bluuebunny/crossref_metadata_2025_split huggingface dataset:
P418 CARDIOMETABOLIC ALTERATIONS IN OBESE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME
Authors: Giofrè F , Arturi F , Ventura M , Pelle M , Cloro C , Zaffina I , Forte V , Lucà S , Melina M , Clausi C , Sciacqua A , Arturi F 
Published: May 2022

Abstract

Background
Obesity and Obstructive Sleep Apnea Syndrome (OSAS) has been recognized as two of the major cardiac risk factors and they often coexist in one patient. OSAS increase the risk of as myocardial infarction, heart failure and arrhythmias. On the other hand, obesity is and independent predictor of cardiovascular mortality since it causes insulin resistance, dyslipidemia, sympathetic hyperactivation, chronic inflammation and endothelial dysfunction.

Aim
To evaluate cardiometabolic profile, echocardiographic alterations and the presence of arrhythmias in obese patients with Obstructive Sleep Apnea Syndrome and non obese patients.

Patients and Methods
67 obese patients (37 male/30 female) and 52 non obese patients (40 male/12 female) were enrolled. All subjects underwent anthropometrical evaluation and a venous blood sample for biochemical and hormonal determinations including fasting plasma glucose, fasting plasma insulin, Hba1c and OGTT to 5 hours. The insulin resistance was evaluated by HOMA–IR. All the patients underwent echocardiographic examination, polysomnographic evaluation, in order to diagnose the OSAS, and a simultaneous 12–lead Holter ECG to evaluate the presence of nocturnal arrhythmias.

Results
As expected, we found a better antropometrics profile in non obese patients. Obese patients display a severe OSAS compared to non–obese patient as shown by higher values of AHI (26.37 ±24.95 vs 16.58 ±14.07; P &lt; 0.05), TC90 (19.61 ±24.45 vs 8.63 ±17.80; P &lt; 0.05) and ODI (40.55 ±27.41 vs 21.06 ±22.78; P &lt; 0,05). In obese patients we also found a significant reduction of both ejection fraction (55.54 ±7.97 vs 66.52 ±8.95; P &lt; 0.05) and A–wave (0.75 ±0.17 vs 0.83 ±0.19; P &lt; 0.05). In 20% of obese patients, 12–lead Holter ECG showed the presence of cardiac pause &gt; 3 sec during apnea. In obese population alone we demonstrated a significant negative correlation between AHI and E–wave (r= –0.3; P = 0.04) and a positive correlation with interventricular septum (r = 0.38; P = 0.01) and left ventricular mass (r = 0.32; P = 0.02). Post–hoc analysis shown how these findings maintained statistical significance even when the obese patients were stratified in subgroups according to the severity of OSAS.

Conclusions
Our data, even if preliminary, seem to indicate that OSAS is not only linked to obesity but it also acts as a negative factor on the cardiometabolic risk.
Diagnostic value of Peguero Lo Presti Electrocardiografic Index for diagnosis of Left Ventricle Hypertrophy in correlation with cardiovascular magnetic resonance
Authors: Sanchez Contreras C , Sierra Fernandez CR , Mendoza Gonzalez CA , Zavala Garcia G , Garcia Arias M R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The gold standard for the diagnosis of left ventricular hypertrophy is cardiac magnetic resonance (CMR). Nonetheless, electrocardiogram is the most widely used screening test due to convenience, availability and low cost. There are more than 35 electrocardiographic indices to diagnose left ventricular hypertrophy among them stand out: Cornell, Sokolow-Lyon and the Index of Peguero- Lo Presti.

Methods
Retrospective cohort study that included 190 cardiovascular patients from January 2015 to December 2019 in a National Cardiology Center. We described demographic and electrocardiographic indices and correlate them with CMR information. A bivariate analysis was performed with association tests as Pearson, Chi square and Fisher’s exact 2x2 test.

Results
Our population included predominantly males (64.6%), with median age of 52 years, ischemic heart disease (74%), diabetes mellitus 2 (74%), dyslipidemia (67.9%), valvular heart disease (62.6%) and hypertension (51.6%.). Ventricular mass average140 grams, with a mean LVEF 52%. Electrocardiographic indices: Peguero Lo-Presti (75.3%) positive for left ventricular hypertrophy, Cornell Index ( 51.6%), Sokolow index (41.1%), RaVL (27.9%) and RDI (21.1%). Quantitative analysis: Peguero Lo-Presti index average 35.1 mm, Sokolow index: 30.9 mm, Cornel index: 25 mm. The most sensitive criteria to determine left ventricular hypertrophy was Peguero Lo-Presti 59.3% (95 CI 41.4% - 55.5%), followed by Cornell 51.6% (95% CI 44.5% - 58.6%), Sokolow Lyon 41.1% (95% CI34.3% to 48.2%).

