bluuebunny/crossref_metadata_2025_split huggingface dataset:
The PONTE (

P

DTA FOR INTEGRATED F

O

LLOW-UP TERRITORY HOSPITAL OF THE PATIE

N

T WITH CARDIAC HEAR

T

FAILUR

E

) (BRIDGE) Heart Failure project: increased adherence to guideline-recommended therapies through web-based shared clinical database
Authors: De Gennaro Luisa , Iacoviello Massimo , Donadeo Vittorio , Ruggiero Massimo , Brunetti Natale Daniele , Caldarola Pasquale 
Published: May 2022

Abstract
The aim of this study was to evaluate the effects on the adherence of drug prescription to the guideline recommendations of a chronic care model based on the close interaction between hospital and local healthcare district cardiologists through a shared web-based database. From 2018 to 2021, patients hospitalized for an episode of acute decompensated heart failure (HF) (de novo or worsening) in cardiology wards from the healthcare district of Bari, Italy, were enrolled. The follow-up programme was based on a first visit after discharge within 1 month; patients were therefore addressed to the local health district cardiologist outpatient clinics when not requiring further invasive investigations and haemodynamically stable and followed-up with at least one visit every 6 months. In order to share in-hospital patients’ data with outpatient clinics, at discharge, they were entered in a web-based database accessible for all cardiologists and centres participating in the Ponte Project. The group of patients affected by HF with reduced ejection fraction (HFrEF) were considered for the analyses. Drug prescription rates at 1-year follow-up were analysed as endpoint, as well as the re-admission for HF worsening. Out of 1200 HF patients enrolled in the project until December 2021, 56% were affected by HFrEF. At 1-year follow-up, 91% of patients were assuming beta-blockers, 86% mineralocorticoid receptor antagonists, 98% angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists/neprilysin angiotensin receptor antagonists, and 13% ARNI. Compared to patients enrolled before 2020, ARNI prescription increased in 2021 (60% vs. 13%, respectively, P &lt; 0.001). In 30% of patients, ARNI were prescribed before hospital discharge. Furthermore, in 10% of the population (most diabetics), sodium-glucose cotransporter 2 inhibitors were also prescribed. The implementation of the PONTE project was associated with an improved adherence to guidelines recommendations.
Genetic predisposition according to the age at the onset of atrial fibrillation
Authors: Hwang I , Hong M , Hwang T H , Yu H T , Kim T-H , Uhm J-S , Joung B , Lee M-H , Jee S H , Pak H-N 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Ministry of Health and Welfare National Research Foundation of Korea (NRF)

Background
Although atrial fibrillation (AF) is a heritable disease, multiple comorbid factors, including aging, contribute to its development.

Purpose
We investigated the association between a weighted genetic risk score (wGRS) for AF and the age at onset.

Methods
We included 1,968 patients with AF (Yonsei AF Ablation cohort) and 5,486 controls from the Korean Genome Epidemiology Study (KoGES). After 1:1 matching, 1,416 patients and 1,416 controls were included in the analyses. The age of AF onset was determined by the first electrocardiogram (ECG) documentation.

Results
We selected nine previously reported AF-associated single-nucleotide polymorphisms (SNPs). Among nine proven AF-associated SNPs, 4 genes (PRRX1, PPFIA4, PITX2, and ZFHX3) were independently associated with the age at the onset of AF (p&lt;0.05), but no associated genes were found in the controls. In the quartile and multivariate analyses, the lower quartile age at the onset of AF had a higher wGRS (p&lt;0.001), and a younger age at the onset of AF was independently associated with the wGRS (β -0.29 [-0.57--0.01], p=0.045), but that association was not observed in the control cohort. Contrarily, the higher quartile of the wGRS group had a younger age of AF onset (p&lt;0.001), and the wGRS was independently associated with the age at onset of AF (β -0.02 [-0.03--0.01], p=0.002). In the subgroup analyses, these age-wGRS associations were significant in males (p&lt;0.001) and in those without heart failure (p&lt;0.001) or strokes (p&lt;0.001).

