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506 results on '"Cardiocentro Ticino [Lugano]"'

1. Reconstruction of three-dimensional biventricular activation based on the 12-lead electrocardiogram via patient-specific modelling

Author: Frits W. Prinzen, Giulio Conte, Rolf Krause, Simone Pezzuto, Mark Potse, Maria Luce Caputo, François Regoli, Angelo Auricchio, Francesco Maffessanti, Fysiologie, RS: Carim - H06 Electro mechanics, Clinical sciences, Center for Computational Medicine in Cardiology (CCMC), Università della Svizzera italiana = University of Italian Switzerland (USI), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University [Maastricht], IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Theo Rossi di Montelera Foundation (Lausanne, Switzerland), Metis Foundation Sergio Mantegazza (Lugano, Switzerland), Fidinam Foundation (Lugano, Swizerland), Swiss Heart Foundation (Bern, Switzerland), SNSF project 32003B_165802 (Bern, Switzerland), Horten Foundation (Castelrotto, Switzerland), and CSCS—Swiss National Supercomputing Centre production grant s778 (Lugano, Switzerland)., University of Zurich, Pezzuto, Simone, Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, and Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: CARDIAC ELECTROPHYSIOLOGY, medicine.medical_specialty, Patient-specific modelling, Heart Ventricles, 0206 medical engineering, 12 lead electrocardiogram, 610 Medicine & health, 02 engineering and technology, 030204 cardiovascular system & hematology, Heart Ventricles/diagnostic imaging, Techincal Issues, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, Nerve conduction velocity, VALIDATION, 03 medical and health sciences, QRS complex, Electrocardiography, 2737 Physiology (medical), 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Physiology (medical), Internal medicine, Eikonal model, medicine, Humans, magnetic resonance imaging, AcademicSubjects/MED00200, cardiovascular diseases, Endocardium, Coronary sinus, medicine.diagnostic_test, Ventricular activation • Three-dimensional activation, business.industry, Cardiac electrophysiology, Body Surface Potential Mapping, Magnetic resonance imaging, 020601 biomedical engineering, Three-dimensional activation, Ventricular activation, Twelve-lead electrocardiogram, Cardiology, cardiovascular system, patient-specific modeling, business, Cardiology and Cardiovascular Medicine
Abstract: Aims Non-invasive imaging of electrical activation requires high-density body surface potential mapping. The nine electrodes of the 12-lead electrocardiogram (ECG) are insufficient for a reliable reconstruction with standard inverse methods. Patient-specific modelling may offer an alternative route to physiologically constraint the reconstruction. The aim of the study was to assess the feasibility of reconstructing the fully 3D electrical activation map of the ventricles from the 12-lead ECG and cardiovascular magnetic resonance (CMR). Methods and results Ventricular activation was estimated by iteratively optimizing the parameters (conduction velocity and sites of earliest activation) of a patient-specific model to fit the simulated to the recorded ECG. Chest and cardiac anatomy of 11 patients (QRS duration 126–180 ms, documented scar in two) were segmented from CMR images. Scar presence was assessed by magnetic resonance (MR) contrast enhancement. Activation sequences were modelled with a physiologically based propagation model and ECGs with lead field theory. Validation was performed by comparing reconstructed activation maps with those acquired by invasive electroanatomical mapping of coronary sinus/veins (CS) and right ventricular (RV) and left ventricular (LV) endocardium. The QRS complex was correctly reproduced by the model (Pearson’s correlation r = 0.923). Reconstructions accurately located the earliest and latest activated LV regions (median barycentre distance 8.2 mm, IQR 8.8 mm). Correlation of simulated with recorded activation time was very good at LV endocardium (r = 0.83) and good at CS (r = 0.68) and RV endocardium (r = 0.58). Conclusion Non-invasive assessment of biventricular 3D activation using the 12-lead ECG and MR imaging is feasible. Potential applications include patient-specific modelling and pre-/per-procedural evaluation of ventricular activation.
Published: 2021

2. Synergistic antiarrhythmic effect of inward rectifier current inhibition and pulmonary vein isolation in a 3D computer model for atrial fibrillation

Author: Stef Zeemering, Ali Gharaviri, Ulrich Schotten, Simone Pezzuto, Angelo Auricchio, Mark Potse, Sander Verheule, Vladimír Sobota, Giulio Conte, Rolf Krause, Fysiologie, RS: Carim - H08 Experimental atrial fibrillation, Center for Computational Medicine in Cardiology (CCMC), Università della Svizzera italiana = University of Italian Switzerland (USI), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Department of Physiology [Maastricht], Maastricht University [Maastricht], European Project: 675351,H2020,H2020-MSCA-ITN-2015,AFib-TrainNet(2015), Clinical sciences, and Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 0301 basic medicine, medicine.medical_specialty, Anti-Arrhythmia Agents/therapeutic use, medicine.medical_treatment, Pulmonary Veins/surgery, Catheter ablation, 030204 cardiovascular system & hematology, Inward rectifier currents, Pulmonary vein, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Fibrosis, Recurrence, Physiology (medical), Internal medicine, Atrial Fibrillation, Medicine, Humans, Computer Simulation, In silico study, Fibrillation, Atrium (architecture), Atrial Fibrillation/drug therapy, business.industry, Atrial fibrillation, Atrial fibrillation recurrence, medicine.disease, 3. Good health, Blockade, 030104 developmental biology, Treatment Outcome, Antiarrhythmic drug, Pulmonary Veins, Cardiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents
Abstract: Aims Recent clinical studies showed that antiarrhythmic drug (AAD) treatment and pulmonary vein isolation (PVI) synergistically reduce atrial fibrillation (AF) recurrences after initially successful ablation. Among newly developed atrial-selective AADs, inhibitors of the G-protein-gated acetylcholine-activated inward rectifier current (IKACh) were shown to effectively suppress AF in an experimental model but have not yet been evaluated clinically. We tested in silico whether inhibition of inward rectifier current or its combination with PVI reduces AF inducibility. Methods and results We simulated the effect of inward rectifier current blockade (IK blockade), PVI, and their combination on AF inducibility in a detailed three-dimensional model of the human atria with different degrees of fibrosis. IK blockade was simulated with a 30% reduction of its conductivity. Atrial fibrillation was initiated using incremental pacing applied at 20 different locations, in both atria. IK blockade effectively prevented AF induction in simulations without fibrosis as did PVI in simulations without fibrosis and with moderate fibrosis. Both interventions lost their efficacy in severe fibrosis. The combination of IK blockade and PVI prevented AF in simulations without fibrosis, with moderate fibrosis, and even with severe fibrosis. The combined therapy strongly decreased the number of fibrillation waves, due to a synergistic reduction of wavefront generation rate while the wavefront lifespan remained unchanged. Conclusion Newly developed blockers of atrial-specific inward rectifier currents, such as IKAch, might prevent AF occurrences and when combined with PVI effectively supress AF recurrences in human.
Published: 2021

