bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5643Simple 12-leads electrocardiography can predict cardiac death in patients with complete left bundle branch block
Authors: Shimizu M , Iiya M , Hara K , Ohmori M , Taomoto Y , Kaneda T , Yamakami Y , Shimada H , Manno T , Isshiki A , Kimura S , Fujii H , Suzuki M , Nishizaki M 
Published: October 2019

Abstract

Background
Patients with complete left bundle branch block (CLBBB) generally fall in two categories: CLBBB with good prognosis and poor prognosis. However, a simple electrocardiography (ECG) was considered impossible to predict the two categories.

Purpose
To elucidate the possibility of 12-leads ECG for predicting cardiac prognosis in patients with CLBBB

Methods
To estimate myocardial damage and left ventricular function, the ECG was performed with semiconductor SPECT simultaneously. Among consecutive 5864 patients who underwent ECG gated SPECT, finally 103 sinus-rhythm patients were enrolled. The observed period of them was median 632 days, and primary endpoint was set as cardiac death.

Results
Eight patients fell into cardiac death. Cox univariate analysis showed ventricular activation time (VAT: duration from onset of Q wave to peak of R wave) in V1 lead, T wave amplitude in aVR (aVR T-amp), and multiple fragmented QRS (At least 2 fQRS in LV anterior/inferior/lateral wall), and left ventricular ejection fraction, standard deviation of phase analysis (Phase SD), and summed rest score were significant predictors. After optimization of all significant continuous predictors by ROC curve analysis, all the significant predictors were analyzed by multivariate Cox analysis (stepwise regression). VAT in V1 (Hazard ratio: 4.594, P=0.034), aVR T-amp ≥-85microV (HR: 11.11, P=0.029), and Phase SD≥48.7 (HR6.047, P=0.035) were independent predictors. Kaplan-Meyer curve analysis demonstrated VAT V1≥70 and aVR T amp≥-85 showed the worst prognosis (P=0.008).
Cox Regression after Optimization by ROC Univariate Multivariate (Stepwise regression) HR 95% CI P HR 95% CI P VAT I ≥70 6.861 1.759–26.76 0.006 4.594 1.126–18.75 0.034 T amp in aVR ≥−85 27.34 3.458–216.2 0.002 11.11 1.274–96.85 0.029 Multiple fQRS 3.836 1.081–13.61 0.037 LVEF ≤37% 7.250 1.874–28.04 0.004 SD ≥48.7 17.30 3.671–81.57 <0.001 6.047 1.133–32.28 0.035 SRS≥17 4.178 1.206–14.48 0.024 SD: standard deviation of histogram by phase analysis of SPECT; SRS: summed rest score by myocardial perfusion analysis of SPECT.

Conclusion
Simple 12-leads ECG could predict the prognosis of patients with CLBBB.
P5648Efficiency and accuracy of arrhythmia detection using implantable cardiac monitor: A prospective multicenter randomized clinical trial comparing Reveal LINQ and Confirm Rx
Authors: Yokokawa M , Jaffe B , Ip R , Azad R , Castellani M , Ip J 
Published: October 2019

Abstract

Background
Implantable cardiac monitor (ICM) has been used to detect occult cardiac arrhythmias in a variety of clinical situations. The reliability and accuracy of diagnosing cardiac arrhythmia could impact patient care. However, it is not clear the efficiency and reliability of detecting cardiac arrhythmias between currently available two ICMs.

Purpose
To compare the efficiency and accuracy of diagnosing cardiac arrhythmias between Reveal LINQ™ and Confirm Rx™.

Methods
In the prospective multicenter randomized study, a total of 80 patients (age: 61±17 years, men: 41 [51%]) with cryptogenic stroke (n=52) or recurrent unexplained episodes of palpitations (n=3) or syncope (n=25) received an ICM for detection of arrhythmias. Patients were randomized one to one into receiving either Reveal LINQ™ or Confirm Rx™. Arrhythmic events are defined as pauses of ≥3.0 seconds, bradycardia with heart rate of ≤40 bpm, tachycardia with heart rate of ≥150 bpm, and atrial fibrillation (AF). The time of detected arrhythmic events and patient activated events to the time of data availability on respective website site for analysis were compared between the two ICM. All of the arrhythmia events were adjudicated by two cardiologists to assess the accuracy.

