bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of antibacterial envelope use in cardiac implantable electronic device infection prevention: insights from real world data
Authors: Ziacchi M , Biffi M , Iacopino S , De Silvestro M , Marchese P , Miscio F , Caccavo V P , Zanotto G , Dello Russo A , Donazzan L , Boriani G 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Infections of Cardiac implantable electronic device (CIED) are rare but serious complications impacting patients and the whole heath care system. Recently, a significative reduction in major CIED infections within 12 months of the procedure has been showed by the use of an absorbable antibiotic-eluting envelope. The aim of the analysis is to evaluate the impact of the use of the envelope on infection-related clinical events (including pocket hematoma, infection, and systemic infection) reduction in a real word patient population

Methods
Data on patients underwent CIED implantation or replacement were collected prospectively in the framework of One HospitalClinicalService project. Patients were divided into two groups according to the utilization of an absorbable antibiotic-eluting envelope or the non-usage of the envelope.

Results
Out of 1819 patients, 872 (47.9%) were implanted with an absorbable antibiotic-eluting envelope and denoted as the Envelope group. Accordingly, 947 (52.1%) patients were categorized as the control group. As compared to control, patients with envelope had higher thrombo-embolic risk, higher BMI, lower LV ejection fraction and in general had more comorbidities. During a mean follow-up of 1.4 year, the incidence rate per 100 patients-months of infective related events were significantly greater in the control compared to the Envelope group (2.85% vs 1.26%, p&lt; 0.001). The 48-month cumulative incidence of infective related events was 6.7% in the control and 2.9% in the Envelope group (HR:0.47; 95%CI: 0.27-0.95, p= 0.032). Fig1 When considering a subgroup of 1170 patients matched by PADIT score, the incidence of infective related events was 1.0 % (6/585) in the envelope and 3.8% (22/585) in the envelope and control group, respectively, p=0.002.

Conclusions
In our analysis, the use of envelope in the general CIED population was effective to reduce the risk of systemic or pocket infection, or pocket hematoma
Disease progression in exercise-induced compared to desmosomal arrhythmogenic cardiomyopathy - a longitudinal cohort study
Authors: Aaserud L , Rootwelt-Norberg C , Aabel E W , Five C K , Hasselberg N , Castrini A I , Haugaa K H , Lie ØH 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Oslo University Hospital, Procardio Center for Innovation

Introduction
Arrhythmogenic cardiomyopathy (AC) is an inheritable heart disease caused by mutations in genes encoding the cardiac desmosomes, while exercise-induced AC (EiAC) has been proposed as an acquired similar phenotype in athletes. Little is known about the progression of EiAC compared to AC.

Purpose
To assess functional and structural disease progression in EiAC compared to desmosomal AC during long-term follow-up.

Methods
We consecutively included probands with definite AC diagnosis according to the 2010 Task Force Criteria and patients with EiAC in a longitudinal cohort study. EiAC was diagnosed in competitive endurance athletes (&gt;24 MET-hours/week for &gt;6 consecutive years) referred with symptomatic ventricular arrhythmias who had no family history, no genetic mutations associated with heart disease, and no other identified etiology after through clinical work-up. All patients in both groups were recommended to avoid high intensity exercise. Progression of the structural phenotype was assessed by regular repeated echocardiographic examinations during long-term follow-up. Right ventricular (RV) function and size were assessed by RV fractional area change (FAC), RV basal diameter (RVD) and RV outflow tract (RVOT) diameter. Disease progression was evaluated and compared using linear mixed model regression.

Results
Forty-one EiAC patients (15% women, age 45±13 years) and 84 AC probands (51% mutation positive, 35% women, age 43±15) were followed for 6.6 (IQR 3.7-10.5) and 7.9 (IQR 5.2-10.8) years, respectively. Key parameters from 570 echocardiographic examinations (184 EiAC and 386 AC) were assessed. There was no deterioration of RV function during follow-up in EiAC patients, in contrast to AC patients (FAC yearly progression rate: EiAC +0.02% [95% CI -0.27 to 0.31] vs AC -0.60% [95% CI -0.71 to -0.50] per year, p=0.001, Figure left panel). RV size did not increase in EiAC patients in contrast to AC patients (RVD: EiAC +0.01 mm [95% CI -0.00 to 0.03] vs AC +0.78 mm [95% CI 0.68 to 0.89] per year, p&lt;0.001, Figure mid panel, and RVOT: EiAC +0.01 mm [95% CI -0.01 to 0.02] vs AC +0.47 mm [95% CI 0.38 to 0.56] per year, p&lt;0.001, Figure right panel).

Conclusion
Patients with exercise-induced AC had no evidence of disease progression during long-term follow-up. These patients had a more benign disease trajectory than patients with desmosomal AC. Despite the limited sample size, these results seem reassuring for patients diagnosed with exercise-induced AC.
Machine learning approach on high risk treadmill exercise test to predict obstructive coronary artery disease by using P QRS and T waves features
Authors: Yilmaz A Y , Hayiroglu M I H , Salturk S S , Pay L P , Demircali A A D , Coskun C C , Varol R V , Tezen O T , Eren S E , Cetin T C , Tekkesin A I T , Uvet H U 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Treadmill Exercise Test (TET) application in terms of detecting Obstructive Coronary Artery Disease is defined to be limited due to low sensitivity and specificity rates. TET results and patients' clinical symptoms influence cardiologists' decision to perform Coronary Angiography (CAG) which is an invasive procedure. Since TET has high false positive rates, it can cause an unnecessary invasive CAG. To improve TET's utility and accuracy in the diagnosis and follow-up of CAD patients, new algorithms need to be proposed.

Purpose
Our primary objective was to develop a machine learning model capable of optimizing TET performance based on electrocardiography (ECG) waves characteristics and signals. we aimed to evaluate the performance of a new algorithm which was based on using ECG signal features such as time difference and amplitude values of P, QRS and T wave. P, QRS and T wave directly follow the cardiac cycle of the heart. For this reason, time and amplitude information of P, QRS, and T waves can improve success of TET results for OCAD detection.

Methods
TET reports from 294 patients who underwent CAG following high risk TET were collected and categorized into those with critical CAD and others. The signal was converted to time series format. A dataset containing the P, QRS, and T wave times and amplitudes was created. Using this dataset, five machine learning algorithms were trained with 5-fold cross validation. All these models were then compared to the performance of cardiologists on V5 signal.

Results
ML models were trained and tested on V5 signal features in this research. The performance of cardiologists was determined based on their ability to classify a TET report correctly by using only the V5 graph. The results from five machine learning models were clearly superior to the cardiologists' V5 signal performance (p &lt; 0.0001). In addition, the XGBoost model, with an accuracy of 80.92±6.42% and an area under the curve (AUC) of 0.78±0.06, was the most successful model.

Conclusion
To the best of our knowledge, this is the first ML study to predict OCAD using time and amplitude features of P, QRS, and T waves. Machine learning models can produce high-performance diagnoses using the V5 signal markers only as it does not require any clinical markers obtained from TET reports. This can lead to significant contributions to improving clinical prediction in non-invasive methods.
Accuracy of continuous photoplethysmography-based heart rate assessment during atrial fibrillation
Authors: Hermans A N L , Isaksen J L , Gawalko M , Pluymaekers N A H A , Van Der Velden R M J , Snippe H , Evens S , De Witte G , Luermans J G L M , Manninger M , Lumens J , Kanters J K , Linz D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aim
Although mobile health tools using photoplethysmography (PPG) technology have been validated for the detection of atrial fibrillation (AF), their utility for heart rate assessment during AF remains unclear. Therefore, we aimed to evaluate the accuracy of continuous PPG-based heart rate assessment during AF.

Methods
Persistent AF patients were provided with Holter electrocardiography (ECG) (for ≥24 hours) simultaneously with a PPG-equipped smartwatch. Both the PPG-based smartwatch and Holter ECG automatically and continuously monitored patients’ heart rate/rhythm. ECG and PPG recordings were synchronised and divided into 1-minute segments from which a PPG-based and an ECG-based average heart rate estimation were extracted.

Results
In total, 47,661 simultaneous ECG and PPG 1-minute heart rate segments were analysed in 50 patients (34% women, age 73±8 years). The agreement between ECG-determined and PPG-determined heart rate was high (root-mean-squared error [RMSE]: 4.7 bpm). Heart rate estimated using PPG was accurate within ±10% in 93.7% of the corresponding ECG-derived heart rate segments. PPG-based heart rate estimation was more often accurate during night- (97%) than during day-time (91%, P&lt;0.001) and during low levels (96%) compared to high levels of motion (92%, P&lt;0.001). A neural network with a 10-minute history of the recording did not further improve the PPG-based heart rate assessment (RMSE: 4.4 [95% confidence interval: 3.5-5.2 bpm]. Only chronic heart failure was associated with a lower agreement between ECG-derived and PPG-derived heart rates (P=0.040).

Conclusions
During persistent AF, continuous PPG-based heart rate assessment is feasible and shows high accuracy compared to Holter ECG. Motion and recording quality among other PPG-derived covariates did not introduce a systematic and correctable bias in the heart rate assessment.
Follow-up of implantable cardiac electronic devices during the Covid-19 pandemic: organizational model and results of a single center experience
Authors: Miracapillo G , Addonisio L , De Sensi F , Orselli P , Piccinetti E , Aramini C , Del Maestro M , Limbruno U 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
During the SARS-CoV-2 COVID-19 pandemic, the global health system has had to review important processes involved in daily routines such as outpatient activities within the hospital, including follow-up visits of implantable cardiac electronic devices (CIEDs), pacemakers (PMs) and implantable defibrillators (ICDs) carried out in office. The aim of this study was to prospectively evaluate the success rate of remote transmissions of all devices followed by the CIED control clinic and verify the adopted organizational models.

Methods
All patients with remote monitoring system were considered in the study if automatic algorithm such as autocapture and autosensing were activated and well-functioning. Between January 2021 and November 2022, they were completely followed by remote monitoring and called for unscheduled in-office visit only because of remote yellow or red alarms. Patients were divided into two groups: Manual Transmission System (MTS) and Automatic Transmission System (ATS), based on the available technology. Organizational models shown in figures 1-2, were followed for the two groups. The technology of the ATS group, in addition to ensuring a daily transmission of any yellow or red alarms, allowed a control of missed communication at least every 14 days. The MTS group provided a manual transmission every 6 months. The ATS group was controlled at least once in the year, even if no alarms occurred.

Results
At the end of 2022 a total of 1193 patients were followed remotely by our center. Of these, 238 from the MTS group and 955 from the ATS group. 3314 remote transmission required medical intervention, which generated 182 unscheduled outpatient visits, mainly due to lack of transmission for prolonged periods, failure of the autocapture test and newly onset atrial fibrillation. 3496 transmissions were generated and 120 transmissions were missed; the overall success rate of transmissions with the organizational model adopted was 96.6% (connectivity index). On average, the monthly rate of unconnected manual devices was 5.1% while 3.5% for automatic devices. 2-year mortality was 12.7%.

Conclusions
By adopting an appropriate organizational model, it is possible to maintain high transmission success rates. The available technology allows you to change hospital outpatient habits in the cardiology field for CIED checks and move to a virtual clinic safely. The automatic transmission technology allows a more frequent control of patients with CIED, the impact on the patients' health must be assessed.
Accuracy of real time heart rate monitoring using smartwatch in a stroke care unit
Authors: Pagola J , Meza C M B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ISCIII
Smartwatch with heart rate (HR) tracker measures may allow for identification of people with high resting HR who have a higher risk of atrial fibrillation (AF), a potent independent risk factor for embolic strokes. In this research, we propose a new protocol for collecting real time data of patients with cryptogenic stroke including HR at rest along with monitoring electrocardiogram (ECG). First, we assess the concordance of HR measurement between telemetry (TLM) and two smartwatches in acute stroke patients, as well as the determinants of measurement error.

Method
We included patients over 50 years of age hospitalized in our Stroke Unit who were monitored by TLM and used the Garmin Vivosmart HR® (S1) and Fitbit Charge 5® (S2) devices. Mean HR was collected at 5, 10, 15, 20, and 25 minutes. We applied the Bland-Altman method in combination with Lin's Concordance Correlation Coefficient (CCC) to assess agreement between measurements. A coefficient CCC &gt; 0.9 indicates acceptable agreement.

Results
The experimental setup was performed using 49 stroke patients (59% women, mean age 78 ± 9.86 years, and 69% with a history of AF). Poor agreement was observed between HR measurements by SI or S2 and TLM (CCC = 0.48 and 0.57 respectively), which was conditioned by the presence of AF during the measurement (CCC = -0.17 and -0.06). There was only good concordance in the absence of AF (CCC = 0.97 and 0.92). A higher percentage of error between measurements was significantly associated with a HR &gt; 90 bpm, a history of AF, or presenting AF during the measurement (p&lt;0.001).

Conclusions
Real-time monitoring of HR at rest in each smartwatch was not accurate in acute stroke patients who had presented AF during the intake, or when HR by TLM was greater than 90. This suggests certain limitations when considering the application of processed data from this wearable technology.
miR-328 - a novel diagnostic and predictive atrial fibrillation biomarker in spontaneously hypertensive rats
Authors: Scridon A , Balan A I , Halatiu V B , Cozac D A , Bobarnac R L , Moldovan V , Banescu C 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Romanian Ministry of Education and Research, CNCS-UEFISCDI

Purpose
Atrial fibrillation (AF) is the most common cardiac arrhythmia and a major cause of morbidity and mortality worldwide. To date, there are no reliable biomarkers for the diagnosis and prediction of AF. Alterations in the atrial expression of various microRNAs contributes to the pathogenesis of AF, suggesting that certain miRNAs may emerge as promising AF diagnostic and/or predictive biomarkers. We aimed to evaluate miR-328 as a potential biomarker for the prediction and diagnosis of AF in an experimental model of spontaneous AF in rats.

Method
Male spontaneously hypertensive rats (SHR) and their normotensive counterparts (WKY) were divided into 6 groups: young (12 weeks, n = 8 each), adult (26 weeks, n = 8 each), and elderly (46 weeks, n = 10 each) SHR and WKY. All animals were implanted with ECG radiotelemetry devices, the ECG was continuously monitored for 72 hours, and the number of spontaneous AF episodes was assessed. At the end of the protocol, blood and left atrium tissue samples were taken and miR-328 levels were quantified. miR-328 levels were normalized with U6 snRNA and compared between groups. Correlations between atrial and blood miR-328 levels, and between mir-328 levels and arrhythmic load were also assessed.

Results
None of the WKY rats and none of the young SHRs presented arrhythmic episodes; two of the adult SHRs and all elderly SHRs had spontaneous AF episodes. Young SHR and WKY rats had similar atrial miR-328 levels (p = 0.67). At adult age, atrial miR-328 levels were significantly higher in SHRs than in WKYs (1.20 ± 0.02 vs. 1.07 ± 0.04; p = 0.01). Between-groups differences were even higher in the elderly rats (1.59 ± 0.01 vs. 1.03 ± 0.03; p&lt; 0.01). Among the SHRs, atrial miR-328 levels increased progressively with age (p = 0.02) and were strongly correlated with the circulating blood levels of miR-328 (r = 0.71; p = 0.04). Moreover, among the elderly SHRs, atrial miR-328 levels correlated positively with the number of arrhythmic episodes (r = 0.72; p&lt; 0.01).

Conclusions
The present study demonstrates a strong association between increased miR-328 expression levels and the presence and burden of AF in the hypertensive rats, suggesting that miR-328 could be a promising biomarker for the diagnosis of AF. Moreover, our results demonstrate that in this model the increase in miR-328 levels precedes the onset of AF, suggesting that dynamic evaluation of miR-328 could be used to predict AF, at least in a hypertensive context. Further studies will have to validate these results in clinical settings and to assess miR-328 manipulation as a potential prophylactic and/or therapeutic strategy in AF.
Unraveling direction- and rate-dependent unipolar electrogram morphology using spontaneous atrial extraystoles
Authors: Van Schie M S , Liao R , Ramdat Misier N L , Heida A , Taverne Y J H J , De Groot N M S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial extrasystoles (AES) are notorious for triggering episodes of atrial fibrillation (AF). AES provoke conduction disorders due to (dispersion in) refractoriness and enhanced non-uniform anisotropy of atrial tissue, which are related to initiation and perpetuation of AF. However, the direction- and rate-dependency of electrophysiological tissue properties on epicardial unipolar electrogram (EGM) morphology is unknown.