3. The structural heart disease interventional imager rationale, skills and training: a position paper of the European Association of Cardiovascular Imaging

Author: Francesco Faletra, Eustachio Agricola, Hani Mahmoud-Elsayed, Nina Ajmone Marsan, Ralph Stephan von Bardeleben, Marc R. Dweck, Erwan Donal, Mark J. Monaghan, Thor Edvardsen, Francesco Ancona, Bogdan A. Popescu, Pal Maurovich-Hovart, José Luis Zamorano, Nina Wunderlich, Martin J. Swaans, Bernard Cosyns, Patrizio Lancellotti, Leyla Elif Sade, José M. C. Ribeiro, Eric Brochet, Agricola, Eustachio, Ancona, Francesco, Brochet, Eric, Donal, Erwan, Dweck, Marc, Faletra, Francesco, Lancellotti, Patrizio, Mahmoud-Elsayed, Hani, Marsan, Nina Ajmone, Maurovich-Hovart, Pal, Monaghan, Mark, Ribeiro, José, Sade, Leyla Elif, Swaans, Martin, Von Bardeleben, Ralph Stephan, Wunderlich, Nina, Zamorano, Jose-Lui, Popescu, Bogdan A, Cosyns, Bernard, Edvardsen, Thor, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale San Raffaele, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], University of Edinburgh, Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Università degli studi di Bari Aldo Moro (UNIBA), Leiden University Medical Center (LUMC), Semmelweis University of Medicine [Budapest], King‘s College London, Başkent University Hospital [Adana, Turkey], St. Antonius Hospital [Nieuwegein], University Medical Center [Mainz], Hospital Universitario Ramón y Cajal [Madrid], Universidad de Alcalá - University of Alcalá (UAH), Université de Médecine Carol Davila, Universitair Ziekenhus Brussel (UZ Brussel), Oslo University Hospital [Oslo], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro (UNIBA), Universitair Ziekenhuis Brussel = University Hospital of Brussels (UZ Brussel), Jonchère, Laurent, Clinical sciences, Cardio-vascular diseases, Cardiology, and Universiteit Leiden
Subjects: medicine.medical_specialty, Cardiac Catheterization, Certification, Heart Diseases, education, Psychological intervention, Context (language use), 030204 cardiovascular system & hematology, Subspecialty, Interventional imaging, Multimodality, 03 medical and health sciences, 0302 clinical medicine, medicine, Medical imaging, Humans, Radiology, Nuclear Medicine and imaging, Medical physics, 030212 general & internal medicine, Structural heart disease, Cardiac imaging, [SDV.IB] Life Sciences [q-bio]/Bioengineering, business.industry, General Medicine, Percutaneous treatment of structural heart disease, 3. Good health, Cardiac Imaging Techniques, Position paper, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Cardiology and Cardiovascular Medicine, business
Abstract: Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of ‘Interventional Imaging’ for SHD interventions and a new dedicated professional figure, the ‘Interventional Imager’ with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.
Published: 2021

4. Sensitivity analysis of ventricular activation and electrocardiogram in tailored models of heart-failure patients

Author: Angelo Auricchio, Frits W. Prinzen, Enrico G. Caiani, Francesco Maffessanti, Rolf Krause, Gabriele D'Ambrosio, Carlos Sánchez, Mark Potse, University of Zurich, Sánchez, C, Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano [Milan] (POLIMI), Maastricht University [Maastricht], Faculty of Informatics [Lugano], IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Swiss National Supercomputing Centre (CSCS) project ID s598, Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Fysiologie, RS: CARIM - R2.08 - Electro mechanics, and Biomedische Technologie
Subjects: Male, medicine.medical_treatment, 02 engineering and technology, 030204 cardiovascular system & hematology, Electrocardiography, 0302 clinical medicine, MAGNETIC-RESONANCE, Computer simulation, ECG morphology, Heart failure, Left bundle branch block, Patient-specific model, Sensitivity analysis, Biomedical Engineering, Computer Science Applications1707 Computer Vision and Pattern Recognition, medicine.diagnostic_test, Models, Cardiovascular, Middle Aged, Computer Science Applications, VARIABILITY, Ventricular activation, Cardiology, MESH: Mathematical Computation, Female, CARDIAC RESYNCHRONIZATION THERAPY, RHYTHM, ARRHYTHMOGENESIS, BUNDLE-BRANCH BLOCK, medicine.medical_specialty, Heart Ventricles, 0206 medical engineering, Cardiac resynchronization therapy, 2204 Biomedical Engineering, 610 Medicine & health, 11171 Cardiocentro Ticino, CELLULAR ELECTROPHYSIOLOGY, 03 medical and health sciences, QRS complex, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, medicine, 1706 Computer Science Applications, Humans, Sensitivity (control systems), MESH: Cardiac electrophysiology, Aged, Demography, Bundle branch block, business.industry, CONDUCTION DEFECTS, Magnetic resonance imaging, medicine.disease, 020601 biomedical engineering, TISSUE, MESH: Heart Failure, PATTERNS, business, Biomedical engineering
Abstract: International audience; Cardiac resynchronization therapy is not effective in a variable proportion of heart failure patients. An accurate knowledge of each patient's electroanatomical features could be helpful to determine the most appropriate treatment. The goal of this study was to analyze and quantify the sensitivity of left ventricular (LV) activation and the electrocardiogram (ECG) to changes in 39 parameters used to tune realistic anatomical-electrophysiological models of the heart. Electrical activity in the ventricles was simulated using a reaction-diffusion equation. To simulate cellular electrophysiology, the Ten Tusscher-Panfilov 2006 model was used. Intracardiac electrograms and 12-lead ECGs were computed by solving the bidomain equation. Parameters showing the highest sensitivity values were similar in the six patients studied. QRS complex and LV activation times were modulated by the sodium current, the cell surface-to-volume ratio in the LV, and tissue conductivities. The T-wavewas modulated by the calcium and rectifier-potassium currents, and the cell surface-to-volume ratio in both ventricles. We conclude that homogeneous changes in ionic currents entail similar effects in all ECG leads, whereas the effects of changes in tissue properties show larger inter-lead variability. The effects of parameter variations are highly consistent between patients and most of the model tuning could be performed with only ~10 parameters.
Published: 2018

5. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial

Author: Sonia S Anand, Jackie Bosch, John W Eikelboom, Stuart J Connolly, Rafael Diaz, Peter Widimsky, Victor Aboyans, Marco Alings, Ajay K Kakkar, Katalin Keltai, Aldo P Maggioni, Basil S Lewis, Stefan Störk, Jun Zhu, Patricio Lopez-Jaramillo, Martin O'Donnell, Patrick J Commerford, Dragos Vinereanu, Nana Pogosova, Lars Ryden, Keith A A Fox, Deepak L Bhatt, Frank Misselwitz, John D Varigos, Thomas Vanassche, Alvaro A Avezum, Edmond Chen, Kelley Branch, Darryl P Leong, Shrikant I Bangdiwala, Robert G Hart, Salim Yusuf, JORGELINA SALA, LUIS CARTASEGNA, MARISA VICO, MIGUEL ANGEL HOMINAL, EDUARDO HASBANI, ALBERTO CACCAVO, CESAR ZAIDMAN, DANIEL VOGEL, ADRIAN HRABAR, PABLO OMAR SCHYGIEL, CARLOS CUNEO, HUGO LUQUEZ, IGNACIO J. MACKINNON, RODOLFO ANDRES AHUAD GUERRERO, JUAN PABLO COSTABEL, INES PALMIRA BARTOLACCI, OSCAR MONTANA, MARIA BARBIERI, OSCAR GOMEZ VILAMAJO, RUBEN OMAR GARCIA DURAN, LILIA BEATRIZ SCHIAVI, MARCELO GARRIDO, ADRIAN INGARAMO, ANSELMO PAULINO BORDONAVA, MARIA JOSE PELAGAGGE, LEONARDO NOVARETTO, JUAN PABLO ALBISU DI GENNERO, LUZ MARIA IBANEZ SAGGIA, MOIRA ALVAREZ, NESTOR ALEJANDRO VITA, STELLA MARIS MACIN, RICARDO DARIO DRAN, MARCELO CARDONA, LUIS GUZMAN, RODOLFO JUAN SARJANOVICH, JESUS CUADRADO, SEBASTIAN NANI, MARCOS RAUL LITVAK BRUNO, CAROLINA CHACON, LAURA ELENA MAFFEI, DIEGO GRINFELD, NATALIA VENSENTINI, CLAUDIO RODOLFO MAJUL, HECTOR LUCAS LUCIARDI, PATRICIA DEL CARMEN GONZALEZ COLASO, FREDY ANTONI FERRE PACORA, PAUL VAN DEN HEUVEL, PETER VERHAMME, BAVO ECTOR, PHILIPPE DEBONNAIRE, PHILIPPE VAN DE BORNE, JEAN LEROY, HERMAN SCHROE, PASCAL VRANCKX, IVAN ELEGEERT, ETIENNE HOFFER, KARL DUJARDIN, CLARISSE INDIO DO BRASIL, DALTON PRECOMA, JOSE ANTONIO ABRANTES, EULER MANENTI, GILMAR REIS, JOSE SARAIVA, LILIA MAIA, MAURO HERNANDES, PAULO ROSSI, FABIO ROSSI DOS SANTOS, SERGIO LUIZ ZIMMERMANN, RAFAEL RECH, EDUARDO ABIB JR, PAULO LEAES, ROBERTO BOTELHO, OSCAR DUTRA, WEIMAR SOUZA, MARIA BRAILE, NILO IZUKAWA, JOSE CARLOS NICOLAU, LUIZ FERNANDO TANAJURA, CARLOS VICENTE SERRANO JUNIOR, CESAR MINELLI, LUIZ ANTONIO NASI, LIVIA OLIVEIRA, MARCELO JOSE DE CARVALHO CANTARELLI, RICHARD TYTUS, SHEKHAR PANDEY, EVA LONN, JAMES CHA, SAUL VIZEL, MOHAN BABAPULLE, ANDRE LAMY, KEVIN SAUNDERS, JOSEPH BERLINGIERI, BOB KIAII, RAKESH BHARGAVA, PRAVINSAGAR MEHTA, LAURIE HILL, DAVID FELL, ANDY LAM, FAISAL AL-QOOFI, CRAIG BROWN, ROBERT PETRELLA, JOSEPH A RICCI, ANTHONY GLANZ, NICOLAS NOISEUX, KEVIN BAINEY, FATIMA MERALI, MICHAEL HEFFERNAN, ANTHONY DELLA SIEGA, GILLES R DAGENAIS, FRANCOIS DAGENAIS, STEEVE BRULOTTE, MICHEL NGUYEN, MICHAEL HARTLEIB, RANDOLPH GUZMAN, RONALD BOURGEOIS, DENNIS RUPKA, YAARIV KHAYKIN, GILBERT GOSSELIN, THAO HUYNH, CLAUDE PILON, JEAN CAMPEAU, FRANCIS PICHETTE, ARIEL DIAZ, JAMES JOHNSTON, PRAVIN SHUKLE, GREGORY HIRSCH, PAUL RHEAULT, WLODZIMIERZ CZARNECKI, ANNIE ROY, SHAH NAWAZ, STEPHEN FREMES, DINKAR SHUKLA, GABRIEL JANO, JORGE LEONARDO COBOS, RAMON CORBALAN, MARCELO MEDINA, LEONARDO NAHUELPAN, CARLOS RAFFO, LUIS PEREZ, SERGIO POTTHOFF, BENJAMIN STOCKINS, PABLO SEPULVEDA, CHRISTIAN PINCETTI, MARGARITA VEJAR, HONGYAN TIAN, XUESI WU, YUANNAN KE, KAIYING JIA, PENGFEI YIN, ZHAOHUI WANG, LITIAN YU, SHULIN WU, ZONGQUI WU, SHAO WEN LIU, XIAO JUAN BAI, YANG ZHENG, PING YANG, YUN MEI YANG, JIWEI ZHANG, JUNBO GE, XIAO PING CHEN, JUNXIA LI, TAO HONG HU, RUIYAN ZHANG, ZHE ZHENG, XIN CHEN, LIANG TAO, JIANPING LI, WEIJIAN HUANG, GUOSHENG FU, CHUNJIAN LI, YUGANG DONG, CHUNSHENG WANG, XINMIN ZHOU, YE KONG, ARISTIDES SOTOMAYOR, JOSE LUIS ACCINI MENDOZA, HENRY CASTILLO, MIGUEL URINA, GUSTAVO AROCA, MARITZA PEREZ, DORA INES MOLINA DE SALAZAR, GREGORIO SANCHEZ VALLEJO, MANZUR J FERNANDO, HENRY GARCIA, LUIS HERNANDO GARCIA, EDGAR ARCOS, JUAN GOMEZ, FRANCISCO CUERVO MILLAN, FREDY ALBERTO TRUJILLO DADA, BORIS VESGA, GUSTAVO ADOLFO MORENO SILGADO, EVA ZIDKOVA, JEAN-CLAUDE LUBANDA, MARKETA KALETOVA, RADIM KRYZA, GABRIEL MARCINEK, MAREK