bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electrophysiologic study for risk stratification in Brugada Syndrome: does it still matters?
Authors: Faia Carvalho Dias G , Oliveira M , Faria B , Von Hafe P , Cardoso F , Pereira T , Tinoco M , Ribeiro S , Sanfins V , Almeida F , Lourenco A 
Published: October 2021

Abstract

Background
The value of eletrophisiologic study (EPS) with programmed ventricular stimulation for risk stratification in patients with Brugada Syndrome (BS) remains controversial.

Purpose
The aim of this study is to determine the clinical and electrocardiographic predictors of positive EPS and to evaluate whether the induction of malignant ventricular dysrhythmias in the EPS is a predictor of events

Methods
A retrospective study was carried out of patients with spontaneous type 1 Brugada pattern followed up in Arrhythmology consultation at our Hospital. From this population, patients who underwent EPS for stratification of dysrhythmic risk were selected. Clinical and electrocardiographic variables were analyzed. Hospital records and monitoring data from cardiac devices were consulted. Statistical analysis was performed using SPSS 20.0.

Results
Fourty nine patients were included, with a mean age at the beginning of follow-up of 45±14 years, 40 (82%) of whom were male. In 16 individuals (33%) the EPS was positive with induction of malignant ventricular dysrhythmias. All patients with positive EPS implanted an implantable cardioverter-defibrillator and of the 32 patients with negative EPS, 10 implanted an implantable event recorder. The group of patients with positive EPS had a higher proportion of male patients (88% vs 78%). The median follow-up time was 31 months.
The family history of sudden death, family history of BS, or identification of a genetic variant classified as pathogenic or probably pathogenic did not present any relationship with EPS positivity. Of the analyzed electrocardiographic markers, PR interval (178±29 vs 171±27) and QRS duration (119±24 vs 113±15) tended to be longer in patients with positive EPS. Additionally, it was found that 74% of patients with a QRS of less than 120 ms had a negative EPS.
In the analysis of the value of EPS in the stratification of dysrhythmic risk, it was found that of all the patients who suffered events (4), 75% had positive EPS. Of the patients with negative EPS, only 3% (1) presented events in the follow-up. However, there was no significant association between these variables.

Conclusion
In this population, the analysed clinical elements did not correlate with the EPS result. Although there was no statistical significance, there was a tendency for patients with narrower QRS to be more likely to have negative EPS. Accordingly with published data, it was found that the EPS result was not a predictor of events during the follow-up period, which highlights the difficulty of risk stratification in patients with BS.

Funding Acknowledgement
Type of funding sources: None.
Direct comparison of adenosine- versus exercise echo-derived distal left anterior descending artery velocity reserve
Authors: Armenis I , Marinou M , Motsi A , Voudris V , Athanassopoulos G.D 
Published: October 2021

Abstract

Introduction
Distal left anterior descending (LAD) velocity reserve (CVR) estimated by vasodilators has been introduced in stress echocardiography as both diagnostic and prognostic parameter. Exercise echocardiography in the form of supine ergometry (Erg) is currently extensively used and provides an alternative means to evaluate CVR.

Aim
Aim of the study was to assess the relationship between the CVR estimated by Erg and the respective one by adenosine (Ad) immediately after Erg recovery.

Methods
Among 73 patients who underwent Erg and were initially screened, 59 (80.8%, age 63±12 years, 45 male, 14 female) with an efficient detection of LAD flow during Erg were studied (19 interrogated for coronary artery disease-CAD, 16 for heart failure with preserved ejection fraction-HFpEF, 7 for asymptomatic aortic stenosis-AS, 17 for mitral regurgitation-MR).
Distal LAD velocity was measured at rest and every 2 min during Erg, provided that a clear envelope was feasible. Time elapsed for the detection of peak velocity and the respective achieved heart rate (Peak V-HR) were measured.
CVR-Ad was estimated blindly by a different operator 30 minutes after Erg recovery. Absolute (dCVR) and % difference (%dCVR) between CVR-Erg and CVR-Ad were calculated.

