bluuebunny/crossref_metadata_2025_split huggingface dataset:
P542Cardiac autonomic dysfunction and inflammatory response in heart failure - markers for cardiac resynchronization therapy response?
Authors: Oliveira S , Abreu A , Cunha P , Carmo M M , Valente B , Ricardo I , Delgado A S , Oliveira L , Pinto F , Oliveira M M 
Published: June 2020

Abstract

Funding Acknowledgements
FCP

Introduction
Cardiac sympathetic activation and inflammatory response are involved in chronic heart failure (HF) pathophysiology. The severity of autonomic dysfunction and inflammation might be responsible for different responses to HF treatment.

Aim
To evaluate the impact of cardiac autonomic dysfunction, and it´s association with systemic inflammation, on cardiac resynchronization therapy (CRT) response in severe HF patients.

Methods
Single centre, prospective, longitudinal study, including consecutive patients, referred to CRT. Demographic data, HF aetiology and NYHA class were evaluated. Left ventricular (LV) function data (LV ejection fraction - LVEF) by echocardiography, heart to mediastinum early ratio (HMRe) by 123I-MIBG cardiac scintigraphy, and plasmatic TNF-α levels (pg/mL) were determined, at baseline and 4 months after CRT implantation. CRT response was defined by an absolute increase of at least 5% in LVEF at 4 months evaluation after CRT. Patients were divided in 4 groups according to HMRe and TNF-α cut-points: Group I (TNF-α &gt; 2.0 pg/ml + HMRe ≥ 1.6), Group II (TNF-α &gt; 2.0 pg/ml + HMRe &lt; 1.6), Group III (TNF-α ≤ 2.0 pg/ml + HMRe ≥ 1.6) and Group IV (TNF-α ≤ 2.0 pg/ml + HMRe &lt; 1.6). Data was analyzed using descriptive statistics and groups were compared by Fisher"s exact test.

Results
A total of 95 patients were included (age 68.6 ± 10.2 years), 67.4% male and 32.6% female, 40% with diabetes mellitus, 30.5% with ischemic cardiomyopathy, 23.2% in NYHA III/IV, baseline LVEF - 26 ± 7%. At 4 months, LVEF was 40 ± 11%. In total, 73.7% were responders and 26.3% were non-responders to CRT. There were 28 patients (29.5%) with HMRe ≥ 1.6, with 25 responders (89.3%) and 48 patients (50.5%) with TNF-α ≤ 2.0 pg/ml, with 38 responders (79.2%). Group I had 16 patients (16.8%), with 81.2% responders; Group II had 31 patients (32.7%), with 61.3% responders; Group III had 12 patients (12.6%), with 100% responders, and Group IV had 36 patients (37.9%), with 72.2% responders. Conclusion: In patients with severe HF submitted to CRT, combining cardiac autonomic dysfunction and inflammation, associated to high rate of CRT non response. Contrarily, those with preserved cardiac autonomic function and no increased levels of inflammation identified most significantly CRT responders.
CRT response according to HMRe and TNFα HMRe ≥ 1.6 (n = 28) HMRe &lt; 1.6 (n = 67) Responders NO Respondersn (%) Responders NO Respondersn (%) TNF α &gt; 2 pg/mL (n = 47) G I: 13 (81.2%) 3 (18.8%) GII: 19 (61.3%) 12 (38.7%) * TNF α ≤ 2 pg/mL (n = 48) G III: 12 (100%) 0 (0%)* G IV: 26 (72.2%) 10 (27.8%)
P1398The modified left atrial anterior line: optimal ablation index target to detect a transmural lesion on cardiac magnetic resonance imaging
Authors: Ammar-Busch S , Mahnkopf C , Mitlacher M , Tose Costa Paiva B , Schwab Figueiredo C , Butz S , Brachmann J , Forkmann M 
Published: June 2020

Abstract

Background
The modified anterior line (MAL) has been described as an alternative to the mitral isthmus line. Despite better ablation results, achieving a bidirectional line block is sometimes challenging. Ablation Index (AI) is a novel lesion quality marker that integrates contact force, time and power. This index has been evaluated for pulmonary vein isolation (PVI) but not for other left atrial (LA) lesions. We aimed to investigate the AI-values to determine a scar on cardiac magnetic resonance (CMR) imaging 3 months after MAL ablation.

