bluuebunny/crossref_metadata_2025_split huggingface dataset:
P309R' wave in precordial leads V1-V2 in patients from the young SCD-SOS cohort
Authors: Carrington M , Creta A , Santos R , Teixeira R , Goncalves L , Providencia R 
Published: October 2019

Abstract

Introduction
Sudden Cardiac Death – Screening Of risk factorS (SCD-SOS) survey aimed to screen for warning signs of potential channelopathies and cardiomyopathies that may course with sudden cardiac death in the young (≤40 years old) and consisted in an ECG and a digital-based previously validated questionnaire.

Purpose
We aimed to study clinical and electrocardiographic characteristics of young patients from the SCD-SOS cohort who presented with an r'-wave in precordial leads V1 and V2.

Methods
All the ECG were screened for the detection of an r'-wave in precordial leads V1 and V2. The ECGs selected were reviewed by a second investigator (agreed in 97.7% of the cases). We performed classical descriptive statistics and multivariate logistic regression to compare patients with and without r'-wave in these leads.

Results
From a total of 14669 patients who had an ECG performed as part of the SCD-SOS survey, 17% displayed an r'-wave in precordial leads V1 and V2 and 0.4% had complete right bundle branch block (RBBB). Patients with rSr' pattern had a mean age of 20±5 years old, 54% of them were male, they had a mean body mass index (BMI) of 22±3kg/m2, and 54% practiced sports regularly, with a mean of 5±4 hours of physical activity per week. Regarding previous symptoms reported by these individuals, 24% (n=487) reported a transient loss of consciousness, 15% (n=310) a reflex syncope, 3% (n=58) had unexplained syncope and 21% (n=425) palpitations. Sudden death in relatives before 50 years-old was present in 11% (n=172) of the patients with an r'-wave in V1-V2. After adjusting for heart rate and physical activity, PQ interval (OR 1.007 - CI95% 1.004–1.010, p<0.001), QTc interval (OR 1.009 - CI95% 1.005–1.012, p<0.001), male gender (OR 2.438 - CI95% 2.144–2.772, p<0.001) and BMI (OR 0.881 - CI95% 0.864–0.900, p<0.001) were independently associated with the presence of r'wave in precordial leads V1-V2. Unexplained syncope, palpitations and family history of sudden death were not associated with r'-wave in the young SCD-SOS population.

Conclusions
We conclude that r'-wave in V1-V2 is a frequent finding in the young population and that it is associated with higher PQ and QTc intervals. The prognostic implications of this pattern are unknown, but thorough differential diagnosis is warranted since this pattern may correspond to incomplete RBBB/athlete's ECG, and may also be suggestive of other potentially serious conditions such as Type 2 Brugada pattern and multiple causes of right ventricular enlargement. Finally, this pattern is also associated with male gender and lower BMI, suggesting a dependence on anatomical factors.
P324Impact of impaired right ventricular strain on the prognosis of HFpEF
Authors: Lejeune S , Roy C , Slimani A , Amzulescu M , Pasquet A , Vancraeynest D , Beauloye C , Vanoverschelde J L , Gerber B , Pouleur A C 
Published: October 2019

Abstract

Background
Right ventricle (RV) strain has emerged as an accurate and sensitive tool for RV function assessment and is a powerful predictor of survival in heart failure with reduced ejection fraction. The impact of impaired RV strain on prognosis of HFpEF patients however, remains unclear.

Purpose
We sought to analyze RV global longitudinal strain (RV-GLS) by 2D speckle tracking echocardiography (STE) in controls and HFpEF patients and determine its prognostic value.

Methods
Between January 2015 and June 2017, we prospectively enrolled 163 consecutive patients with HFpEF (78±9 years, 62% women) and 27 age and sex matched controls (76±5 years, 67% women). All patients underwent complete 2D echography. Myocardial deformation was assessed on a dedicated four chambers view, with a speckle tracking software. Due to poor tracking quality, RV-GLS could not be analyzed in 14 patients (7.4%). Impaired RV-GLS was defined as a GLS above −17.5% corresponding to the mean + 2 SD of age and sex matched controls. HFpEF patients were followed up for a combined outcome of all-cause mortality and first HF hospitalization.