Results
A total of 680 arrhythmic events including 352 AFs, 109 bradycardias, 167 tachycardias and 52 pauses were transmitted over a mean follow-up of 4.2±2.5 months. The mean time to data transmission was significantly faster in Confirm Rx™ than in Reveal LINQ™ (24±103 vs 475±426 min, P<0.0001). One-hundred fifty-nine of 352 AF events (45%) and 237 of 328 non-AF events (72%) were accurately detected by ICMs (P<0.0001). Twenty-eight of 51 AF events (55%) were detected accurately by Reveal LINQ™ and 131 of 301 AF events (44%) were accurately detected by Confirm Rx™ (P=0.13). The reason for inaccurate AF detection was frequent ectopic beats (n=134), P-wave oversensing (n=15), T-wave oversensing (n=8), both P- and T-waves oversensing (n=18) and sinus tachycardia with R-wave undersensing (n=18).

Conclusions
Data transmission of arrhythmic events using Confirm Rx™ is significantly faster than Reveal LINQ™. The accuracy of AF detection with current algorithms in both ICM remains suboptimal. More patients and longer follow-up is required to confirm these findings.
P5661Validation of CHA2DS2-VA score (excluding female sex) in non-valvular atrial fibrillation patients: a nationwide population-based study
Authors: Choi S Y , Kim M H , Lee K M , Kim J K , Woo J Y , Cho Y R 
Published: October 2019

Abstract

Background
Sex category (Sc, ie, female sex) confers 1 point on CHA2DS2-VASc score. So, no woman with atrial fibrillation (AF) can have a CHA2DS2-VASc score of 0. This study aimed to compare CHA2DS2-VA (excluding female sex) and CHA2DS2-VASc score in Korean AF patients.

Methods
Using the Korean National Health Insurance Service database, we analyzed the risk of ischemic stroke in non-valvular AF patients between 2013 and 2017. The predictive value of the CHA2DS2-VA and CHA2DS2-VASc scores for ischemic stroke was evaluated by c-statistic difference and net reclassification improvement (NRI). The propensity score matching method was used to balance covariates across male and female AF patients.

Results
A total of 182,133 patients with AF (49.2% women) were included to this study. The adjusted incidence rate (IR) of ischemic stroke was not significantly different between males and females (0.89%/y and 0.90%/y, respectively, p=0.411) in low-risk patients without risk factor. Also, no sex difference was found in high-risk patients with above 2 risk factors for ischemic stroke (4.46%/y for male and 4.49%/y for male, p=0.498). In c-statistic analysis for ischemic stroke, there was no significant difference between the CHA2DS2-VA and CHA2DS2-VASc scores (AUC 0.662 vs. 0.664, z=1.572, p=0.116). When compared with CHA2DS2-VASc score, CHA2DS2-VA score was not significantly inferior in net reclassification improvement (NRI 0.031, 95% CI 0.002–0.037, p=0.118) for ischemic stroke.
C-statistics

Conclusions
In Korean AF patients, the CHA2DS2-VA score excluding female sex is a useful risk scoring system for ischemic stroke.
P5668A decision-support tool framework to predict adverse outcome in patients with atrial fibrillation: J-Rhythm registry substudy
Authors: Watanabe E , Yamashita T , Inoue H , Atarashi H , Okumura K , Kodani E , Origasa H , Kiyono K 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is associated with increased mortality and morbidity. Modelling the risk of thrombosis, major bleeding and total mortality are often limited by the inadequate number of independent predictors.

Purpose
We compared the predictive accuracy of the decision-support tool framework and conventional risk score in AF patients.

Methods
We used data of AF patients enrolled into the nationwide AF registry. A random forest model was implemented to predict each outcome, and its predictive power was tested by a 5-fold cross-validation.

Results
We analyzed 7,937 patients with AF (age 70±10 years, female 31%). The type of AF was paroxysmal (37%), persistent (14%), and permanent (49%). The number of antithrombotic treatments were follows: warfarin only (n=5461), antiplatelet only (n=581), both warfarin and antiplatelet (n=1471) and no antithrombotic agents (424). The mean CHA2DS2-VASc score was 2.8±1.6 and HAS-BLED score was 2.7±1.2, respectively. We selected 20 from 50 clinical parameters and compared by the area-under-curve with the CHA2DS2-VASc score for thromboses and the HAS-BLED score for major bleeding. During the 2-year follow-up, 126 patients (1.6%) had thromboses, 140 (1.8%) had major bleeding, and 195 (2.5%) died. A random forest model had a higher value of the area-under-curve for predicting thromboses compared with the CHA2DS2-VASc (0.66 vs. 0.61, P<0.05), and had a significantly higher area-under-curve for major bleeding compared with the HAS-BLED (0.67 vs. 0.61, P<0.05). The area-under-curve for the all-cause mortality was 0.77.

