bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2533Prospective randomized study on implanted cardiac rhythm recorders in pregnant women with symptomatic arrhythmia and/or structural heart disease
Authors: Viljoen C A , Sliwa K , Azibani F , Johnson M R , Baard J , Osman A , Briton O , Ntsekhe M , Anthony J , Chin A 
Published: October 2019

Abstract

Background
Cardiac arrhythmia is an important cause of maternal morbidity and mortality in pregnancy, but is difficult to diagnose.

Purpose
The aim of this single-centre, prospective, randomized pilot study was to compare the implantable loop recorder (ILR) with standard assessment of arrhythmia (12-lead ECG; 24-hour Holter ECG) in terms of acceptability, detection of arrhythmias and impact on outcome in pregnant women with symptomatic arrhythmias and/or structural heart disease (SHD).

Methods
The study recruited 40 consecutive patients from a weekly, dedicated cardiac obstetric clinic. Inclusion criteria: symptoms of arrhythmia and/or having SHD at risk of arrhythmia. Patients were randomized to either standard care (SC) or standard care plus ILR (SC-ILR). ILR recordings were read at the monthly visits and/or when presenting with symptoms.

Results
There were no demographic differences between the study groups. Seventeen patients consented to ILR insertion, all of whom found the procedure acceptable. No arrhythmias were recorded by the 12-lead ECGs. Holter monitoring detected arrhythmias in 10 of 23 patients (43%) from the SC group. In the SC-ILR group, 8 of 17 patients (47%) had arrhythmias detected by Holter, whereas 13 of 17 patients (76%) patients had arrhythmias detected by ILR (p=0.157). One of 4 patients with supraventricular tachycardia, 2 of 3 patients with premature ventricular complexes and 2 patients with paroxysmal atrial fibrillation (AF) recorded by ILR did not have the arrhythmias detected by Holter monitoring (Figure 1A shows a scatter plot of the variable R-R intervals seen in AF and 1B a rhythm strip of AF with irregular RR intervals and the absence of P waves, both downloaded from the ILR). Four of these 5 patients (80%) had a change in management as a direct result of their ILR recordings. There were no maternal deaths up to 42 days postpartum in either of the study groups. Nine babies were born with a low birthweight (<2500g), 5 stillbirth/neonatal deaths and 1 pregnancy termination occurred (5 in the Holter group and 1 in ILR group, p=0.37).
Figure 1

Conclusion(s)
This study suggests that an ILR is an acceptable diagnostic modality in pregnant women with a suspected or at risk of arrhythmia. The ILR increased the diagnostic yield to detect arrhythmias that were not detected by routine ECG and Holter monitoring which led to a change in management in the SC-ILR group and was associated with better maternal and neonatal outcomes. The impact of ILR monitoring should be further assessed in larger studies with longer follow up.
P2534Prevalence and risk factors of acquired LQTS among pregnancy: a single-center study
Authors: Han D , Sun C F , Li G L 
Published: October 2019

Abstract

Background
Prolonged QT intervals have been observed in pregnant women, especially those with twin pregnancy, which predisposes them to a high risk of ventricular arrhythmias.

Purpose
To evaluate the prevalence of acquired long QT syndrome (aLQTS) in hospitalized parturient women with single and twin pregnancy and search for potential risk factors.

Methods
Information about age-matched parturient women with single and twin pregnancy were retrospectively collected in our hospital from January 2016 to June 2018. The prevalence of aLQTS was evaluated. The common risk factors for corrected QT (QTc) prolongation were compiled, and multivariable logistic regression analysis was used to evaluate how each factor was related to aLQTS in such population.

Results
Totally 293 parturient women (147 twin pregnancy, 50.17%) were included. The prevalence of aLQTS was 72.70% in all cases, 53.15% in the single pregnancy, 93.20% in the twin pregnancy. The proportion of severely prolonged QTc was 36.18% in all cases, 8.22% in the single pregnancy and 63.95% in the twin pregnancy. The QTc interval was much longer in the twin pregnancy than in the single pregnancy with significant difference. Differences in systolic blood pressure, diastolic blood pressure, total cholesterol, serum uric acid, fetal weight, QRS, RV5+SV1, Tp-Te, Tp-Te/QT have been revealed to be statistically significant between the QTc-prolongation group and the QTc-normal group. The incidence of gestational hypertension and twin pregnancy in the QTc-prolongation group were more prevalent than in the QTc-normal group with significant difference. In the multivariable logistic regression analysis, gestational hypertension, twin pregnancy, increase of diastolic blood pressure, high total cholesterol, high serum uric acid, and heavy fetal weight were identified to be associated with QTc prolongation in parturient women.
Table 1. Risk factors significantly correlated with QTc prolongation in parturient women Index P value OR (95% CI) DBP (mmHg) 0.033* 1.052 (1.004 to 1.101) TC (mmol/L) 0.001** 1.442 (1.165 to 1.785) UA (μmol/L) 0.007** 1.004 (1.001 to 1.008) Fetal weight (g) <0.001** 1.001 (1.001 to 1.001) Hypertention (%) 0.029* 2.561 (1.099 to 5.967) Twin (%) <0.001** 12.618 (6.145 to 25.909)

Conclusion
To our knowledge, this is the first clinical study to evaluate the prevalence of aLQTS between single and twin pregnancy. The prevalence of aLQTS is much higher in the parturient women, particularly in twin pregnancy.
P2544Acute effects of synthetic cannabinoids on ventricular repolarization parameters
Authors: Yildiz S S , Sutasir N , Sigirci S , Topcu H , Kilickesmez K 
Published: October 2019

Abstract

Bacground
The association between ventricular repolarization parameters (VRP) and ventricular arrhythmias has been shown in previous studies. However, there are limited data on the association between synthetic cannabinoids (SCs) and VRP.

Purpose
To analysis the acute effects of SCs on VRP by using T-peak to T-end (Tp-e) interval, Tp-e/QT ratio and Tp-e/QTc ratio.

Methods
The present study included 58 patients who admitted to the emergency department and who used of SC (SC+) during the years 2014–2016, and 50 healthy control subjects (SC−). QT and QTc intervals, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured from the 12-lead electrocardiogram in all subjects. Then, this parameters were compared between the groups and were performed correlation analysis.

Results
The Tp-e and QTc intervals were significantly higher in SC+ when compared to SC- (92.2±10.0, 77.4±9.3, p<0.001; 434.5±30.8, 410.9±27.3, p<0.001, respectively). Tp-e/QT and Tp-e/QTc ratios were increased in SC+ in comparison to SC− (0.26±0.02, 0.22±0.02, p<0.001; 0.21±0.02, 0.18±0.02, p<0.001, respectively). Significant correlations were found between use of SC and Tp-e interval (r=0.610, p<0.001), Tp-e/QT (r=0.655, p<0.001) and Tp-e/QTc ratios (r=0.437, p<0.001).
Table 1. Electrocardiographic findings in between SC+ group and SC− group. SC+ group (n=58) SC− group (n=55) p value QRS duration (ms) 92.6±8.2 90.1±7.9 0.492 QT (ms) 348.4±29.0 353.4±30.7 0.301 QTc (ms) 434.5±30.8 410.9±27.3 <0.001 Tp-e (ms) 92.2±10.0 77.4±9.3 <0.001 TPe/QT ratio (ms) 0.26±0.02 0.22±0.02 <0.001 TPe/QTc ratio (ms) 0.21±0.02 0.18±0.02 <0.001

Conclusion
The present study revealed that Tp-e interval, Tp-e/QT and Tp-e/QTc ratios increased in subjects who used SC. Therefore, SC users might have an increased risk of ventricular arrhythmia.
P2546The treegenes study: psycho-trauma and cardiovascular impact in offspring
Authors: Barth J D , Van Beurden-Cahn M M 
Published: October 2019

Abstract

Introduction
The TreeGenes study assesses health, chronic psycho-trauma, and disease in three Dutch post-Holocaust generations. It has been shown before that chronic psycho-trauma accelerates atherosclerosis and Post Traumatic Stress Disorder (PTSD) offspring shows signs of both increased cardiovascular morbidity and mortality. Hypothesis: PTSD offspring lacks adequate specialized medical intervention.

Methods
Mental health problems play an important role in this group and may contribute to chronic diseases. Therefore, we studied disease management in this group with a focus on cardiovascular disease (CVD). Cases and controls were randomly drawn from the TreeGenes database. Extensive personalized interviews and assessment of CVD were done non-invasively (heart rate variability, ECG, blood pressure and saturation assessment). In addition, risk factors and medication were noted.

Procedures
38 Cases of PTSD offspring were assessed for CVD as well as other chronic diseases in an outpatient setting.

Results
Most study cases were suffering from chronic and active diseases: notably hypertension, CVD, gastrointestinal diseases as well as mental problems. All cases were seen by local family physicians and a psychological/psychiatric support system. Cases that were suffering from CVD were treated according to routine treatment protocol standards. Medical care was considered adequate by health care professionals standards.
Study characteristics TreeGenes participants (n) Study group Controls Significance level Age in years (range) 65 (61–73) 62 (58–70) Active CVD 32/38 2/38 p<0.01 Hypertension medication 28/38 4/38 p<0.01 Lipid problem medication 31/38 6/38 p<0.01 Arrythmia 10/38 2/38 p<0.01 Smoking 2/38 1/38 ns Psychotropic medication 38/38 4/38 p<0.001 ns, not significant; psychotropic medication: anxiolitics, antidepressants and major psychotropic medication; CVD, cardiovascular disease, n, number.

Conclusion
The results (table 1) from the two groups are significantly different though matched for age and gender. Given the extra care offered to this offspring group, successful treatment of the underlying diseases should have been better. Given the poor success rate of routine protocol assessment, specialized training should be given to medical personnel involved. These results demand further investigation in similarly affected populations.

Acknowledgement/Funding
Jeremiasz Foundation
P2554Bleedings during antithrombotic therapy: a blessing in disguise
Authors: Cosmi D , Mariottoni B , Cosmi F 
Published: October 2019

Abstract

Background and purpose
Antithrombotic therapy in patients with heart diseases is associated with minor and major, sometimes fatal bleedings. On the other hand, bleeding can favor the diagnosis of diseases that have a significant impact on patient's prognosis. In our research, we evaluated the incidence of occult malignancies associated with bleeding during antithrombotic therapy.

Methods
In the last 5 years, we evaluated 20,154 outpatients. We found that antithrombotic therapy was performed in 9.356 (46%) of subjects.
Of these, 6,560 took an antiplatelet monotherapy. 658 were on dual antiplatelet therapy, 465 were anticoagulated with warfarin, 1,154 received new anticoagulants, 145 were on triple antithrombotic therapy, and 354 patients took one anticoagulant plus an antiplatelet.
Twenty patients who already had a diagnosis of malignancy were excluded from the analysis. In a one year follow-up, we evaluated the incidence of minor, major and fatal bleedings.
All patients with bleedings and suspicion for occult malignancies underwent further diagnostic investigations.

Results
Table 1 shows the incidence of bleeding (classified according to the ISTH bleeding score). Overall, there were 1,045 bleeds, of which 289 (3.1%) were major, and 756 (8.1%) minor. In 2 cases the bleeding was fatal (0.2%).
Malignancies were identified in 88 patients (8.4%); in 72 cases (82%) the treatment was resolutive.
Table 1. Rates of major and minor bleedings and occult malignancies Bleedings Major Occult malignancies Minor Occult malignancies Gastrointestinal 130 (1.4%) 15 (5.1%) 289 (3.1%) 45 (6.0%) Urinary 46 (0.5%) 6 (2.1%) 207 (2.2%) 14 (1.8%) Musculo-cutaneous 30 (0.3%) – 47 (0.5%) Epistaxis and airways 36 (0.4%) – 198 (2.1%) 8 (1.0%) Intracranial 28 (0.3%) – – – Ocular 9 (0.1%) – 15 (0.2%) – Intraarticular 10 (0.1%) – – – Others – – – Total 289 (3.1%) 21 (7.2%) 756 (8.1%) 67 (8.8%)

Conclusions
Our research underlines the importance of prosecuting diagnostic investigations even in patients with minor bleedings, especially in case of gastrointestinal or urinary bleedings, to exclude cancer, since there were no significant differences in the incidence of malignancies between the two groups.
P2557A novel tool for light sheet-guided analysis of myocardial injury in murine and human samples
Authors: Korste S , Merz S F , Bornemann L , Michel L , Stock P , Hendgen-Cotta U , Rassaf T , Gunzer M , Totzeck M 
Published: October 2019

Abstract

Background
Cardiovascular diseases are the most prominent global health threats. For optimal treatment, myocardial biopsies are an indispensable requirement. Current analysis includes histological and biochemical assays with particular limits. Here we present a first approach utilizing light sheet fluorescence microscopy (LSFM) to visualize the 3D vasculatory architecture in the murine heart after experimental myocardial infarction (MI) and in human cardiac biopsies with simultaneously imaging of various immunological infiltrates for disease investigation.

Methods and results
For murine hearts, cardiac vasculature was stained using CD31-AF790 antibody, where we found distinct spots of negative staining, which correlated in size and localisation with other markers of cardiac damage such as triphenyl tetratzolium chloride (TTC) staining, ejection fraction (EF) reduction and plasma cardiac troponin I levels. Using a Ly6G-AF647 antibody, we were able to visualize neutrophil infiltrates 24 h after MI, which localized at the border of the I/R-injury zone. 5 d after MI we imaged the healing vasculatory network using the CD31 marker as well as infiltrated macrophages using F4/80 staining.
Human cardiac vasculature was stained using CD31-AF790 antibody in a whole-mount staining approach. In short, human samples were fixed in 4% PFA and permeabelized using saponin-based detergents. Antibody staining was conducted at 30 °C in the dark over several days. Immunological infiltrates were visualized using human CD66b, CD16, CD64, CD3 and CD19 antibodies in various, simultaneous approaches. After staining, cardiac samples were dehydrated and cleared using ethyl cinnamate (ECi) for light sheet microscopy. The spatial resolution of cardiac blood vessels was determined by CD31 staining, revealing a highly organized and structured vascular tree. Simultaneous staining for immunological infiltrates showed association with areas of enhanced CD31 staining, displaying activated endothelium at sites of inflammation.
Ly6G events in a murine heart

Conclusion
Light sheet-guided analysis of cardiac samples shows promising results in terms of synchronous vascular and immunological investigation. We highlighted its applicability in identifying specific immune cells based on immune-phenotyping. This novel technique may enable future clinical heart disease investigation with a powerful tool for visualization of 3D cardiac structure and identification of multiple immune cell infiltrates.
P2562Changes in the electrocardiographic/mechanical relation may explain the low risk of arrhythmia during moderate hypothermia
Authors: Wisloff-Aase K , Skulstad H , Halvorsen P S , Fiane A E , Espinoza A 
Published: October 2019

Abstract

Introduction
Hypothermia is therapeutically used after cardiac arrest. The moderate hypothermia alters cardiac function, with reduced heart rate (HR), prolonged systolic duration and increased QT interval. The risk of arrhythmia increases with prolonged QT-interval, but clinical studies have not been able to demonstrate an increase of arrhythmic events during moderate hypothermia. The mechanism of this is not thoroughly described, but the concurrent increase in mechanical systolic duration may play a part of the explanation.

Purpose
QT prolongation and increased electromechanical window (EMW) negativity; the duration of left ventricle mechanical systole relatively to the duration of the electrical systole, are associated with arrhythmia. We hypothesized that moderate hypothermia would increase ECG intervals and systolic duration without an increase in EMW negativity.

Methods
In an open-chest porcine model (n=10), 2D echocardiography measurements and Doppler recordings were performed with concurrent 3-lead ECG registrations during normothermia (38°C) and moderate hypothermia (33°C) at spontaneous HR. Diastolic and systolic durations were assessed by valve opening to valve closure and Doppler assessed ejection time (ET). Isovolumetric contraction time (IVCT) and EMW, were measured. Systolic function was assessed by ejection fraction (EF), stroke volume (SV) and systolic velocity (s'). Results are presented as means ± SD. Two-sided T-test was used for comparison and P-value <0.05 was considered significant.

Results
Moderate hypothermia reduced HR from 91±9 to 82±7 beats/min (p<0.0001) and increased QT and QT-corrected (QTc) intervals, the latter from 484±52 to 555±50 ms (p<0.0001). Systolic duration increased as ET was prolonged from 293±15 to 397±39 ms (p<0.0001). There was a reduction in systolic velocity (s') (p=0.003) but a non-significant reduction in EF and SV. EMW changed from a negative to a positive value, −49±57 to 9±53 ms (p=0.017) during moderate hypothermia.

Conclusion
Moderate hypothermia increased the QTc-interval but the mechanical systolic duration was even more prolongated. The EMW became positive demonstrating that the mechanical systole outlasted the electrical systole. As less EMW negativity is considered to be protective regarding arrhythmia, these findings may explain why arrhythmia is not frequently occurring during moderate hypothermia.

Acknowledgement/Funding
None
P2565Decreased cardiac pacemaking and attenuated beta-adrenergic response in tric-a knock-out mice
Authors: Toyama Y , Yonekura M , Tomita H , Murakami M 
Published: October 2019

Abstract

Background
Trimeric intracellular cation (TRIC) channels are expressed on the surface of the sarcoplasmic reticulum and compensate for calcium release from ryanodine receptors. Tric-a knock-out (KO) mice showed diminished calcium release from ryanodine receptors in vascular smooth muscle cells. The cardiac pacemaker is controlled by the surface membrane and intracellular calcium clocks. In spontaneously firing sinus node action potentials, the membrane and calcium clocks work together via numerous interactions modulated by membrane voltage, intracellular calcium release, and protein phosphorylation. Intracellular calcium changes modulate cardiac pacemaking in the sinus node, but the physiological importance of TRIC channels in cardiac rhythm formation is still obscure.

Purpose
In this study, we aimed to clarify the importance of TRIC channels on cardiac pacemaking using Tric-a KO mice.

Methods
The expression level of mRNA and proteins in the sinus node was examined by RT-PCR and immunoblotting. Systolic blood pressure was measured with tail-cuff method. Heart rate was measured by ECG, and heart rate variability was examined. The atrial contractile force from isolated hearts was measured with a force transducer. Cardiac action potential and spontaneous sinus rate from isolated hearts were measured with a microelectrode. Isoproterenol was used for sympathetic nerve manipulation.

Results
Tric-a KO heart showed increased adrenergic β1-receptor expression in immunoblotting. Although there was no significant difference in basal systolic blood pressure between Tric-a KO and wild type (WT) mice, basal heart rate in Tric-a KO mice was significantly lower than that in WT mice (660±10 and 698±10 bpm, n=15 and 19, Tric-a KO mice and WT mice, respectively, p=0.017). Tric-a KO mice showed limited heart rate changes to isoproterenol (24±6 and 99±15 bpm, n=9 and 10, Tric-a KO mice and WT mice, respectively, p<0.001). In the action potential recordings, Tric-a KO atria showed only limited sinus rate changes to isoproterenol (35±9 and 71±10 bpm, n=8 and 6, Tric-a KO mice and WT mice, respectively, p=0.038). WT mice and Tric-a KO mice atrial contractile force showed dose-dependent changes in response to isoproterenol (10–100 nM), but Tric-a KO mice atria showed limited contractile force changes to isoproterenol (116 and 169%, n=7 and 6, Tric-a KO mice and WT mice, respectively, p<0.01). In heart rate variability, Tric-a KO mice showed unstable RR intervals and longer standard deviation of RR intervals than WT mice.

Conclusion
Tric-a KO mice showed decreased cardiac pacemaking in the sinus node and attenuated responses to beta-adrenergic stimulus, which indicates the involvement of TRIC channels in cardiac rhythm formation and sympathetic nerve regulation.
P2579Experience of application in Russia pulsoxymetry as screening for detecting critical states in the newborns: critical congenital heart defects and pulmonary hypertension
Authors: Kustova N , Sadykova D R , Sabirova D R , Babintseva A A 
Published: October 2019

Abstract

Despite the improvement in the last decades of prenatal ultrasound diagnosis and clinical examination of newborns, even in countries with developed health care, up to 28% of newborns with critical congenital heart defects (CHD) are discharged from the hospital without a diagnosis. Early detection of persistent pulmonary hypertension in newborns (PPHN) is often associated with certain difficulties, which leads to a delayed diagnosis of this syndrome and a later start of therapy.

Objective
To improve the methods of diagnosing the early detection of newborns with hypoxemia due to critical CHD or persistent pulmonary hypertension of the newborn, as well as to achieve a reduction in infant mortality.

Materials and methods
During the study period – from April 2017 to February 2018 using the developed algorithm for performing screening of critical conditions in newborns using pulse oximetry, 8,358 newborns were examined on the basis of maternity hospitals of the Republic of Tatarstan, which accounted for 88.4% of 9459 births registered. A modified two-band pulse oximetry technique was used, followed by echocardiography of the newborn with a positive screening result.

Results
The introduction of pulse oximetry screening in the early neonatal period (3rd hour of life) allowed the timely detection of 95 children with a positive test result, whose conditions caused the greatest risk to the health of newborns, which accounted for 1.14% of all children studied. Thanks to the screening, in 13 newborns in the first hours of life, congenital heart defects that were not diagnosed in utero were detected, 5 of them were critical. Persistent pulmonary hypertension was detected in 20 patients. Intrauterine pneumonia was diagnosed in 30 newborns. Among the critical CHDs, the following diagnoses were established: transposition of the great vessels – 2 children, aortic coarctation – 1 child, total abnormal pulmonary vein drainage – 1 child, Taussin-Bing anomaly – 1 child. Evaluation of the effectiveness of the screening showed that a positive result had a decisive role in the timely diagnosis of critical CHD and persistent pulmonary hypertension of the newborn.

Conclusions
Pulse oximetry helps to identify both systemic hypoxemia and postductal desaturation, which is characteristic of both critical CHD and PPHN, and can be used to screen newborns for these conditions. Pulse oximetry is an easily accessible, non-invasive, painless method that can be included in a regular examination of the newborn. The advantages of pulse oximetry also include simplicity and short procedure time.