Results
Mean RV-GLS was significantly altered in HFpEF patients compared to controls (−21.7±4.9% vs −25.9±4.2%; p<0.001). 28 HFpEF patients (19%) had an impaired RV-GLS.
During a mean follow-up of 19±9months, 73 HFpEF patients (49%) reached the combined outcome (15 all cause deaths and 58 first HF hospitalization). In univariate Cox regression analysis, loop diuretic medication (HR 1.92 [1.10–3.32], p=0.021), low hemoglobin (HR 0.85 [0.75–0.97], p=0.013), low eGFR (HR 0.97 [0.96–0.99], p<0.001), E wave velocity (HR 1.01 [1.00–1.02], p<0.001), septal E/e' (HR 1.03 [1.00–1.05], p=0.011) and impaired RV-GLS (HR 2.01 [1.19–3.40], p=0.009) were significantly associated with worse prognosis.
In multivariate Cox analysis, hemoglobin levels (HR 0.83 [0.72–0.96], p=0.01), eGFR (HR 0.98 [0.97–0.99]; p=0.009) and impaired RV-GLS (HR 2.48 [1.38–4.44], p=0.002), were independent predictors of the combined outcome. Kaplan-Meier event free survival curves show that HFpEF patients with RV-GLS above −17.5% had worse prognosis than those with better myocardial deformation (p=0.009, Figure).

Conclusions
RV-GLS is significantly different between controls and HFpEF patients. In HFpEF, impaired RV-GLS is associated with worse prognosis.
P334Prospective FU in various subtypes of cardiomyopathies: insights from the EORP Cardiomyopathy Registry of the ESC
Authors: Gimeno Blanes J R , Elliott P M , Tavazzi L , Tendera M , Kaski J P , Laroche C , Maggioni A , Caforio A , Charron P H 
Published: October 2019

Abstract

Background
The EORP Cardiomyopathy Registry is a prospective, observational, multinational registry of consecutive patients with cardiomyopathies. The objective of this report is to describe the outcomes at one year of follow-up of adult patients (>18 years old) enrolled in the registry.

Methods
A total of 3,208 patients (median age: 55.0 (43.0; 64.0) years, males: 65.1%) were recruited at baseline. Follow-up data at 1 year were obtained in 2,713 patients (84.6%), including 1,420 with hypertrophic (HCM), 1,105 dilated (DCM), 128 arrhythmogenic right ventricular (ARVC) and 60 restrictive cardiomyopathy (RCM).

Results
Improvement of symptoms (NYHA, chest pain, syncope) was globally observed over time (p<0.001 for each). Additional invasive therapeutics were performed during follow-up: implantation of ICD (primary prevention) (N=109 patients, 5.2%), pacemaker (N=28, 1.2%), heart transplant (N=30, 1,1%), ablation for atrial or ventricular arrhythmia (0.5% & 0.1%). The proportion of patients with history of AF increased from baseline to FU in 3.6% (from 28.2% to 31.8%). ICD therapy at 1 year was delivered more frequently in ARVC then in DCM, HCM and RCM (11.4%, 9.0%; 8.1%, 0% respectively for primary prevention). Major cardiovascular events (MACE) occurred in 29.3% of RCM, 10.5% of DCM, 7.9% of ARVC and 5.3% of HCM. MACE were globally higher in index patients compared to relatives (10.8% vs 4.4%, p<0.001).
When considering geographical areas, MACE were higher in East Europe (13.1%) and lower in South Europe (5.3%) (univariate); heart transplant was higher in West Europe (2.40%) and lower in South Europe (0.25%) (univariate).

Conclusions
Despite symptomatic improvement in most cases, there is still a significant burden of arrhythmic and heart failure events in patients with cardiomyopathies. Outcomes were different not only according to cardiomyopathy subtypes but also in relatives versus index patients.

Acknowledgement/Funding
None
P576The first handheld device for autonomic self-detection of symptomatic acute coronary artery occlusion: feasibility, performance and implications for time-efficient self-triage of outpatients with CAD
Authors: Van Heuverswyn F , De Buyzere M , Coeman M , De Pooter J , Drieghe B , Duytschaever M , Gevaert S , Kayaert P , Vandekerckhove Y , Voet J , El Haddad M , Gheeraert P 
Published: October 2019

Abstract

Background
Time delay between onset of symptoms and seeking medical attention is a major determinant of mortality and morbidity in patients with acute coronary artery occlusion (ACAO). Response time might be reduced by reliable self-detection of ACAO. Currently no self-applicable device can accurately detect ACAO. We have recently shown that an automatic algorithm based upon a three lead system (RELF method) accurately detects ACAO.

Purpose
In this multicenter observational study we tested the operational feasibility, sensitivity and specificity of our RELF method, built into a mobile handheld device, for detection of ACAO.

Methods
Patients with planned elective percutaneous coronary intervention (PCI), who were able to use a smartphone, were asked to perform random ambulatory self-recordings for at least one week. A similar self-recording was made before angioplasty and at 60 s of balloon occlusion.