Results
In 62.7% of cases the maximum CVR-Erg was detected earlier than 3 min during Erg. The respective Peak-V-HR was 81±11% of the maximum HR achieved during Erg.
CVR-Erg was lower than CVR-Ad (2.17±0.61 vs 2.95±0.60, p=0.0001). The underlying substrate did not affect the difference dCVR (CAD: 0.81±0.70, HFpEF: 0.84±0.72, AS: 0.86±0.60, MR: 0.62±0.65, p=0.76).
dCVR and %dCVR were inversely related with the CVR-Erg (r=−0.63, p=0.0001, r=−0.69, p=0.0001 respectively). A greater than 1.7 CVR-Erg had a 100% predictive accuracy for CVR-Ad greater than 2.0.
CVR-Ad was predicted by the CFR-Erg using the following linear regression:
CVR-Ad = 0.258 x CVR − Erg + 2.290

Conclusion
CVR-Erg evaluation is feasible in the majority of patients undergoing Erg for contemporary guidelines indications, even at a relatively low workload, and may be used as a surrogate for CVR-Ad for either diagnostic or prognostic purposes.
The observed metric discrepancies may be explained by the different coronary artery/microvasculature dynamics applied by exercise and vasodilators.

Funding Acknowledgement
Type of funding sources: None. LAD velocity at baselineLAD velocity at peak exercise
Magnetic resonance imaging in the evaluation of idiopathic frequent premature ventricular complexes with normal ventricular function
Authors: Hosseini F , Gulsin G , Murphy D , Hawkins N , Andrade J , Laksman Z , Bennett M , Yeung-Lai-Wah J , Chakrabarti S , Krahn A , Deyell M 
Published: October 2021

Abstract

Background
The role of cardiac magnetic resonance (CMR) imaging in the diagnostic evaluation of patients with frequent premature ventricular complexes (PVCs) and normal left ventricular ejection fraction (LVEF) remains unclear. Existing data has been predominantly derived from highly selected populations, that may overestimate the true prevalence of abnormal findings on CMR in this patient population.

Purpose
The aim of this study was 2-fold: 1) to establish the prevalence of CMR imaging abnormalities in a cohort with normal LVEF and high PVC burden; 2) to identify predictors of CMR imaging abnormalities in patients with frequent PVCs and normal LVEF.

Methods
In this cohort study, 211 patients (age 53.2±19 years; 41% male) with frequent PVCs (≥5%/24 h), of normal LVEF (≥50% by echocardiography) and no known underlying structural heart disease were prospectively enrolled from 2016–2020. Of these, 166 (79%) patients were symptomatic from their PVCs in the form of palpitations, fatigue, chest pain, dizziness, and/or dyspnea. Patients underwent CMR imaging (1.5 Tesla) with a late gadolinium enhancement (LGE) protocol at the time of enrollment for the detection of scarring and/or fibrosis.

Results
Patients had a median baseline echocardiographic LVEF of 60% (± 5%) with 195 (92%) of patients having a normal native QRS morphology. Median PVC burden of the study cohort was 16% (± 14%). CMR LGE abnormalities were found in 19 (9%) patients including 17 scans with non-ischemic LGE and 2 with ischemic LGE. Age &gt;60 (odds ratio [OR]: 3.20, 95% confidence interval [CI]: 1.20–8.51, p=0.020), male sex (OR: 4.67, 95% CI: 1.61–13.50, p=0.004), history of hypertension (OR: 3.43, 95% CI: 1.31–8.97, p=0.012), native QRS duration (OR: 1.03, 95% CI: 1.00–1.05, p=0.031), and history of non-sustained ventricular tachycardia (OR: 2.81, 95% CI: 1.03–7.68, p=0.044) were significantly associated with the presence of imaging abnormalities on CMR. Dominant PVC origin from the left ventricle had a positive trend (OR: 2.60, 95% CI: 0.99–7.66, p=0.083) to association with CMR imaging abnormalities. On multivariate analysis, male sex (OR: 4.10, 95% CI: 1.40–12.04, p=0.010) and history of hypertension (OR: 2.89, 95% CI: 1.08–7.75, p=0.035) remained significantly associated with the presence of CMR abnormalities. There was no association between CMR imaging abnormalities and the burden of PVCs or the number of PVC morphologies.

