bluuebunny/crossref_metadata_2025_split huggingface dataset:
48Remote monitoring of Heart Failure patients with a Multisensor ICD Algorithm: value of an alert-based follow-up strategy
Authors: Pecora D , Tavoletta V , Dello Russo A , De Ruvo E , Ammirati F , La Greca C , Favale S , Petracci B , Molon G , Montella G M , Santini L , Nozza C , Valsecchi S , Calo L 
Published: June 2020

Abstract

Background
The HeartLogic algorithm measures and combines multiple parameters, i.e. heart sounds, intrathoracic impedance, respiration pattern, night heart rate, and patient activity, in a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation, and the HeartLogic alert condition was shown to identify patients during periods of significantly increased risk of HF events.

Purpose
To report the results of a multicenter experience of remote HF management with HeartLogic algorithm and appraise the value of an alert-based follow-up strategy.

Methods
The HeartLogic feature was activated in 104 patients (76 male, 71 ± 10 years, left ventricular ejection fraction 29 ± 7%). All patients were followed according to a standardized protocol that included remote data reviews and patient phone contacts every month and at the time of HeartLogic alerts. In-office visits were performed every 6 months or when deemed necessary.

Results
During a median follow-up of 13[11-18] months, centers performed remote follow-up at the time of 1284 scheduled monthly transmissions (10.5 per pt-year) and 100 HeartLogic alerts (0.82 alerts/pt-year). The mean delay from alert to the next monthly remote data review was 14 ± 8 days. Overall, the patient time in the alert state (i.e. HeartLogic index above the threshold) was 14% of the total observation period. HF events requiring active clinical actions were detected at the time of 11 (0.9%) monthly remote data reviews and at 43 (43%, p &lt; 0.001) HeartLogic alerts. Moderate to severe symptoms of HF were reported during 2% of remote visits when the patient was out of HeartLogic alert condition and during 15% of remote visits performed in alert condition (p &lt; 0.001). Out of 100 alerts, 17 required an in-office visit and 5 a hospitalization to manage the clinical condition. Overall, 282 scheduled and 56 unscheduled in-office visits were performed during follow-up. Any HF sign (i.e. S3 gallop, rales, jugular venous distension, edema) was detected during 18% of in-office visits when the patient was out of HeartLogic alert condition and during 34% of visits performed in alert condition (p = 0.002).

Conclusions
HeartLogic alerts are frequently associated with relevant actionable HF events. Events are detected earlier and the volume of alert-driven remote follow-ups is limited when compared with a monthly remote follow-up scheme. The probability of detecting common signs and symptoms of HF at regular remote or in-office assessment is extremely low when the patient is out of HeartLogic alert state. These results support the adoption of an alert-based follow-up strategy.
P328Satisfaction towards clinical training and academic activities among residents and early-career cardiologists
Authors: Nesti M , Tola G , Brunacci M , Santobuono V E , Dendramis G , Picciolo G , Lucciola M T , Russo V 
Published: June 2020

Abstract

Background
Because of the progress in diagnostic and therapeutic cardiovascular disease, the skills to be acquired during fellowship training has increased significantly. In particular, the evolution in arrhythmology and electrophysiology was fast in the last years. This could have created a gap between the training program during the fellowship and the new technologies, growing demand for re-defined educational requirements to ensure uniformity of knowledge and competence of those practicing in electrophysiology.

Purpose
The AIAC (Italian Association of Arrhythmology and Cardiostimulation) Young Pacing committee conducted a survey to obtain information the satisfaction on the educational and training obtained during the residency course by residents and young cardiologists (arbitrarily defined as age ≤ 40 years).

Methods
The survey was conducted from January to May 2019. Residents and young cardiologists were contacted to complete the survey by e-mail. They were asked to answer a questionnaire containing information about scholarly activity included satisfaction of educational and clinical proficiency in arrhythmology and electrophysiology and educational in electrophysiology after the residency.