Conclusion
Peguero- Lo Presti criteria are more sensitive than other electrocardiographic criteria for the diagnosis of left ventricular hypertrophy
Association between excessive supraventricular ectopic activity and future diagnosis of atrial fibrillation in patients with cryptogenic stroke
Authors: Gogos C , Zarvalis E , Pantelidis P , Davora F , Karakanas A , Pitetzis D , Moschovidis V , Kantartzi V , Stamatiadis N , Stamos K , Sachpekidis V , Deretzi G , Rudolf J , Styliadis I 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The relationship between the excessive supraventricular ectopic activity (ESVEA) and the subclinical atrial fibrillation (AF) in patients with cryptogenic stroke is yet not fully understood.

Purpose
The aim of this study is to examine the prognostic significance of ESVEA for the development of AF in those patients.

Methods
The study retrospectively included 124patients, hospitalized for a cryptogenic stroke between 2014 and 2015. Twenty-four hour inpatient Holter monitoring, was used to define ESVEA as the presence of ≥20 premature atrial complexes per hour (PACs/h), along with a duration of the longest run of supraventricular tachycardia (LSVR) ≥5 seconds. After approximately 5 years of follow-up, the patients were examined for AF.

Results
The remaining 111 patients(12 died and 1 was lost during follow-up) had a median age of 56 and 13 (11.71%) of them were diagnosed with AF (AF patients). The median value of CHA2DS2-VASc score was 3 and was similar for the two groups (p=0.252). Patients with AF had a significantly higher number of PACs/h and a longer duration of LSVR compared to nonAF patients (16.67 vs. 0.21, p&lt;0.001 and 3 vs. 0 seconds, p&lt;0.001, respectively). The existence of ESVEA was also significantly more prevalent among the AF patients (46.15%, 95% CI: 17.78% - 74.22%) compared to non-AF ones (6.1%, 95% CI: 1.3% - 10.7%, p&lt;0.001). ROC analysis revealed the high diagnostic test accuracy of both PACs/h and LSVR for AF. The area under the curve was 97.2% (p&lt;0.001) for PACs/h and 81.1% (p&lt;0.001) for LSVR.

Conclusions
Excessive atrial ectopy, detected with 24h inpatient Holter monitoring, is a significant indicator of future development of AF, in patients presenting originally with a cryptogenic stroke.
Low-level vagus nerve stimulation during cardiac surgery: smart neuromodulation
Authors: Zwijnenburg RD , Kharbanda RK , Van Schie MS , Van Der Does WFB , Knops P , Taverne YJHJ , Bogers AJJC , De Groot NMS 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): CVON-AFFIP Dutch Heart Foundation

Objective
The goal of this study is to unravel the anti-arrhythmogenic effects of low-level vagus nerve stimulation (LL-VNS) by performing high-resolution and high-density epicardial mapping studies before and after transcutaneous LL-VNS in patients undergoing primary cardiac surgery.

Background
Vagus nerve stimulation has pro-arrhythmogenic and anti-arrhythmogenic properties. LL-VNS has been proven to reduce AF incidence and burden, but the anti-arrhythmogenic effect of LL-VNS remains largely unexplored thereby hampering clinical implementation and optimal patient selection.

Methods
10 patients (90% male, age 75±6 years) undergoing coronary artery bypass surgery (CABG) were included in this study. Epicardial sinus rhythm mapping of the right atrium and Bachmann’s bundle (BB) was performed prior, after acute- and chronic transcutaneous LL-VNS.

Results
LL-VNS did not result in any significant changes in potential fractionation, conduction block, conduction velocity or voltage. Potential duration prolonged from 37.5 [31.0-56.0] ms to 48 [36.0-50.0] ms during acute (p=0.002) and 52.5 [45.8-61.0] ms during chronic LL-VNS (p=0.007).

Conclusions
This is the first epicardial mapping study in humans investigating the effect of LL-VNS on atrial conduction. Compared to no LL-VNS, acute and chronic LL-VNS prolonged potential duration significantly.
Sex differences in atrial electrical properties
Authors: Giammarino L , Hof T , Nimani S , Alerni N , Matas L , Odening KE 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss Heart Foundation

Background
Pronounced sex differences are known in the incidence and recurrence rates of atrial fibrillation (AF). In general, men carry a higher risk for AF - particularly at younger age - during which women are protected.