Conclusions
AF-associated genetic loci significantly contributed to the age at the onset of AF, as determined by the first ECG.
Machine-learned physiological signatures from the ECG predict sudden death in ischemic cardiomyopathy
Authors: Deb B , Selvalingam A , Alhusseini M , Rogers A , Ganesan P , Feng R , Clopton P , Ruiperez-Campillo S , Narayan S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH)

Background
Low left ventricular ejection fraction (LVEF) is an imperfect predictor of sudden cardiac death (SCD) in patients with ischemic cardiomyopathy. Novel features from the ECG might provide a readily available tool to better predict risk.

Purpose
We hypothesized that machine learning (ML) of the ECG can be used to predict SCD, and the ML-learned ECG features could be referenced to interpretable intracardiac signals (monophasic action potentials: MAP) to provide mechanistic insights.

Methods
We studied 5603 ECG Lead V1 beats in 41 patients (64±10 Y) with coronary disease and LVEF≤40% in steady-state pacing. Patients were randomly allocated to independent training and test cohorts in a 70:30 ratio, repeated K=10-fold. Support vector machines were trained to predict mortality at 3Y from the top 20 features derived from these beats. Patient-level predictions were made by computing an ECG score that indicates the proportion of test set beats in that patient computed by the beat-level model to predict death. Explainability analysis was performed using the arithmetic mean of MAP and ECG beats that predicted SCD versus those that predicted survival.

Results
Fig 1A. shows ECG lead V1 and MAP in a 79 Y man with LVEF 29%. Fig 1B shows the dataflow in the study. Predictive accuracies of ML models were 78 and 70% and optimal with 20 features for both ECG and MAP models respectively (Fig. 1C). Beat-level predictions in the validation (n=1678 Lead I beats) cohorts yielded c-statistics of 0.78 with the ECG (95% CI, 0.62–0.91) and 0.75 with MAPs (95% CI, 0.75-0.76) (data not shown). In multivariable patient-level models, c-statistic was 0.87 with ECGs (95% CI, 0.76-0.98) (Fig 1D) and 0.82 with MAPs. On explainability analysis, ECG beats that predicted SCD (Fig 2; red) had lower amplitude and more notched T-waves in lead V1 than beats that predicted no SCD (Fig 2; blue). MAP that predicted SCD had higher repolarization current at the same time points. Both QT duration (ECG) and action potential duration (MAP) did not differ (Fig 2).

Conclusions
Machine learning of the ECG reveals novel predictors of SCD risk in patients with ischemic cardiomyopathy analogous to those identified in intracardiac signals. This approach can be used as a point-of-care ECG risk tool to improve risk stratification and allocation for ICD therapy beyond LVEF alone and may shed insights into the pathophysiology of ventricular arrhythmias.
Assessment of activation duration across the right ventricular outflow tract in patients with premature ventricular contractions using noninvasive electrocardiographic mapping: a validation study
Authors: Parreira A , Carmo P , Marinheiro R , Mesquita D , Marques L , Mancelos S , Ferreira A , Goncalves A , Nunes S , Chmelevsky M , Ferreira J , Coelho R , Goncalves P , Marques H , Adragao P 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Learning Health

Introduction
Previous studies have reported that wavefront propagation speed across the right ventricular outflow tract (RVOT) can distinguish premature ventricular contractions (PVCs) with a RVOT origin from PVCs with a left ventricular outflow tract (LVOT) origin.

Aim
Validate the non-invasive electrocardiographic mapping (ECGI) for assessment of RVOT activation duration (AD) during PVCs and assess its value as a predictor of the origin of the PVCs.

Methods
We studied 18 consecutive patients, 8 males, median age 55 (35-63) years that underwent ablation of frequent (&gt; 10.000 per 24 h) idiopathic PVCs with inferior axis, that had and an ECGI performed before ablation and the RVOT mapped in PVC. The ECGI was performed with the Amycard system, and invasive mapping was performed with the Carto or Ensite system. Isochronal activation maps of the RVOT in PVC were obtained with the activation direction method (ADM) of the ECGI, and with the Carto and Ensite systems. Total RVOT AD was measured as the time interval between the earliest and the latest activated region. Agreement between the two methods was performed using a Bland-Altman plot and linear regression . The cutoff value of AD to predict PVC origin was calculated with ROC curve.

