bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic approach at specialized syncope units in the netherlands: a cross-sectional, nationwide survey
Authors: Van Zanten S , De Jong J S Y , Scheffer M G , Kaal E C A , De Groot J R , De Lange F J 
Published: November 2023

Abstract

Introduction
The European Society of Cardiology Guidelines recommend a structural approach for the initial evaluation of syncope patients, yet implementation of such approach appears cumbersome. There are several specialized Syncope Units in the Netherlands. Here we investigated the diagnostic strategy of specialized Syncope Units and adherence areas for syncope patients.

Purpose
We aimed to identify the current network of Syncope Units in the Netherlands and to assess to which extent the units fulfil requirements as indicated by the European Heart Rhythm Association consensus and the current guidelines.

Methods
All units Neurology, Internal Medicine, and Cardiology in hospitals in the Netherlands were contacted. Units with specialized Syncope care were included and requested to fill out a questionnaire of 25 questions regarding which medical specialties are involved during evaluation, which diagnostic tests are available and being performed and which adherence regions were associated. We specifically investigated whether the Syncope Units adhered to the consensus statements 1 and 3 as described by the European Heart Rhythm Association position paper as gold standard for best practices.

Results
Specialized care for syncope was reported in 20/72 hospitals. Most (17/20) reported that multiple specialties are involved during the initial evaluation. 19/20 had either Neurology, Cardiology, or both responsible for the Syncope Unit. 18/20 perform guideline-based orthostatic blood pressure measurement. A non-invasive-beat-to-beat blood pressure monitor was present in 11/20 units. 16/20 perform tilt table testing and do &gt; 48 per year, 3/16 this was during the initial evaluation and 15/20 perform carotid sinus massage. The adherence areas cover 64.2% of the Netherlands. Both European Heart Rhythm Association consensus statements 1 and 3 for best practice were met in 4/20 of the Syncope Units, 4/20 only met consensus statement 1 and 14/20 only met consensus statement 3.

Conclusion
We identified 20 Syncope Units in the Netherlands. The diagnostic approach varies in the medical specialties involved, protocols for cardiovascular testing, and timing of diagnostic tests. Most units did not completely perform the Guideline suggested initial evaluation. Four out of 20 Syncope Units met the European Heart Rhythm Association consensus statements for best clinical practice.Overview Syncope Units NetherlandsAdherence of the Syncope Unit
Quantitative autonomic testing after recovery from acute COVID-19 infection: comparison with findings in controls and individuals with neurogenic autonomic dysfunction
Authors: Mascarenhas L , Kohno R , Mcdonald D , Colburn S , Benditt D 
Published: November 2023

Abstract

Background/Introduction
Cardiovascular autonomic dysfunction (CvAD) is believed to contribute to the persistence of troublesome symptoms following apparent recovery from an acute COVID-19 infection. Common complaints in this setting include cognitive impairment (‘brain fog’), fatigue, and both postural and exertional intolerance with a sensation of excessive rapid heart beating. However, while the occurrence of CvAD post-acute COVID-19 has been widely recognized, its quantitative assessment remains largely unexplored.

Purpose
The purpose of this study was to determine whether quantitative cardiovascular autonomic testing in post-acute COVID-19 patients differ from findings in Controls and are more similar to individuals with Neurogenic CvAD, such as those with Pure Autonomic Failure.

Methods
Quantitative autonomic testing was prospectively undertaken in two patient groups: post-acute COVID-19 and Neurogenic CvAD patients, and in control subjects. Acute COVID-19 was documented by the nasopharyngeal PCR method and all affected patients had recovered at least 1 week prior to their autonomic study. Neurogenic CvAD patients were studied as part of their diagnostic evaluation, and none had a COVID-19 infection prior to their study. Measurements included i) heart rate (HR) and blood pressure (BP) responses during active standing (AS), ii) time to BP nadir and time to BP recovery during AS, iii) Valsalva ratio (VR), and iv) respiratory sinus arrhythmia (RSA). The unpaired student t-test and Mann Whitney U test were used to analyze normally and non-normally distributed data, respectively, between post-acute COVID patients and the Control and Neurogenic CvAD patients. All variables were continuous and presented as means with corresponding standard deviations (SD) when normally distributed or interquartile ranges (IQR) when non-normally distributed. A p-value of &lt;0.05 was considered statistically significant.