RICHTER, JINDRICH SPINAR, JIRI MATUSKA, MARTIN TESAK, ZUZANA MOTOVSKA, MARIAN BRANNY, JIRI MALY, MARTIN MALY, MARTIN WIENDL, LENKA FOLTYNOVA CAISOVA, JOSEF SLABY, PETR VOJTISEK, JAN PIRK, LENKA SPINAROVA, MIROSLAVA BENESOVA, JULIA CANADYOVA, MIROSLAV HOMZA, JINDRICH FLORIAN, ROSTISLAV POLASEK, ZDENEK COUFAL, VLADIMIRA SKALNIKOVA, RADIM BRAT, MIROSLAV BRTKO, PETR JANSKY, JAROSLAV LINDNER, PAVEL MARCIAN, ZBYNEK STRAKA, MARTIN TRETINA, YAN CARLOS DUARTE, FREDDY POW CHON LONG, MAYRA SANCHEZ, JOSE LOPEZ, CARMITA PERUGACHI, RICARDO MARMOL, FREDDY TRUJILLO, PABLO TERAN, JAAKKO TUOMILEHTO, HENRI TUOMILEHTO, MARJA-LEENA TUOMINEN, ILKKA KANTOLA, GABRIEL STEG, VICTOR ABOYANS, FLORENCE LECLERCQ, EMILE FERRARI, FRANCK BOCCARA, EMMANUEL MESSAS, PATRICK MISMETTI, MARIE ANTOINETTE SEVESTRE, GUILLAUME CAYLA, PASCAL MOTREFF, STEFAN STOERK, HANS-DIRK DUENGEN, CHRISTOPH STELLBRINK, OSMAN GUEROCAK, CHRISTOPH KADEL, RUEDIGER BRAUN-DULLAEUS, MICHAEL JESERICH, CHRISTIAN OPITZ, HANS-FRIEDRICH VOEHRINGER, KARL-FRIEDRICH APPEL, BERNHARD WINKELMANN, THOMAS DORSEL, SIGRID NIKOL, HARALD DARIUS, JURGEN RANFT, SEBASTIAN SCHELLONG, WOLFGANG JUNGMAIR, PIROZE DAVIERWALA, MARC VORPAHL, LASZLO BAJNOK, ZOLTAN LASZLO, EBRAHIM NOORI, GABOR VERESS, ANDRAS VERTES, ANDRAS ZSARY, ERNO KIS, LASZLO KORANYI, JUDIT BAKAI, ZOLTAN BODA, FERENC POOR, ZOLTAN JARAI, VENDEL KEMENY, JOHN BARTON, BRENDAN MCADAM, ANDREW MURPHY, PETER CREAN, NIALL MAHON, RONAN CURTIN, BRIAIN MACNEILL, SEAN DINNEEN, MAJDI HALABI, REUVEN ZIMLICHMAN, DAVID ZELTSER, YOAV TURGEMAN, ELIEZER KLAINMAN, BASIL LEWIS, AMOS KATZ, SHAUL ATAR, EUGENIA NIKOLSKY, STEFANO BOSI, MONICA NALDI, POMPILIO FAGGIANO, DEBORA ROBBA, LUCIO MOS, GIANFRANCO SINAGRA, FRANCO COSMI, LUIGI OLTRONA VISCONTI, DE MATTEIS CARMINE, GIUSEPPE DI PASQUALE, MATTEO DI BIASE, SARA MANDORLA, MARINO BERNARDINANGELI, GIOVANNI CARLO PICCINNI, MICHELE MASSIMO GULIZIA, MARCELLO GALVANI, FLAVIO VENTURI, GIORGIO MOROCUTTI, MARIA GRAZIA BALDIN, CARLO OLIVIERI, GIAN PIERO PERNA, VINCENZO CIRRINCIONE, TAKAYASU KANNO, HIROYUKI DAIDA, YUKIO OZAKI, NAOMASA MIYAMOTO, SHINICHI HIGASHIUE, HIROSHI DOMAE, SHINOBU HOSOKAWA, HIROO KOBAYASHI, TAKEHIKO KURAMOCHI, KENSHI FUJII, KAZUAKI MIZUTOMI, KEIJIRO SAKU, KAZUO KIMURA, YOSHIHARU HIGUCHI, MITSUNORI ABE, HARUHITO OKUDA, TOSHIYUKI NODA, TERUAKI MITA, ATSUSHI HIRAYAMA, HARUHIKO ONAKA, MORIAKI INOKO, MITSUGU HIROKAMI, MUNENORI OKUBO, YUTAKA AKATSUKA, MIZUHO IMAMAKI, HARUO KAMIYA, MAMORU MANITA, TOSHIHARU HIMI, HIDEKI UENO, YUJI HISAMATSU, JUNYA AKO, YASUHIRO NISHINO, HIDEO KAWAKAMI, YUTAKA YAMADA, YUKIHIRO KORETSUNE, TAKAHISA YAMADA, TETSURO YOSHIDA, HIDEKI SHIMOMURA, NORIYUKI KINOSHITA, AKIHIKO TAKAHASHI, KHALID YUSOFF, WAN AZMAN WAN AHMAD, MUHAMMAD RADZI ABU HASSAN, SAZZLI KASIM, AIZAI AZAN ABDUL RAHIM, DIMON MOHD ZAMRIN, MASAHARU MACHIDA, YORIHIKO HIGASHINO, NORIAKI UTSU, AKIHIKO NAKANO, SHIGERU NAKAMURA, TETSUO HASHIMOTO, KENJI ANDO, TOMOHIRO SAKAMOTO, F.J. PRINS, DIRK LOK, JOHANNES GERT-JAN MILHOUS, ERIC VIERGEVER, FRANK WILLEMS, HENK SWART, MARCO ALINGS, ROB BREEDVELD, KEES-JAN DE VRIES, ROGER VAN DER BORGH, FANNY OEI, STIENEKE ZOET-NUGTEREN, HANS KRAGTEN, JEAN PAUL HERRMAN, PAUL VAN BERGEN, MARCEL GOSSELINK, EDUARD HOEKSTRA, ERWIN ZEGERS, EELKO RONNER, FRANK DEN HARTOG, GERARD BARTELS, PETER NIEROP, COEN VAN DER ZWAAN, JACOB VAN ECK, EDWIN VAN GORSELEN, BJORN GROENEMEIJER, PIETER HOOGSLAG, MARC ROBERT DE GROOT, ALDRIN LOYOLA, DENNIS JOSE SULIT, NANNETTE REY, MARIA TERESA ABOLA, DANTE MORALES, ELLEN PALOMARES, MARC EVANS ABAT, GREGORIO ROGELIO, PHILIP CHUA, JOSE CARLO DEL PILAR, JOHN DENNIS ALCARAZ, GERALDINE EBO, LOUIE TIRADOR, JOSEFINA CRUZ, JOHN ANONUEVO, ARTHUR PITARGUE, MARIANNA JANION, TOMASZ GUZIK, GRZEGORZ GAJOS, MACIEJ ZABOWKA, ANDRZEJ RYNKIEWICZ, MARLENA BRONCEL, ANDRZEJ SZUBA, DANUTA CZARNECKA, PAWEL MAGA, IRINA STRAZHESKO, YURY VASYUK, ZHANNA SIZOVA, YURY POZDNYAKOV, OLGA BARBARASH, MIKHAIL VOEVODA, TATIANA POPONINA, ALEXEY REPIN, IRINA OSIPOVA, ANNA