Methods
Twelve consecutive patients who underwent a MAL ablation have been included. The indication for MAL was perimitral flutter (n = 3) or substrate ablation for diffuse anterior LA low-voltage area in persistent atrial fibrillation (AF) (n = 9). The MAL was divided into three segments: segment 1 (S1) from mitral annulus to height of lower begin of left atrial appendage (LAA) antrum; segment 2 (S2) height of lower begin of LAA antrum to end of upper LAA antrum; segment 3 (S3) from end of upper LAA antrum to left superior pulmonary vein. Ablation was performed using a contact force catheter, automated lesion tagging and Ablation Index. AI target was left to the operator’s choice. An inter-lesion distance of ≤ 6mm was recommended. The bidirectional block was systematically evaluated at the end of procedure. All patients underwent a CMR study at 3 months, regardless of symptoms, to identify myocardial lesions (scar).

Results
Bidirectional MAL block was achieved in all patients. The mean reached AI value was 443 ± 55. CMR imaging revealed scar in 25 of 36 (69%) segments. In total, the mean AI value for detecting a scar was 451 ± 51 and was higher in S1 compared to S2 and S3 (474 ± 36 vs. 451 ± 63 vs. 423 ± 46, respectively). The AI value in S1 was significantly higher compared to S3 (p = 0.02). The minimal AI value to detect a scar was 410 ± 183 in S1, 379 ± 109 in S2 and 369 ± 68 in S3.

Conclusion
Different AI targets are required for each segment of the MAL to show transmural lesions on CMR imaging 3 months post-ablation. Higher AI values are required for the lower segment of the line. Additional data are needed to demonstrate if considering these targets will be reflected in better long-term results.
P387Revealing channels of interatrial communication during atrial fibrillation
Authors: Pope M , Kuklik P , Briosa E Gala A , Mahmoudi MICHAEL , Paisey J O H N , Betts TIMOTHY 
Published: June 2020

Abstract

Introduction
Interatrial propagation has been widely studied in anatomical specimens and electrophysiological studies during sinus rhythm or pacing. However, pathways of conduction during atrial fibrillation (AF) are poorly characterised in vivo.

Purpose
We sought to develop a method of identifying the dominant channel of communication between atria during AF with a view to characterising the role of localised mechanisms in maintaining AF between both chambers.

Methods
10 patients undergoing simultaneous bi-atrial non-contact charge density mapping before and following pulmonary vein isolation (PVI) were analysed. Simultaneous 30s recordings during AF were obtained. Virtual electrograms from every vertex of the reconstructed left and right atrial (LA, RA) anatomies were exported and phase calculated using a method of sinusoidal recomposition and Hilbert transform. For each vertex, coherence between a sequence of activations between this point and every other point on the opposing chamber was calculated using mean phase coherence (MPC). The maximum of all MPC values was assigned to this local point to estimate the degree of coherence between activity at a given point and the entire opposing chamber. The regions with highest MPC value represent the channel of communication. Each activation of this zone is then evaluated and difference in local activation time between LA and RA determined (figure). Communication between atria is determined where a normal distribution of timing shift within this channel can be demonstrated (as opposed to a uniform histogram in the case of a lack of any correlation between electrograms). If seen to be preceding the opposite chamber for ≥60% of the recording then the chamber was deemed to be leading.

Results
A total of 18 maps were obtained (pre-PVI only in 2). A clear channel of interatrial propagation could be seen in 17 maps (MPC value 0.48 ± 0.16) with communication within this channel demonstrated in 13 of these (MPC 0.52 ± 0.16). In the RA the most common site was in the posterior inter-caval zone (in 13) and on the posterior septum of the LA (in 14). The LA was leading in 4 maps and the RA in 2 with balanced propagation in 7.

