bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomical dilation for the coronary sinus ostium in patients with pulmonary arterial hypertension and its impact to trigger the atrioventricular reentrant tachycardia: a case control study
Authors: Ding L , Weng S , Tang M , Zhang S ,   State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Cardiovascular Institute
Published: October 2021

Abstract

Background
The incidence of atrioventricular reentrant tachycardia (AVNRT) in pulmonary arterial hypertension (PAH) patients is higher than the general population [1–3]. AVNRT had been reported with larger coronary sinus (CS) ostium in general population, while the mechanism and correlation between AVNRT and the CS ostium in PAH patients are poorly understood.

Purpose
We aim to investigate the impact of the CS ostium on AVNRT and find out its risk factors in PAH patients.

Methods
Of 102 pulmonary arterial hypertension (PAH) patients with catheter ablation of SVT, 10 patients confirmed AVNRT who underwent computed tomographic angiography (CTA) were enrolled as study group. The control group (PAH patients without SVT, n=20) were matched in a ratio of 2:1 based on gender and BMI. We measured maxium diameter of CS ostium in axial and LAO plane by CTA. All baseline characteristics and imaging materials were collected.

Results
PAH patients with AVNRT were older (45.9±14.8 vs. 32.1±7.6 years, P=0.025) and more likely to have larger CS ostium in LAO plane (18.6±3.3 vs. 14.8±4.0 mm, P=0.011) than those without AVNRT. The maximal diameter of CS ostium in LAO plane was an independent predictor for AVNRT in PAH patients (Odds ratio, 1.389; 95% confidence interval, 1.003–1.923; P=0.048). The cut-off value of CS ostium in LAO plane was 14.1mm (Area under curve = 0.79, P=0.012), and the sensitivity and specificity were 90% and 55%, respectively.

Conclusions
The larger CS ostium in LAO plane correlated with the higher prevalence of AVNRT in PAH patients with age. Patients with CS ostium larger than 14.1mm in LAO plane are more likely to develop AVNRT.

Funding Acknowledgement
Type of funding sources: None. Measurements and diagnosis value
Illusion of coronary artery chronic total occlusion-associated ventricular arrhythmia: results from a multi-centre study
Authors: Limaye S.S , Siraj A , Karim S 
Published: October 2021

Abstract

Background/Introduction
Coronary artery chronic total occlusion (CTO) is frequently encountered in patients with established coronary artery disease (CAD) with a reported incidence of more than thirty percent in this population (1). A previous large single-centre study established CTO as an independent risk factor for occurrence of ventricular arrhythmia in patients with ICD and ischemic heart disease (2). The significance of CTO in all-comers has not been investigated. In this large retrospective data, it was analysed that there is no significant difference in ventricular arrhythmia occurrence in patients with CTO versus those with CAD and no CTO.

Purpose
The purpose of this study is to examine the association between CTO and ventricular arrhythmia in patients with CAD using a pooled de-identified database.

Methods
This retrospective observational study used IBM Explorys, which is a pooled de-identified multi-institutional database of more than 60 million unique patients in the United States. A search was done to identify patients with CTO and those with CAD with the exclusion of CTO diagnosis. The data were analysed for ventricular tachycardia (VT) and/or ventricular fibrillation (VF) occurrence. The data were stratified by presence of systolic HF to identify possible effect modification. Statistical analysis was performed by calculating odds ratios (OR) with associated confidence intervals.

Results
Among the 190 patients with the diagnosis of CTO, 11.8% had VT/VF. Of the 2,796,600 patients with CAD and no CTO, 6.9% had VT/VF. The diagnosis of CTO was associated with an increased risk for VT/VF with OR 1.7143 (1.0786, 2.7247), p&lt;0.05. Upon stratification by presence or absence of systolic HF, there was no statistically significant difference in occurrence of VT/VF in the two strata. In the systolic HF group, the OR was 1.4331 (0.6708, 3.0619), p=0.47; the no systolic HF group had OR 0.9717 (0.5123, 1.843), p=0.92. In patients with CAD, the diagnosis of systolic HF was associated with an increased risk of CTO with OR 2.5616 (1.7268, 3.7999), p&lt;0.05.