Results
We obtained 334 answers to the survey. One hundred forty-six individuals (43.7%) were residents and 188 (56.2%) were young cardiologist.
In Electrophysiology Department, 3-6 months were dedicated to Clinical Arrhythmology for 135 partecipants (40.4%), 1-2 months to cardiac pacing for 132 partecipants (39.5%) and 1-2 months to EP Lab for 139 partecipants (41.6%).
Three hundred twenty-nine people responded to questions about satisfaction in educational. In terms of educational in Clinical Arrhythmology, 100 responders (30.4%) were "very satisfied", 105 (31.9%) were "satisfied" and 124 (37.7%) were "dissatisfied". About Cardiac Pacing, 84 responders (25.5%) were "very satisfied", 93 (28.3%) were "satisfied" and 152 (46.2%) were "dissatisfied". Only 51 (15.5%) participants were "very satisfied" with their training in Electrophysiology, whereas 81 (24.6%) were "satisfied" and 197 (59.9%) were "dissatisfied".
About self-assessed clinical proficiency in Arrhythmology at the end of fellowship, 30 responders (9%) defined themselves as completely confident in Clinical Arrhythmology, 126 (37.7%) in Ambulatory Electrophysiology (ECG Holter and device check), 28 (8.4%) in cardiac pacing, 10 (3%) in performing electrophysiological study and nobody in catheter ablation.
One hundred twenty-one (36.8%) participants improved their competence in Cardiac Arrhythmia Management attending courses after fellowship.

Conclusion
The survey underlines the need to fill a gap in order to address the needs of young interventional cardiologists and it may serve as a starting point for developing tailored educational initiatives.
P1506Prolonged and recurrent hospital admissions predict risk of cardiac implantable electronic device infections in hospitalized patients with bacteriaemia
Authors: Esteves A F , Marinheiro R , Parreira L , Mesquita D , Fonseca M , Farinha J M , Pinheiro A , Ferreira J , Amador P , Fonseca N , Silvestre I , Caria R 
Published: June 2020

Abstract

Background
As the use of Cardiac Implantable Electronic Devices (CIED) is expanding, the burden of device-related infections, particularly infectious endocarditis, is also increasing. Furthermore, with the increase in life expectancy, these devices are being implanted in patients who are older, with more serious co-morbidities and who are frequently hospitalized.

Purpose
To assess incidence and predisposing factors for infective endocarditis (IE) in hospitalized patients with CIED and nosocomial bacteraemia.

Methods
We performed a retrospective analysis of all hospitalized patients with CIED and positive blood cultures admitted to the Cardiology department between January 2012 and February 2019. Endocarditis was defined according to modified Duke criteria. We analyzed clinical parameters, device- and procedure-related characteristics, length of hospital stay and hospitalizations in the previous year.

Results
25 patients had positive blood cultures, 4 patients (16.0%) were diagnosed with infective endocarditis (median age 59.25 years, 75.0% male).
Patients characteristics are displayed in the Table.
In univariable analysis, the number and presence of hospitalizations in the previous year and the length of hospital stay was significantly associated with the possibility of endocarditis (respectively, OR 3.411, 95% CI 1.164-9.998, p-value 0.025; OR 18.000, 95% CI 1.375-235.686, p-value 0.028; and OR 1.047, 95% IC 1.001-1.096, p-value 0.046).

Conclusion
In this group of patients with positive blood cultures during hospitalization, the possibility of CIED infection was predicted by the length of hospital stay and the presence and number of hospitalizations in the previous year.
With CIED-IE Without CIED-IE p-value Age in years, median (IQR) 63 (16) 76 (16) 0.002 Heart failure, n (%) 4 (100%) 10 (47.6%) 0.105 LVEF in %, median (IQR) 21 (9) 51 (30) 0.008 LV dilation, n (%) 4 (100%) 8 (38.1%) 0.039 Device revision/upgrade/substitution, n (%) 2 (50.0%) 6 (28.57%) 0.570 LOS in days, median (IQR) 58.5 (83) 20 (15) 0.004 Hospital admissions in the previous year, n (%) 3 (75.0%) 3 (14.3%) 0.031 No. of hospital admissions in the previous year, mean (standard deviation) 1.67 (1.528) 0.29 (0.784) 0.005 Use of central venous access, n (%) 4 (100%) 4 (19.05%) 0.008 LOS – Length of Stay; LV – Left Ventricle; LVEF – Left Ventricle Ejection Fraction
P1106Fundamental differences and predictors of scar arrhythmogenicity in ischemic patients using cardiac magnetic resonance: a propensity score-matching study
Authors: Jauregui B , Soto-Iglesias D , Teres C , Ordonez A , Chauca A , Penela D , Acosta J , Fernandez-Armenta J , Perea R J , Prat-Gonzalez S , Ortiz-Perez J T , Berruezo A 
Published: June 2020

Abstract

Introduction
Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits to identify the arrhythmogenic substrate (AS) in ischemic patients. However, it is unknown why the majority of them never develop ventricular tachycardias (VT), irrespectively of their left ventricular ejection fraction (LVEF).

