bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upright exercise stress echocardiography may unmask dynamic left ventricular obstruction also beyond hypertrophic cardiomyopathy
Authors: Cotrim C , Cafe H , Goncalves I , Guardado J , Cotrim N , Cordeiro P , Feliciano J , Baquero L , Picano E 
Published: October 2021

Abstract

Background
Dynamic left ventricular outflow obstruction (LVOTO) during exercise stress echocardiography (ESE) is recommended in hypertrophic cardiomyopathy (HCM) to identify the obstructive phenotype.

Aim
To assess left ventricular outflow gradient (LVOTG) during ESE in different conditions.

Methods
In a single-group, prospective, observational study, we performed peak and/or post-treadmill ESE with systematic assessment of LVOTG in the orthostatic position by continuous-wave Doppler in 1333 subjects (837 males, mean age 38,2±20 ranging from 6 to 87 years) recruited over a period of twenty years, from 2001 to 2021. Peak LVOTG ≥30 mm Hg was considered abnormal for LVOTO during ESE. We enrolled 7 different populations: asymptomatic healthy controls (n=35); HCM (n=81); genotype-positive, phenotype negative asymptomatic HCM (n=6); patients with chest pain symptoms, suspected myocardial ischemia and either normal coronary arteries (INOCA, n=131,or with very low pre-test probability of coronary artery disease (probable INOCA, n=416) and; fatigue and suspected heart failure with preserved ejection fraction (HFpEF, n=206); amateur athletes with ischemia-like ECG changes during exercise-test or symptoms such as near syncope or chest pain or dizziness (n=457); aborted sudden death and with negative screening (n=1).

Results
Technical success rate of LVOTG assessment was 1333/1333 at rest and at peak stress (feasibility 100%). Imaging and analysis time were &lt;1 minute. LVOTG at rest was present in 25 pts (2.8%) of the overall population: 23 HCM, 1 INOCA, and 1 HFpEF. Overall prevalence during ESE was 432/1333 (32%). During ESE, LVOTO (see Figure 1 and 2) was 0% (0/35) in normals, 58% (47/81) in HCM (23 with obstruction at rest), 33% (2/6) in genotype-positive, phenotype negative HCM, 37% (33/131) in INOCA, 40% (135/416) in athletes and 1/1 in the patient with aborted sudden death on strenuous exercise.

Conclusion
LVOTO in orthostatic position is detectable during treadmill ESE in several cardiovascular conditions associated with symptoms such as dyspnea, chest pain or near syncope, and even in asymptomatic patients with genotype-positive, phenotype-negative HCM. The identification of the obstructive phenotype is easy to capture during ESE without any significant additional imaging and analysis burden and can be important also outside HCM.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Two-year outcomes of patients with atrial fibrillation treated with rivaroxaban: results from RIVER registry
Authors: Beyer-Westendorf J , Camm A.J , Virdone S , Fox K.A.A , Pieper K.S , Le Heuzey J.-Y , Haas S , Kayani G , Gersh B.J , Turpie A.G.G , Kakkar A.K ,   RIVER Investigators
Published: October 2021

Abstract

Introduction
Non-vitamin-K oral anticoagulants (NOACs) were recommended in preference to oral vitamin K antagonists (VKAs) in the 2020 updated guidelines for stroke prevention in atrial fibrillation (AF), from the European Society of Cardiology (ESC). Rivaroxaban is a NOAC that is approved in many countries worldwide for reducing the risk of stroke or systemic embolism in patients with nonvalvular atrial fibrillation (AF).

Purpose
To explore the baseline characteristics, dosing and 2-year outcomes of patients with AF treated with rivaroxaban.

Methods
RIVaroxaban Evaluation in Real Life setting (RIVER) is a prospective international, multicenter registry of patients with newly diagnosed non-valvular AF treated with rivaroxaban for the prevention of thromboembolic stroke and at least one investigator-determined risk factor for stroke.

Results
A total of 5043 patients were enrolled into RIVER between January 2015 and June 2017. Mean (SD) age at diagnosis was 69.5 (11.0) years and 55.7% were males. Caucasian patients represented the largest proportion of patients in RIVER (80.3%), followed by Asians (5.5%) and hispanic/latino (3.7%). Almost all patients (98.5%) were prescribed a single daily dose of rivaroxaban, most commonly 20 mg (77.3%) and 15 mg (20.4%), while a 10 mg dose was prescribed in only 2.3% of patients. During the 2-year follow-up, the rates (95% CI) of all-cause mortality, stroke/SE, and major bleeding were 2.75 (2.43 to 3.12), 0.89 (0.72; 1.11), and 1.26 (1.05 to 1.52) per 100 person years, respectively (Figure 1). The most common cardiovascular cause of death was congestive heart failure (30.4%) and myocardial infarction (11.4%). Leading non-cardiovascular causes of death were malignancy (27.4%), respiratory failure (18.9%) and infections/sepsis (13.2%). Over 2 years, 710 (14.1%) of patients discontinued rivaroxaban. The corresponding proportions at 6 months and 1 year were 7.8% and 10.8%, respectively. Out of all the patients who discontinued, 62 (8.7%) restarted rivaroxaban during their follow-up (Table 1).

Conclusion
During 2 years of follow up in the international, prospective RIVER registry, rivaroxaban treatment for AF was associated with low rates of stroke or major bleeding.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by an unrestricted research grant from Bayer AG, Berlin, Germany, to TRI, London, UK. This work is supported by KANTOR CHARITABLE FOUNDATION for the Kantor-Kakkar Global Centre for Thrombosis Science.
Polygraphy as a new screening method for obstructive sleep apnea in patients with atrial fibrillation?
Authors: Delesie M , Knaepen L , Miljoen H , Willemen M , Verbraecken J , Weytjens K , Dendale P , Heidbuchel H , Desteghe L ,   Research Group Cardiovascular Diseases, University of Antwerp, Belgium
Published: October 2021

Abstract

Background
Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients. According to the 2020 European Society of Cardiology guidelines for the diagnosis and management of AF, it seems reasonable to test for OSA in symptomatic AF patients before initiation of rhythm control therapy. A good OSA screening pathway is lacking in the guidelines and in daily clinical practice in most centers today. Polysomnography (PSG) is the gold standard for diagnosing OSA but it is not an ideal screening method, due to its expensiveness, labour-intensiveness and limited availability.

Purpose
The aim of this study was to validate and examine the performance of different (cardiorespiratory) polygraphy (PG) devices, used with their automated algorithm to detect OSA in an AF cohort, compared with PSG as gold standard.

Methods
Prospective study with three PGs (ApneaLink Air (ALA), SOMNOtouch RESP (STR) and SpiderSAS (SpS) combined with ResMed Airview-, SomnoMedics DOMINO- and Microport SYNESCOPE software respectively) in consecutive AF patients who were referred for a PSG evaluation. Patients received the three devices with instructions for use after their PSG and were requested to use each one during three consecutive nights at home. Severity of OSA was classified according to the Apnea-Hypopnea Index (AHI) with &lt;5 events/hour= no OSA, 5–14= mild-, 15–30= moderate-, &gt;30= severe OSA.

Results
A total of 100 AF patients presenting for PSG were included (64.0±8.6 years, 73% male, 87% non-permanent AF, mean Body Mass Index 30.6±5.9 kg/m2, mean CHA2DS2-VASc score 2.4±1.7, mEHRA≥2 in 64%; mean AF history 5.4±5.6 years). PSG diagnosed ≥mild OSA in 90% of patients, ≥moderate in 69%, and severe OSA in 33%. Successful PG execution to determine the AHI, i.e. ≥4 hours of data on automated analysis, was obtained in 72.0%, 73.0% and 79.0% of patients with the ALA, STR and SpS respectively. In screening for clinically relevant OSA (i.e. at least moderate OSA), the PGs had an area under the curve of 0.802, 0.761 and 0.803 for the ALA, STR and SpS respectively (Figure 1).

Conclusions
This first analysis shows that PGs combined with an automated algorithm for AHI determination, can be used as OSA screening tools in AF patients before referral for PSG. Further optimisation is likely by choosing an appropriate AHI cut-off value for each PG.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This study is supported by the Antwerp University Cardiology Research Fund, and is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Figure 1
Safety and efficacy of His-bundle pacing/left bundle branch area pacing versus right ventricular pacing: a systematic review and meta-analysis
Authors: Peng X.Y , Chen Y , Li X.X 
Published: October 2021

Abstract

Background
Recent studies have demonstrated that right ventricular pacing (RVP) has deleterious effects on non-synchronized ventricular contraction, while His-bundle pacing (HBP) or left bundle branch area pacing (LBBaP) contribute to improvements in patients' mid- and long-term outcomes. This meta-analysis aimed to compare the safety and efficacy of physiologic pacing (HBP/LBBaP) versus those of RVP.

Methods
A systematic search of PubMed, Cochrane Library, and Embase was conducted for studies that compared the effects of physiologic pacing and RVP. All eligible studies were published before January 1, 2021 and were conducted in humans. STATA software version 15.0 was used for all the data analyses.

Results
Twenty articles (n=2787 patients) were included in this meta-analysis. Compared to RVP, physiologic pacing were associated with a shorter QRS duration (weight mean difference [WMD] −41.84, 95% confidence interval [CI] −50.74, −32.94), better cardiac function (57.95±9.72% vs. 52.35±13.75%), and lower rates of mitral regurgitation (standardized mean difference [SMD] −0.33, 95% CI −0.76, 0.10), pacing-induced cardiomyopathy (odds ratio [OR] 0.77, 95% CI 0.52, 1.15), death (OR 0.94, 95% CI 0.78, 1.12), heart failure hospitalization (OR 0.94, 95% CI 0.79, 1.12) and atrial fibrillation (OR 0.95, 95% CI 0.76, 1.18), although some results were not statistically significant. In addition, RVP led to the achievement of higher success rates than physiologic pacing (OR 0.05, 95% CI 0.02, 0.13), a shorter fluoroscopic time and mean procedure duration (WMD 6.21, 95% CI 2.00, 10.42; WMD 20.75, 95% CI 13.78, 27.72), a lower pacing threshold (WMD 0.48, 95% CI 0.24, 0.72), and fewer surgical complications (OR 1.02, 95% CI 0.88, 1.19). Compared with HBP, LBBaP appeared to have some advantages in R wave amplitudes, pacing threshold, fluoroscopic time, procedure time, and success rate, however, some results were not statistically significant.

Conclusion
Physiologic pacing (HBP/LBBaP) might be a better strategy than RVP and improve long-term clinical outcomes like cardiac function. Although LBBaP appears to have some advantages over HBP, the long-term benefits are still controversial. More large-scale randomized clinical trials are needed for further verification.

Funding Acknowledgement
Type of funding sources: None.
Frequency and predictors of physical trauma during reflex syncope
Authors: Tavolinejad H , Yadangi S , Sadeghian S , Bozorgi A , Tajdini M 
Published: October 2021

Abstract

Background
Reflex syncope is a common and generally benign condition; however, the occurrence of secondary trauma can be a potentially harmful complication. Identification of characteristics and conditions associated with trauma after syncope are important for clinicians.

Purpose
We aimed to investigate the frequency and predictors of secondary injury during reflex syncope in a large dataset from a tertiary syncope unit.

Methods
All patients referred with an episode of transient loss of consciousness between December 2017 and November 2020 were evaluated. Patients who received a diagnosis of reflex syncope based on 2018 European Society of Cardiology guidelines entered the study. Clinical characteristics, conditions surrounding syncope, and – in patients with a history of previous episodes – a detailed history of up to three prior syncopal attacks were documented. The primary outcome was the presence of any clinically relevant injury that was related to syncope. In a secondary per-episode analysis, the outcome was a combination of traumatic injuries related to the current and past syncopal episodes.

Results
Among 1258 consecutive patients with reflex syncope (Mean age: 42.3 years; 49.6% female), 239 (23.3%) had evidence of trauma in their initial visit. Female sex (prevalence ratio [PR]: 1.24; P=0.037), body mass index ≥25 kg/m2 (PR: 1.28; P=0.016), previous injury caused by syncope (PR: 1.63; P&lt;0.001), occurrence of syncope in morning hours (PR: 1.90; P&lt;0.001), occurrence of syncope at home (PR: 1.61; P&lt;0.001), absence of prodromes (PR: 1.32; P=0.024), and standing position at the time of syncope (PR: 1.61; P&lt;0.001) were associated with injury. Although family history of syncope was not related to injury, history of syncope in brother showed a significant association with secondary trauma (PR: 2.19; P=0.003). In multivariable logistic regression, five characteristics (previous injury after syncope, occurrence of syncope in the morning, occurrence of syncope at home, absence of prodromes, and standing position at the time of syncope) were independent predictors of injury. In the absence of all five conditions, the risk of injury was &lt;3%. In the secondary per-syncope analysis, of 2849 syncopal episodes, 1028 (36.1%) were associated with trauma. Having syncope in the morning (PR: 1.34; P&lt;0.001), occurrence of syncope at home (PR: 1.51; P&lt;0.001), absence of prodromes (PR: 1.34; P&lt;0.001), and standing position at the time of syncope (PR: 1.55; P&lt;0.001) were again associated with injury.

Conclusions
Secondary trauma after reflex syncope is a common complication. Specific conditions at the time of syncope are associated with traumatic injuries, suggesting that interventions to avoid syncopal attacks in those conditions might reduce secondary trauma.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Tehran University of Medical Sciences
Prognosis of apical hypertrophic cardiomyopathy in patients with an implantable cardioverter defibrillator
Authors: Nakano M , Kondo Y , Nakano M , Kajiyama T , Ito R , Takahira H , Kitagawa M , Sugawara M , Chiba T , Kobayashi Y 
Published: October 2021

Abstract

Background
Prophylactic use of implantable cardioverter-defibrillators (ICDs) to prevent sudden cardiac death (SCD) is widely spread all over the world in patients with hypertrophic cardiomyopathy (HCM). Apical HCM is a phenotype variant of HCM, with hypertrophy predominantly affecting apex, that was initially described 30 years ago. Apical HCM patients may have different clinical prognosis compared with other subsets of HCM. In previous studies, apical HCM patients seem to have a more benign prognosis than other types of HCM. However, little is known about the long-term outcomes of apical HCM and there are many unclear points. Moreover, there are few reports about the clinical prognosis in apical HCM patients with an ICD.

Objective
The aim of this study is to identify the difference between the prognosis of apical and the other HCM patients with an ICD.

Methods
We retrospectively analyzed the database of our ICD clinic. All subjects had been implanted with an ICD from October 2006 to August 2017. We classified HCM patients into LV outflow tract obstruction (LVOTO) and midventricular obstruction (MVO), apical HCM and other non-obstructive types. We divided all the patients into apical and other types of HCM, and examined their background, incidence of appropriate ICD therapies, hospitalization for heart failure, electrical storm and death.

Results
A total of consecutive 62 Japanese HCM patients with an ICD (follow-up period, 86±25 months; age, 67±14 years; male sex, 85%; left ventricular ejection fraction, 57±12%; LV max wall-thickness, 19±5mm; LV apical aneurysm, 9.7%; HCM Risk-SCD, 4.4±3.0) were enrolled in this study. We classified them into 14 apical HCM and 48 other types of HCM patients. The clinical characteristics and major events of these patients are shown in the Figure. During the follow-up periods, there were no significant differences in the incidence of hospitalization for heart failure, electrical storm and death between the 2 groups (p=0.40; p=0.22; p=0.23). Appropriate therapies occurred in 5 of 14 (36%) patients with apical HCM and 4 of 48 (8.3%) patients with other types of HCM (p=0.022).

Conclusions
Appropriate ICD therapy was more prevalent in patients with apical HCM, compared to patients with other types of HCM. However, the incidences of hospitalization for heart failure, electrical storm and death were not significantly different between two groups.

Funding Acknowledgement
Type of funding sources: None.
Frequency and distribution of J waves in survivors of ventricular fibrillation relationship with presence of myocardial fibrotic and or fat change and coronary arterial stenosis on cardiac CT
Authors: Funabashi N , Nakamura K , Sasaki T , Naito S , Kobayashi Y 
Published: October 2021

Abstract

Background
The presence and distribution of J waves, the occurrence of ventricular fibrillation (VF), and the presence of left ventricular (LV) myocardial fibrotic or fat change or coronary stenosis may be related.

Purpose
To determine the relationship of frequency and distribution of J waves with presence of myocardial fibrotic or fat change and coronary arterial stenosis on cardiac computed tomography (CT) in survivors of VF.

Methods
We conducted a retrospective analysis of 21 survivors of VF (17 males; mean age, 61±14 years) that were implanted with a cardioverter defibrillator and underwent cardiac CT.

Results
On ECG, four subjects had atrial fibrillation. The mean corrected QT interval was 442±39 msec. On CT, two subjects had significant coronary artery stenosis and 12 had LV myocardial fibrotic and/or fat change. The distribution of J waves were as follows: five subjects had J waves in II, III and aVF leads (three had myocardial fibrotic and/or fat change); and 2 had J waves in III lead (one had myocardial fibrotic and/or fat change). One subject each had J waves in V1 lead; V1, 2 leads; II, III, aVF and V1 leads; II, III, aVF and V1–3 leads; II, III, aVF, aVL and V1–6 leads; II, III, aVF and V1–6 leads; II, III, aVF and V4,5 leads; II, III, aVF and V2–5 leads; and III and aVF leads, respectively. The first two subjects did not have LV myocardial fibrotic and/or fat change and the remaining six subjects had myocardial fibrotic and/or fat change (Figure).

Conclusions
Survivors of VF with organized LV myocardial fibrotic and/or fat change showed more frequent J waves with a wider distribution (reached LV inferior wall leads) than survivors without these changes. Monitoring these characteristics on CT may be useful to predict VF.

Funding Acknowledgement
Type of funding sources: None. CT images of fat in a VF survivorJ waves and fibrotic and/or fat change
The efficacy of three dimensional echocardiography in assessment of aortic atherosclerotic plaques compared to two dimensional echocardiography
Authors: Behjati M , Mirdamadi A , Rahimi R.S 
Published: October 2021

Abstract

Background
Complex aortic atherosclerotic plaques (AAPs) carry a significant risk of embolism. Currently, two-dimensional (2D) transesophageal echocardiography (TEE) is the principal diagnostic tool of AAPs. However, we hypothesized that the data obtained from three-dimensional (3D) imaging may improve AAPs' spatial assessment.

Purpose
This study was aimed to evaluate the efficacy of 3DTEE in assessment of AAPs.

Methods
This study includes 96 patients who underwent routine TEE in our center within 2018–2019. The entire aorta including aortic root, ascending aorta, aortic arch, and descending thoracic aorta was investigated using both 2D and 3D TEE. The size and grade of aortic atherosclerotic plaques were compared using both 2D and 3D TEE. In addition, we examined to see if there is any correlation between the grade and size of the plaque, and patient's cardiac risk factors including their history of atherosclerotic diseases.

Results
Patients with atherosclerotic plaque in the ascending aorta had a larger plaque thickness in both two-dimensional and three-dimensional echocardiography. Obesity was an important risk factor for development of AAPs. Also, patients with a history of cerebrovascular attack (CVA) or transient ischemic attach (TIA) had larger AAPs. While age and gender showed no impact on the thickness of AAPs. According to the results obtained from comparing three-dimensional over two-dimensional echocardiography, one patient (1.04%) showed a decrease in grading scale, while nine patients (9.38%) showed enhancement in their grading (P-value=0.03). For the rest of 86 patients (89.58), atherosclerotic plaque grading was similar using both methods. This means that in almost 9% of cases 3D TEE increases the grading of the attributed atherosclerotic plaque, while it is the same to 2DTEE in most cases.

Conclusions
The information obtained from three-dimensional echocardiography would be most often very similar to the two-dimensional echocardiography, while in few cases, it would improve the grading scale. Cases with obesity and history of CVA and TIA had larger thickness of AAPs in both 2D and 3DTEE, while age and gender had no impact on plaque thickness.

Funding Acknowledgement
Type of funding sources: None.
Intraoperative echocardiography for electrode implantation into the left bundle branch region in patients with indications for cardiac resynchronization therapy
Authors: Karpenko I , Pavlinova N , Volkov D , Bochonko O 
Published: October 2021

Abstract

Background
Left bundle branch (LBB) pacing recently became a novel pacing modality for cardiac resynchronization therapy (CRT).

Purpose
We evaluated the feasibility and utility of intraoperative Echocardiography (TTE) for implantation Select Secure pacing lead 3830 through interventricular septum (IVS) into the LBB area.

Methods
60 patients with LBB block and indications for CRT in the period 2019–2020 underwent electrode implantation into the LBB area. Immediately before implantation, the IVS thickness and density (color scale ZOOM function, Siemens SC 2000 Prime) in the basal and middle region of IVS was assessed. White color corresponds to areas with a large amount of fibrosis, gray – conditionally viable myocardium. The implantation of the electrode by screwing it clockwise was carried out under constant echocardiographic control of the electrode advance from the right ventricle perpendicular to the IVS to the left ventricular (LV) endocardium. The ultimate target was the LV subendocardial region. After reaching the end position, the duration of mechanical LV systole was assessed (Velocity Vector 2D Speckle Analysis). Opposite wall delay (OWD) &lt;120 ms – considered as a marker of good mechanical resynchronization.

Results
Technically, the procedure was successful in 54 from 60 patients (90%). The average IVS thickness at the site of successful implantation was 11±3, the maximum thickness was 18 mm. Average number of attempts to screw in the electrode in IVS per patient – 4.2±2.1. Predictors of failure were: 2 – IVS thickness over 15 mm throughout entire length and in 4 cases – total IVS fibrosis, despite the normal thickness (9±3). In two cases IVS perforation was detected, corrected by immediate electrode repositioning. In 4 (6.6%) cases, the initial point of implantation was not effective: OWD &gt;120 ms, which required reimplantation of the lead in a more optimal position.

Conclusion
The use of intraoperative echocardiography during electrode implantation in the IVS allows choosing an optimal site for successful implantation, reliably monitoring the electrode position during implantation, and assessing LV intraventricular asynchronism and effectiveness of resynchronization

Funding Acknowledgement
Type of funding sources: None.