Conclusion
In this cohort, only 9% of patients with apparently idiopathic frequent PVCs and normal LVEF had concealed myocardial abnormalities on CMR imaging. Male sex and history of hypertension were associated with a higher rate of CMR abnormalities.

Funding Acknowledgement
Type of funding sources: None.
Leadless pacemaker implant in the elderly: a safe and feasible solution
Authors: Barletta V , Parollo M , Mazzocchetti L , Giannotti Santoro M , Canu A , Sbragi S , Di Cori A , De Lucia R , Segreti L , Viani S.M , Zucchelli G , Bongiorni M.G 
Published: October 2021

Abstract

The use of leadless pacing systems could overcome peri-and post-procedural complications related to the presence of transvenous leads and the post-operative recovery, being a favorable option in elderly patients.
The study aimed to investigate feasibility and outcomes of M-TPS implant in a specific patient population, like the elderly, which represent a challenge for conventional cardiac pacing.

Methods
Between May 2014 and March 2021, 138 patients (106 males, 77%, mean age 78) underwent M-TPS implantation in our Centre, targeting a non-apical site of delivery when feasible. A subgroup of 59 patients (43 males, 73%) were older than 80 years. All patients fulfilled standard criteria for pacemaker implantation with specific indication to receive VVI pacing. Study population was divided into two groups according to age (group 1 &lt;80 years vs group 2 ≥80 years). The outcome evaluation included electrical performance (capture threshold, pacing impedance, R wave amplitude) before hospital discharge and then followed at 1, 6, and 12 months and then annually. Major complications were defined as life-threatening events, requiring surgical intervention or any event causing significant hemodynamic instability or resulting in death. High pacing threshold (HPT) was defined as &gt;1.0 V@ 0.24 ms.

Results
In 59/138 cases (43 males, 73%) M-TPS was implanted in patients older than 80 years. There were no statistically significant differences between groups for demographics characteristics, except for age, and PM implant indications. The implant procedure was successful in all cases and no device-related events were registered during follow-up. In particular, no device infection and/or malfunction were reported. Patients were followed-up for an average of 22,19±20,66 months (median 18 months). No differences were observed between groups in procedure duration (44,97±20,24 min vs 45,80±23,27 min; P=0,83), single device delivery (group 1 vs group 2: 63,16% vs 66,07%; P=0,73), fluoroscopy time (11,64±6,22 min vs 12,13±8,67 min; P=0,72) electrical performance at implant [group 1 vs group 2: pacing threshold 0,56±0,37 vs 0,58±0,32, P=0,78; impedance 727,53±170,36 vs 752,88±256,21, P=0,49; R wave amplitude 10,39±4,86 vs 9,26±4,66, P=0,18] and at median follow-up [group 1 vs group 2: pacing threshold 0,63±0,55 vs 0,51±0,1, P=0,40; impedance 535,34±102,53 vs 577,34±69,02, P=0,20; R wave amplitude 12,56±4,56 vs 12,00±5,80, P=0,77]

Conclusions
The demand for cardiac pacing is strongly related to ageing, driving the clinical practice to look for the best solution for a considered fragile population. MTP-S implant is an effective and safe procedure in elderly patients, with similar electrical performance and outcome compared with younger patients at mid-term follow-up.

