bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of cardiovascular autonomic dysfunction in symptomatic post COVID-19 patients
Authors: Noureldin A M , Bassem M , Abdelsalam Z 
Published: October 2022

Abstract

Background
The COVID-19 disease is known for its severe respiratory complications, however it was found to have some cardiovascular complication in post COVID-19 patients. The heart rate variability (HRV) is a non invasive, objective and reliable method for assessment of autonomic dysfunction in those recovered patients.

Purpose
We aimed to evaluate the cardiac autonomic function by using valid HRV indices in subjects who recovered from mild to moderate acute COVID-19 but still symptomatic.

Methods
The study Group composed of 50 subjects with confirmed history of mild to moderate post COVID 19. All subjects underwent routine 2D echocardiography assessment in addition to 2D speckle tracking and 24 hours Holter monitoring for HRV analysis.

Results
The mean age of the study population was 42±18 years, symptoms were reported as follows 27 (54%) had Dyspnea, 17 (34%) had palpitations, 7 (14%) had dizziness. Time domain parameters SDNN, SDANN and rMSSD were diminished with mean SDNN value being markedly impaired in 12 (24%) patient, while frequency domain parameters as assessed by LF/HF ratio with mean of 1.837 with 8% of patients being impaired. SDNN was significantly reduced in elderly patients (p=0.001), smokers (p=0.019) and hypertensive (p=0.016) and those complaining mainly of palpitation (p=0.006). SDNN was significantly reduced in patient with impaired LV diastolic function (p=0.009), in patients with reduced MAPSE (p=0.047), reduced TAPSE (p=0.00) and impaired Global longitudinal strain (0.000).

Conclusion
Patients with post COVID-19 syndrome have abnormalities in the HRV which indicates some degree of dysfunction in the autonomic nervous system and consequently impaired parasympathetic function in this population, however this have been also correlating with subtle impairment of the left ventricular systolic function. We believe that this preliminary research can serve a starting point for future research in this direction.

Funding Acknowledgement
Type of funding sources: None.
Atrial fibrillation diagnosis by a systematic 14-day continuous ECG-Holter in patients with high cardiovascular risk and clinical palpitation: the prospective AFTER study
Authors: Halimi F , Sabouret P , Huberman J P , Cohen S , Ouazana L , Hoffman O , Assouline S , Guedj-Meynier D , Schwartz J , Weiss P , Lafont C , Lellouche N 
Published: October 2022

Abstract

Background
Atrial Fibrillation (AF) is asymptomatic in 20–30% of cases. New technologic tools for continuous ECG monitoring have been developed to detect and potentially treat AF in specific population with high cardiovascular risk.

Purpose
We aimed to evaluate the prevalence and the management of AF diagnosed in patients with no previous documented AF but with a high cardiovascular risk and clinical palpitation undergoing systematic 14-day continuous ECG-Holter monitoring and associated characteristics.

Methods
Patients were prospectively enrolled from December 2019 to December 2021 in this multicentered study, sponsored by the French National College of Cardiology. Patients needed to meet the following criteria: CHA2DS2VASc score ≥3 in women &gt;2 in men associated with clinical palpitation without previous documented arrhythmia, particularly AF. Exclusion criteria were: previous documented AF, participation to another study that could interfere with the current study, pregnancy, previous skin intolerance to ECG-Holter electrodes. Included patients underwent a 14-day monitoring Holter-ECG to detect cardiac arrhythmia, particularly AF. Patients' characteristics, type of arrythmias and management of detected AF were described.

Results
Among the 336 included patients, 39% were men, median age was 73 [64.5–78] years, 71.5% had hypertension and 46.5% had a previous history of stroke. AF was detected in 14% of patients, among which 23.4% in the first 24 hours monitoring. In univariate analyses, older age (p=0.045) was significantly associated with AF, and a trend was observed regarding male gender (p=0.067) and less antiplatelet therapy (p=0.058). Patients with diagnosed AF had a prescription of anticoagulation therapy in 90% of cases consisting in apixaban and rivaroxaban for 72% and 28% respectively. Antiarrhythmic drugs were administered in 90% of AF patients and 13% underwent AF ablation.