Conclusions
A random forest model has a higher accuracy than conventional risk scheme in predicting thromboses and major bleeding, in addition to total mortality.
P5674Direct comparison of three high-sensitivity cardiac troponins in syncope
Authors: Du Fay De Lavallaz J , Badertscher P B , Zimmermann T Z , Walter J W , Strebel I S , Puelacher C P , Peacock F P , Boeddinghaus J B , Nestelberger T N , Geigy N G , Miro O M , Kuehne M K , Reichlin T R , Mueller C M 
Published: October 2019

Abstract

Background
It is unknown, whether high-sensitivity cardiac troponin I (hs-cTnI) or hs-cTnT provide higher accuracy for the diagnosis and risk-stratification of patients with syncope.

Methods
We directly compared the diagnostic and prognostic accuracy of hs-cTnI and hs-cTnT in a prospective international multicenter study enrolling patients older than 40 years presenting with syncope to the emergency department (ED). Hs-cTnI/T concentrations were measured in a blinded fashion using three assays. Cardiac syncope, as adjudicated by two independent physicians using all available clinical information including 1-year follow-up, was the diagnostic endpoint. Death and nonfatal major adverse cardiovascular events (MACE) at 5, 30 and 720 days were the prognostic endpoints.

Results
Among 1219 patients, cardiac syncope was the adjudicated final diagnosis in 204 (16.7%). All three hs-cTn showed higher concentrations in patients with cardiac syncope compared with other causes (all p<0.01, Figure 1) and remained independent predictors of cardiac syncope in multivariable models. While the diagnostic accuracy of the three assays for cardiac syncope was similar (area under the curve (AUC) of 0.76–0.77 (95% CI, 0.72–0.80, p>0.05 for all direct comparisons)), the percentage of patients above/below the assay-specific cut-off strongly varied (Figure 1). The prognostic accuracy of hs-cTnI/T was comparable among the assays and very high for imminent (within 5 days) death (AUC 0.93–0.94), and high for 30 and 720-day death (AUC 0.74–0.8), as well as MACE (AUC 0.74–0.78).
Figure 1

Conclusion
Hs-cTnI/T concentrations may have clinical utility in patients presenting with syncope as they provide diagnostic as well as prognostic information.

Acknowledgement/Funding
Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation, Basel (Switzerland), University Basel (Switzerland)
P5690Comparison of two methods to navigate the stereotactic body radiotherapy ablation for ventricular tachycardia, the invasive electrophysiological study and substrate identification
Authors: Neuwirth R , Cvek J , Jiravsky O , Knybel L , Chovancik J , Fiala M , Sknouril L 
Published: October 2019

Abstract

Purpose
To compare two methods used for identifying the arrhythmogenic substrate - invasive electrophysiological study versus PET-CT scar identification. The substrate is then targeted by stereotactic body radiotherapy (SBRT) in patients with previously unsuccessful radiofrequency catheter ablation.

Methodology
Patients with ischemic cardiomyopathy, LVEF less than 40% and unsuccessful conventional treatment resulting in recurring ventricular tachycardias, were divided into two groups with different methods of obtaining arrhythmogenic substrate. In the group A, invasive electrophysiological mapping was used, while in the group B, scar identification by PET-CT was done, enhanced with non-invasive body surface ecg mapping of all inducible ventricular tachycardias. This target obtained was then attacked with SBRT. We compared the size of the planned target volume (PVT), the SBRT duration, the calculated dose for the esophagus, stomach and lung and the incidence of acute complications.

Cohort description
Patients in group A were recruited from April 2014 to December 2018, patients in group B from June to December 2018. Group A (8 patients) – mean age 66, NYHA class 2.4, LVEF 29,4%. Group B (6 patients) – mean age 71, NYHA class 2.1, LVEF 25,2%. All patients were men.