Purpose
To examine the impact of spontaneous AES on potential amplitude, -type (single-, double-, fractionated), -duration and low-voltage areas (LVA), and to correlate these differences with various degrees of prematurity and aberrancy.

Methods
Intra-operative high-resolution epicardial mapping of the right and left atrium (RA, LA), Bachmann’s Bundle (BB) and pulmonary vein area (PVA) was performed during SR in 298 patients. EGM characteristics were quantified during SR and AES, and subsequently compared. AES were categorized according their prematurity index (&gt; 25% shortening) and degree of aberrancy (none, mild, moderate and severe). LVA were defined as the amount of unipolar voltages &lt;1 mV.

Results
During 917 unique AES (495 premature; 364 mild-, 186 moderate- and 167 severe aberrant), average voltage decreased (-1.1 [-1.2, -0.9] mV, P&lt;0.001) at all atrial regions, whereas the amount of LVA and fractionation increased (respectively +3.6 [2.9, 4.3]% and +3.2 [2.7, 3.7]%, P&lt;0.001). Although potential voltages were mainly decreased during AES, in 910 (99.2%) AES, at least 0.8% (median 33.3 [19.0–52.1] %) of the recorded voltages was locally larger during AES compared to SR. Only weak or moderate correlations were found between each of the parameters and prematurity indices (R2&lt;0.592, P&lt;0.001). On the other hand, voltages decreased and the amount of fractionation increased with increasing degree of aberrancy. The effect of AES with opposite propagation direction was frequently similar as compared to severely aberrant AES. All parameters were most severely affected by either opposite or severely aberrant AES, without clear relation with degree of prematurity.

Conclusions
Unipolar EGM characteristics during spontaneous AES are mainly directional-dependent and not rate-dependent. This indicates enhanced non-uniform anisotropy that is induced by spontaneous AES.
Update on rare variants in inherited arrhythmogenic syndromes: when to reclassify?
Authors: Martinez Barrios E , Sarquella Brugada G , Cruzalegui Gomez J , Cesar Diaz S , Chipa Ccasani F , Greco A , Fiol V , Cerralbo P , Brugada Terradellas J , Campuzano Larrea O 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Discerning a definite pathogenic role of rare variants in genes associated with inherited arrhythmogenic syndromes (IAS) is critical because of their potential implications for clinical decision-making. The discovery of new gene-disease associations, the publication of functional studies and update on population genetic data may lead to changes in the interpretation of genetic variants classified in previous studies.

Aim
To update the classification of rare variants previously identified in genetic testing of IAS cases.

Methods
This is a retrospective descriptive analysis that enrolled rare variants previously identified in genetic tests from 145 families with a clinical diagnosis of any IAS between 2015-2020. These variants were re-evaluated and reclassified following the American College of Medical Genetics and Genomics guidelines, including newly available data.

Results
In their previous study, 78% of all cases harboured a rare variant classified as a variant of uncertain significance (VUS). Only 22% had a definitive diagnosis with a variant classified as pathogenic (P) or likely pathogenic (LP). In our comprehensive reanalysis following current available data, the classification of 26.7% of these variants changed, mainly due to updated population frequencies, but also to the addition of clinical data and segregation studies. As showed in 2015, the majority of variants were now classified as VUS (57.5%). The percentage of rare variants classified as potentially deleterious increased from 22% to 30%. In addition, 76.5% of reclassified variants gained certainty.

Conclusions
The large number of variants remaining as VUS is one of the main limitations in current diagnosis of IAS. Clarifying the role of rare variants can help to obtain a definitive genetic diagnosis, allowing the identification of those carriers at risk of developing the disease and ruling out those who are not. We propose that a periodic review of rare variants no later than 5 tears may help to improve clinical decision-making in the diagnosis, follow-up, treatment and risk stratification of families with IAS.