Conclusion
The method of average MPC identifies channels of inter-atrial communication during AF which appear to predominantly involve posterior interatrial connections. Further application of this technique to characterise interatrial propagation may help to define patient specific phenotypes of AF and guide targeted therapy.
Abstract Figure 1
1246High-power and short-duration radiofrequency ablation for atrial fibrillation: feasibility, safety and one-year results
Authors: Castrejon Castrejon S , Martinez Cossiani M , Ortega Molina M , Escobar Cervantes C , Batlle M , Gonzalez Davia R , Lopez Sendon J L , Merino J L 
Published: June 2020

Abstract

Funding Acknowledgements
SEC-Bayer research project 2018, Spanish Society of Cardiology. Research project 2018, FIS, Insituto de Salud Carlos III.

OnBehalf
none
Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than cryoablation. In addition, it is associated with more oesophageal lesions. The aim of this study was to evaluate the feasibility, safety and 1-year efficacy of PVI by high power short duration (HPSD) PPRF in patients with atrial fibrillation (AF).

METHODS
PPRF around the PV was performed in 125 patients (P) distributed in two groups. Conventional PPRF with 30W/≤30 s under luminal oesophageal temperature monitoring was performed in the first 47 P (Group 1). 68 P were enrolled in the HPSD (Group 2). Power was set to 50 W and delivered to reach a predefined lesion index value (LSI≥5 or AI≥350) in the first 18 P (Group 2A). 30 P underwent PPRF with 60 W for 7-10 s (Group 2B) and the last 30 P underwent PPRF with 70W for 9 s (Group 2C). Oesophageal endoscopy was performed after ablation in all P.

RESULTS
17 (36%) P in Group 1 and 30 (38%) in Group 2 had persistent AF. PVI of all targeted veins was achieved in 96% and 100% of P in both groups (p = 0,6). Total RF time was 30 [27-42], 25[ 20-29], 16 [14-20] and 13 [11-16] in Groups 1, 2A, 2B and 2C respectively (p &lt; 0.01). RF duration per target lesions was 12[9-17], 9[8-9] and 9[9-9] s in Groups 2A, 2B and 2C respectively (p &lt; 0.001). First-pass PVI was achieved in 35% 56%, 57% and 85% of left PV circles (p &lt; 0.001) and in 46%, 56%, 60% and 82% of right PV circles (p = 0.04) in groups 30W, 50W, 60W and 70W respectively. Reconnections occurred in 8% of PV circles in Group 1 and in 6.5% of PV circles in Group 2 (p = 0.8). Dormant conduction was tested with adenosine in Groups 2B and 2C and the incidence was 30% and 25% of PV circles respectively (p = 0.31). The carina was the most frequent location of conduction gaps, reconnections and dormant conduction in all groups. The incidence of oesophageal lesions was 28% in Group 1, 22% in Group 2A and 0% in groups 2B and 2C (p &lt; 0.002). The 1-year efficacy (freedom from any atrial tachycardia recurrences &gt;30 s) was 59% in Group 1, 88% in group 2A, 77% in group 2B and 87% in group 2C (p = 0.019).

CONCLUSIONS
PVI by HPSD PPRF is feasible and results in high 1-year efficacy in P with AF. This approach appears safe and associated with low incidence of oesophageal damage especially when short application time and 60 or 70W are used. However, this latter power setting is associated with slightly better 1-year efficacy than HPSD PPRF using 60W.
Abstract Figure. Recurrences of atrial arrhythmias (&gt;30 s
P1407Efficacy of radiofrequency ablation of paroxysmal and persistent atrial fibrillation in heart failure patients
Authors: Seliutskii S , Savina N , Chapurnykh A 
Published: June 2020

Abstract

Background
radiofrequency ablation (RFA) is considered to be one of the most preferred treatments for atrial fibrillation (AFib) in patients with heart failure (HF).