Results
There was a statistically significant difference in PTV – Group A (mean 24.1ml, SD = 3,9), Group B (mean 76.0ml, SD 14.1), p<0,001 (two-sample t-test). There was no difference in the calculated secondary radiation doses acquired by surrounding organs. The most frequent adverse event was acute anorexia, occurring in 4 patients from Group A and in 2 patients from Group B. The anorexia subsided in one week time. One patient from Group B suffered from esophageal ulcer, which developed 6 months after the therapy.

Conclusion
Using invasive electrophysiology mapping to identify arrhythmogenic substrate for SBRT yields significantly smaller volume of targeted tissue. Despite this finding, we did not find any difference neither in radiation dose delivered to the surrounding organs, nor in the radiation duration.
P5695Catheter ablation of ventricular tachycardia in patients with acute vs. previous myocarditis
Authors: Peretto G , Sala S , Gigli L , Rizzo S , Palmisano A , Esposito A , Thiene G , Basso C , Della Bella P 
Published: October 2019

Abstract

Background
Ventricular tachycardias (VT) may occur late after myocarditis, as well as in the acute inflammatory phase of the disease. However, the role of catheter ablation (CA) in preventing VT recurrences in patients with acute (AM) vs. previous myocarditis (PM) has never been investigated so far.

Purpose
To evaluate the results of CA performed in patients presenting with VA and biopsy-proved myocarditis at different inflammatory stages.

Methods
We enrolled 46 consecutive patients (74% males, mean age 43±12y, mean LVEF 46±9%) with myocarditis and VT at index hospitalization. Based on endomyocardial biopsy and cardiac magnetic resonance (CMR) results, the patients were divided into AM and PM groups: in AM group, myocarditis was biopsy-proved, according to the ESC criteria; PM patients had a history of biopsy-proved myocarditis more than 12 months before, with no current signs of active inflammation (negative biopsy according to the ESC criteria; nonischaemic LGE at CMR with negative Lake-Louise criteria; absence of unexplained troponin abnormalities). ICD were implanted upon clinical indications. All of the patients underwent electroanatomical mapping (EAM) and VT CA. During 3 (2.5–3.5)y FU, VT recurrences were evaluated by 2/y Holter ECG and ICD interrogation.

Results
At baseline, 23 patients (50%) had AM, and 23 PM. Overall, 16 AM and 21 PM patients underwent ICD implant (p=n.s.). The clinical VT was monomorphic in 22 AM and 23 PM patients, respectively (p=n.s.) with a dominant right-bundle branch block with superior axis (RS) morphology in both groups (16 AM vs. 17 PM cases, p=n.s.). However, RS morphology was associated with left ventricular inferoposterior LGE at CMR in 9/16 AM vs. 17/17 PM patients (p=0.003). Similarly, inferoposterior localization of low-voltage areas at EAM was found in 11/16 AM vs. 17/17 PM patients (p=0.018). Furthermore, CMR showed a greater LGE transmural extension in AM patients (65±19%) as compared to PM ones (40±25%, p<0.001). Epicardial EAM and CA were performed in 14 AM vs. 15 PM patients, with endocardial-only approach adopted in the remaining cases (p=n.s.). VT CA was defined as successful (class A) in all of the subjets. However, during FU VT recurrences were documented in 7/23 AM vs. 0/23 PM patients (p=0.009). Four AM cases underwent redo CA late after myocarditis (1.5±0.3y after index hospitalization), with no further VT recurrences in FU.

Conclusion
In myocarditis patients presenting with VT, CA results are significantly better in PM cases as compared to AM ones. These findings are consistent with the different underlying substrate, and suggest the best role for ablation strategy after myocarditis healing.

Acknowledgement/Funding
None
P5702Non-invasive epicardial and endocardial mapping in patients with idiopathic right ventricular outflow tract premature ventricular contractions: new insights into arrhythmia substrate
Authors: Parreira A L , Carmo P , Adragao P , Pinho J , Jeronimo R , Cavaco D , Soares A , Budanova M , Zubarev S , Costa F , Carmo J , Marques H , Goncalves P 
Published: October 2019

Abstract

Background
It has been accepted for years that idiopathic premature ventricular contractions (PVCs) with origin in the right ventricular outflow tract (RVOT) are benign. They are thought to result from triggered activity and most studies do not describe abnormal findings during electroanatomical mapping
Dispersion of ventricular repolarization is associated with the susceptibility to ventricular arrhythmias and may indicate the presence of diseased myocardium. The activation recovery interval (ARI) has been used as a surrogate measure of ventricular action potential duration and refractory period.