EFREMUSHKINA, NINA NOVIKOVA, OLEG AVERKOV, DMITRY ZATEYSHCHIKOV, ARKADIY VERTKIN, AZA AUSHEVA, PATRICK COMMERFORD, SAADIYA SEEDAT, LOUIS VAN ZYL, JAN ENGELBRECHT, ELLEN MAKONLI MAKOTOKO, CATHARINA ELIZABETH PRETORIUS, ZAID MOHAMED, ADRIAN HORAK, THOMAS MABIN, ERIC KLUG, JANG-HO BAE, CHEOLHO KIM, CHONG-JIN KIM, DONG-SOO KIM, YONG JIN KIM, SEUNGJAE JOO, JONG-WON HA, CHUL SOO PARK, JANG YOUNG KIM, YOUNG-KWON KIM, CHRISTINA JARNERT, THOMAS MOOE, MIKAEL DELLBORG, INGEMAR TORSTENSSON, PER ALBERTSSON, LARS JOHANSSON, FARIS AL-KHALILI, HENRIK ALMROTH, TOMMY ANDERSSON, EMIL PANTEV, BENGT-OLOV TENGMARK, BO LIU, GUNDARS RASMANIS, CARL-MAGNUS WAHLGREN, TIZIANO MOCCETTI, ALEXANDER PARKHOMENKO, VIRA TSELUYKO, VOLODYMYR VOLKOV, OLENA KOVAL, LYUDMYLA KONONENKO, OLEKSANDR PROKHOROV, VALERIY VDOVYCHENKO, ANDRIY BAZYLEVYCH, LEONID RUDENKO, VADYM VIZIR, OLEKSANDR KARPENKO, YAROSLAV MALYNOVSKY, VALENTYNA KOVAL, BORYS STOROZHUK, JAMES COTTON, ASOK VENKATARAMAN, ANDREW MORIARTY, DEREK CONNOLLY, PATRICK DAVEY, ROXY SENIOR, INDERPAUL BIRDI, JOHN CALVERT, PATRICK DONNELLY, JASPER TREVELYAN, JUSTIN CARTER, AARON PEACE, DAVID AUSTIN, NEVILLE KUKREJA, THOMAS HILTON, SUNNY SRIVASTAVA, RONALD WALSH, RONALD FIELDS, JOSEPH HAKAS, EDWARD PORTNAY, HARINDER GOGIA, ABRAHAM SALACATA, JOHN J. HUNTER, J MICHAEL BACHARACH, NICOLAS SHAMMAS, DAMODHAR SURESH, RICKY SCHNEIDER, PAUL GURBEL, SUBHASH BANERJEE, PAUL GRENA, NOEL BEDWELL, STEPHEN SLOAN, STEVEN LUPOVITCH, ANAND SONI, KATHLEEN GIBSON, RENEE SANGRIGOLI, RAJENDRA MEHTA, PETER I-HSUAN TSAI, EVE GILLESPIE, STEPHEN DEMPSEY, GLENN HAMROFF, ROBERT BLACK, ELLIS LADER, JOHN B. KOSTIS, VERA BITTNER, WILLIAM MCGUINN, KELLEY BRANCH, VINAY MALHOTRA, STEPHEN MICHAELSON, MICHAEL VACANTE, MATTHEW MCCORMICK, RALUCA ARIMIE, ALAN CAMP, GEORGE DAGHER, N. MATHEW KOSHY, STEPHEN THEW, FREDERICK COSTELLO, MARK HEIMAN, ROBERT CHILTON, MICHAEL MORAN, FREDRIC ADLER, ANTHONY COMEROTA, ANDREW SEIWERT, WILLIAM FRENCH, HARVEY SEROTA, ROBERT HARRISON, FAISAL BAKAEEN, SHUAB OMER, LOKESH CHANDRA, ALAN WHELAN, ANDREW BOYLE, PHILIP ROBERTS-THOMSON, JAMES ROGERS, PATRICK CARROLL, DAVID COLQUHOUN, JAMES SHAW, PETER BLOMBERY, JOHN AMERENA, CHRIS HII, ALISTAIR ROYSE, BHUWAN SINGH, JOSEPH SELVANAYAGAM, SHIRLEY JANSEN, WINGCHI LO, CHRISTOPHER HAMMETT, ROHAN POULTER, SESHASAYEE NARASIMHAN, HENRIK WIGGERS, HENRIK NIELSEN, GUNNAR GISLASON, LARS KOBER, KIM HOULIND, VIBEKE BOENELYKKE SOERENSEN, ULRIK DIXEN, JENS REFSGAARD, ELISABETH ZEUTHEN, PETER SOEGAARD, MARIAN HRANAI, LUDOVIT GASPAR, DANIEL PELLA, KATARINA HATALOVA, ERIKA DROZDAKOVA, IOAN COMAN, DOINA DIMULESCU, DRAGOS VINEREANU, MIRCEA CINTEZA, CRINA SINESCU, CATALINA ARSENESCU, IMRE BENEDEK, ELENA BOBESCU, DAN DOBREANU, DAN GAITA, ADRIAN IANCU, ADRIANA ILIESIU, DANIEL LIGHEZAN, LUCIAN PETRESCU, OCTAVIAN PIRVU, IULIA TEODORESCU, DAN TESLOIANU, MARIUS MARCIAN VINTILA, OVIDIU CHIONCEL, Divisions of Cardiology and Thromboembolism McMaster University Hamiton, Population Health Research Institute, McMaster University [Hamilton, Ontario], Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Research Center [Associazione Nazionale Medici Cardiologi Ospedalieri] (ANMCO Research Center), Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), Department of Statistics, University of Haifa [Haifa], Cardiology, University and Emergency Hospital, University of Edinburgh, VA Boston Healthcare System, Hamilton General Hospital, Universidad Autonoma de Madrid (UAM), Cardiology Department, Dipartimento di Bioscienze, University of Parma, University of Barcelona, Hospital Clinic Barcelona, Laval University and Hospital Heart and Lung Institute, UVSQ - UFR des sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), University Hospital Brno, Masaryk University, Department of Public Health, Hémostase, bio-ingénierie et remodelage cardiovasculaires (LBPC), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Galilée, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Pasteur [Nice] (CHU), Service de Cardiologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Paris-Centre de Recherche Cardiovasculaire (PARCC - UMR-S U970), Université Paris Descartes - Paris 5 (UPD5)-Hôpital Européen Georges Pompidou [APHP] (HEGP), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), CHU Gabriel Montpied (CHU), CHU Clermont-Ferrand, Department of Medicine (DEBRECEN - Dpt Medicine), University of Debrecen, University of Trieste, Lab Dev Cell Biol,Bunkyo Ku, The University of Tokyo, The Netherlands Organisation for Applied Scientific Research (TNO), Regional Specialist Hospital in Wroclaw, Research and Development Centre, Kamienskiego, Division of Angiology, Wroclaw Medical University, Sahlgrenska University Hospital/Östra, Cardiocentro Ticino [Lugano], University of Zürich [Zürich] (UZH), Danylo Halytskyi Lviv National Medical University, Department of Cardiology, Sandwell General Hospital, Physiopathologie et thérapie des déficits sensoriels et moteurs, Université Montpellier 2 - Sciences et Techniques (UM2)-IFR76-Institut National de la Santé et de la Recherche Médicale (INSERM), Rigshospitalet [Copenhagen], Université de Médecine Carol Davila, Cardiology Department [Târgu Mureș], University of Medicine and Pharmacy of Târgu Mureș, Institute for Cardiovascular Diseases C.C. Iliescu, Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), Associazione Nazionale Medici Cardiologi Ospedalieri [Firenze] (ANMCO), University of Parma = Università degli studi di Parma [Parme, Italie], Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Gabriel Montpied [Clermont-Ferrand], The University of Tokyo (UTokyo), Universität Zürich [Zürich] = University of Zurich (UZH), and Copenhagen University Hospital
Subjects: Carotid Artery Diseases, Male, Myocardial Infarction, MESH: Lower Extremity, 030204 cardiovascular system & hematology, THERAPY, Stroke/epidemiology, MESH: Dose-Response Relationship, Drug, 0302 clinical medicine, Rivaroxaban, prevention, Hemorrhage/chemically induced, MESH: Peripheral Arterial Disease, MESH: Double-Blind Method, guidelines, MESH: Incidence, 030212 general & internal medicine, Cardiovascular Diseases/mortality, risk, RISK, MESH: Aged, MESH: Middle Aged, Incidence, General Medicine, Middle Aged, 3. Good health, Stroke, MESH: Myocardial Infarction, Lower Extremity, Cardiovascular Diseases, MESH: Platelet Aggregation Inhibitors, Factor Xa Inhibitors/administration & dosage, Drug Therapy, Combination, Female, MESH: Factor Xa Inhibitors, OUTPATIENTS, MESH: Rivaroxaban, management, MESH: Hemorrhage, metaanalysis, Lower Extremity/blood supply, Rivaroxaban/administration & dosage, Hemorrhage, MESH: Drug Administration Schedule, Amputation, Surgical, Drug Administration Schedule, MESH: Stroke, Peripheral Arterial Disease, 03 medical and health sciences, Double-Blind Method, atherothrombosis, Myocardial Infarction/epidemiology, MANAGEMENT, Humans, MESH: Amputation, MESH: Aspirin, Aspirin/administration & dosage, Platelet Aggregation Inhibitors/administration & dosage, METAANALYSIS, Aged, MESH: Humans, Aspirin, Dose-Response Relationship, Drug, MESH: Carotid Artery Diseases, MORTALITY, MESH: Cardiovascular Diseases, cardiovascular event rates, PREVENTION, CARDIOVASCULAR EVENT RATES, MESH: Male, outpatients, atrial-fibrillation, MESH: Drug Therapy, Combination, MESH: Morbidity, Carotid Artery Diseases/complications, lower-extremity amputation, Peripheral Arterial Disease/complications, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Morbidity, MESH: Female, Platelet Aggregation Inhibitors, Amputation/statistics & numerical data, Factor Xa Inhibitors
Abstract: BACKGROUND: Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.METHODS: This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.FINDINGS: Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).INTERPRETATION: Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding.FUNDING: Bayer AG.
Published: 2018