Purpose
In this project, we aimed to investigate electrophysiological properties of the atria that may underlie sex differences in AF development in the younger population.

Methods
First, we assessed sex differences in P-wave morphology (duration: PWD; area: PWA, amplitude) in 12-lead ECG in healthy volunteers (men 31.3±1.6 y, n=10; women 29.8±1.6 y, n=10) and wildtype (WT) rabbits (3-6 months, males n=12, females n=15). We investigated sex differences in atrial action potential (AP) in WT rabbits of both sexes using sharp electrode recording technique (males n=5, females n=6). To elucidate underlying mechanisms, sex differences on atrial inwardly rectifying potassium current IK1 at 37°C were evaluated using whole-cell patch-clamp technique in isolated atrial rabbit cardiomyocytes; to evaluate the long-term effect of sex hormones on IK1, we incubated the isolated cardiomyocytes for 24h with 3 or 10µM of 17β-estradiol (EST) or of dihydrotestosterone (DHT).

Results
Analyzing ECG parameters (figure 1), we observed a prolonged PWD and an increased PWA both in healthy men (p&lt;0.0001) and in male rabbits (p&lt;0.0001) as compared to healthy women or female rabbits, which may theoretically be due to a slower conduction velocity or longer AP duration in males. Intracellular AP recordings (figure 2A) showed a more negative atrial resting membrane potential (RMP, males -83.07±0.3mV vs. females -74.33±2.6mV, p&lt;0.05) and a prolonged atrial AP duration (APD10, 18.20±3.6ms vs. 10.06±1.9ms, p=0.06; APD50, 36.60±6.6ms vs. 20.06±1.9ms, p&lt;0.05; APD90, 91.00±10.3ms vs. 74.00±4.0ms, p=0.13) in males as compared to females. As highlighted in figure 2B, male atrial cardiomoycytes had smaller IK1 current densities, which could be due to high DHT concentration; in line with these findings (figure 2C) 24h DHT incubation of atrial cardiomyocytes from females reduced IK1, mimicking the sex differences observed.

Conclusions
Sex impacts on atrial electrophysiology, resulting in sex differences in P-wave morphology, AP parameters and ionic current densities. Delayed (early) repolarization in males may be causatively linked to the observed changes in P-wave morphology. The reduction of IK1 observed in males may be due to testosterone, since this reduction was observed even in female cardiomyocytes when incubated with DHT.
Recurrent variant of unknown significance in KCNH2 classified through functional characterisation
Authors: Copier JS , Bootsma M , Wilde AAM , Bertels RA , Bikker H , Christiaans I , Koopmann TT , Lommerse AAJ , Bezzina CR , Verkerk AO , Barge-Schaapveld DQCM , Lodder EM 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Dutch Research Council (NWO Talent Scheme)

Background
Variants in KCNH2, the gene encoding the hERG channel and responsible for the cardiac rapid delayed rectifier K+ current (IKr), have been linked to Long QT Syndrome type 2 (LQTS2). The KCNH2-p.S906L variant has been found in eight, small unrelated families with variable clinical pictures and incomplete penetrance of LQTS2.

Purpose
Due to the small size of the families, co-segregation analysis is limited. Functional studies were performed to evaluate the effect of the variant on channel functionality. Thereby assessing if KCNH2-p.S906L leads to functional changes explanatory for the phenotype.

Methods
Clinical data of the patients and family members were collected thereby, creating an overview of the phenotype. The biophysiological properties of the hERG channel were assessed by manual whole-cell patch-clamp, using HEK293a cells expressing (i) the wild type (WT) KCNH2, (ii) KCNH2-p.S906L alone (homozygous, hm) or KCNH2-p.S906L in combination with WT (heterozygous, Hz).

Results
Assessment of the clinical data of the patients and family members shows an incomplete and low penetrance of the LQTS2. All carriers were heterozygous for the variant. In carriers of the KCNH2-p.S906L variant, LQTS2 severity was very variable, ranging from asymptomatic, to life-threatening arrhythmic events. The KCNH2-p.S906L variant reduced current density in a dosage-dependent manner compared to KCNH2-WT. The current density was reduced by 63, and 54% in KCNH2-p.S906L-Hm and KCNH2-p.S906L-Hz, respectively. Changes in gating properties were absent, except for activation kinetics in KCNH2-p.S906L-Hm. In these cells, an increase in the time constant, and a positive shift in voltage dependency of activation were observed.