Conclusions
The systematic AF screening of selected patients based on CHA2DS2VASc score ≥3 in women &gt;2 in men associated with palpitations allows to diagnose AF in 14% of the population with a 14-day continuous ECG-Holter. This strategy seems efficient as it induced the prescription of anticoagulation and antiarrhythmic therapy in 90% of individuals.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NATIONAL COLLEGE OF FRENCH CARDIOLOGISTS
A prediction model for ventricular tachycardia events using 24h ambulatory ECG
Authors: Economou Lundeberg J , Engstrom G , Dziubinski M , Sridar A , Healey J S , Bhavnani S , Persson A , Johnson L 
Published: October 2022

Abstract

Background
Ventricular tachycardia (VT) is a potentially lethal condition that occurs intermittently. The aim of this study was to derive a risk prediction model for VT episodes detected on ≤30 day mobile cardiac telemetry using a 24 hour ambulatory ECG recording.

Methods
We included patients who were monitored for 2–30 full days in the USA using a full-disclosure mobile cardiac telemetry device in 2017. Patients with a VT episode ≥10 beats duration (VT≥10 beats) on the first full recording day were excluded. Arrhythmias were algorithmically detected and manually verified. A LASSO model was derived for the outcome of a VT≥10 beats detected on days 2–30. Potential predictors included age, sex, and ECG data from the first 24h: heart rate (max, min and mean), premature atrial and ventricular complexes occurring as singles, couplets, triplets, and runs ≥4 beats as well as the fastest rate for each event. The population was split into equal random training and testing samples.

Results
In a population of 19,789 patients (mean age 65.3, 43.4% men), and during a median recording time of 18 days there were 1,511 patients with at least one VT≥10 beats. The LASSO model had good discrimination in the testing sample, ROC-statistic 0.7586, 95% CI 0.7398–0.7774 (Figure 1a). A model excluding age and gender had similar discrimination (ROC 0.7528, 95% CI 0.7339–0.7717). In the testing sample the model was well calibrated (Figure 1b). In the top quintile more than one in five patients had a VT≥10 beats, enough to warrant extended monitoring.

Conclusion
A risk score based on variables easily derived from a standard 24h ECG can be used to predict high risk of VT episodes ≥10 beats within 30 days. In the top quintile VT events ≥10 beats were ten times more common than in the bottom quintile.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Hjärt-LungfondenSwedish Society for Medical Research
The state of systolic and diastolic functions of the left ventricle and heart rate variability in patients with atrial fibrillation after infection of COVID-19
Authors: Sychov O S , Nesukay O G , Stasyshena O V , Getman T V , Sribna O V , Romanova O M , Ilchyshyna O Y A , Deyak S I 
Published: October 2022

Abstract

Introduction
It is known that atrial fibrillation (AF) is one of the most common arrhythmias in patients (pts) who have had a COVID-19 infection (CI).
The aim of our study was to evaluate systolic and diastolic functions of the left ventricle (LV) and heart rate variability (HRV) in pts with AF depending on the past CI.
Research material and methods 131 pts with paroxysmal or persistent forms of AF in sinus rhythm were studied. 93 people had a history of an average of 6.2±0.5 months ago of COVID-19 infection. They made up the 1st group of examined pts. The remaining 38 patients did not have a history of this infection. They constituted the 2nd group of the study group, which was the control group. Transthoracic echocardiography and Holter monitoring ECG were performed according to the standard technique.

Results of the study
We did not find any difference in hemodynamic parameters characterizing the systolic function of LV. So, the values of the end-diastolic volume (117.0±7.6 mm and 116.0±7.2 mm), end-systolic volume (55.7±4.9 mm and 55.2±4.7 mm) and ejection fractions (55.0±2.1% and 54.4±2.0%) in the groups did not differ significantly. However, statistical significance was obtained in indicators characterizing LV diastolic function. So, significantly different flow rates in the 1st and 2nd groups of pts – E (60.8±1.63 sm/s and 94.6±2.97 sm/s, p&lt;0.001), A (61.8±0.83 sm/s and 73.1±1.03 sm/s, p&lt;0.001), their E/A ratios (0.98±0.02 and 1.39 + 0.03, p&lt;0.001) and DE score (175.9±2.20 ms and 202.5±4.03 ms, p&lt;0.001). A more significant violation of LV diastolic function after CI led to an increase in the diameter of the left atrium (LA) (4.99±0.14 cm in the 1st group compared with 4.40±0.004 sm in the 2nd group, p&lt;0.001) and LA index (46.4±0.011 sm in the 1st group compared with 42.93±0.08 in the 2nd group, p&lt;0.001). We also found a significant difference in such indicators of HRV between groups “1” and “2” as – SDANN (102.7±2.33 and 151.7±1.23 ms, p&lt;0.001), SDNN (124, 3±4.06 and 181.3±4.83 ms, p&lt;0.001), and RMSSD (100.4±4.57 and 173.2±13.51 ms, p&lt;0.001).