Objective
to study the effectiveness of AFib RFA in patients with HF, to compare the effectiveness of the procedure in patients with paroxysmal (PaAFib) and persistent (PeAFib) AFib.

Materials and methods
65 patients with AF and HF with LVEF &lt; 50%, who underwent RFA were included in a prospective study. All patients underwent transthoracic echocardiography and quality of life assessment using the SF-36 questionnaire before RFA and after 12 months. AFib was recorded in 42 (65%) of patients, AFL in 23 (35%). Thirty (46%) patients had PaAfib (Group 1), and 35 (54%) PeAFib (Group 2).

Results
In 45 (69%) patients sinus rhythm (SR) was restored during RFA, in 15 (23%) SR was restored by electrical cardioversion. In 5 (8%) patients with PaAFib revealed SR at the time of RFA. Twelve month follow-up period revealed 49 (75%) patients who were free from AFib: 23 (77%) patients with PaAFib and 26 (74%) with PeAFib. After 12 month follow-up we revealed the improvement in LVEF (p &lt; 0.001 in both groups), decrease of anteroposterior size of left atrium (LA) (p &lt; 0.001 in both groups) and LA volume (p &lt; 0.001 in both groups), improvement in the mental (p = 0.008 in Group 1; p = 0.006 in Group 2) and physical component of health according to the SF-36 questionnaire (p = 0.036 in Group 1; p = 0.049 in Group 2). There were no significant differences between two groups of follow-up period.

Conclusions
AFib RFA significantly improves the course of heart failure and the quality of life of patients, leads to decrease of left atrium size and increase of LVEF. The effectiveness of RFA does not depend on the type of arrhythmia in HF patients.
P504VT ablation outcomes and predictors in a UK population- validating existing predictors and novel markers
Authors: Ahluwalia N , Graham A , Orini M , Williams S , Ahsan S , Khan F , Ezzat V , Sporton S , Earley M , Chow A , Lambiase P , Dhinoja M 
Published: June 2020

Abstract

Background
Radiofrequency catheter ablation (CA) can reduce ventricular tachycardia (VT) burden and registry data suggests an improvement in mortality. However, there is significant heterogeneity in patient morbidity and VT phenotype. A risk prediction model derived from observational data has suggested pre-procedural left ventricular (LV) function, age and underlying ischaemic cardiomyopathy are associated with greater post-procedural mortality. Validation of proposed factors in clinical practice is required to facilitate comprehensive pre-procedural risk stratification and inform decision making.

Purpose
To determine whether proposed pre-procedural predictors of mortality after VTCA are valid in a UK population and explore any association with other predictors.

Method
Patients undergoing VTCA at a tertiary electrophysiology centre between 06/07/16 and 31/07/19 were included. Pre-specified characteristics and mortality follow-up data were analysed from electronic health records. Cox regression analysis was undertaken to determine association with mortality.

Results
161 patients with mean age of 63 ±15.9 years underwent VTCA of whom 133 (83%) were male. During the follow-up period (16 months, 13-24; median, 1st-3rd quartile) 16 patients died. No deaths occured in the 27 (16%) patients with structurally normal hearts. Chronic kidney disease (CKD) stage III-IV (HR 14.73 [4.9-44.4]), LV ejection fraction &lt;35% (HR 7.13 [1.59-31.88]), underlying ischaemic cardiomyopathy (HR 6.17 [1.37-27.85]), LV internal diameter (LVID) (1.08 [1.02-1.15]) and age (HR 1.08 [1.02-1.14]) were associated with significantly greater mortality risk (Table 1) (Figure 1).