Conclusion
Stratification by presence or absence of systolic HF yielded inconsistent and statistically insignificant odds ratios compared to the all-comers group, suggesting effect modification by HF with no statistically significant association between CTO and VT/VF. These findings from this large multicentre retrospective data suggest that CTO itself is not an independent risk factor for ventricular arrhythmia in patients with CAD. Limitations of this study include that it is a retrospective pooled analysis without individualised data on ejection fraction and the inability to distinguish if the CTO was infarct-related. Further prospective studies are needed to evaluate the significance of CTO in patients with CAD as it pertains to ventricular arrhythmia.

Funding Acknowledgement
Type of funding sources: None.
Noninvasive functional testing in ANOCA: hyperventilation-exercise study for spasm (SESPASM)
Authors: Dedic S , Boskovic N , Giga V , Nedeljkovic I , Tesic M , Jovanovic I , Aleksandric S , Beleslin B , Picano E , Djordjevic Dikic A 
Published: October 2021

Abstract

Introduction
In patients with angina and no obstructive coronary artery disease (ANOCA), different mechanisms of ischaemia, epicardial spasm, microvascular spasm, and impaired microvascular dilatation frequently coexist.
The aim was to assess CFVR changes during coronary vasoconstrictor and vasodilator stimuli in patients with ANOCA.

Methods
In a prospective single center study, we enrolled 29 ANOCA patients (age 59.6±11 years, 27 females) with previously normal angiograms. All underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise (HYP+EXE); and adenosine CFV evaluation (ADO 140 mcg/kg in 1 min) on the other day. Coronary flow velocity (CFV) was assessed in distal LAD by Transthoracic Doppler echocardiography. The ratio of peak/rest changes of CFV during HYP in LAD was taken as an index of vasoconstriction, and CFV reserve was evaluated after EXE. An abnormal response to HYP was a CFV ratio &lt;1.0 (vasoconstrictor response). An abnormal response to ADO was a CFV reserve &lt;2.0 (blunted vasodilatory response). CFVR at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation.

Results
The double product increased during HYP, in comparison to rest (13213 vs 10517, p&lt;0.01), and further increased with EXE (23387 vs HYP, p&lt;0.001). Chest pain or dyspnea were present in 4/29 pts during HYP, and in 7/29 patients during HYP+EXE (13.8% vs 24.1%, p=0.001). ST segment depression (≥1mm) was present in 7/29 patients during HYP, and 14/29 during HYP+EXE (24.13% vs 48.3%, p&lt;0.01). Five patients (17%) showed regional wall motion abnormalities with HYP+EXE. CFVR response was abnormal in 19/29 (65%) patients during HYP+EXE, and abnormal for vasoconstriction during HYP in 13 (44%). Vasodilation during ADO was preserved in all patients.There was significant difference between CFVR response during HYP+EXE and ADO (1.9±0.35 vs 2.47±0.42 respectively, p&lt;0.01), and between CFVR HYP and ADO (1.28±0.29 vs 2.47±0.42, p&lt;0.001).

Conclusion
In patients with ANOCA, HYP+EXE is a more powerful ischemic stress than HYP alone. In over one-half of patients HYP+EXE unmasks abnormalities in CFVR response and/or regional wall motion, likely unmasking the underlying endothelium dependent microcirculatory dysfunction with enhanced vasoconstriction in 44% of the patients and mixed vasoconstriction and reduced relaxation in 65%.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Clinical Centre of Serbia, Faculty of Medicine
Socioeconomic data predict adverse cardiovascular outcomes
Authors: Kostis J.B , Wang J , Dobrzynski J.M , Kostis W.J , Cabrera J ,   MIDAS
Published: October 2021

Abstract

Background/Introduction
Socioeconomic status (SES) factors predict the occurrence of adverse cardiovascular (CV) outcomes.

Purpose
SES has been studied in many contexts. We present data on SES in a new context using yelp, an American public company that publishes crowd-sourced reviews about businesses. A dataset containing aggregated yelp data for New Jersey zip codes pertaining to the number of fast-food restaurants, grocery stores, gyms and other fitness centers, nursing homes, and pharmacies was created. Cardiovascular outcomes were obtained from the Myocardial Infarction Data Acquisition System (MIDAS).

Methods
Linear regression models of the SES factors were used to predict the occurrence of hospitalized stroke, myocardial infarction (MI), and heart failure (HF).