Conclusion
In pts with AF, after undergoing CI, the LV diastolic function begins to suffer first, which leads to an increase in the size of the LA. Pts after CI also had a change in the autonomic regulation of the heart rhythm, and as a result, an increase in the electrical instability of the atria.

Funding Acknowledgement
Type of funding sources: None.
Agreement between ultrashort-term and long-term heart rate variability based on 24-hour Holter monitoring
Authors: Bantolo A P , Purino F M A 
Published: October 2022

Abstract

Introduction
Heart rate variability (HRV) measured for 24 hours (long-term HRV) serves as the clinical gold standard in the risk stratification of patients with comorbidities such as myocardial infarction, stroke, multiple sclerosis, end stage renal disease, and diabetic neuropathy.
Previous studies explored the utility of ultra-short (US) HRV, measured for less than five minutes which could be used for bedside prognostication, for future research, or as a cheaper diagnostic alternative.

Purpose
This study determined the agreement between US-HRV and long-term HRV based on 24-hour holter monitoring results at a tertiary Filipino hospital. It also found the agreement in the US-HRV and long-term HRV by time of day and condition, age, sex, comorbidities, and by ability to detect abnormal HRV.

Methods
Tracings of 24-hour holter monitoring from January 2017 and December 2019 were reviewed. Excluded from the study were those who had arrhythmias or were taking medications affecting the autonomic nervous system.
Samples of three-minute excerpts were obtained at 7am (daytime, awake), 12nn (daytime, awake, with activity), 7pm (evening, awake), and 12mn (evening, asleep). RR intervals were measured and HRV through SDNN and RMSSD were determined.
Interclass correlation coefficient and kappa statistic were used to analyze the agreement between values of US and long-term HRV. Bland-Altman plots were constructed, and the limits of agreement (LOA) were reported. Kappa statistic was used to determine the agreement between the two methods in detecting abnormal HRV.

Results
A total of 92 results were reviewed for this study, with most patients having hypertension. Results showed that US-HRV by SDNN underestimates HRV by 47.35 to 60.58 ms (mean difference). The average discrepancy was found to be highest during daytime, awake with activity.
Meanwhile, US-HRV by RMSSD was found to overestimate HRV by −29.86 to −85.24 ms (mean difference). The average discrepancy was found to be highest during evening, awake.
There is poor agreement between SDNN and RMSSD measured using long-term HRV and US-HRV in all four samples, even with age, gender, and comorbidities factored in. Likewise, there is poor agreement between US-HRV and long-term HRV values in detecting abnormal HRV. At best, evening US-HRV RMSSD values have moderate agreement in detecting abnormal US-HRV.
However, the study was done in a less controlled environment. Also, long-term time-domain variables (RMSSD and SDNN) are known to reflect circadian rhythms and the overall change in the autonomic nervous system, hence three-minute measurements might poorly reflect changes occurring in the autonomic nervous systems.

Conclusion
There is poor agreement between three-minute US-HRV and long-term HRV obtained through 24-hour holter monitoring. Studies done in a more controlled environment are recommended.

Funding Acknowledgement
Type of funding sources: None.
Race disparities in atrial fibrillation detection using implantable loop recorder for cryptogenic stroke
Authors: Aslam F , Al-Sadawi M , Gore A , Ijaz H , Dhar K , Dhaliwal A , Singh A 
Published: October 2022

Abstract

Background
Cryptogenic stroke represents about 25–30% of all ischemic strokes. Continuous electrocardiographic monitoring using implantable loop recorder (ILR) can detect asymptomatic and undiagnosed atrial fibrillation (AF).

Purpose
To assess patient-specific factors in ILR implantation and AF detection in patients with cryptogenic strokes.

Methods
We retrospectively reviewed 379 patients with cryptogenic stroke indicated for ILR implantation, from January 2017 to June 2021 at our university hospital. We evaluated patient demographic and clinical characteristics to assess the risk factors associated with higher incidence of AF detection, using logistic regression models.