Results
The operational feasibility of ambulatory self-recordings in enrolled patients with CAD was 59/64 (92.1%, 95% CI: 83.0–96.6). Of all self-recordings 91.1% (n=4567) were automatically classified as successful within one minute. The mean false positive rate during daily life conditions was 4.19% (95% CI: 3.29–5.10). Amongst 65 balloon occlusions, 63 index-tests at 60 s of occlusion were available. The sensitivity for the target conditions “ACAO”, “ACAO with ECG changes” and “ACAO with ECG changes and ST segment elevation myocardial infarction (STEMI) criteria” was respectively 55/63 (0.87; 95% CI: 0.77–0.93), 54/57 (0.95; 95% CI: 0.86–0.98) and 35/35 (1.00). The figure depicts all (n=3936) ST difference vector (STDVn) measurements obtained during ambulatory postural changes, exercise and coronary artery occlusion with and without ECG changes and/or STEMI criteria. Receiver Operator Curve (ROC) for ACAO at different cut-off values of the magnitude of STDVn was 0.973 (95% CI: 0.956–0.990).
Boxplots of all STDVn test recordings

Conclusions
Self-recording with our RELF device is feasible for the majority of patients with CAD. The sensitivity and specificity for automatic detection of the earliest phase of acute coronary artery occlusion support the concept of our RELF device for patient empowerment to reduce delay and increase survival without overloading emergency services. This is the first clinical study that confirms the proof-of-concept of self-detection of acute coronary artery occlusion in outpatients with CAD.

Acknowledgement/Funding
Ghent University, Industrial Research Fund (IOF reference: F2015/IOF-advanced/084).
P580Performance evaluation of dual vs. single lead automatic, real-world arrhythmic ECG recordings
Authors: Olsson A , Samuelsson M 
Published: October 2019

Abstract

Background
Detection of treatment-demanding paroxysmal arrhythmias can be difficult. Use of single lead ECG recordings for detection of Atrial Fibrillation (AF) has shown to lead to high false positive discovery rates, and requirements of additional manual clinical interpretation or 12-lead ECG to reach satisfactory diagnostic precision. Use of sequential, dual-lead ECG recordings for detection of AF has indicated significant clinical improvement in detection yield of AF and reduction of false positive discovery rates as compared to single lead-ECG.

Methods
The Coala Heart Monitor (Coala Life AB, Stockholm Sweden) system was evaluated by manual interpretation of 1,000 consecutive anonymous printouts of chest- and thumb-ECG waveforms, without any exclusion. The anonymized printouts contained three 10 s. strips of ECG at 25 mm/s, including mean heart rate, RR median and any user-provided annotation but with personal identification and algorithm analysis results blinded. The recordings were derived from actual Coala users with no training, control or influence, under a defined time period. The prevalence of cardiac conditions in the user population was unknown.
The blinded recordings were manually interpreted by a trained cardiologist. The interpretation was compared with the automatic analysis performed by an enhanced algorithm in the Coala Cloud to evaluate ECG signal performance and to calculate performance metrics of a combination of sequential dual chest- and thumb-ECG measurements as compared to the clinical performance metrics of singe lead ECG measurements only.
Results Metric Result using dual chest- and thumb-ECG and P-wave detection algorithm Result based on single lead thumb-ECG only Prevalence of AF in the recordings 14.4% (143 of 990 recordings) 14.4% (143 of 990 recordings) Percentage of recordings with ECG quality good enough to permit manual interpretation. 99,2% (8 of 998 non-readable) 98,7% (13 of 998 non-readable) Negative predictive value (NPV) for detecting AF 0.992 0.995 Positive predictive value (PPV) for detecting AF 0.872 0.647 False positive discovery rate 12.8% 35,3% Sensitivity for detecting AF 0.951 0.972 Specificity for detecting AF 0.976 0.909 Accuracy 0.973 0.919

Conclusion
Based on 1,000 real-world recordings the combination of dual chest- and thumb-ECG with P-wave detection yielded significantly higher Positive Predictive Values as compared to single lead ECG measurements. Dual chest- and thumb-ECG reduced false positive AF indications from 35,3% for single lead-ECG to 12,8% using combined chest- and thumb-ECG with P-wave detection.
P592Myocardial strain measurement with cardiovascular magnetic resonance in professional soccer athletes
Authors: Jimenez Franco V , De La Pena-Almaguer E P A , Jerjes-Sanchez C J S D , Trevino Ortiz A T O 
Published: October 2019

Abstract

Background
Over the last decade, cardiovascular screening in sports has gained interest due to the presence of sudden cardiac death in apparently healthy athletes. In these specific group of patients, a reliable evaluation of the ventricular dimensions and volumes by non-invasive methods is of utmost importance to rule out potentially lethal cardiomyopathies. Cardiovascular magnetic resonance (CMR) has emerged as a corner stone in the characterization of the athlete's heart and contributing to diagnosis of underlying diseases. Strain evaluation by CMR adds information regarding ventricular mechanics and little, or no data has yet been described in professional soccer players.