6. The relation between local repolarization and T-wave morphology in heart failure patients

Author: Angelo Auricchio, Maria Luce Caputo, Daniel Sürder, Annekatrin Illner, Joris Wanten, Tiziano Moccetti, François Regoli, Francesco Maffessanti, Giulio Conte, Frits W. Prinzen, Rolf Krause, Mark Potse, Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Maastricht University [Maastricht], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Otto-von-Guericke University [Magdeburg] (OVGU), Swiss National Science Foundation project 32003B_165802, Theo Rossi di Montelera Foundation, Metis Foundation Sergio Mantegazza, Fidinam Foundation, Horten Foundation, Biologic Delivery Systems, Biosense Webster, a Johnson & Johnson Company, Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2, Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Otto-von-Guericke-Universität Magdeburg = Otto-von-Guericke University [Magdeburg] (OVGU), RS: CARIM - R2.08 - Electro mechanics, Fysiologie, University of Zurich, and Prinzen, Frits W
Subjects: 0301 basic medicine, Male, medicine.medical_treatment, Repolarization, 030204 cardiovascular system & hematology, ACTIVATION, Electrocardiography, 0302 clinical medicine, Prospective Studies, Aged, 80 and over, Left bundle branch block, ACTION-POTENTIAL DURATION, Depolarization, Middle Aged, MESH: Cardiac Electrophysiology, medicine.anatomical_structure, Cardiology, Female, CARDIAC RESYNCHRONIZATION THERAPY, VENTRICULAR REPOLARIZATION, Cardiology and Cardiovascular Medicine, CANINE, BUNDLE-BRANCH BLOCK, medicine.medical_specialty, Cardiac resynchronization therapy, GRADIENTS, 610 Medicine & health, Heart failure, Electro-anatomic mapping, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Heart Conduction System, Internal medicine, medicine, Humans, MODULATION, Coronary sinus, Aged, ARRHYTHMIAS, Bundle branch block, business.industry, MEMORY, Stroke Volume, MESH: C14.280.434, medicine.disease, 030104 developmental biology, Ventricle, T-wave, business
Abstract: Background: Both duration and morphology of the T-wave are regarded important parameters describing repolarization of the ventricles. Conventionally, T-wave concordance is explained by an inverse relation between the time of depolarization (TD) and repolarization (TR). Little is known about T-wave morphology and TD-TR relations in patients with heart failure.Methods: Electro-anatomic maps were obtained in the left (LV) and right ventricle (RV) and in the coronary sinus (CS) in patients with heart failure with narrow (nQRS, n = 8) and wide QRS complex with (LBBB, n = 15) and without left bundle branch block (non-LBBB, n = 7). TD and TR were determined from the thus acquired electrograms.Results: In nQRS and non-LBBB patients, TD-TR relations had a slope between 0 and +1, indicating that repolarization followed the sequence of depolarization. In LBBB patients, repolarization occurred significantly earlier in the RV than in the LV, fitting with the idea that the discordant T-waves in LBBB are secondary to the abnormal depolarization sequence. However, the slopes of the TD-TR relations in the LV and CS were not significantly different from zero, indicating no major spatial gradient in LV repolarization, despite a considerable gradient in depolarization. Remarkable was also the large (similar to 100ms) transseptal gradient in repolarization. Values of the slopes of the TD-TR relation overlapped between the three patient groups, despite a difference in T-wave morphology between LBBB (all discordant) and nQRS patients (all flat/biphasic).Conclusions: Discordant T-waves in LBBB patients are explained by interventricular dispersion in repolarization. T-wave morphology is determined by more factors than the TD-TR relation alone. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.
Published: 2017

7. Fast And Accurate Reconstruction Of Transmural Activation Maps From Standard 12-lead ECG Using An Eikonal Model

Author: Pezzuto, Simone, Prinzen, Frits, Potse, Mark, Regoli, François, Caputo, Maria, Conte, Giulio, Krause, Rolf, Auricchio, Angelo, Faculty of Informatics [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Center for Computational Medicine in Cardiology (CCMC), Department of Physiology [Maastricht], Maastricht University [Maastricht], IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Center for Computational Medicine in Cardiology [Lugano], Heart Rhythm Society, Potse, Mark, Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, and Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Abstract: International audience
Published: 2019