Results
Post-acute COVID-19 patients (N=55, 83.6% female) and Controls (N=82, 86.6% female) were of similar age (39 [IQR 27.3, 49.2] vs. 33 [IQR 21.4, 40.0] years, respectively, p=0.034). Neurogenic CvAD patients (N=27, 51.9% female) were older (68 [IQR 62.9, 74.3], p&lt;0.00001). The main findings (Table 1, mean [SD]) indicate that post-acute COVID-19 patients exhibited HR and BP responses during AS similar to the Control group; on the other hand, average VR, maximum systolic BP drop during AS, and maximum HR increase during AS in COVID-19 patients trended towards findings in Neurogenic CvAD patients.

Conclusion
Recovered post-acute COVID-19 patients referred for autonomic dysfunction evaluation due to persisting symptoms exhibit autonomic testing findings similar to control subjects but trending towards observations in neurogenic CvAD.
A leadless ventricular pacemaker providing atrioventricular synchronous pacing in the real-world setting: results from the Micra AV post-approval registry
Authors: Garweg C , Chinitz J , Marijon E , Haeberlin A , Winter S , Iacopino S , Curnis A , Breitenstein A , Hussin A , Mela T , El-Chami M F , Roberts P R , Piccini J P , Stromberg K , Clementy N 
Published: November 2023

Abstract

Introduction
Advances in leadless pacemaker technology have enabled accelerometer based atrioventricular synchronous (AVS) pacing by sensing atrial mechanical contraction. However, longer-term performance of these devices in real-world clinical practice has not been assessed.

Objectives
To report the performance of the Micra AV transcatheter pacemaker from the worldwide Micra AV post-approval registry (PAR) through 1-year post-implant.

Methods
The Micra AV PAR is an ongoing prospective single-arm observational study designed to assess the safety and effectiveness of the Micra AV system in the real-world setting. Patients enrolled in the Micra AV PAR will be followed for 3 years. For the present interim analysis, baseline characteristics, total AV synchrony index (sum of %AM-VP, %AM-VS, and AV conduction mode switch percentage), major complications, and system revisions through 12-months of implant were summarized and compared to a historical cohort of 2,667 transvenous dual chamber (TV-DC) pacing patients.

Results
The device was successfully implanted in 797 of 801 patients (99.4%) at 98 centers in 19 countries between February 2020 and April 2022. Mean age was 74.1±15.1 years, 42.2% were female, and 31.3% were precluded from transvenous device therapy. Micra AV patients were on average older (74.1 vs. 71.1 yrs, P&lt;0.0001) and had a significantly higher incidence of renal disease (22.3% vs. 9.8%, P&lt;0.0001) compared with TV-DC patients. Mean follow-up was 7.7±6.4 months. Through 12-months, the major complication rate was 4.2% in Micra AV patients compared to 8.8% TV-DC patients (HR: 0.48, P&lt;0.001, Figure). At 12-months, the system revision rate was 1.9% in Micra AV patients compared to 5.5% for TV-DC patients (HR: 0.28, P&lt;0.001). The reduction in system revisions was largely driven by the absence of lead dislodgements requiring revision. Of the 397 patients with device interrogation files available for analysis, 315 (79.4%) were programmed to VDD mode at last follow-up and had a median AV synchrony index of 86.4% (IQR: 68.8% - 97.4%).