Funding Acknowledgement
Type of funding sources: None.
Effects of obesity on survival in patients with implantable cardioverter defibrillator
Authors: Polat F , Yalin K , Ikitimur B , Karadag B , Ongen Z 
Published: October 2021

Abstract

Background
Studies have shown that increased body weight and obesity may be associated with an increased risk of arrhythmic events. However, studies conducted in patients with implantable cardioverter-defibrillator (ICD) have found that low body mass index (BMI) is associated with higher mortality. The aim of this study is to evaluate the effect of obesity on the risk of arrhythmic events, hospitalization and death in patients receiving ICD therapy for primary or secondary prevention.

Methods
The study was designed as a single-center prospective and observational. Patients with BMI &lt;30 kg/m2 were classified as non-obese and patients with ≥30 kg/m2 as obese. The primary endpoints were all-cause mortality, cardiac mortality, and cardiac rehospitalization.

Results
Among the total of 340 patients, 78.2% were male, 21.8% were female, and the mean age of the patients was 60.9 years. Among all patients, there were 30.6% normal weight, 47.4% overweight and 22.1% obese patients. AF recording was significantly higher in obese patients compared to the normal weight patient group (p=0.02). Shock, appropriate shock, and liquid load sensing were statistically higher in obese than non-obese patients (p=0.042, p=0.011 and p=0.007). In the primary prevention group, all-cause mortality and cardiac mortality rates were lower in the obesity group (p=0.022, p=0.037).

Conclusion
Our findings showed that although cardiac arrhythmic events are more common in obese patients, mortality and hospitalization events are less common in obese patients. These findings are consistent with the reverse epidemiology that has been demonstrated previously between obesity and mortality

Funding Acknowledgement
Type of funding sources: None. Events obtained from device controlSurvival normal weight and overweight
Mitral and tricuspid annular abnormalities in hypereosinophilic syndrome – a three-dimensional speckle-tracking echocardiographic study
Authors: Nemes A , Kormanyos A , Racz G , Marton I , Borbenyi Z 
Published: October 2021

Abstract

Introduction
Peripheral eosinophilia with absolute eosinophil count more than 1.500 cells/uL and eosinophilic tissue and end-organ damage are typical features in hypereosinophilic syndrome. In the present study it was hypothesized that hypereosinophilic syndrome-related atrial and ventricular abnormalities are associated with changes in size and function of mitral and/or tricuspid annuli.

Methods
The study comprised 17 patients with hypereosinophilic syndrome who were recruited, prospectively, 2 patients had to be excluded due to suboptimal image quality (mean age: 61.7±11.2 years, 10 males). The control group consisted of 24 healthy volunteers (mean age: 55.2±7.9 years, 12 males). Complete two-dimensional Doppler echocardiography was performed, mitral and tricuspid annuli were measured by three-dimensional speckle-tracking echocardiography.

Results
Only interventricular septum proved to be significantly thickened in patients with hypereosinophilic syndrome, other parameters did not differ between the groups examined. Increased end-diastolic and end-systolic mitral annular diameter (2.6±0.3 cm vs. 2.4±0.3 cm, p&lt;0.05 and 2.2±0.2 cm vs. 1.7±0.3 cm, p&lt;0.05, respectively), area (9.5±2.3 cm2 vs. 7.5±1.9 cm2, p&lt;0.05 and 6.7±2.0 cm2 vs. 3.8±1.1 cm2, p&lt;0.05, respectively), and perimeter (11.6±1.7 cm vs. 10.4±1.3 cm, p&lt;0.05 and 9.9±1.9 cm vs. 7.4±1.1 cm, p&lt;0.05, respectively) together with reduced mitral annular fractional area change (29.6±13.0% vs. 47.7±15.8%, p&lt;0.05) and fractional shortening (16.6±11.9% vs. 28.9±12.7%, p&lt;0.05) could be detected in patients with hypereosinophilic syndrome as compared to that of matched controls. From tricuspid annular morphological parameters, only end-diastolic tricuspid annular area (9.1±2.4 cm2 vs. 7.5±1.9 cm2, p&lt;0.05) and end-systolic tricuspid annular perimeter (9.9±1.2 cm vs. 9.3±1.4 cm, p&lt;0.05) proved to be significantly increased in patients with hypereosinophilic syndrome as compared to controls with preserved tricuspid annular functional parameters.