Purpose
To characterize the fundamental differences and potential predictors of scar arrhythmogenicity in post-myocardial infarction (MI) patients with and without VT.

Methods
36 consecutive ischemic patients with no arrhythmia evidence underwent a LGE-CMR study 4 years after the MI (controls). Scar data were compared with those obtained from 49 ischemic patients referred for VT substrate ablation (cases). Propensity score matching (PSM) was performed to adjust for age, LVEF, scar mass, and time from MI. The myocardium was segmented in 10 layers (endo- to epicardium), characterizing the core, border zone (BZ) and BZ channels (BZCs) using a dedicated post-processing software.

Results
Compared to controls, cases were significantly older (67.3 ± 9.1 vs. 56.5 ± 11), had lower LVEF (33.1 ± 10.1 vs. 51 ± 9.4), greater scar mass (33.9 ± 17.2 vs. 14.2 ± 11.6 g), BZ mass (21.1 ± 9.9 vs. 9.6 ± 7.6 g), core mas (12.6 ± 8.8 vs. ± g), number of BZC (2.9 ± 1.4 vs. 1.1 ± 1.1) and BZC mass (10.5 ± 4.2 vs. 2.3 ± 2.4 g) (p &lt; 0.001 in all cases). After PSM (2:1) adjustment[BJG1] , cases had more BZCs (2.9 ± 1.4 vs. 2.2 ± 0.6; p = 0.01) and a greater BZC mass (10.5 ± 4.2 vs. 4.6 ± 2.6 g; p &lt; 0.001). In the multivariable logistic regression analysis, the BZC mass was the only independent predictor of being a case [OR 2.3 (1.5–3.4); p &lt; 0.001]. Receiver operating characteristic curve analysis identified a cut-off point of BZC mass &gt;4.28 g (AUC 0.98; p &lt; 0.001), showing 100% sensitivity and 91% specificity for cases’ discrimination.

Conclusions
Compared with the cases, an otherwise similar control group (PS-matched for age, LVEF, scar mass, and time from MI) showed fewer BZC and a reduced BZC mass. BZC mass was the only independent predictor of being a case. A BZC mass cut-off point of &gt; 4.28 g showed a 100% sensitivity and 91% specificity for the identification of ischemic patients with documented VT.
Abstract Figure. Mean BZC mass and ROC curve analysis
668Principal component analysis can identify ventricular regions with highest variability in the arrhythmogenic substrate of ventricular tachycardia patients
Authors: Thibault B , Richer L P , Relan J , Mcspadden L , Ryu K , Rivard L , Dyrda K , Dubuc M , Mondesert B , Cadrin-Tourigny J , Tadros R , Macle L , Khairy P , Gregoire J , Harel F 
Published: June 2020

Abstract

Introduction
Left ventricle (LV) substrate can be characterized by imaging modalities providing physiological variables (tissue perfusion, ischemia, etc.) grouped in a complex dataset. Principal Component Analysis (PCA) can identify the dataset variables that best explain its variance. Variables linked to substrate arrhythmogenicity will lead PCA to identify LV regions most influenced by the variables on a LV 3D geometry.

Purpose
To evaluate whether regions identified by PCA correspond to regions targeted by physicians in a ventricular tachycardia (VT) ablation procedure.

Methods
Ischemic VT subjects underwent SPECT/CT perfusion imaging (rest and stress) prior to LV voltage mapping with the cardiac mapping system. Co-registration allowed projection of ablation sites onto SPECT/CT geometries. PCA retrospectively analyzed the following dataset: tissue perfusion (rest and stress), tissue ischemia and the local (1cm2 sub-regions) stress-rest difference for: 1) standard deviation (STD) and 2) skewness (Skew). PCA components (PCAc) explaining ≥85% of the total variance were plotted on the LV 3D geometry to display regions highly influenced by the dataset variables (see figure below).

Results
Ten subjects (9 males, 66 ± 8 years old, LVEF 37 ± 11%) underwent co-registration. In 7/10 subjects, tissue perfusion (in PCAc#1) and ischemia (in PCAc#2) were most influential on LV regions variance. Ischemia and low perfusion (≤40%) areas equaled 32 ± 19 % of the LV with 21 ± 23% of these areas highly involved in the arrhythmogenic substrate (≥75% of explained LV variance). The location of 63 ± 18% of ablation sites were &lt;1 cm from areas explaining ≥50% of LV variance.