Results
PVCs originated from the RVOT in 11 (61%) patients. The median (Q1-Q3) RVOT AD measured with ECGI was 54 (39-68) ms and with invasive map 57 (36-70) ms. The agreement between both methods was good with an R2 of 0.747, p&lt;0.0001. Figure displays the Bland-Altman plot (panel A), the linear regression plot (panel B). and two examples of the ECGI isochronal map (panel C). The AD was significantly higher in PVCs from the RVOT vs LVOT, both with ECGI and Carto, respectively 62 (58-73) vs 37 (33-40) ms, p&lt;0.0001 and 68 (60-75) vs 34 (30-40) ms, p&lt;0.0001. The cutoff value of 43 ms for AD measured with ECGI, predicted the origin of the PVCs with a sensitivity and specificity of 100%.

Conclusions
We found good agreement between ECGI and Carto. The AD obtained with ECGI was accurate to predict the origin of the PVCs.
PR and QRS intervals in basal electrocardiogram as a useful tool in screening family members for diagnosis of Brugada Syndrome
Authors: Devesa Neto V , Santos JM , Pereira JG , Ferreira Santos L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Diagnosis of Brugada Syndrome (BrS) requires documentation of a spontaneous or pharmacologically induced type 1 Brugada pattern. In individuals with normal basal electrocardiography, screening methods could be challenging. The aim of the study was to detect if other parameters in basal ECG could be a tool to predict the diagnosis of BrS in family members.

Methods
Prospective analysis of 78 patients with family history of BrS and referenced for screening. Basal electrocardiogram was performed in all patients. Patients with spontaneous type 1 Brugada pattern in basal ECG were initially excluded. Definitive diagnosis required a presence of a type 1 ECG pattern or conversion of a type 2 to type 1 following provocative test. The Mann-Whitney U test was used for median comparison between groups as univariate analysis. Analysis of the receiver operating characteristic (ROC) curves were performed to evaluate the predictive values of ECG parameters.

Results
6% (n=5) had spontaneous type 1 Brugada syndrome. 53% were male (n=41); mean age of 28,9±15,3 years. 31% (n=24) had confirmative diagnosis of BrS. 27% (n=21) were carriers of SCN5A mutation. Mean duration of intervals on basal ECG were: RR 871,2±156,0ms; PR 159,3±34,1ms; QRS 91,4±13,4ms; QTc 404,2±32,0. Syncope occurred in 5% of patients (n=5), 94% were asymptomatic.
By univariate analysis the distribution of PR and QRS intervals was significantly different. Wider PR interval was found in patients with BrS (p&lt;0,01) with a median of 200ms (variance of 1269) versus healthy individuals (median of 150ms and variance of 601). Wider QRS intervals were also found in BrS patients compared with healthy individuals (p&lt;0,01) (100ms (288) versus 80ms (204)). The cut-off point, with the most sensitivity (S) and specificity (E) obtained using the Youden index (YI) for PR interval was 170ms (YI 0,5389; Sensitivity (S)≈65% and Specificity(E)≈89%) and for QRS interval was 97ms (YI 0,5148; Sensitivity (S)≈70% and Specificity(E)≈82%).

Conclusion
Higher PR and QRS intervals were associated with BrS diagnosis comparing to healthy family members which may pose a cost-effective screening tool. More studies are needed to validate this hypothesis.
Incidental arrhythmias during atrial fibrillation screening in a hospital-based patient population
Authors: Goulouti E , Lam A , Nozica N , Elchinova E , Spirito A , Servatius H , Noti F , Seiler J , Baldinger S , Haeberlin A , Babken A , Franzeck F , Tanner H , Reichlin T , Roten L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Screening for atrial fibrillation may reveal other, incidental arrhythmias of relevance. We sought to describe such incidental arrhythmias in the prospective STARFIB cohort study, which screened for silent atrial fibrillation in hospitalized patients aged 65-84 years.

