bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term follow-up of patients with tetralogy of Fallot and implantable cardioverter defibrillator
Authors: Waldmann V , Bouzeman A , Duthoit G , Koutbi R , Bessiere F , Labombarda F , Marquie C , Gourraud J.B , Ladouceur M , Mondoly P , Sacher F , Iserin L , Thambo J.B , Combes N , Marijon E 
Published: November 2020

Abstract

Background
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and sudden cardiac death represents an important mode of death in these patients. Data evaluating the implantable cardioverter defibrillator (ICD) in this patient population remain scarce.

Purpose
We aimed to describe long-term follow-up of patients with TOF and ICD through a large nationwide registry.

Methods
Nationwide Registry including all TOF patients with an ICD initiated in 2010. The primary outcome was the first appropriate ICD therapy. Secondary outcomes included ICD-related complications, heart transplantation, and death. Clinical events were centrally adjudicated by a blinded committee. Cox proportional hazard models were used to identify predictors of appropriate ICD therapies and ICD-related complications.

Results
A total of 165 patients (mean age 42.2±13.3 years, 70.1% males) were included from 40 centers, including 104 (63.0%) in secondary prevention. During a median (IQR) follow-up of 6.8 (2.5–11.4) years, 78 (47.3%) patients received at least one appropriate ICD therapy, giving an annual incidence of 10.5% (7.1% and 12.5% in primary and secondary prevention, respectively, p=0.03). Overall, 71 (43.0%) patients presented with at least one complication, including inappropriate ICD shocks in 42 (25.5%) patients and lead/generator dysfunction in 36 (21.8%) patients. Among 61 (37.0%) primary prevention patients, the annual rate of appropriate ICD therapies was 4.1%, 5.3%, 9.5%, and 13.3% in patients with respectively no, one, two, or ≥ three guideline-recommended risk factors. In our cohort, QRS fragmentation was the only independent predictor of appropriate ICD therapies (HR 4.34, 95% CI 1.42–13.23), and its integration in a model with current criteria increased the area under the curve from 0.61 to 0.72 (p=0.006). No patient with left ventricular ejection fraction (LVEF) ≤35% without at least one other risk factor had appropriate ICD therapy. Patients with congestive heart failure and/or reduced LVEF had a higher risk of non-sudden death or heart transplantation (HR=11.01, 95% CI: 2.96–40.95).

Conclusions
Our findings demonstrate high rates of appropriate therapies in TOF patients with an ICD, including in primary prevention. The considerable long-term burden of ICD-related complications, however, underlines the need for careful candidate selection. A combination of easy-to-use criteria might improve risk stratification beyond low LVEF.
Freedom from appropriate ICD therapy

Funding Acknowledgement
Type of funding source: None
Optimal programming of cardiac resynchronisation therapy with His bundle pacing based on aortic velocity time integral in patients with congestive heart failure and permanent atrial fibrillation
Authors: Boczar K , Zabek A , Slawuta A , Debski M , Gajek J , Lelakowski J , Malecka B 
Published: November 2020

Abstract

Background
Cardiac resynchronisation therapy (CRT) in patients with permanent atrial fibrillation (AF) is usually less effective than in sinus rhythm patients. Recent evidence has shown that His bundle pacing (HBP) might be a valuable alternative to conventional pacing systems resulting in more physiologic electrical activation of the heart. Currently, there is a need to identify the optimal way of CRT + HBP programming in patients with congestive heart failure (CHF) and permanent AF to achieve high cardiac output and improve physical capacity and survival.

Purpose
The aim of this study was to evaluate the impact of CRT + HBP programming on cardiac output in the early post-operative measurements.

Methods
We included consecutive patients with: 1. permanent AF, 2. CHF in NYHA class III-IV, 3. bundle branch block with QRS &gt;130 ms or QRS &lt;130 ms and high expected requirement of ventricular pacing, 4. severely reduced left ventricular ejection fraction (LVEF) ≤35%, 5. CHF refractory to optimal medical therapy, 6. implanted CRT + HBP. All patients gave informed consent for CRT + HBP implantation and optimization of device programming.
During the early post-operative phase, we aimed to optimize CRT + HBP settings in order to achieve the highest cardiac output assessed by repeated echocardiographic measurements of aortic velocity time integral at various pacing programs (Table 1). Then, we selected the optimal pacing settings of CRT + HBP for each individual patient.