Conclusions
Both the reduced current density and changes in activation kinetics suggest the variant to result in a moderate loss-of-function of the hERG channel, fitting with the observed LQTS2. These observed functional changes in hERG combined with the reduced penetrance in the affected individuals suggest that this variant in KCNH2 is a risk factor for LQTS2.
Additional features in Brugada Syndrome stratification: frequent PVC and QRS duration
Authors: Couto Pereira S , Brito J , Silverio Antonio P , Velente Silva B , Alves Da Silva P , Simoes De Oliveira C , Garcia B , Lima Da Silva G , Carpinteiro L , Cortez-Dias N , Pinto FJ , De Sousa J 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Brugada syndrome (BrS) is a channelopathy with high prevalence of malignant arrhythmic events. The risk stratification in patients (pts) with Brugada electrocardiographic (ECG) pattern is of major importance, to prevent sudden cardiac death (SCD). A higher risk is evidenced in spontaneous type 1 pattern when compared with induced type-1 pattern, as so other electrocardiographic features have been explored aiming to detect additional prognostic factors.

Purpose
To evaluate the association of QRS duration and frequent premature ventricular contractions (PVC) with malignant arrhythmic events.

Methods
Prospective single-center study of consecutive pts with BrS, with spontaneous or induced type 1 pattern included from 2003 to 2021. All pts were enrolled in a protocol including annual non-invasive assessment with ECG and 24-hours Holter monitoring. Primary endpoints were defined as SCD or appropriate shocks in the context of ventricular tachycardia or fibrillation (VT/FV) during follow-up. Cox regression and Kaplan-Meier survival analyses were used to determine the association between the baseline ECG and Holter characteristics and the long-term risk of arrhythmic events.

Results
A total of 117 pts was included, 75 (65%) with a spontaneous type 1 pattern and 44 (33%) with an induced type 1 pattern. The mean age was 47±13years and 38 (32.5%) were male.
During a median follow-up of 4.1±0.3 years, the primary endpoint occurred in 8 (6.8%) pts, with sudden cardiac death in 3 (2.6%) and appropriate shocks due to VT/FV in 5 (4.3%). Pts who suffered arrhythmic events had presented at the study inclusion higher QRS duration (124±18 vs. 108±16ms, p= 0.014) and more frequent PVCs on 24-hour Holter (169±297 vs. 29±198; p = 0.001) - Figure 1. Indeed, the presence of QRS ≥119ms was associated with a 7-fold higher risk (HR: 7.250, 95% CI 1.619-32.461, p = 0.010) and the presence of more than 6 PVC on 24-hour Holter was also associated with a 5-fold higher risk of malignant arrhythmic events (HR 5.376, 95% 1.186-24.260, p = 0.029).

Conclusion
QRS duration and frequent PVC may established themselves as additional risk factors. In our cohort, they were both predictors of arrhythmic events during follow-up and thus can further complement BrS risk stratification.
Comparison of 24-hour holter monitoring with wire-free, single lead ECG patch monitor in the diagnosis of cardiac rhythm abnormalities
Authors: Saggu D , Devidutta S , Yalagudri S , Bhogu A , Bhogu R , Narasimhan C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Monitra Healthcare Private Limited

Aim
There is increasing interest in the development of small, portable ECG patch devices to overcome the cost, patient inconvenience and relatively low diagnostic yield of the ‘gold standard’ Holter monitoring in arrhythmia detection. One such portable device, (study device), is a small, wire-free, adhesive, water-resistant single lead ECG monitoring patch with 24 bit sensor resolution for better p wave capture. The aim of this study was to assess its diagnostic utility compared to standard Holter monitor.

Methods
A prospective comparison of the study device with the standard Holter monitor (EASI full 12 lead ECG analysis using five electrodes) was done on 37 consecutive patients undergoing 24-hour Holter monitoring. All patients received both the study device and Holter monitor concurrently for 24 hours, and outcomes assessed. Each patient served as a control for themselves. The Holter and study device reports were read by two electrophysiologists blinded to the reports of the other corresponding test. The primary outcome was to compare the detection of arrhythmia and conduction disorders over total wear time for both devices. The matched pairs of data from the two devices were compared using McNemar’s test.

Results
Over the total wear time of both devices, the study device detected 75 arrhythmias and conduction disturbances compared to 67 by Holter monitor (P=0.02). The diagnostic yield of arrhythmia and conduction disorders by study device and Holter is given in the table.