Conclusion
Preliminary results showed that PCA can synthesize the influence of different perfusion derived variables, like tissue perfusion and ischemia, used in SPECT/CT imaging of the LV. Further analysis is needed to confirm whether this could be used to select VT ablation targets.
Abstract Figure.
P1493Cardiac contractility modulation in left ventricular systolic dysfunction: 1-year single Centre experience and clinical outcome
Authors: Matta M , Devecchi C , De Vecchi F , Barbonaglia L , Occhetta E , Rametta F 
Published: June 2020

Abstract

Funding Acknowledgements
None
Introduction. Cardiac contractility modulation (CCM) is a treatment option for patients suffering symptomatic chronic heart failure (CHF) with reduced ejection fraction (LVEF) despite optimal medical therapy, who are not eligible for or non-responders to cardiac resynchronization therapy (CRT). Despite randomized trials showing benefit in the short term, data on mid-term follow-up (over 12 months) are limited to small observational studies.
Purpose. The aim of this observation, prospective study is to assess the impact of CCM therapy on quality of life, symptoms, exercise tolerance and left ventricular function in a population of patients with CHF and moderate-to-severe left ventricular systolic dysfunction.
Methods. Consecutive patients suffering from CHF with LVEF &lt;45%, symptomatic, in NYHA class &gt; II despite optimal medical therapy, underwent CCM implantation at our Centre from October 2017 to October 2018. Enrolled patients underwent baseline evaluation and at 3, 6 and 12 months with transthoracic echocardiogram, ECG, clinical assessment, 6-min hall walking test and Minnesota Living With Heart Failure Questionnaire (MLWHFQ).
Results. Overall, 10 patients underwent CCM implantation (100% males, mean age 70 ± 8 years, 80% ischaemic cardiomyopathy, mean LVEF 29.4 ± 8%). All patients had at least one hospitalization for worsening heart failure during the previous 12 months. After a mean follow-up of 15 months, 9 patients were alive, while one patient died for worsening heart failure precipitated by pneumonia 2 months following CCM implantation. Among the remaining 9 patients, LVEF improved non-significantly to 32.2 ± 10% (p = 0.092), 6-min walking test distance improved from 170 ± 132 m to 305 ± 99 m (p &lt; 0.001), mean NYHA class improved from 3.0 ± 0.4 to 1.6 ± 0.5 (p = 0.003) and MLWHFQ score improved from 59.0 ± 33 to 34.0 ± 38 (p = 0.037) (Figure 1). Only 2 patients have been hospitalized during the 12 months, for worsening heart failure and sustained ventricular tachycardia, respectively. Overall, a net clinical benefit was detected in 6 out of 9 patients. Among the responders, 2 patients were device-naïve, presenting LVEF &gt; 35%; one patient was a CRT non-responder, while the remaining 3 had narrow QRS. All the non-responders patients had ischaemic cardiomyopathy, one of them with a moderately reduced LVEF and one with a CRT.
Conclusion. CCM is effective in improving quality of life, symptoms and exercise tolerance, and reduces hospitalizations in patients with symptomatic CHF on top of optimal medical and electrical therapy. The benefit in responders is maintained over one year after implantation, so this treatment should be considered for highly symptomatic patients suffering from CHF and reduced LVEF.
Abstract Figure 1
P507Cumulative comorbidity and survival in out-of-hospital cardiac arrest
Authors: Van Dongen L , Oving I , Beesems S G , Blom M T , Tan H L 
Published: June 2020

Abstract

Funding Acknowledgements
EU Horizon 2020 - 733381, CVON2017-15 RESCUED, CVON2018-30 Predict2, an unconditional grant from Physio-Control Inc., Redmond, WA USA.

OnBehalf
ARREST

Introduction
Multiple chronic health conditions have been associated with survival after out-of-hospital cardiac arrest (OHCA). The influence of cumulative disease burden on survival rates at successive stages of post-resuscitation care is unknown.

Purpose
To study the relationship between cumulative disease burden (Charlson Comorbidity Index [CCI]) and survival rates in the course of post-resuscitation care.

Methods
From a prospective community-based OHCA registry, 2544 OHCA patients aged ≥18y with presumed cardiac cause in 2010-2014 were included. CCI was determined using medical histories from general practitioners and hospital correspondence, and categorized into: no (CCI = 0), moderate (CCI = 1-2) or high (CCI≥3) disease burden. The following stages of post-resuscitation care were defined: (1) pre-hospital: from OHCA to hospital admission, (2) in-hospital: from hospital admission to hospital discharge. The association between CCI and overall survival and survival at successive stages of care was assessed using logistic regression analyses. Results were stratified according to sex.