Conclusion
Proposed risk stratifying factors are validated in our UK centre’s experience. Additionally, CKD and baseline LVID appear to be associated with mortality in our population and warrant further study.
Risk factor Hazard ratio Lower confidence interval Upper confidence interval P-value Atrial fibrillation (yes/no) 0.14 0.02 1.11 0.06 Age (years) 1.08 1.02 1.14 &lt;0.01 Diabetes (yes/no) 2.43 0.85 6.92 0.10 Chronic kidney disease (yes/no) 14.73 4.88 44.41 &lt;0.01 Ischaemic cardiomyopathy (yes/no) 6.17 1.37 27.85 0.02 LV EF &lt;35% (yes/no) 7.13 1.59 31.88 &lt;0.01 LV internal diameter (mm) 1.08 1.02 1.15 &lt;0.01 Procedural urgency (urgent/elective) 1.12 0.57 2.20 0.75 Table 1: Association between baseline risk factors and mortality risk after VT catheter ablation
Abstract Figure 1: Kaplan-Meier survival curves
P1358Atrial electromechanical interval in patients with arrhythmias: is everyone the same?
Authors: Parollo M , Zucchelli G , Barletta V , Della Tommasina V , Canu A , Giannotti Santoro M , Ridolfi C , Branchitta G , Carluccio M , Bongiorni M G 
Published: June 2020

Abstract

Background
Atrial electromechanical delay, assessed calculating the PA-TDI interval using tissue Doppler imaging, is a known and promising determinant for atrial fibrillation recurrence prediction after pulmonary vein isolation and electrical cardioversion.
Purpose
To determine the relationship between atrial electromechanical delay and the presence of atrial fibrillation.
Methods
We prospectively enrolled patients presenting at our Unit in sinus rhythm scheduled for an arrhythmogenic substrate ablation (atrial fibrillation -AF-, supraventricular tachycardia -SVT- and premature ventricular contractions -PVC-). Demographic and echocardiographic characteristics were evaluated upon admission. Atrial electromechanical delay was inferred via the PA-TDI interval, obtained by calculating the time difference between the P wave onset and the A" wave peak on TDI recordings.
Results
From October 2018 to August 2019, 200 patients (60% male, mean age 58,21 ± 14,26, mean BSA 1,9 ± 0,21 m2, mean BMI 26,42 ± 6,28 kg/m2, mean EF 60,91% ± 5,43%) were admitted to our unit to undergo AF (group 1: n = 145; 72,50%), SVT or PVC ablation (group 2: n = 55; 27,5%). Compared with the control group (group 2), patients admitted for AF ablation had a larger LA size (group 1 vs group 2: mean LA area 23,21 ± 5,07 vs 16,87 ± 4,01 cm2, p &lt; 0,001; mean indexed LA volume 46,71 ± 20,41 ml vs 32,04 ± 14,7 ml, p &lt; 0,001; mean LAD 41,77 ± 5,66 vs 33,84 ± 6,06, p &lt; 0,001) and a longer PA-TDI interval (lateral 148,55 ± 28,5 vs 128,57 ± 20,9, p &lt; 0,001; medial 125,34 ± 21,02 vs 109,11 ± 21,49, p &lt; 0,001; average 141,43 ± 27,58 vs 119,08 ± 18,63, p &lt; 0,001).

Conclusion
The PA-TDI interval is a non-invasive and easily achievable echocardiographic parameter, which is demonstrated to be prolonged in patients with a history of AF in contrast with patients with other arrhythmias, as expression of atrial conduction heterogeneity.
Abstract Figure. PA-TDI measurement
MicroRNA microarray analysis to detect biomarkers of aortic dissection from paraffin-embedded tissue samples
Authors: Ji Jun , Xu Qiong , He Xia , Chen Xiao-ling , Yang Jianan 
Published: June 2020

Abstract

OBJECTIVES
The aim of this study was to explore the differential expression profiles of microRNAs (miRNAs) in paraffin-embedded acute aortic dissection (AAD) tissues to find potential biomarkers for this disease.