Results
Of the 379 ILRs implanted, 60.4% were males with 71.2% Caucasian, mean age 67.6 years, and mean BMI 28.5. The mean CHADSVASC score of 3.9 at the time of ischemic stroke. These patients had prior diagnosis of diabetes mellitus (27.4%), hypertension (65.7%), chronic kidney disease (19.5%), coronary artery disease (20%) and congestive heart failure (2%). Of the entire cohort, AF was diagnosed in 16% of patients with 14 months mean follow up. There were more females diagnosed with AF on ILR (20% v. 18.7%, p&gt;0.05). Caucasians were more likely to have AF detected compared to non-Caucasians (OR 2.3, 95% CI, p&lt;0.02). There were 52 patients with mobile cardiac outpatient telemetry (MCOT) before having ILR implantation. AF was not detected on MCOT, but 15% were diagnosed with AF with ILR monitoring. In univariate analysis, increasing age is strongly associated with the detection of AF (p=0.03).

Conclusions
There continues to exist race disparities in ILR implantation and eventual AF detection, leading to further socioeconomic health disparities. ILR should be considered especially in elderly with cryptogenic stroke given the higher incidence of AF detection.

Funding Acknowledgement
Type of funding sources: None.
Accurate respiratory rate determination using a novel insertable cardiac monitor algorithm: implications for diagnostic and monitoring potentials beyond heart rhythm disorders
Authors: Kennedy L P , Reddy R K , Health K M , Pitman B P , Hnin K , De Voir C , Whittington H , Lau D 
Published: October 2022

Abstract

Background
Respiratory rate (RR) is a critical vital sign that is highly relevant in patients with cardiopulmonary disorders. The implantable cardiac monitor (ICM) provides useful data pertaining to heart rhythm, but little is known up to this point regarding its potential diagnostic value in the direct measurement of respiratory parameters. The addition of respiration information could improve understanding of overall health status of heart rhythm patients with ICM.

Objective
The primary objective of this study was to evaluate the accuracy of the RR detected by an existing implanted ICM as compared to gold-standard polysomnography (PSG) measurement of respiration.

Methods
This prospective single center study enrolled 25 patients (17 male, 62.7±12.2 yesrs) with an implanted ICM and suspected sleep-disordered breathing. The ICM was custom configured with research software to collect respiration data (Fig. 1). Simultaneous, time-synchronized PSG and ICM data were evaluated in two-minute epochs episodically during the night. The offline novel prototype RR algorithm was evaluated on episodes collected by the ICM and compared against expert manual adjudicated RR from PSG by two separate investigators. The interobserver agreement was assessed using intraclass correlation coefficient (ICC). The performance of the novel algorithm was assessed using Bland-Altman analysis with 95% limits of agreement (LOA).

Results
A total of 495 epochs were graded by two independent observers, with good ICC of 0.83 (95% C.I. 0.79–0.86). Epochs free of severe sleep disordered breathing/apnea (n=363) were included in this analysis with 106 of these containing periods of hypopnea. The development and validation datasets were comprised of 235 and 128 epochs, respectively. In the development data, the mean RR was 14.99±3 breaths per minute, and the mean RR was 13.44±2 breaths per minute in the test data. Using Bland-Altman analysis, the bias for the novel prototype algorithm was only −0.13 and +0.32 breaths per minute with 95% LOA of −2.24 to +1.98 and −2.56 to +3.19 breaths per minute (Fig. 2), in the in the development and test dataset respectively.

Conclusion
The novel prototype algorithm applied to the ICM data provided accurate determination of respiratory rate as compared to gold-standard PSG data. The capability to determine respiratory rate accurately from an existing ICM platform demonstrates the potential to extend the diagnostic power of ICMs beyond heart rhythm abnormalities to address a broad range of comorbidities including breathing disorders and heart failure.

Funding Acknowledgement
Type of funding sources: None.
Comparison of adhesive single-lead ECG device and Holter test for atrial fibrillation monitoring
Authors: Kwon S , Lee S R , Choi E K , Ahn H J , Song H S , Lee Y S 
Published: October 2022

Abstract

Background
There is insufficient validation of diagnostic benefits of extended monitoring with an adhesive single-lead ECG device compared to Holter test for routine medical care of AF patients.

Purpose
The study aimed to compare AF detection rates between 72-hour monitoring using an adhesive single-lead ECG device (mobiCARE MC-100, Seers Technology, Republic of Korea) and 24-hour Holter test among AF patients at outpatient clinics.