Conclusion
Mitral annular dilation is more pronounced compared to that of tricuspid annulus in hypereosinophilic syndrome. Mitral annular functional impairment is present in hypereosinophilic syndrome.

Funding Acknowledgement
Type of funding sources: None.
Development of a risk stratification score based on social predictors in patients undergoing implantable cardioverter defibrillator
Authors: Viana T , Vieira De Melo R.M , Figueiredo C.S , Azevedo D.F.C , Carvalho W.N , Grimaldi A.C , Da Silva D.N.V , Passos L.C.S 
Published: October 2021

Abstract

Introduction
The implantable cardioverter defibrillator (ICD) has been shown to be effective in reducing cardiovascular mortality in selected patients with cardiomyopathy in primary and secondary prevention. However, as it is an invasive and costly procedure, it is necessary to identify the patients who most benefit from this therapy. The evaluation of a multidisciplinary team for CRT candidates can contribute to the improvement of results.

Objective
Development of a risk score based on social predictors in patients undergoing ICD implantation.

Methods
Prospective cohort conducted between January 2017 and September 2019 with patients who underwent ICD implantation in primary and secondary prevention. Patients were evaluated before implantation of the device by a multidisciplinary team that analyzed four social predictors for an unfavorable outcome (low medication adherence, presence of psychosocial risks, low family income and low level of education). The social score was calculated by the simple arithmetic sum of the number of predictors present in each patient. Variables with a possible association (p&lt;0.1) with mortality in 1 year of follow-up were used in the multivariate model by Cox regression.

Results
205 patients were evaluated with a mean follow-up of 416.5 (± 271.6) days. 140 (68.3%) were male, with an mean age of 54.6 years (± 14.6) and an mean LVEF of 43.8% (± 18.5). Most patients 160 (78.0%) were referred for secondary prevention, with Chagas disease being the most prevalent cause of cardiomyopathy 113 (55.1%). Mortality at 1 year was 32 (15.6%). In the multivariate analysis, with the inclusion of the variables: age, secondary prevention, Chagas' disease, LVEF &lt;40% and social score; only the highest score on the social score and LVEF &lt;40% were independently associated with 1-year mortality, RR: 1.5, IC 1.2–2.0; p=0.003 and RR: 4.1, CI 1.2–14.2; p=0.02, respectively. Mortality increased significantly as the score on the social score increased: 6.0% for a score of 0, 7.5% for 1 point; 21.7% for 2 points; 25.0% for 3 points and 29.0% for 4 points; p=0.006, Log-Rank (Figure 1).

Conclusion
The social score can represent a simple prognostic tool that can be usefully used in candidates for ICD. The use of a multidisciplinary team to evaluate patients who are candidates for ICD can help to correctly identify patients who can benefit most from therapy.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Timing of ejection fraction reassessment after sacubitril-valsartan initiation for indication to defibrillator implantation. A single center experience
Authors: Carinci V , Leci E , Bugani G , Greco C , D'Angelo C , Pecoraro A , Casella G 
Published: October 2021

Abstract

Background
Sacubitril/Valsartan (SV) has recently been validated in the therapy of heart failure (HF) with reduced ejection fraction (EF). SV is effective on symptoms and heart remodeling. At the moment the best timing to EF assessment after SV initiation in order to proceed with defibrillator (ICD) implantation, it's unknown.

Purpose
Evaluate the timing of improvement of EF after SV initiation in patients (pts) with systolic HF, candidates to primary prevention ICD implantation.

Methods
We enrolled all consecutive pts candidates to primary prevention ICD implantation that underwent SV initiation from February 2018. We evaluated clinical and echo follow up (Fup). Results have been analyzed with paired T-test).

Results
The study involved 61 pts (mean age 67±10 years, 71% male, ischemic cardiopathy 44%, mean time from diagnosis 31 months) with mean EF at enrollment 30±5% (ED vol 94 ml/m2, ES vol 64 ml/m2, severe MR 21%) and mean NYHA 3±0.6. After a mean Fup of 6 months mean EF increased to 37±7% (ED vol 80 ml/m2, ES vol 51 ml/m2, severe MR 8%, p&lt;0.004), NYHA decreased to 2±0.6 (p&lt;0.04). In 69% pts SV dosage reached 97/103 mg bid. 28 pts (45%) had first Fup at 3 months and showed already mean EF 34±6% and mean NYHA 1.6±0.6 (p&lt;0.04). 26 pts (43%) had last Fup echo after 1 year (mean 17±10 months) and showed further EF little improvement (38.3±8%, p 0.05).

Conclusions
After SV initiation in systolic HF, heart remodeling is already evident at 3 months Fup and better appreciable at 6 months Fup. Little non significant further EF improvement could be seen later. In our study best timing to decide for primary prevention ICD is likely between 3 and 6 months after SV initiation.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Detailed analysis of left ventricular deformation in athletes doing high dynamic sports – a three-dimensional speckle-tracking echocardiographic study
Authors: Nemes A , Gyenes N , Kormanyos A , Vagvolgyi A , Balogh L , Pucsok J , Lengyel C 
Published: October 2021

Abstract

Background
Physiologic remodeling due to repetitive overload induced by exercise training is a known feature in the athletes' heart including significant changes in left ventricular (LV) deformation mechanics. The aim of the present study was to investigate three-dimensional speckle-tracking echocardiography- (3DSTE-)derived LV strains in elite athletes doing high dynamic sports with different grades of static components of their training.

Methods
The athlete group comprised 67 subjects (mean age: 23.6±6.4 years, 50 men). The following groups were created regarding their physical activity: Group C. I. (high dynamic/low static) (n=12, mean age: 23.1±4.0 years, Group C. II. (high dynamic/moderate static) (n=22, mean age: 24.8±7.8 years) and Group C. III. (high dynamic/high static) (n=33, mean age: 23.0±6.1 years). Their results were compared to 83 age- and gender-matched non-athletic healthy controls (mean age: 23.6±3.2 years, 50 men). All athletes and non-athletes underwent a complete two-dimensional Doppler echocardiography examination with 3DSTE.

Results
None of the healthy subjects or athletes had any known cardiovascular risk factors or received drugs and ECG showed no significant alterations. Athletes spent 10.8±3.3 years, 10.1±5.9 years and 6.9±4.2 years in elite sport in Groups C. I., C. II. and C. III., respectively. No significant differences could be seen in the ratio of athletes being in an actual race period between Groups C. I., C. II. and C. III. [n=3 (25%), n=11 (50%) and n=11 (32%), respectively]. Enlarged LV dimensions and thickened posterior wall and interventricular septum were found in all athletes compared to the non-athlete healthy control group by 2-dimensional echocardiography. Increased 3DSTE-derived LV end-diastolic and end-systolic volumes could be seen in all athletes, the largest values were seen in the C. III. group. Global LV-LS (−18.5±3.0% vs. −16.3±2.3%, p&lt;0.05), LV-CS (−29.9±5.2% vs. −28.1±4.8%, p&lt;0.05) and LV-AS (−43.7±5.4% vs. −40.9±4.8%, p&lt;0.05) were increased as compared to those of non-athlete controls. All apical regional LV strains proved to be increased in all athletes with enhanced basal LS and midventricular LS, AS and 3DS. Global LV strains did not differ between the athlete groups based on static component of their training. No significant regional differences in LV strains could be detected between C. I., C. II. and C. III. groups (except in midventricular LV-LS).

Conclusions
Enhanced LV contractility represented by LV strains in longitudinal and circumferential directions could be demonstrated in elite athletes doing high dynamic sports, which does not depend on the grade of the static component of their training.

Funding Acknowledgement
Type of funding sources: None.