METHODS
A total of 92 paraffin-embedded tissue specimens were collected from 92 patients with AAD who underwent surgical replacement. Among these specimens, 54 had partial normal aortic segments (smooth intima surface, non-atherosclerotic lesions) in proximal crevasse of aorta. Samples of these segments were taken 1 cm away from aortic lesions as the control group, after eliminating the tunica adventitia tissues. miRNA expression profiles were obtained by miRNA microarray analysis. Differentially expressed miRNAs were found by comparing the AAD group with the control group and were verified by fluorescence real-time quantitative polymerase chain reaction and by fluorescence in situ hybridization.

RESULTS
A total of 71 differentially expressed miRNAs were detected. Twenty-two were up-regulated and 49 were down-regulated. Four up-regulated miRNAs (hsa-miR-636, hsa-miR-142-3p, hsa-miR-425-3p, hsa-miR-191-3p) were selected for validation by real-time fluorescence quantitative polymerase chain reaction and fluorescence in situ hybridization. In the fluorescence real-time quantitative polymerase chain reaction analysis, only hsa-miR-636 showed a statistically significant difference in the AAD versus control comparison (3.3-fold, P = 0.012). The fluorescence in situ hybridization validation showed that the expression level of hsa-miR-636 was significantly increased in the AAD versus control comparison (P &lt; 0.001), with average optical densities of 61.29 ± 16.83 in the AAD group and 9.30 ± 3.98 in the control group.

CONCLUSIONS
Hsa-miR-636 is involved in the pathogenesis of AAD and may be a potential biomarker for this disease.
Epidemiology of Respiratory Syncytial Virus Across Five Influenza Seasons Among Adults and Children One Year of Age and Older—Washington State, 2011/2012–2015/2016
Authors: Jackson Michael L , Scott Emily , Kuypers Jane , Nalla Arun K , Roychoudury Pavitra , Chu Helen Y 
Published: June 2020

AbstractBackgroundVaccines and novel prophylactics against respiratory syncytial virus (RSV) are in development. To provide a baseline for evaluating these interventions, we characterized the incidence and molecular epidemiology of RSV in persons aged ≥1 year.MethodsWe identified patients with medically attended acute respiratory illness (MAARI) from the 2011/2012 through 2015/2016 influenza seasons among members of Kaiser Permanente Washington. We estimated the cumulative incidence of MAARI for laboratory-confirmed RSV or influenza infection.ResultsAnnual cohorts ranged from 82 266 to 162 633 individuals, 14% of whom were children aged 1 to 17 years. Cumulative incidence of RSV each season ranged from 14 per 1000 population (95% confidence interval [CI], 12–16) to 22 per 1000 (95% CI, 19–25). Incidence of RSV was greater than influenza in children aged 12–23 months and 2–4 years; incidence of influenza was greater in other age groups. Respiratory syncytial virus subtype A dominated in 2011/2012, 2012/2013, and 2015/2016, with ON1 being the most common genotype. Respiratory syncytial virus subtype B dominated in 2013/2014 and 2014/2015, primarily of the BA genotype.ConclusionsThe burden of RSV is comparable to that of influenza across the life course. These results provide a baseline for evaluating the impact of new RSV interventions on the epidemiology of RSV.
Estimation of Seasonal Influenza Attack Rates and Antibody Dynamics in Children Using Cross-Sectional Serological Data
Authors: Minter Amanda , Hoschler Katja , Jagne Ya Jankey , Sallah Hadijatou , Armitage Edwin , Lindsey Benjamin , Hay James A , Riley Steven , de Silva Thushan I , Kucharski Adam J 
Published: June 2020

Abstract
Directly measuring evidence of influenza infections is difficult, especially in low-surveillance settings such as sub-Saharan Africa. Using a Bayesian model, we estimated unobserved infection times and underlying antibody responses to influenza A/H3N2, using cross-sectional serum antibody responses to 4 strains in children aged 24–60 months. Among the 242 individuals, we estimated a variable seasonal attack rate and found that most children had ≥1 infection before 2 years of age. Our results are consistent with previously published high attack rates in children. The modeling approach highlights how cross-sectional serological data can be used to estimate epidemiological dynamics.