Purpose
We evaluated cardiac deformation by measuring endomyocardial global longitudinal strain (GLS) by CMR in professional soccer players (First Division Mexican Soccer League) compared to sedentary controls. Secondary objectives were to evaluate structural and morphological changes as compared to healthy and deconditioned controls.

Methods
We performed a monocentric, non-randomized, observational and control study, that evaluated the GLS by CMR in professional soccer players compared to healthy and deconditioned controls. Primary end point was percentage of GLS by feature tracking method. Secondary end point included diastolic and systolic left ventricular diameters, left and right ventricular volumes, left ventricular and right ventricular ejection fraction, ventricular mass and cardiac output.

Results
From January 2017 to March 2018, information was gathered from CMR studies in 37 subjects, 20 of them being high performance athletes, and 17 healthy sedentary subjects. The GLS by CMR showed a non-significant trend towards a higher negative deformation percentage of athletes as compared to the control group of deconditioned participants: (−22.0±2.0% vs. 20.9±2.05%, p=0.36). There were no differences in the cardiac output and the indexed cardiac output (6.0 L/min and 3.2 L/min/m2 vs. 6.1 L/min and 3.1 L/min/m2; p=NS). Athletes had higher systolic (42.9 mm vs. 35 mm; p<0.0001) as well as diastolic LV diameters (60.5 mm vs. 51 mm; p<0.0001). LV mass and indexed mass were significantly greater in the group of soccer players (145 gr and 75 gr/m2 vs. 109 gr and 52 gr/m2 respectively; p<0.0001). We found no difference in the LVEF 60±2.5%; p=0.55).

Conclusion
Despite athletes having higher LV mass and diameters, we found no difference in ventricular deformation values as evaluated GLS by CMR, which in turn may represent a normal and physiological adaptation. Further studies are warranted to reproduce these results.
P594Cardiac magnetic resonance imaging in lung transplant assessment: the clinical significance of right ventricular-pulmonary arterial coupling and right ventricular trabecular complexity
Authors: Sarri G , Halim K , McCurry M , Pierce I , Asaria P , Chen Z , Rahman-Haley S , Simon A , Carby M , Reed A , Wong J 
Published: October 2019

Abstract

Introduction
Right ventricular (RV) dysfunction complicating lung disease is prognostic in patients undergoing lung transplantation. However key metrics are not clear.

Purpose
We assessed RV-pulmonary arterial (PA) coupling and RV trabecular complexity through cardiac magnetic resonance (CMR) imaging in patients undergoing lung transplant assessment.

Methods
Between 2013 and 2018, 91 consecutive patients underwent lung transplant assessment with echocardiography and CMR (1.5T - Siemens). RV trabecular complexity was assessed by its fractal dimension (FD) on CMR, using freely available code (FracAnalyse). RV functional adaptation to increased afterload was assessed with the RV-PA coupling index (stroke volume (SV)/RV end-systolic volume (ESV) ratio).