Method
Patients included in the STARFIB cohort study had up to three 7-day Holter ECGs, performed in two-month intervals. We analysed all the 7-day Holter ECGs of study participants for the presence of one of the following incidental arrhythmias: 1) sick-sinus-syndrome (SSS), defined as sinus arrest of ≥3 seconds duration; 2) second or higher degree atrioventricular block (AVB); 3) sustained atrial tachycardia of ≥30 seconds duration (AT); and 4) sustained ventricular tachycardia of ≥30 seconds duration (VT).

Results
A total of 2’077 Holter ECGs were performed in 794 patients (mean age 74.7 years; 49% females), resulting in a mean cumulative duration of an analyzable ECG signal of 414±136 hours per patient. We found incidental arrhythmias in 94 patients (11.8%). Among these were SSS in 14 patients (1.8%), AVB in 41 (5.2%), AT in 41 (5.2%), and VT in two (0.3%). The median pause duration in SSS was 4 seconds and SSS resulted in pacemaker implantation in one patient with a pause of 9 seconds duration. The most severe type of AVB found per patient was second degree AVB type Wenkebach in 23 patients (2.9%), second degree AVB type Mobitz or 2:1 AV conduction in 10 patients (1.3%) and complete AVB in 8 (1%; maximum pause 18 seconds). AVB led to pacemaker implantation in 9 patients (1.1%). The median duration and heart rate of AT was 2.2 minutes and 144 bpm, respectively. Initiation of betablocker therapy was recommended in 3 patients (0.4%) due to symptomatic AT. The duration and heart rate of VT was 3 minutes at 216 bpm in one patient and 38 seconds at 150 bpm in another. The former patient with VT experienced syncope and an ICD was implanted, whereas in the latter the betablocker dose was increased. One patient died from a non-cardiac cause during a Holter ECG, which showed progressive bradycardia and finally asystole.

Conclusion
Incidental arrhythmias were frequently discovered during screening for atrial fibrillation and resulted in device therapy in 1.4% of our cohort patients.
Prediction of ablation success in atrial fibrillation patients based on electrocardiographic imaging
Authors: Molero R , Climent AM , Guillem MS 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III, and Ministerio de Ciencia, Innovación y Universidades (supported by FEDER Fondo Europeo de Desarrollo Regional PI17/01106), Agencia Estatal de Investigación (RYC2018-024346B-750 and PID2020-119364RB-100), Generalitat Valenciana Grants (ACIF/2020/265) and EIT Health (Activity code 19600), EIT Health is supported by EIT, a body of the European Union).

Introduction
Success rates of pulmonary vein isolation (PVI) are still suboptimal for termination of Atrial Fibrillation (AF). Electrocardiographic imaging (ECGI) could be used to determine the state of the atrial substrate non-invasively.

Objective
Improve the current stratification protocol for AF patients candidates to PVI using ECGI metrics prior to the referral to an ablation procedure.

Methods
ECGI from 35 AF patients (22 male, 10 paroxysmal, 63.3 ± 9.5 years) were recorded prior to PVI plus rotor ablation. Patients were latter classified based on their 6 months follow-up (23 sinus rhythm vs. 12 arrhythmia recurrence). ECGI dominant frequencies (DF) and rotor metrics were calculated in each patient, together with their temporal variability. Multivariate logistic regression was computed on the metrics, their variability and AF type to study the prediction power on ablation outcome.

Results
Dominant frequency metrics present higher values in patients with arrhythmia recurrence after the ablation. Rotor metrics showed higher variability in patients with bad PVI outcome (Table 1). ECGI metrics alone allow better outcome prediction (Fig. 1) than standard AF classification (AUC = 0.85 vs. 0.65). ECGI metrics combined with the type of AF increased outcome prediction, AUC = 0.88.

Conclusion
Patients with poor ablation outcome presented higher DFs and reentrant activity variability than patients with good PVI outcome. ECGI derived metrics in combination with AF classification increase PVI follow-up prediction compared to traditional patient stratification showing potential to be an alternative to the standard of care.
Low coronary flow reserve in patients with long-standing persistent atrial fibrillation is associated with worse clinical outcomes
Authors: Daniels F , Elvan A , Beemsterboer ITA , Mouden M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background / Introduction
Atrial fibrillation (AF) is associated with an increased risk of myocardial infarction, stroke and all-cause mortality. Myocardial perfusion imaging (MPI) is well-established for the diagnosis of coronary artery disease (CAD) and risk-stratification in sinus rhythm (SR) patients.