Conclusions
The Micra AV leadless pacemaker was implanted with a high rate of success in patients with a high co-morbidity burden, with a significantly lower rate of complications and system revisions through 12-months compared to dual-chamber transvenous pacemakers despite patients being older and having a higher incidence of renal disease. Longer-term performance will continue to be assessed in this ongoing trial.Major Complications Through 12-months
New-onset syncope in diabetic patients treated with sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase 4 inhibitors: A Chinese population-based cohort study
Authors: Gao X , Zhang N , Gao T , Tse G , Lip G Y H , Liu T , Zhou J 
Published: November 2023

Abstract

Background and Aims
Type 2 diabetes mellitus (T2DM) is an independent risk factor for syncope. Sodium-glucose cotransporter-2 inhibitor (SGLT2i) shows strong cardiovascular benefits, but a therapeutic benefit on syncope has not been previously investigated. This study aims to investigate the incidence of new-onset syncope in T2DM patients treated with SGLT2i v.s. dipeptidyl peptidase-4 inhibitors (DPP4i) in a Chinese population.

Methods
This was a retrospective cohort study of T2DM patients treated with SGLT2i or DPP4i between January 1st, 2016, and December 31st, 2020, in Hong Kong. The study outcomes were new-onset syncope, cardiovascular mortality and all-cause mortality.

Results
A total of 55370 patients (50.48% male; median age: 62.78 years) were included with a median follow-up of 5.56 years. In the matched cohort (SGLT2i: n=18751; DPP4i: n=18751), SGLT2i use was significantly associated with lower risks of syncope (HR: 0.49, 95%CI: [0.41, 0.57], P &lt; 0.0001), cardiovascular mortality (HR: 0.35, 95%CI: [0.26, 0.46], P &lt; 0.001) and all-cause mortality (HR: 0.30, 95%CI: [0.26, 0.34], P &lt; 0.0001). Of the SGLT2i types, empagliflozin (HR: 0.79, 95%CI: [0.59, 1.05], P = 0.0999), dapagliflozin (HR: 0.70, 95%CI: [0.58, 0.85], P = 0.0004), canagliflozin (HR: 0.48, 95%CI: [0.36, 0.63], P &lt; 0.0001) and ertugliflozin (HR: 0.45, 95%CI: [0.30, 0.68], P = 0.0001) were all associated with significantly lower risks of syncope.

Conclusions
SGLT2i is associated with lower risk of new-onset syncope, cardiovascular death and all-cause death compared to DPP4i. Of the different SGLT2i, dapagliflozin, canagliflozin and ertuglifolzin were significantly associated with lower risks of new-onset syncope.
Conventional cardiovascular risk factors in young individuals with three-vessel coronary artery disease experiencing sudden cardiac death
Authors: Vahatalo J H , Holmstrom L , Pakanen L , Kaikkonen K , Perkiomaki J , Huikuri H V , Junttila M J 
Published: November 2023

Abstract

Background
Coronary artery disease (CAD) is a major cause of sudden cardiac death (SCD) in young victims under 50 years of age. Despite the young age, highly advanced CAD is a common finding at autopsies.

Purpose
We aimed to determine the prevalence of conventional cardiovascular risk factors in ischemic SCD victims under the age of 50 years with a three-vessel CAD detected at autopsy.

Methods
The study population was derived from the Fingesture study, consisting of consecutive victims of SCD in Northern Finland between years 1998-2017 (n=5,869). All victims underwent medico-legal autopsy with histological examinations, and toxicology investigations was performed if necessary. Pre-mortem clinical history was obtained from available medical records and medication, questionnaires to closest family members and police reports about the conditions of the death.

Results
In the Fingesture study, a total of 266 SCDs caused by CAD were observed in victims under 50 years of age. Three-vessel disease was detected in 118 victims (44%). The victims with three-vessel disease had more commonly a history of diabetes (26% vs. 14%, p=0.017) compared with victims with fewer major coronary arteries affected. No statistically significant difference was detected in the prevalence of known dyslipidemia (16% vs. 9%, p=0.134), hypertension (29% vs. 19%, p=0.103), male gender (88% vs. 91%, p=0.552), family history of SCD (33% vs. 36%, p=0.841), smoking (81% vs. 72%, p=0.371), or mean age (45 years vs. 44 years, p=0.120).