Results
91 patients (median age 53±15 years, 54% male) were analysed; 97% had underlying lung disease. Median follow up period was 23.8 months. Tricuspid regurgitation was echo-detected in 71 patients; 74% (53 patients) had echo-diagnosed pulmonary hypertension (PH). 85%, 10%, and 4% of PH patients were categorized to WHO PH classification Groups 3, 5 and 1 respectively. Mean LV and RV ejection fraction (EF) were 62±1.01% and 51±15.5%.
SV/ESV correlated to CMR indexed RV end-diastolic volume (RVEDVi), indexed RV end-systolic volume (RVESVi), RV EF, right atrial area and echo mean pulmonary artery pressure (mPAP) (r −0.437, r −0.646, r 0.824/all p<0.001; r −0.290/p 0.005; r −0.348/p 0.003 respectively). Global FD also correlated to these parameters (r 0.371, r 0.369/both p 0.001; r −0.245/p 0.021; r 0.352, r 0.403/both p<0.001). RV FD did not differ significantly in patients with PH. Survival was predicted by SV/ESV ratio, RVEF, RVEDVi, RVESVi, and mPAP on univariate analysis (Table).
All patients (n=91) Alive (n=77) Dead (n=14) Alive vs dead HR CI p value median/mean/counts (SEM/IQR) median/mean/counts (SEM/IQR) median/mean/counts (SEM/IQR) p value CMR RVESVI (ml/m2) 35 (20) 33 (18) 54 (41) <0.001 1.03 1.02, 1.04 <0.001 CMR RVEF (%) 51 (15.5) 53 (13) 38 (15) 0.001 0.93 0.90, 0.93 <0.001 RV-PA coupling SV/ESV 1.06 (0.64) 1.13 (0.61) 0.57 (0.38) <0.001 0.10 0.02, 0.46 0.003 6 minute walk test distance (m, n=90) 290 (188) 300 (190) 190 (264) <0.05 0.99 0.99, 1.00 0.13 Transplanted 22 15 7 0.04 2.39 0.80, 7.17 0.12 Echo mPAP (mmHg, n=71) 27 (10.7) 27 (9) 33 (14.8) <0.05 1.05 10.1, 1.05 0.008

Conclusion
RV functional adaptation to afterload assessed by CMR may predict survival among patients with underlying lung disease referred for lung transplant assessment. Fractal analysis of RV trabecular complexity correlated with metrics influencing RV remodelling and contractility, although not survival. Assessment in a larger cohort is required to determine utility of these metrics.
P596Early markers of right ventricular involvement in experimental chronic postcapillary pulmonary hypertension
Authors: Garcia Lunar I , Jorda P , Pereda D , Ascaso M , Santiago E , Sanchez J , Galan C , Fuster V , Ibanez B , Garcia-Alvarez A 
Published: October 2019

Abstract

Background
In chronic pulmonary hypertension (PH), the main cause of death is right ventricular (RV) failure. However, the onset of RV dysfunction varies significantly among patients. Early recognition of RV maladaptation would be highly relevant.

Purpose
To identify cardiac magnetic resonance (CMR)-derived parameters affected in early stages of PH before the development of RV dysfunction.

Methods
Experimental chronic PH was generated by pulmonary vein banding in 76 pigs whereas 14 animals underwent sham operation. Animals were followed-up monthly with right heart catheterization (RHC) and immediate CMR for a maximum of 9 months. CMR exams included a T1-mapping sequence to quantify equilibrium-extracellular volume (ECV) at the RV insertion points. Pairs of RHC and CMR examinations were compared among controls and PH with normal RV ejection fraction (RVEF≥55%) or reduced (REVF<55%) using ANCOVA test with Bonferroni correction. All procedures followed the “Principles of laboratory animal care”.

Results
In the presence of PH confirmed by RHC and normal RVEF, the RV displays significant hypertrophy and increased myocardial native T1 and ECV, despite preserved ventricular dimensions and PA flow (Fig 1B). In advanced stages of the disease, RV-AP uncoupling and reduced PA pulsatility develop together with RV dilatation and failure (Fig 1C).
CMR parameters in sham and PH animals Sham controls (n=25 evaluations) PH with normal RVEF (n=155 evaluations) PH with low RVEF (n=70) RVEF (%) 62±5 61±4 47±8# RVEDV (mL/m2) 73±18 83±17 111±29# RVESV (mL/m2) 28±8 32±8 61±25# RV mass (g/m2) 17±4 23±5* 30±11# PA area (cm2/m2) 5.5±1.2 6.3±1.6 8.7±2.2# Native T1 anterior RVIP (ms) 983±75 1043±78* 1055±90# ECV anterior RVIP (%) 27±5 31±6* 36±7# Native T1 inferior RVIP (ms) 959±68 1022±71* 1032±99# ECV inferior RVIP (%) 25±5 31±6* 36±7# PA pulsatility (%) 29±6 27±7 21±3# Ea/Emax 40±16 47±11 97±65# RVEDV: RV end-diastolic volume; RVESV: RV end-systolic volume; RVIP: RV insertion point. *p<0.05 1 vs. 2; #1 vs. 3.
NativeT1: control, PH-normal RV, RV dysf

Conclusion
RV hypertrophy and ECV expansion are early mechanisms in RV adaptation to postcapillary PH, whereas ventricular and PA dilatation, RV-PA uncoupling and reduced pulsatility appear in more advanced stages concurring with systolic dysfunction.

Acknowledgement/Funding
The CNIC is supported by the Ministerio de Ciencia, Innovaciόn y Universidades and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence