rank testing and Cox regression were used to compare time to events between treatment groups.

Results
In ATHENA, 43.6% of placebo and 42.2% of dronedarone patients had mild-to-moderate CKD (Table). Median time to CV hospitalisation/death was longer in all strata for dronedarone vs placebo, reaching significance in the 45–59 and ≥60 mL/min groups (Figure 1). There was a trend towards more treatment-emergent adverse events (TEAEs), deaths and discontinuations due to TEAEs in patients with eGFR 10–44 mL/min. No clear difference in safety was seen between treatment arms except for discontinuations, which were higher with dronedarone.

Conclusions
This analysis confirms the efficacy of dronedarone, demonstrated in ATHENA, across different stages of renal impairment. Further assessment of safety will require larger populations of patients with CKD.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Sanofi
Rate control drugs differ in the prevention of progression of atrial fibrillation
Authors: Koldenhof T , Wijtvliet E.P.J.P , Pluymaekers N.A.H.A , Rienstra M , Folkeringa R.J , Bronzwaer P , Elvan A , Elders J , Tukkie R , Luermans J.G.L.M , Van Gelder I.C , Crijns H.J.G.M , Tieleman R.G 
Published: November 2020

Abstract

Background
In patients with paroxysmal atrial fibrillation (PAF), verapamil reduces progression to persistent AF through its intracellular calcium-lowering effects. Little is known on the effects of beta-blockade.

Methods
In this pre-specified post-hoc analysis of the RACE4 randomised trial (nurse-led care versus usual-care in newly detected AF) all patients with PAF and treated with beta-blockers or verapamil for rate control, were analyzed. Patients using class I or III antiarrhythmic drugs were excluded. The primary outcome was time to first electrical cardioversion (ECV) for non-selfterminating persistent AF. Event rates are reported using Kaplan-Meier analysis, and multivariate analysis was used to correct for baseline differences.

Results
Out of 430 patients with PAF, 383 used beta-blockers and 47 verapamil. Compared to verapamil patients, patients on beta-blocker were significantly older (60±12 versus 66±9 years), had a higher CHA2DS2-VASc score (1.5 versus 2.0) and a lower left ventricular ejection fraction (60% versus 55%). There were no other significant baseline differences between the two groups. Over a mean follow up of 36 months, 99 out of 430 (23%) patients underwent a first ECV after progression to persistent AF. In the beta-blocker group 95 of 383 (25%) patients underwent ECV, compared to 4 out of 47 (9%) in the verapamil group (P=0.013, Figure 1). After correction for baseline differences verapamil remained significantly associated with less progression (OR 0.23, confidence interval 0.08 to 0.67). Similarly, ECV or chemical cardioversion, whichever came first, was performed in 113 of 383 (30%) beta-blocker patients and 7 of 47 (15%) verapamil patients (P=0.022). In total 35 atrial ablations were performed, 34 (9%) in the beta-blocker group and only 1 (2%) in the verapamil group (p=0.075).

Conclusion
In patients with newly diagnosed PAF, verapamil was associated with less progression to persistent AF, as compared to beta-blockers. In order to draw firm conclusions, these results need to be confirmed by a prospective study
ECV free survival

Funding Acknowledgement
Type of funding source: None
Long-term outcome of patients with invasive electrophysiology procedure related cardiac tamponade
Authors: Von Olshausen G , Bourke T , Schwieler J , Drca N , Bastani H , Tapanainen J , Saluveer O , Benson L , Goedel A , Kenneback G , Insulander P , Jensen-Urstad M , Braunschweig F 
Published: November 2020

Abstract

Aims
Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analyzed the risk of death or serious cardiovascular events in patients suffering from EP related cardiac tamponade requiring pericardiocentesis during long-term follow-up.

Methods and results
Out of 19997 invasive EPs at our university hospital between January 1998 and September 2018, all patients with EP related periprocedural cardiac tamponade were identified (n=60) and matched (1:3 ratio) to a control group (n=180). After a follow-up of 5 years, the composite primary end point - death from any cause, acute myocardial infarction, TIA/stroke and hospitalization for heart failure – occurred in significantly more patients in the tamponade than in the control group (12 patients (20.0%) vs 19 patients (10.6%); Hazard ratio (HR) 2.53 (95% CI, 1.15–5.58); p=0.021). This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group (HR 3.75 (95% CI, 1.01–13.97); p=0.049). Death from any cause, acute myocardial infarction and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group (HR 36.0 (95% CI, 4.68–276.86); p=0.001).

Conclusion
Patients with EP related cardiac tamponade are at higher risk for cerebrovascular events during the first two weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation
Change of the pulmonary vein anatomy after cryoballoon ablation reflecting left atrial reverse remodeling
Authors: Miyama H , Takatsuki S , Hashimoto K , Yamashita T , Fujisawa T , Katsumata Y , Kimura T , Fukuda K 
Published: November 2020

Abstract

Background
Cryoballoon ablation (CBA) is a widely used procedure for atrial fibrillation (AF). However, the anatomical change of pulmonary veins (PVs) and the risk factors of PV stenosis is less clear. We aimed to decipher the prevalence and the predictive factors for PV stenosis after CBA.

Methods
We analyzed the data of 320 PVs from 80 patients who underwent CBA for AF (age: 62±10 years, 59 males, 75 paroxysmal AF). All patients underwent pre- and post-procedural cardiac computed tomography (mean 6.7±3.3 months after ablation). We defined the PV stenosis when the cross sectional area of PV was less than 50% compared with that of PV before the CBA.

Results
The average cross sectional PV area decreased significantly after CBA (pre- vs. post-CBA; 2.4±1.0cm2 vs. 2.3±1.1cm2, P&lt;0.001), whereas the volume of left atrium (LA) also decreased significantly (pre- vs. post-CBA; 75.0±23.2cm3 vs. 70.7±21.9cm3, P&lt;0.001). There was a weak but significant correlation between the reduction rate of PV area and that of LA volume (Pearson's correlation coefficient 0.411, p&lt;0.001). Only 6 PV stenosis were revealed, in which area reduction of more than 75% and 50–75% were observed in 2 PVs and 4 PVs, respectively. The incidence of PV stenosis was greater in female (male vs. female; 0.8% vs. 4.8%, P=0.043) and tend to be frequent in left PVs (left PVs vs. right PVs; 3.1% vs. 0.6%: P=0.107). Moreover, patients who developed PV stenosis tended to have lower weight and shorter height (PV stenosis group vs. non-PV stenosis group; 58.2±12.4kg vs. 67.7±13.0kg: P=0.078, 161.2±9.1cm vs. 167.2±8.8cm: P=0.094). There were no significant differences in the number of freezing, minimum temperature and total freezing time between PV stenosis group and non-PV stenosis group.

Conclusions
The ostial PV area decreased significantly but little after CBA, possibly due to LA reverse remodeling. The PV stenosis was more common in women and tend to be frequent in left PVs, lower weight, and shorter height patients, though severe stenosis after CBA was not observed in this study.

Funding Acknowledgement
Type of funding source: None
Impact of body mass index on atrial fibrillation ablation using cryoballoon: procedural data and clinical outcomes
Authors: Urbanek L , Chen S , Bordignon S , Tsianakas N , Bologna F , Chun K.R.J , Schmidt B 
Published: November 2020

Abstract

Background
The impact of body mass index (BMI) on atrial fibrillation (AF) ablation using cryoballoon (CB) has been seldom reported.

Purpose
To evaluate the impact of BMI on procedural data as well as the clinical efficacy and safety character of using CB.

Methods
Symptomatic AF patients (paroxysmal / persistent AF) with BMI ≥25 who underwent CB based pulmonary vein isolation (PVI) were enrolled. CB PVI was performed using the second generation CB (CB 2, 28mm), with 4min based freeze protocol and bonus freeze delivery in case of time-to-isolation (TTI) &gt;75 sec. All procedures were performed under conscious sedation. Procedural endpoint was electrical pulmonary vein isolation. Clinical success was defined as no recurrence of AF/atrial tachycardia (AT).

Results
Data from 600 consecutive patients were collected. Three groups defined: BMI 25–29 (Group 1, G1 n=337); BMI 30–34 (Group 2, G2 n=149); BMI ≥35 (Group 3, G3 n=114). Patients in Group 3 were younger (G1: 67±11 y; G2: 68±10y G3 62±11y; p&lt;0,001) and presented bigger LA (G1 39,5±4,9 mm; G2: 41,6±5,5; G3 42,4±5,1; p&lt;0,001). Most of the patients presented with PAF (G1: 59,3% G2: 57,7% G3: 54,4%).
Among 2342 Targeted PVs, 2332 (99,6%) were isolated using solely the CB (G2: one procedure was abolished due to failed aortic puncture during transseptal access; G3: one PVI was not completed due to PNP; 6 touch up RF ablation in G1 and 2 in G3). Procedure time (G1:58,45 min; G2: 60,44 min; G3 63,19 min) and fluoroscopy time (G1: 9,3 min; G2: 9,5 G3: 10,6 min) were comparable among the groups. PN Injury was the main recorded complication: 20/600 (2,6%) patients with a transient PN palsy (PNP) and 6/600 (1%) with a persistent PNP. No sedation related complication was recorded.
Follow up survival curve analysis after one year revealed a favorable follow up in G1 (78,4%) and G2 (82,5%) compared to G3 (66,5%) (G1 Vs G3 p: 0,002 G2 vs G3 p=0,008, G1 vs G2 p=0,47). The influence of BMI on the follow up was confirmed in the subgroup of patients with paroxysmal AF but not in patients presenting persistent AF.

Conclusions
Cryoballoon ablation in obese patients is feasible and associated with a relatively low complication rate. BMI plays a role in predicting recurrences especially in patients presenting with paroxysmal AF.

Funding Acknowledgement
Type of funding source: None