Conclusions
The study device ECG patch monitor is comparable to 24-hour Holter monitor. The study device with its 24 bit sensor resolution for better p wave capture resulted in a higher diagnostic yield than the standard 24-hour Holter monitor in the detection of arrhythmias and conduction disorders.
Limitation: This is a single centre pilot study on a small sample size. The findings need to be confirmed on a multicenter larger sample size.
A cardiac magnetic resonance myocardial strain patterns analysis in left bundle branch block
Authors: Santos M , Silva M , Guerreiro S , Gomes D , Rocha B , Cunha G , Freitas P , Abecasis J , Carmo P , Cavaco D , Morgado F , Adragao P , Mendes M , Ferreira A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Recently, a classification with four types of septal longitudinal strain patterns was described using a speckle tracking based strain analysis in echocardiography suggesting pathophysiological continuum of LBBB-induced LV remodeling. Little data exist on feature tracking cardiac magnetic resonance (FT-CMR) in LBBB patients, and whether such patterns could be reproduced in CMR is not established yet.

Purpose
In this study, we aimed to: 1) Assess and reproduce the new strain patterns classification by CMR and 2) Evaluate its association with LV remodeling and myocardial scar in a LBBB cohort.

Methods
Single center registry which included LBBB patients with septal flash (SF) referred to CMR to assess the structural cause of LV dysfunction. LBBB was defined according to Strauss criteria as strict LBBB, non-strict LBBB or nonspecific LV conduction delay.
A semi-automated FT-CMR was used to quantify myocardial strain and detect the four septal longitudinal and radial strain patterns, according to the recent classification (LBBB-1 through LBBB-4) – Figure. Extent of SF was visually scored as mild, moderate, or prominent.

Results
A total of 115 patients were included (mean age 66±11 years; 57% men; 38% with ischemic heart disease). Median duration of QRS was 150± 26ms and majority of the patients (n=90, 78%) were classified as strict LBBB.
In longitudinal strain analyses LBBB-1 was observed in 23 (20%), LBBB-2 in 37 (32.1%), LBBB-3 in 25 (21.7%), and LBBB-4 in 30 (26%) patients. Patients at higher LBBB stages (longitudinal or radial pattern) had more prominent septal flash, greater LV volumes, lower LV ejection fraction and lower absolute global longitudinal, circumferential and radial strain values compared with patients in less advanced stages (p &lt; 0.05 for all) - table.
There was no difference between patterns in clinical characteristics, ischemic etiology, QRS duration and time delay between septal and lateral LV wall.
Late gadolinium enhancement (LGE) was found in 63 patients (54.8%), with a septal location in 34 (29.6%) patients, lateral in 4 (3.5%) patients, septal and lateral in 11 (9.6%) patients. Furthermore, no difference was found for LGE presence, distribution or location between the four strain patterns.

Conclusions
Among patients with LBBB, our study found a good association between longitudinal and radial strain patterns with the degree of LV remodeling and LV dysfunction by FT-CMR analysis. Additionally, myocardial fibrosis didn’t seem to interfere with the staged LBBB classification.
Endocardial and epicardial ECG imaging during sinus rhythm to detect local conduction delay in arrhythmogenic cardiomyopathy
Authors: Boonstra MJ , Te Riele ASJM , Roudijk RW , Kloosterman M , Asselbergs FW , Van Dam PM , Loh P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation

Introduction
We recently optimized our ECG imaging (ECGi) method for the estimation of endo- and epicardial activation during sinus rhythm. In patients with arrhythmogenic cardiomyopathy, late gadolinium enhancement (LGE)-CMR can identify regional myocardial injury and the combination of structural and electrical information may provide valuable insight in disease progression and risk stratification. However, the effect of structural disease and local conduction delay on the ECGi estimation of ventricular activation has not been studied.

Purpose
Evaluate the relation between LGE-CMR and non-invasively estimated local conduction velocity (CV).

Methods
8 pathogenic mutation carriers (PKP2/PLN) underwent LGE-CMR for clinical follow up and 67 lead body surface mapping. Subject specific triangulated surface heart/torso/lung meshes were created. ECGi activation sequences were used to determine local CV with the triangulation method. The LGE location was identified according to the AHA 17 segment model. Per segment, variation in CV was computed and local activation timing maps and CV maps were constructed.

Results
Isochronal crowding was observed in subjects in segments with LGE (figure, red boxes) and locally, conduction velocity decreased. Variation in conduction velocity per segment in subjects with extensive LGE presence (&gt;9 segments) was higher 0.031±0.018 vs. 0.026±0.013 m/s/cm2 in subjects without.

Conclusion
Our preliminary results indicate the ability of the ECGi method to identify regions with higher variation in local CV. This increase in CV variability might be used to assess the vulnerability to cardiac arrhythmia. Analysis will be extended towards the RV and subsequently, more subjects will be included.