Conclusions
The history of diabetes was the only conventional risk factor associated with three-vessel disease in young individuals who experienced SCD determined to be caused by CAD. Along with previous studies, these results highlight the role of diabetes in the development of CAD and adverse outcomes in young people.
Burden and impact of comorbid depression on in-hospital outcomes of Hypertrophic Cardiomyopathy patients in the USA: a nationwide analysis, 2020
Authors: Bhanushali A D I T I , Sampath S , Ahmed H , Mohammed A D I L S , Ganampet N , Muslehuddin Z A I N A B , Bandaru R , Allamneni R A K E S H , Behera A , Kumar S , Adompreh-Fia K O K O U , Desai R U P A K 
Published: November 2023

Abstract

Background
Depression has emerged as a critical risk factor for development and progression of various cardiovascular diseases; however, the association between depression and Hypertrophic Cardiomyopathy (HCM) outcomes is less clear. We aimed to determine the impact of comorbid depression on patients hospitalized with HCM.

Methods
The National Inpatient Sample (2020) was assessed to identify patients hospitalized with HCM using relevant ICD-10 codes. Propensity score matching of 1:1 was performed and the cohort was divided into two - those with comorbid depression (HCM-D+) and those without (HCM-D-). Baseline characteristics and comorbidities were compared between the two cohorts. Impact of comorbid depression on hospitalized HCM patients was evaluated using a multivariate regression analysis adjusting for confounders.

Results
We identified a cohort of 15530 in-hospital HCM patients with a median age of 67 years (66.9% females, 33.1% males, 74.6% whites, 19.1% blacks, 4.3% hispanics, 1.7% Asians). Amongst 15530, 85.5% admissions were non-elective. The HCM-D+ cohort had significantly higher rates of comorbidities such as hypertension (76.4% vs 71.4%), hyperlipidemia (62.5% vs 52.4%), obesity (27.9% vs 24.9%), smoking (28.1% vs 25.7%), dementia (8.2% vs 4.4%) and cancer (7.5% vs 5.8%) (p&lt;0.001). When in-hospital outcomes were compared, HCM-D+ cohort paradoxically appeared to have 44% lower risk of all-cause mortality (OR-0.56; 95%CI: 0.37- 0.84), 22% lower risk of composite end points (all-cause mortality, heart failure, atrial fibrillation, cardiac arrest including ventricular fibrillation, acute ischemic stroke) (OR-0.78; 95%CI:0.66-0.91), 21% lower risk of atrial fibrillation alone (OR-0.79; 95%CI:0.67-0.92) (p&lt;0.001).

Conclusion
Despite having higher rates of comorbidities, comorbid depression in HCM patients appeared to improve in-hospital outcomes. Further studies are needed to uncover the paradoxical protection provided by underlying depression.
Association between scar quantification and documented history of ventricular tachycardia in patients with hypertrophic cardiomyopathy
Authors: Mann C , Gharib D , Widmann K , Tosun R , Dachs T M , Kronberger C , Hengstenberg C , Zelniker T A , Dalos D 
Published: November 2023

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is a major risk factor for sudden cardiac death, and it is crucial to accurately identify patients who may benefit from implantable cardioverter defibrillator (ICD) implantation. Therefore, accurate risk stratification remains an unmet clinical need for patients with obstructive (HOCM) and non-obstructive (HNCM) hypertrophic cardiomyopathy.

Methods and Aim
Consecutive HCM patients were enrolled at a tertiary academic center and underwent cardiac magnetic resonance imaging. We aimed to explore risk factors for a documented history of ventricular tachycardia (VT).