Methods
A total of 200 AF patients indicated for Holter test at cardiology outpatient clinics enrolled in the study. Study participants equipped both Holter and MC-100 for the first 24 hours (Figure 1). After then, only MC-100 continued ECG monitoring for additional 48 hours. AF detection during the first 24 hours was compared between two devices. The diagnostic benefits of extended monitoring with MC-100 were evaluated.

Results
During the first 24 hours, both monitoring methods detected AF in the same 40/200 (20.0%) patients (20 patients with paroxysmal and persistent AF each). Compared to 24-hour Holter, MC-100 increased AF detection rate by 1.5-fold (58/200; 29.0%) and 1.6-fold (64/200; 32.0%) with 48- and 72-hour monitoring, respectively (Figure 2A). With MC-100, the number of newly discovered patients with paroxysmal AF was 20/44 (45.5%), 18/44 (40.9%), and 6/44 (13.6%) for 24-, 48-, and 72-hour monitoring. Compared to 24-hour Holter, 72-hour monitoring with MC-100 increased the detection rate of paroxysmal AF by 2.2-fold (44/20). If only the episodes lasting over 30 seconds were counted as AF with MC-100, the detection rate of paroxysmal AF was decreased by 9.1% (Figure 2B).

Conclusion
Compared to Holter, AF detection rates could be improved with an adhesive single-lead device, especially for patients with paroxysmal AF. This device is expected to be useful for AF detection among patients whose conventional ECG tests were ineffective in documenting AF episodes.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, Republic of Korea, the Ministry of Food and Drug Safety)
Patients parameters and results of the tilt table test depending on referrals
Authors: Kirnosova K , Keller H , Stoellberger C 
Published: October 2022

Abstract

Introduction
The tilt table examination (TTT) is used to investigate patients with syncope for 50 years, and was downgraded by the 2018 Guidelines of the European Society of Cardiology for syncope-evaluation from class I to II a/b.

Aim
Aim of the study was to assess changes in the referrals for TTT from 2014 to 2018. In addition, it was examined if there were differences in the history, clinical findings, and results of the TTT among patients depending on the referral for TTT.

Patients and methods
Included in the retrospective cohort study were 205 patients, 49% females, mean age 52 (15–82) years, in whom TTT was carried out between 2014 and 2018 in a cardiology department. Information from the discharge letters and electronic hospital information system was collected.

Results
Referrals for TTT were suspected orthostatic hypotension (OH) (n=53), suspected reflex syncope (n=98), and unexplained syncope (n=54). By TTT the diagnosis of OH was established in 32%, reflex syncope in 27%, and postural orthostatic tachycardia syndrome in 16%. There was an increase of positive TTT findings from 2016 to 2018 (54 to 79%, p=0.039). The referrals for unexplained syncope decreased from 2014 to 2018 (33 vs. 14%, p=0.039). Compared to patients with suspected reflex syncope, patients with unexplained syncope suffered more from coronary artery disease (CHD) (19 vs. 5%, p=0.011) and arrhythmias (24 vs. 10%, p=0.032), were more often taking beta-blockers (26 vs. 7%, p=0.002) and more often had ST-segment abnormalities (11 vs. 1%, p=0.008). Compared to patients with suspected OH, patients with unexplained syncope suffered more from palpitations (11 vs. 8%, p=0.0024). Compared to patients with suspected reflex syncope, patients with suspected OH had more comorbidities such as CHD (17 vs. 5%, p=0.036), hypertension (45 vs. 18%, p=0.01), diabetes mellitus (25 vs. 3%, p=0.0) and synucleinopathies (6 vs. 0%, p=0.042) and took more antidiabetic (23 vs. 4%, p=0.001), antithrombotic (42 vs. 12%, p=0.0), diuretic (15 vs. 2%, p=0.004), beta blocking (23 vs. 7%, p=0.009), anticonvulsant (6 vs. 0%, p=0.042), antiparkinsonian (6 vs. 0%, p=0.042), antidepressant agents (26 vs. 11%, p=0.022) and statins (26 vs. 8%, p=0.004). Compared to patients with suspected OH, patients with suspected reflex syncope suffered more from prodromes like flushing (17 vs. 2%, p=0.001) and nausea (33 vs. 8%, p=0.004).

Conclusions
If patients are referred for appropriate reasons, the TTT has a high diagnostic value. The results confirm other studies indicating that unexplained syncope may suggest a cardiac origin.

Funding Acknowledgement
Type of funding sources: None.