Results
Study included 17 consecutive patients aged 71.5±6.3 years, 12 were male. Mean LVEF was 24% and median NYHA class was III. The most efficacious method of pacing in terms of aortic VTI was HBP combined with left ventricular pacing (LV) which resulted in median VTI of 22.5. HBP + LV was superior to right ventricular pacing (RV): VTI of 22.5 vs 18.5, P=0.003 and outperformed biventricular pacing: VTI 22.5 vs 18.7, P=0.019. Detailed results are shown in Figure 1.

Conclusion
His bundle pacing coupled with LV pacing proved to be the most advantageous pacing program setting with regard to cardiac output and it performed significantly better than RV pacing only or biventricular pacing. Our observation supports the use of His bundle pacing in CRT systems in patients with CHF and permanent AF.
Figure 1

Funding Acknowledgement
Type of funding source: None
Cardiac changes after cardiac resynchronization therapy assessed using cardiac magnetic resonance imaging during biventricular pacing
Authors: Czimbalmos C , Papp R , Szabo L , Toth A , Csecs I , Suhai F.I , Molnar L , Kosztin A , Geller L , Merkely B , Vago H 
Published: November 2020

Abstract

Cardiac magnetic resonance (CMR) is a valuable tool in the assessment of left and right ventricular volumes and functions therefore establishing the effect of cardiac resynchronization therapy (CRT), but in majority of the devices MR safe mode does not include biventricular pacing as an option. We aimed to assess the effect of cardiac resynchronization using CMR with resynchronization on.
NYHA class II-III patients with LVEF≤35% despite optimal medical therapy and complete LBBB with broad QRS (&gt;150 ms) were prospectively recruited (n=16, 65±7 years, 56% male, 69% nonischaemic). CMR examination was performed at baseline and at 6-month follow-up, applying both biventricular and AOO pacing. The following data were measured: conventional CMR parameters including left and right ventricular ejection fraction (LVEF), end-diastolic index (LVEDVi) and end-systolic volume index (LVESVi), stroke volume and mass, remodelling indices such as 3D sphericity and relative wall thickness (RWT: 2x end-diastolic wall thickness /end-diastolic long-axis diameter). Using feature tracking analysis global longitudinal, circumferential, radial strain, global dyssynchrony (mechanical dispersion (MD)) and regional dyssynchrony was measured.
Comparing the baseline and follow-up CMR parameters measured during biventricular pacing, we found a significant increase in LVEF (27±7 vs 45±9%; p&lt;0.001) and decrease in LVEDVi and LVESVi (LVEDVi: 149±28 vs 91±20ml/m2; LVESVi: 108±31 vs 51±17ml/m2; p&lt;0.001). Based on decrease in LVESVi 14 patients were classified as super-responder (&gt;30%), one responder (&gt;15%) and one non-responder (&lt;15%). ProBNP levels significantly decreased (1186±83 vs 323±271 pg/ml, p&lt;0.05). LV remodelling indices (3D sphericity: 0.46±0.13 vs 0.61±0.11, RWT: 0.33±0.07 vs 0.43±0.10), global longitudinal, circumferential and radial strain values showed significant improvement. Circumferential MD decreased (18.3±6.7 vs 13.3±3.4, p&lt;0.01), while longitudinal MD did not change. Regional dyssynchrony drastically improved (358±108 vs 98±61ms, p&lt;0.001). Applying AOO pacing resulted in an immediate deterioration in LVEF (45±9 vs 38±9%), LVESVi (51±17 vs 58±19 ml/m2), global circumferential and radial strain and regional dyssynchrony.
In conclusion CMR imaging during biventricular pacing is feasible and enables a more precise quantification of LV function, morphology and mechanics. As a result, it may contribute to a better understanding of the effects of resynchronization therapy and might improve responder rate in the future.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office of Hungary (NKFIA)
Total remote pacemaker follow-up versus standard follow-up reduces global health care utilization
Authors: Ayala Valani L , Badra Verdu M , Dussault C , Roux J.F , Ayala Paredes F 
Published: November 2020

Abstract

Background
Remote pacemaker monitoring reduces in person pacemaker clinic visits, but a complete remote follow-up could be associated with an increase in total clinical encounters or even admissions, as patients (pts) have less access to a cardiologist or health care provider in a regular basis.