Results
In total 246 HCM (160 HNCM, 86 HOCM) patients were included in the present analysis. Patients with HOCM and HNCM had similar rates of documented VTs (20.0% vs. 23.2%, p=0.61). However, the HCM-risk-score was significantly lower in HNCM patients (4.56% vs. 3.36%, p=0.003).
There was no significant difference in age (53 vs. 57 years, p=0.65), sex (female sex 30% vs. 42%, p=0.14), or echocardiographic parameters, including the maximum outflow tract gradient (59 vs. 67 mmHg, p=0.71), the maximum wall thickness (21 vs. 20 mm, p=0.088), and the left atrial diameter (57 vs. 56 mm, p=0.59), in patients with versus without a history of documented VT.
Furthermore, NT-proBNP (1040 vs. 1199 pg/mL, p=0.74) and high sensitivity troponin-T levels (22 vs. 19 ng/L, p=0.38) did not differ between groups.
Patients with a history of VT were significantly more likely to have late gadolinium enhancement (LGE, 80% vs 50%, p=0.007) and had a higher percentage of LGE in relation to the left ventricular mass (9.2% vs 3.7%, p=0.001). These findings were consistent in patients with HOCM and HNCM (3.32% vs. 5.72% p=0.085).
In an adjusted logistic regression model, the percentage of LGE was independently associated with the presence of VT (Odds ratio 1.27 [95%CI 1.08-1.50]).

Conclusion
These findings suggest that LGE may be a useful imaging marker for risk assessment in patients with HOCM and HNCM.
Prevalence and prognostic value of epilepsy and Brugada syndrome
Authors: Villatore A , Rossetto E , Sala S , Della Bella P , Di Resta C , Peretto G 
Published: November 2023

Abstract

Background
The correlation between Brugada syndrome (BrS) and epilepsy has been previously reported. Sudden death (SD) is a manifestation of BrS due to malignant ventricular arrhythmias (VA), but may occur also in patients with epilepsy. Whether seizure is an uncommon event in BrS, or certain genetic variants are responsible for both seizure and arrhythmia in a subset of patients with BrS, is still to be clarified.

Purpose
To evaluate the comorbidity with epilepsy in a large cohort of patients with BrS at a referral center.

Methods
We retrospectively screened a large cohort of patients with BrS (n=238) in regular follow-up at a third-level center for arrhythmia management. Patients who previously received a diagnosis of epilepsy were enrolled. Patients with epilepsy (BrS/E+) were compared with a control group of consecutive patients without epilepsy (BrS/E-) matched for sex and age. The study endpoints were: 1) prevalence of epilepsy; 2) comparison between BrS/E+ and BrS/E- phenotypes, and assessment of VA incidence by 8-year follow-up.

Results
Of 238 BrS patients, 13 (5%) had a pre-existing diagnosis of epilepsy. Tonic-clonic seizures were present in 9/13, absence seizures in 3/13, and both in 1/13. Among BrS/E+ patients (median age 52 years, IQR 37-67, 80% males) 69% had spontaneous type 1 ECG pattern (9/13), and 46% presented with syncope (6/13), of which 50% arrhythmia-related (3/6). Electrophysiological study was performed in 8 BrS/E+ patients, and tested positive for sustained ventricular tachycardia/fibrillation in 50%. ICD was implanted in 61% (8/13), all in primary prevention. As compared with the matched control group (n=13), there were no differences in terms of ECG pattern, syncope, and ICD implantation rate (p&gt;0.050). However, BrS/E+ had a positive trend for familiarity for SD (5/13 vs. 1/13, p=0.063), and more frequently experienced VA during follow-up (4/13 vs. 0/13, p=0.030).

Conclusion
Our retrospective analysis revealed a prevalence of 5% of epilepsy among a large cohort of BrS patients. Epilepsy was associated with a higher frequency of VA events during follow-up.
Interpretable machine learning model using Extreme Gradient Boosting with Nonnegative Matrix Factorization improves the accuracy of arrhythmic risk prediction in Brugada Syndrome
Authors: Tse G , Zhou J , Li S , Lee S , Li K H C , Leung K S K , Wong W T , Mililis P , Asvestas D , Bazoukis G , Letsas K P , Liu T , Zhang Q 
Published: November 2023

Abstract

Background
Both depolarization and repolarization abnormalities contribute to ventricular arrhythmogenesis in Brugada syndrome (BrS). In this study, we tested the hypothesis that incorporating latent features extracted by various nonnegative matrix factorization (NML) techniques into an interpretable machine learning (IML) prediction model can outperform IML models without latent variables and logistic regression model.

Methods
This study was based on a published anonymised dataset of BrS patients from the Hong Kong, China. XGBoost was selected as the IML model, with and without incorporating latent features using 11 different NMF techniques: Bayesian nonnegative matrix factorization (BNMF), Iterated Conditional Modes nonnegative matrix factorization (ICM), Fisher Nonnegative Matrix Factorization for learning Local features (LFNMF), Alternating Nonnegative Least Squares Matrix Factorization Using Projected Gradient (bound constrained optimization) method for each subproblem (LSNMF), Non-smooth Nonnegative Matrix Factorization (NSNMF), Probabilistic Nonnegative Matrix Factorization (PMF), Probabilistic Sparse Matrix Factorization (PSMF), Sparse Nonnegative Matrix Factorization (SNMF) based on alternating nonnegativity constrained least squares, Sparse Network-Regularized Multiple Nonnegative Matrix Factorization (SNMNMF), Penalized Matrix Factorization for Constrained Clustering (PMFCC) and Separable Nonnegative Matrix Factorization (SepNMF).

Results
A total of 548 patients were included (7.3% females, age at diagnosis: 51.0 [38.0-61.0] years old. Of these, 66 suffered from spontaneous ventricular tachyarrhythmias over 84±55 months follow-up. The baseline model using multivariable logistic regression achieved an area under the curve (AUC) of 0.78 [0.72-0.85], which was improved to 0.88 [0.83-0.93] for the IML model without NMF. The AUC was further increased by incorporating additional latent variables extracted using NSNMF (0.95 [0.92-0.98]) and PMFCC (0.94 [0.88-1.00]).

Conclusion
Incorporation of latent variables by different NMF techniques into an IML prediction model significantly improved the accuracy of risk prediction in BrS.
Roles of atrial arrhythmias in triggering torsade de pointes in patients with acquired long QT syndrome
Authors: Tochibora R , Takasugi N , Endo S , Yoshida A , Watanabe T , Kawaguchi T , Takasugi M , Yamada Y , Kanamori H , Okura H 
Published: November 2023

Abstract

Background
Little is known about a role of atrial arrhythmias (AAs) in triggering Torsade de Pointes (TdP) in patients with long QT syndrome (LQTS).

Purpose
To determine the prevalence of AAs-induced TdP in acute acquired LQTS patients and to classify the AAs’ roles in the development of TdP.

Methods
Initiation patterns of 81 episodes of TdP obtained from 34 consecutive acquired LQTS patients (14 men; median age, 69 years; median QTc, 645.5 ms) with documented TdP were analysed. The patients were divided into 2 groups based on the presence or absence of AAs involvement in triggering TdP: AAs-induced and non-AAs-induced groups.

Results
AAs-induced group comprised 52.9% (18/34) of the patients studied. TdP was preceded by AAs-induced short-long sequences (SLSs) in 41.2% (14/34) of the patients and directly induced by R-on-T AAs (AAs coincidentally encounter a vulnerable repolarizing region during the T wave) in 23.5% (8/34). AAs-induced group experienced TdP after initiating therapy more frequently than non-AAs-induced group (2.5 vs. 1, p=0.008). AAs triggered 48 (59.3%) of the 81 TdP episodes. AAs-induced SLS comprised 67.8% (40 /59) of the SLS-induced TdP episodes. R-on-T AAs accounted for 23.5% (19/81) of the TdP episodes.

Conclusions
Our observations suggest that AAs are associated with the onset mechanism of TdP in more than half of acute acquired LQTS patients and even increase TdP frequency. Thus, AAs are not benign but rather can be lethal in acute acquired LQTS patients.Representative casesAnalysis of Torsade de Pointes episodes