Results
Overall, the number of fast-food restaurants, grocery stores, nursing homes, and pharmacies were associated with increased rate of adverse CV outcomes, while gyms and other fitness centers were associated with improved outcomes. Also, the SES factors of grocery, nursing home, pharmacy and fast-food restaurants were associated with increased rate of MI (p&lt;0.0001). In addition, the SES factors of grocery, nursing home, pharmacy and fast food were associated with increased rate of HF (p&lt;0.0001). On the contrary, gyms and other fitness centers were associated with lower rate of CV outcomes (p&lt;0.0001). With respect to stroke, the SES factors of grocery, nursing home, pharmacy and fast-food restaurants were associated with increased rate of this condition (p&lt;0.0001, figure). The y axis of the figure is proportional to the square root of the number of strokes in each zip code per 10,000 people.

Conclusions
In conclusion, persons living in zip codes of low socioeconomic status are associated with a high rate of occurrence of MI, HF and stroke. The number of gyms and other fitness centers is associated with a low rate of these outcomes. This information may be important in designing and implementing preventive strategies.

Funding Acknowledgement
Type of funding sources: None.
Ertugliflozin to reduce arrhythmic burden in ICD/CRT patients (ERASe-trial). a phase III study
Authors: Von Lewinski D , Tripolt N , Sourij H , Oulhaj A , Gwechenberger M , Martinek M , Nuernberg M , Roithinger F.X , Steinwender C , Stuehlinger M , Rohrer U , Manninger-Wuenscher M , Scherr D ,   ERASe study group
Published: October 2021

Abstract

Background and aim
Sodium glucose cotransporter 2 (SGLT2) have proven profound positive effects in heart failure with reduced ejection fraction (HFrEF). These effects are independent from the presence of diabetes. Since SGLT2 receptors are not expressed in human myocardium, these cardioprotective effects be indirect or pleiotropic. Besides metabolic effects anti-inflammatory anti-fibrotic properties are discussed.
Despite a strong correlation of ventricular arrhythmias with HFrEF, the impact of ertugliflozin on the arrhythmic burden has not been investigated, yet. Therefore, the Ertugliflozin to Reduce Arrhythmic burden in ICD/CRT patientS (ERASe) trial was designed to investigate the efficacy and safety of ertugliflozin in diabetic and non-diabetic HFrEF patients.

Methods
Methods: Within a multicentre, national, randomized, double-blind, placebo-controlled, phase 3b trial we aim to enrol a total of 402 patients across Austria. Patients with HFrEF or HFmrEF and ICD±CRT therapy &gt;3 months and previous ventricular tachycardia (at least 10 documented non-sustained VT episodes within the last 12 months) are randomized in a 1:1 ratio to ertugliflozin (5mg once daily orally administered) or matching placebo.
The primary endpoint of the ERASe trial is to investigate the impact of Ertugliflozin on total burden of ventricular arrhythmias. Further objectives will be the number of therapeutic interventions of implanted devices, atrial fibrillation, heart failure biomarker and changes in physical function quality of life, stress and anxiety.

Conclusion
The ERASe trial will be the first trial to test ertugliflozin in heart failure patients with non-preserved ejection fraction and ongoing ICD/CRT therapy regardless of their diabetic status. The ERASe trial may therefore extend the concept of SGLT2 inhibition to improve cardiac reverse remodelling, including reduced arrhythmic burden.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): unrestricted grant of MSD
Incremental value of atrial sensing in the diagnosis of ICD recordings: findings from the THINGS registry
Authors: Carinci V , Ziacchi M , Iori M , De Maria E , Bolognesi G , Zardini M , Calvi V , Allocca G , Ammendola E , Boggian G , Saporito D , Giorgi D , Grassini D , Giacopelli D , Biffi M 
Published: October 2021

Abstract

Background
Automatic diagnosis of implantable cardioverter defibrillator (ICD) requires confirmation through analysis of electrograms (EGM) recordings by an electrophysiologist (EP) specialist.

Purpose
To investigate whether the atrial sensing capability in single-chamber ICD improves reliability in episodes assessment.

Methods
The THINGS registry enrolled 526 consecutive patients without atrial pacing indication who underwent single-lead ICD implantation. Of them, 343 patients received a conventional single-chamber ICD (ICD VR) and 183 a single-lead ICD with atrial sensing capability (ICD DX, BIOTRONIK). Device-detected ventricular episodes were independently classified by two experienced electrophysiologists as ventricular (VT) or supraventricular tachycardia (SVT) by analyzing the EGMs. In case of disagreement, a third experienced EP specialist, blinded to previous assessment, was consulted. The inter-rate reliability was evaluated using the Cohen's kappa (k) coefficient in the ICD VR and ICD DX group.

Results
A total 441 (383 in the ICD VR and 58 in the ICD DX group) device-detected events were analyzed. Using ventricular EGM alone for ICD VR patients, the proportion of observed agreement between the 1st and 2nd adjudicator was 86.4% consisting of 268 (70.0%) episodes confirmed as VT and 63 (16.4%) classified as SVT. The k coefficient was 0.61 and no agreement was reached for 52 (13.6%) tracings. For them, the third assessment had low agreement with both previous EP evaluations (the k coefficients 1st/3th and 2nd/3th EP specialist were 0.03 and −0.05, respectively).
In ICD DX group, with available atrial EGM, the proportion of observed agreement in the first stage improved to 93.0%: 44 (75.8%) episodes were adjudicated as VT and 10 (17.2%) as SVT with a k=0.79. Only 4 (7.0%) recordings had a discordant classification. For them, the 2nd and 3rd EP specialist had perfect agreement (k=1).

Conclusions
Atrial sensing capability improves EP specialist assessment of ICD episodes allowing dual EGMs analysis. Misinterpretation of ICD recordings may thus be less common in ICD DX than in conventional single-chamber ICD VR and may improve clinical decisions.

Funding Acknowledgement
Type of funding sources: None.
Selectra 3D- guided conduction system pacing: single-center experience
Authors: Marcantoni L , Pastore G , Baracca E , Andreaggi S , Pellegrini N , Galuppi E , Bartolomei M , Centioni M , Rigatelli G , Roncon L , Zanon F 
Published: October 2021

Abstract

Background
Conduction system pacing (CSP)is becoming increasingly popular thanks to the ability to both maintain physiological electrical activation in patients with narrow QRS and restore ventricular synchrony in patients with bundle branch block (BBB). The Selectra3D introducer is a new tool able to support the correct positioning and screwing of the catheter on the bundle of His (HBP) or on the left branch (LBBP). It does exist in 3 different shapes: S, M, L (Fig. 1) based on the radius of main curvature. The internal diameter of 7.3 Fr allows it to support both the 3830 lumen-less catheter historically used for CSP, as well as standard 6Fr stylet-driven leads.

Objective
To evaluate the effectiveness of the Selectra3D introducer for CSP (including both HBP and LBBP), considering the procedural success rate and the lead stability (stability of electrical parameters or need for implant revision) in the medium-term follow-up.

Methods and results
The Selectra3D introducer was used in 56 patients' candidates for CSP (mean age 80±6 years). Pacing indications included A-V block in 21 patients, AF with slow ventricular response in 9 patients; SND in 8 patients and HF and severe ventricular dysfunction in 18 patients (of which 4 were PICM). The mean baseline EF was 40±15%. A PM was implanted in 40 patients and an ICD in 16. A standard stylet-driven lead was used in 48 cases, a fixed exposed screw lead was used in 8 patients. HBP was obtained in 21 cases and LBBP in 30 cases, while in 5 cases (8.9%) neither HBP nor LBBP could be obtained. Implants were performed via a left-sided approach in 55 cases and a right-sided approach in 1 case. The baseline QRS duration was 144±38 ms and the paced QRS duration was 118±21 ms. The electrical parameters were optimal with sensing 8.7±8 mV; impedance 625±276 ohm; threshold 1±0.5 V. During follow-up, 2 lead dislodgement (3.9%) (1 HBP and 1 LBBP) were recorded, both within 7 days after implantation. All the others showed stability of the electrical parameters at a mean follow-up of 8.4±4.2 months.