Results
In the pre-hospital stage, no association between CCI and survival to hospital admission was found (OR 0.93, 95%CI 0.73-0.1.18, P = 0.61) (Figure 1). In contrast, during the in-hospital stage high CCI was significantly associated with lower survival rate (OR 0.41, 95% CI 0.27-0.61, P &lt; 0.01) (Figure 1), but, when stratified according to sex (pinteraction= &lt;0.01), this association was only statistically significant in men (OR 0.34; 95%CI 0.21-0.55; P &lt; 0.01), and not in women (OR 0.68; 95%CI 0.31-1.50; P = 0.33). When assessed individually, OHCA patients with congestive heart failure (24.8% vs. 12.0%, P &lt; 0.01), peripheral vascular disease (11.7% vs. 5.4%, P &lt; 0.01), diabetes (22.0% vs. 13.2%, P &lt; 0.01), renal disease (17.1% vs. 5.9%, P &lt; 0.01), malignancy (17.8% vs. 9.6%, P &lt; 0.01), chronic pulmonary disorder (19.9% vs. 13.7%, P &lt; 0.01), or dementia (0.3% vs. 3.0%, P &lt; 0.01), were less likely to survive during the in-hospital stage.

Conclusion
Pre-existing comorbidity burden plays a significant role in OHCA survival, but only during the in-hospital stage. In order to ultimately improve survival after OHCA, in-hospital care needs further study taking pre-existing comorbidity burden into account.
Abstract Figure 1
74Subclinical atrial fibrillation before and after acute medical illness or noncardiac surgery: insights from ASSERT
Authors: Mcintyre W , Wang J , Connolly S J , Benz A P , Conen D , Devereaux P J , Wong J A , Belley-Cote E P , Hohnloser S H , Capucci A , Lau C P , Gold M R , Whitlock R P , Healey J S 
Published: June 2020

Abstract

OnBehalf
ASSERT Investigators

Background
Atrial fibrillation (AF) is frequently detected perioperatively or during acute medical illness. It is unclear if such AF is reversible and unlikely to recur, or is a manifestation of paroxysmal AF.

Objective
To compare the prevalence of pacemaker-detected, subclinical AF (atrial rate &gt;190 bpm) before and after hospitalization for noncardiac surgery or medical illness in patients without a history of clinical AF.

Methods
ASSERT enrolled patients who were &gt;65 years old and had hypertension but no known AF. Pacemakers and defibrillators recorded episodes of subclinical AF. We identified participants who were hospitalized for noncardiac surgery or medical illness, and created heart rhythm profiles, centred on the day of hospitalization. We compared the prevalence of subclinical AF before and after hospitalization. We blanked the 30 days before hospitalization, because of uncertainty in defining the precise onset of illness.

Results
Among 2580 patients, 436 had a documented surgical or medical hospitalization. In the 30 days following a first hospitalization, 43 patients (9.9%) had &gt;1 episode of &gt;6 minutes of subclinical AF; 20 (4.6%) had &gt;6 hours and 13 (3%) had &gt;24 hours.
A higher proportion of patients had &gt;1 episode of subclinical AF &gt;6 minutes in the 30 days following a first surgical or medical hospitalization, as compared to the period between 30 and 60 days before hospitalization (9.9% versus 4.4%, P &lt; 0.001). There was no significant difference when comparing 0-90 days after hospitalization to 30-120 days before (13.7% versus 10.6%, P = 0.1). Similar results were observed for the same comparisons with episodes &gt;6 hours (4.6% versus 2.3%, P = 0.03 and 5.9% versus 5.6%, P = 0.8, respectively).
The majority of patients with subclinical AF in the 30 days following hospitalization had at least one episode of subclinical AF of the same duration in the 6 months prior (50% for episodes &gt;6 minutes; 69% for &gt;6 hours and 60% for &gt;24 hours). Those who did have subclinical AF in the 30 days following hospitalization were more likely to have had subclinical AF in the past 6 months than those who did not (OR 7.2 95%CI 3.2-15.8 for episodes &gt;6 minutes; OR 32.6, 95%CI 10.3-103.4 for &gt;6 hours and OR 36.3 95%CI 9.0-146.0 for &gt;24 hours).

Conclusions
The prevalence of subclinical AF increased following hospitalization for noncardiac surgery or medical illness. However, most patients with subclinical AF following hospitalization had previously experienced similar episodes, particularly those with longer episodes of subclinical AF.