Purpose
The aim of this study was to use the new non-invasive epicardial and endocardial mapping system (NEES) to study patients with RVOT PVCs in order to evaluate the ARI in the epicardium of RVOT during sinus rhythm (SR).

Methods
Non-invasive mapping was performed with the NEES, based on body surface electrocardiograms of a maximum of 224 electrodes and computed tomography imaging data. Unipolar electrograms were reconstructed on the epicardial and endocardial surfaces. Patients were excluded if they had structural heart disease, previous ablation or conduction abnormalities. ARI was defined as the interval between times of minimum derivative of the QRS and the maximum derivative of the T wave in the unipolar electrograms. We evaluated the ARI map in patients with RVOT PVCs and in a control group of patients without PVCs (Figure). We assessed the maximum value of ARI (Max ARI), the minimum value of ARI (Min ARI) and the difference between the Max ARI and the Min ARI (Diff ARI).

Results
We studied 8 patients with RVOT PVCs and 8 patients without PVCs.
The results are presented in the table.
Demographic and NEES data RVOT PVCs (n=8) Control (n=8) P value* Demographic data   Age in years, median (IQR) 53 (48–65) 59 (52–67) 0.536   Male gender, n (%) 4 (50) 6 (75) 0.608 NEES data   Max ARI in msec, median (IQR) 285 (236–331) 228 (197–298) 0.195   Min ARI in msec, median (IQR) 176 (138–192) 216 (185–255) 0.161   ARI diff in msec, median (IQR) 111 (83–147) 15 (4–34) <0.0001
NEES map

Conclusion
In this group of patients we found a significantly higher dispersion of the ARI measurements through the epicardium of the RVOT in patients with PVCs in comparison with patients without PVCs.
P5707An evaluation of the use of propensity scores in cardiovascular literature: a systematic review and recommendations
Authors: Samuel M , Batomen B , Rouette J , Kim J , Platt R W , Brophy J , Kaufman J S 
Published: October 2019

Abstract

Background
As randomized trials cannot always be conducted, propensity score (PS) methods are frequently used in cardiovascular observational studies. Previous evaluations found insufficient and inaccurate reporting of PS methods in the clinical literature, however; a comprehensive and current evaluation of their use and reporting is thus warranted.

Purpose
1) To conduct a systematic review of cardiovascular articles published in high-impact medical and cardiovascular journals to evaluate the use and reporting of PS methods, as well as interpretation of results. 2) To identify key reporting and analysis elements when using PS methods.

Methods
Cardiovascular articles using PS published between 2010 to 2017 in high-impact medical (5) and cardiovascular (3) journals were reviewed. Included studies used a PS-based method, and focused on cardiovascular diseases, outcomes, interventions, or techniques. Information was extracted on: (1) PS assumptions, (2) variable selection and assessment of model success, (3) specifics of each PS method, and (4) consistency of written interpretation with the causal effect estimated. Each article was evaluated by 2 reviewers. Recommendations for key elements to be included in publications were based on findings and PS methodological literature.

Results
Of the 296 included articles, most were published in Journal of the American College of Cardiology (83 articles; 28%), followed by Circulation (79 articles; 27%), European Heart Journal (46 articles; 14%), Journal of the American Medical Association (35 articles; 12%), British Medical Journal (30 articles; 10%), New England Journal of Medicine (10 articles; 3%), Annals of Internal Medicine (10 articles; 3%), and Lancet (3 articles; <1%). The most commonly used PS method was matching (53% of studies), followed by a combination of methods (19%), direct adjustment (13%), inverse probability weighting (IPW, 12%), and stratification (3%). Variables in the PS model were predefined in 77% of articles, selected with statistical testing in 17% of articles, or both in 5% of articles (no details for 1% of articles). Balance was not assessed in 16% of papers and 38% of articles that evaluated balance did not report standardized differences, the recommended measure to assess balance. For matching, most studies (85%) conducted a 1:1 match; however, 17% of studies had >50% of unmatched treated (or untreated) patients (based on targeted parameter). Overall, heterogeneity of effects was assessed in 89% of all articles. In 48% of the reviewed articles, however, interpretations of the effect estimates did not correspond to the PS method conducted or described.

Conclusions
Detailed reporting of PS methods is important to maintain transparency and reproducibility, evaluate the appropriateness of the method, and correctly interpret the results and the population to which they apply. This systematic review describes areas for improvement.