Methods
Due to a shortage in EP cardiologists between 2009 and 2012 a cohort of 296 pts implanted with a pacemaker, were offered Biotronik home monitoring only follow-up (HM f-p); gradually since 2012, pts came back to usual schedule (once or two a year in clinic follow-up). We matched the same amount of time in HM f-p to standard pacemaker follow-up (STD f-p), aiming to detect any difference in health care utilisation (clinical visits and admissions of all cause). For non de novo implants, the STD f-p period was calculated backwards until pacemaker replacement.

Results
One third of pts refused, were non compliant or were disconnected early (less than 6 months) to HM f-p only; 200 patients completed a median of 804 days in RM f-p only (range 88–3003 days). Mean age at implant was 74.9 years old (range 22.9–92.3, median 78 y.o.), 57.5% were male and 76% had de novo implants (15% VVI, 82% DDD and 3% CRT-P devices). The median of unscheduled pacemaker visits was 1 (range 0 to 7, 22.5% of pts never required a pacemaker clinic visit during HM f-p). The load of HM messages (number and type -i.e. administrative, clinical and clinical triggering a visit) was similar between both periods of follow-up. During HM f-p there were a median of 3 pacemaker clinic visits saved (range −3 to 16) as expected, but total number of visits were also reduced significantly from a median of 12 (range 1–115) to 8 (0–90) visits p&lt;0.05, between STD f-p versus HM f-P (mean visits reduced from 16.96±16.4 versus 13.91±15.7). Finally, there was not an increase in total admissions between these two periods of f-up (mean of 0.8±1.3 for STD f-p versus 0.4±0.8 for HM f-p, median of 0 hospitalizations for both groups range de 0–8 versus 0–5, p=NS)

Conclusion
Total remote pacemaker follow-up is feasible in two thirds of patients, and when achieved, it saves in person pacemaker follow-up visits and visits of any cause, without increasing the number of admissions during the same period.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Centre de recherche du CHUS - CIUSSS de l'Estrie
Success and complication rate of Tightrail mechanical percutaneous lead extraction: a multicenter French study
Authors: Artus A , Guenancia C , Behar N , Leclercq C , Schatz A , Mansourati J , Garnier F 
Published: November 2020

Abstract

Background
Our objective was to assess Philips TightRail™ rotating dilator sheath efficacy and safety for extraction of endocardial leads. No large scale multicenter data is available on this mechanical lead extraction device, now commonly used in France.

Methods and results
We conducted a retrospective, multicenter (from 4 French university hospitals) study. These centers that only perform mechanical lead extraction using this device were selected on the basis of the annual volume of procedures (&gt;10 leads/year). All patients from January 2015 to January 2020 who underwent at least one extraction of an endocardial lead with using TightRail™ were included. All of the extracted leads were &gt;12 months old and indications for extraction were based on ESC guidelines.
Overall, 395 leads were extracted using TightRail™ in 203 patients (mean age 70 years, 75% male sex).
Indications for lead removal included cardiac device infection in 172 (85%) cases, lead malfunction in the 25 (12%) cases, vein thrombosis in 3 (1.5%) cases and 3 for other indications (1,5%). The extracted devices were pacemaker in 134 (66%) cases, implantable cardioverter-defibrillator (ICD) in 69 (44%) cases. The mean time from implantation was 124 months. Complete procedural success with TightRail™ system alone was achieved in 180 (89.1%) patients (352 leads) and overall clinical success was 93% (367 leads). Fifteen right sided leads were completely removed with the help of femoral snare. Ten (5%) patients had at least one major perioperative complication: 3 cardiac tamponades, 1 haemothorax, 1 stroke, 5 vascular breaches requiring surgical intervention. No in-hospital death was observed.

Conclusion
Our large scale retrospective study in 4 high-volume mechanical lead extraction centers shows that TightRail™ is highly effective for chronically implanted lead extraction. The safety profile appears similar to the rate recently described with power sheaths.

Funding Acknowledgement
Type of funding source: None
The relationship between the key markers of myocardial fibrosis and gut microbiota composition in patients with heart failure and preserved ejection fraction
Authors: Kaburova A.N , Drapkina O.M , Uydin S.M , Pokrovskaya M.S , Koretsky S.N , Efimova I.A , Makarov V.V 
Published: November 2020

Abstract

Background
Increased myocardial fibrosis may play a key role in heart failure with preserved ejection fraction (HFpEF) pathophysiology. The current gold standard for the diagnosis and assessment of myocardial fibrosis is endomyocardial biopsy. A number of circulating biomarkers have been proposed for the assessment of myocardial fibrosis, however the most consistent results have been found for C-terminal propeptide of procollagen type I (PICP) and N-terminal propeptide of pro-collagen type III (PIIINP). Some evidence suggests the possible link between the gut microbiota composition and myocardioal fibrosis.

Purpose
The aim of the study was to investigate the association between the serum markers of myocardial fibrosis (PICP and PIIINP) with gut microbial genera in patients with HFpEF.

Methods
42 patients with confirmed HF-pEF (mediana and interquartile range of age 67 [64; 72] years, 47% men, body mass index &lt;35 kg/m2 with no history of myocardial infarction or diabetes mellitus) were enrolled in the study. The patients underwent transthoracic echocardiography with Doppler study, HF-pEF was confirmed according to the recent ESC guidelines (based on E/e' ratio, N-terminal pro-B type natriuretic peptide &gt;125 pg/ml and symptoms of HF). The levels of PICP and PIIINP were evaluated in patients' serum using enzyme-linked immunosorbent assay. The intestinal microbiome was investigated using high-throughput sequencing of bacterial 16S rRNA gene.

Results
The mediana and interquartile range in PICP was 918 [700; 1044] pg/ml, in PIIINP it was 6.215 [3.99; 8.29] pg/ml. The analysis revealed significant correlations between PICP and the following bacterial genera of Firmicutes:Ruminococcus (r=−0,36); Gemmiger (r=−0,35), Allisonella (r=0,32) and Howardella (r=−0,30). PIIINP significantly correlated with 2 genera: Blautia which belongs to Firmicutes phylum (r=0,36) and Bilophila which belongs to Proteobacteria phylum (r=−0,33). All values with p&lt;0,05.

Conclusion
Both PICP and PIIINP had negative significant correlations with beneficial bacterial genera and positive correlations with several potencially harmful gut bacterial genera. This type of relationship might become the novel field of research in the group of patients with HF-pEF due to myocardial fibrosis.

Funding Acknowledgement
Type of funding source: None
The link between left ventricular extracellular volume determined by T1 myocardial mapping and gut microbiota composition in individuals with heart failure and preserved ejection fraction
Authors: Kaburova A.N , Drapkina O.M , Uydin S.M , Vishnyakova M.V , Pokrovskaya M.S , Koretsky S.N , Abramenko A.S , Chermensky G.V , Efimova I.A , Makarov V.V 
Published: November 2020

Abstract

Introduction
Heart failure with preserved ejection fraction (HFpEF) represents a major challenge in modern cardiology. As described previously, in HFpEF comorbidities promote a systemic inflammatory state, leading to diffuse myocardial fibrosis resulting in myocardial stiffening. Gut dysbiosis which is considered as the novel source of chronic systemic inflammation has been actively investigated as the risk factor for the development and aggravation of cardiovascular diseases including heart failure. Cardiac magnetic resonance T1-mapping is a novel tool, which allows noninvasive quantification of the extracellular space and diffuse myocardial fibrosis. Moreover, the extracellular volume (ECV) fraction can be calculated, providing information on the relative expansion of the extracellular matrix, thus being a noninvasive alternative to myocardial biopsy studies.

Purpose
The research was aimed at investigating the correlation between the left ventricular ECV and gut microbial genera in patients with HFpEF.

Methods
42 patients with confirmed HF-pEF (mediana and interquartile range of age 67 [64; 72] years, 47% men, body mass index &lt;35 kg/m2 with no history of myocardial infarction or diabetes mellitus) were enrolled in the study. The patients underwent transthoracic echocardiography with Doppler study, HF-pEF was confirmed according to the recent ESC guidelines (based on E/e' ratio, N-terminal pro-B type natriuretic peptide &gt;125 pg/ml and symptoms of heart failure). The intestinal microbiome was investigated using high-throughput sequencing of bacterial 16S rRNA gene. As the last step of research T1-myocardial mapping with the modified look-locker inversion-recovery protocol (MOLLI) sequence at 1.5 Tesla was performed to assess left ventricular extracellular volume fraction.