Purpose
The aim of this study was to determine the prognostic impact of AF and coronary flow reserve (CFR) in patients undergoing positron emission tomography (PET) MPI.

Methods
680 patients without a known history of CAD were included. 226 paroxysmal AF (PAF) and 114 long-standing persistent AF (LSPAF) patients were identified from a prospective PET MPI registry in the Isala Hospital and propensity matched in a 1:1 ratio to SR patients. The main indications for PET MPI were chest pain and dyspnea. Follow-up was obtained for the occurrence of major adverse cardiac and cerebrovascular events (MACCE, composite of myocardial infarction (MI), stroke/transient ischemic attack (TIA) or all-cause death).

Results
Compared with patients with PAF, patients with LSPAF were older (p=0.011) and more frequently male (p=0.031), with no significant differences in medical history. There were no significant differences between SR and AF in the occurrence of MACCE during a mean follow-up of 36 months. However, the incidence of downstream coronary angiography (p&lt;0.001) and MACCE (p=0.028) was higher in patients with LSPAF compared to those with PAF and SR. A low CFR (defined as CFR below the median of 2.4) in patients with LSPAF showed significantly more MACCE compared with SR and PAF (p&lt;0.001). Moreover, LSPAF was an independent predictor of MACCE (odds ratio 1.667, 95% confidence interval 1.028±2.705).

Conclusion
Low CFR in patients with LSPAF is associated with a higher incidence of MI, stroke/TIA and death compared with low and normal coronary flow parameters in patients with SR and PAF.
Nurse-led compared to physician-led implant of cardiac monitors
Authors: Steinhauer B , Spicher J , Aerschmann S , Ambord N , Bartkowiak J , Servatius H , Noti F , Seiler J , Baldinger S , Haeberlin A , Madaffari A , Tanner H , Reichlin T , Roten L , Duetschler S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Implantation of an implantable cardiac monitor (ICM) is a simple and straightforward procedure. However, with a growing demand for such implants, workload significantly increases. In January 2020, we established a completely nurse-led ICM implantation service (N-IMPLANT) with a standard operating procedure.

Purpose
The present study aimed to analyze the safety, efficacy, and patient satisfaction of N-IMPLANT compared to implantation of ICMs by a physician (P-IMPLANT).

Method
Consenting patients implanted with an ICM were included in a prospective registry, which collects patient characteristics, procedural and remote monitoring data. All patients were followed-up by phone interview four weeks after ICM implantation and a standardized questionnaire was completed.

Results
Of 321 patients implanted with an ICM (median age 67 years; 33% women), 189 (59%) were N-IMPLANT. Significantly more N-IMPLANT were performed in the outpatient clinic compared to P-IMPLANT (94% vs. 10%; p&lt;0.001). For wound closure, N-IMPLANT used wound glue in 65 (34%) and a single subcutaneous stitch in 124 patients (66%). Two N-IMPLANT patients experienced vaso-vagal reaction during implantation, whereas no adverse events occurred during P-IMPLANT (p=0.51). Two-hundred and fifty-two patients (79%) completed the questionnaire. We found no difference between N-IMPLANT and P-IMPLANT regarding pain after implant, analgesic use, wound closure after 2 weeks and presence and size of patient reported hematoma (see Table). Duration of pain was longer after P-IMPLANT. All N-IMPLANT patients indicated to be satisfied with the implant procedure. Three patients were dissatisfied with P-IMPLANT for the following reasons: ongoing pain at implant site; discomfort at implant site; and too numerous people present during the implant procedure. In three N-IMPLANT (2%) the ICM was explanted prematurely. The reasons for explantation were infection (with reimplantation of another ICM), discomfort at implant site and attempt to avoid interferences during magnetic resonance tomography in one patient each. One P-IMPLANT (1%) was explanted prematurely because of ICM malfunction.

Conclusion
Nurse-led implantation of cardiac monitors is effective without compromising patient safety and has excellent patient satisfaction. N-IMPLANT is a suitable model to reduce the workload of physicians.