Conclusions
The new Selectra3D introducer supports effectively and safely the lead implant on conduction system catheters (HBP and LBBP), allowing the implant of both exposed fixed screw leads and standard stylet-driven leads, leading to procedural success&gt;90%. The electrical parameters were optimal at implantation and remained stable during follow-up.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Ten-year follow-up of implantable cardioverter-defibrillator device implantation in non-ischaemic cardiomyopathy – an insight from real world practice in a large district general hospital
Authors: Abramik J , Moore H.L , Doolub G , Dayer M.J , Furniss G 
Published: October 2021

Abstract

Introduction
The benefits of implantable cardioverter-defibrillators (ICDs) in ischaemic cardiomyopathy are well established. The DANISH study, a large randomized controlled trial of prophylactic ICD implantation, found no benefit in preventing all-cause mortality in patients with non-ischaemic cardiomyopathy (NICM). However, ESC guidelines recommend ICDs for patients with NICM and LVEF ≤35% who receive optimal medical therapy (IB recommendation). The 2014 NICE guidelines have similar endorsements but prior to that ICDs were not routinely recommended in NICM in the UK.

Purpose
We evaluated clinical outcomes of patients who had ICDs implanted prior to 2014 in a NICM population at a large district general hospital.

Methods
An ICD database of 454 patients at our district general hospital was retrospectively reviewed. We identified 70 patients who had ICD insertion for non-ischaemic cardiomyopathy between 2006 and 2014. Mean follow up time was 9 years 9 months (SD 23 months). 39 patients had an ICD inserted for primary prevention and 31 for secondary prevention. Data was collected from patients' electronic notes and analysed with relation to baseline demographics, mortality, complications and both appropriate and inappropriate therapy in these two subgroups.

Results
The baseline patient characteristics are presented in Table 1 and show similar characteristics between the primary and secondary prevention groups, except for a higher level of CRT-D implantation in the primary prevention group (p=0.006). Table 2 shows therapy that the device delivered and complication rates.
Overall, 16% of patients with an ICD for non-ischaemic cardiomyopathy received a shock for VF. 41% of patients received appropriate therapy (Shocks or Anti-Tachycardia Pacing (ATP)) from their ICD with median time to first therapy of 30 months (IQR 12–66). Shocks for VF were similar in each group (15% vs. 16%, p=0.919). Six patients (8.6%) had inappropriate shocks and two inappropriate ATP (2.9%). 9 (13%) of patients had a complication either at implant or during follow-up; two had pericardial effusions following implant of which one required pericardiocentesis, three required lead replacement due to lead failure, two developed device infections, one was anticoagulated for a lead thrombus and one patient's device failed to treat VF.

Conclusion
16% of non-ischaemic cardiomyopathy patients received a shock for VF and 41% received ICD therapy for VT or VF over a mean follow-up period of almost 10 years. This was seen in both primary and secondary prevention. Inappropriate shocks and life-threatening complications were uncommon.

Funding Acknowledgement
Type of funding sources: None. Table 1. Patient characteristicsTable 2. ICD therapy and complications
ICD exchange in the elderly
Authors: Ritter O , Pagonas N , Eisert M , Patschan D , Nordbeck P , Buschmann I , Sasko B , Andresen H 
Published: October 2021

Abstract

Background
ICD therapy in elderly patients is controversially discussed, since survival benefits might be attenuated by non-arrhythmic causes of death.

Purpose
This study aimed to investigate the outcome of septua- and octogenarians after ICD generator exchange (GE).

Methods
506 patients undergoing elective GE were analysed to determine the incidence of ICD shocks and survival after GE. For further analysis, patients were divided according to age (70 – 79 or ≥80 years) and previous ICD therapy: patients that did not experience a shock and patients that received at least one shock from prior ICDs.

Results
The effect of the ICD on all-cause mortality and arrhythmic death was determined for two groups (patients with 70 – 79 and ≥80 years). Comparing septua- with octogenarians, similar left ventricular ejection fraction (35.6±11.2% vs. 32.4±8.9%) and baseline prevalence of NYHA class 3 or 4 heart failure (17.1% vs. 14.7%) was found. Older patients were more likely to die of non-arrhythmic death (22% per year vs. 8% per year, p&lt;0.001). We also investigated the necessity of ICD therapy dependent on whether ICD therapy occurred during the previous battery live. Septuagenarians and octogenarians with previous shocks had a higher incidence of further ICD therapy in the following battery life period (41% vs. 19%, p&lt;0.001, and 22% vs. 17%, p&lt;0.001).

Conclusion
Decision making for ICD generator exchange among elderly patients should be considered carefully for an individual patient during clinical practice.

Funding Acknowledgement
Type of funding sources: None.