Results
The mean±std in ECV was 31.02±4.4%. The relative abundance (%) of the most prevalent phyla in gut microbiota was 48±22.5 for Firmicutes, 47.4±22.8 for Bacteroidetes and 1.5 [1.5; 2.5] for Proteobacteria. The analysis showed significant negative correlations between ECV and the following bacterial genera: Faecalibacterium (r=−0.35), Blautia (r=−0.43), Lachnoclostridium (r=−0.32). Moreover ECV positively correlated with Holdemania (r=0.4), Victivallis (r=0.38), Dehalobacterium (r=0.38), Enterococcus (r=0.33) and Catabacter (r=0.32). All correlation values with p&lt;0.05.

Conclusion
We discovered both negative and positive significant correlations between ECV – the non-invasive marker of myocardial fibrosis and several bacterial genera, which may have negative impact on myocardial remodeling in HF-pEF.

Funding Acknowledgement
Type of funding source: None
Evaluating diastolic and systolic reserve by strain imaging during resistance exercise training in heart failure with preserved ejection fraction
Authors: Jain V , Nhola B.L , Larsen C.M , Villarraga N , Anastasius M , Badawy M , Zahid A , Bruhn E.J , Smith J.R , Bonikowske A , Olson T.P , Villarraga H.R 
Published: November 2020

Abstract

Background
Exercise intolerance is the cardinal manifestation of heart failure (HF), yet its underlying mechanism(s) remain poorly understood. Measures of ventricular function such as ejection fraction often have no relationship with exercise capacity in HF. 2D-STE has proved to be more reliable method to evaluate myocardial mechanical function. Our hypothesis is Resistance exercise training (Resist-HFpEF) will improve exercise tolerance and exertional symptoms in patients with HFpEF.

Purpose
The study aims to evaluate myocardial mechanical function by strain imaging during resistance exercise training in Heart Failure patients with Preserved Ejection Fraction (HFpEF)

Methods
This is a single centre prospective pilot study. 24 HFpEF patients were enrolled and their baseline comorbidities were recorded. Baseline 2D-STE imaging was performed at rest and during exercise (Visit 1). Patients were then randomized to either a novel resistance exercise training program for 36 sessions (3 sessions per week for 12 weeks) or a standard of care control group. 2D STE imaging was then repeated at follow-up (Visit 2). Peak Global Longitudinal strain (GLS), systolic strain rate (SSR), early diastolic strain rate (SRe) were measured offline.

Results
Mean age of the Rehab cohort was 68.57±10.52 years and the control cohort was 68.1±6.47 years. 23 study subjects were male (96%). 17% of the study subjects were hypertensive, 63% were diabetic, 42% had NYHA I, 46% had NYHA II and 13% had NYHA III of heart failure. The mean LV ejection fraction in the control and Rehab group after the training program at rest was 61.88±2.26% & 54.74±2.07% (p-value 0.04) and during exercise was 59.90±2.05% and 53.13±2.05% (p-value 0.04). The peak GLS was −18.80±4.29% and −17.7±2.21% in controls during rest and exercise at Visit 1 (p-value 0.27) while the rehab cohort had −18.71±4.7% and −20.82±2.4% respectively (p-value 0.0268). The peak GLS was −17.40±3.05% and −17.96±2.65% in controls during rest and exercise at Visit 2 (p-value 0.3430) while rehab cohort had −17.97±6.21% and −16.57±3.82% respectively (p-value 0.67). (Figure 1a and 1b shows GLS, SRS, SRe at Baseline and after exercise program respectively)

Conclusion
This pilot study suggest systolic and diastolic reserve can be measured reliably during low grade exercise. These results could reflect improvement in clinical status and exercise tolerance.
Figure 1. Comparison of peak GLS, SSR, SRe amongst HFpEF patients at rest and during exercise before and after the rehab training program.

Funding Acknowledgement
Type of funding source: None