8. Effect of Na+-channel blockade on the three-dimensional substrate of atrial fibrillation in a model of endo-epicardial dissociation and transmural conduction

Author: Rolf Krause, Mark Potse, Sander Verheule, Ali Gharaviri, Nico H.L. Kuijpers, Ulrich Schotten, Angelo Auricchio, Jens Eckstein, Department of Physiology [Maastricht], Maastricht University [Maastricht], Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), University Hospital Basel [Basel], Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Fontys Hogeschool Toegepaste Natuurwetenschappen = Fontys University of Applied Sciences (FONTYS), This work was supported by grants from the European Union, the ITN Network AFibTrainNet, No. 675351, and the ERACoSysMED H2020 ERA-NET Cofound project Systems medicine for diagnosis and stratification of atrial fibrillation to US. This work was also supported by grants from the Swiss National Supercomputing Centre (CSCS) under project ID s668 and s778., European Project: 675351,H2020,H2020-MSCA-ITN-2015,AFib-TrainNet(2015), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, University of Zurich, Schotten, Ulrich, Fysiologie, RS: CARIM - R2 - Cardiac function and failure, Promovendi CD, RS: CARIM - R2.11 - Experimental atrial fibrillation, and Biomedische Technologie
Subjects: 0301 basic medicine, Time Factors, medicine.medical_treatment, Action Potentials, Sodium-channel block, 030204 cardiovascular system & hematology, Cardioversion, 2737 Physiology (medical), 0302 clinical medicine, Sodium channel blocker, Computer model, Heart Rate, TERMINATION, Sinus rhythm, Treatment Failure, Models, Cardiovascular, Atrial fibrillation, CARDIOVERSION, INSIGHTS, Transmural conduction, Cardiology, FLECAINIDE, SINUS RHYTHM, Cardiology and Cardiovascular Medicine, Three-dimensional, Anti-Arrhythmia Agents, Sodium Channel Blockers, medicine.drug, 030103 biophysics, medicine.medical_specialty, Sodium, chemistry.chemical_element, 610 Medicine & health, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, MECHANISMS, PERSISTENT, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Physiology (medical), Internal medicine, medicine, Humans, Computer Simulation, Heart Atria, Flecainide, Atrium (architecture), business.industry, Sodium channel, Atrial Remodeling, medicine.disease, CONVERSION, Electrical dissociation, chemistry, business
Abstract: Aims Atrial fibrillation (AF) is a progressive arrhythmia characterized by structural alterations that increase its stability. Both clinical and experimental studies showed a concomitant loss of antiarrhythmic drug efficacy in later stages of AF. The mechanisms underlying this loss of efficacy are not well understood. We hypothesized that structural remodelling may explain this reduced efficacy by making the substrate more three-dimensional. To investigate this, we simulated the effect of sodium (Nathorn)-channel block on AF in a model of progressive transmural uncoupling. Methods and results In a computer model consisting of two cross-connected atrial layers, with realistic atrial membrane behaviour, structural remodelling was simulated by reducing the number of connections between the layers. 100% of endoepicardial connectivity represented a healthy atrium. At various degrees of structural remodelling, we assessed the effect of 60% sodium channel block on AF stability, endo-epicardial electrical activity dissociation (EED), and fibrillatory conduction pattern complexity quantified by number of waves, phase singularities (PSs), and transmural conduction ('breakthrough', BT). Sodium channel block terminated AF in non-remodelled but not in remodelled atria. The temporal excitable gap (EG) and AF cycle length increased at all degrees of remodelling when compared with control. Despite an increase of EED and EG, sodium channel block decreased the incidence of BT because of transmural conduction block. Sodium channel block decreased the number of waves and PSs in normal atrium but not in structurally remodelled atrium. Conclusion This simple atrial model explains the loss of efficacy of sodium channel blockers in terminating AF in the presence of severe structural remodelling as has been observed experimentally and clinically. Atrial fibrillation termination in atria with moderate structural remodelling in the presence of sodium channel block is caused by reduction of AF complexity. With more severe structural remodelling, sodium channel block fails to promote synchronization of the two layers of the model.
Published: 2018

9. Major cardiac and vascular complications after transvenous lead extraction: acute outcome and predictive factors from the ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) registry

Author: Giulio Zucchelli, François Regoli, Maria Grazia Bongiorni, Luca Segreti, Christian Butter, Jean Luc Pasquié, Aldo P. Maggioni, Andrea Di Cori, Pascal Defaye, Andrzej Kutarski, Angelo Auricchio, Carina Blomström-Lundqvist, Cécile Laroche, Université de Pise, Uppsala Universitet [Uppsala], Medical University of Lublin, Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Medizinische Hochschule Brandenburg Theodor Fontane / Brandenburg Medical School Theodor-Fontane (MHB Theodor Fontane), Hôpital Michallon, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), MORNET, Dominique, University of Pisa - Università di Pisa, University of Zurich, and Zucchelli, Giulio
Subjects: Male, Pacemaker, Artificial, medicine.medical_treatment, 030204 cardiovascular system & hematology, 0302 clinical medicine, 2737 Physiology (medical), Postoperative Complications, Risk Factors, Cardiac tamponade, Occlusion, 030212 general & internal medicine, Registries, Incidence, Pericardiocentesis, Middle Aged, Prognosis, Thrombosis, 3. Good health, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Defibrillators, Implantable, Europe, Outcome and Process Assessment, Health Care, Cardiology, Equipment Failure, Female, Tamponade, Cardiology and Cardiovascular Medicine, Major complications, medicine.medical_specialty, Registry, 610 Medicine & health, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Physiology (medical), Internal medicine, medicine, Humans, Device Removal, Lead extraction, business.industry, Avulsion fracture, Vascular System Injuries, medicine.disease, Cardiac Tamponade, Chest tube, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Complication, business
Abstract: International audience; Aims: We aimed at describing outcomes and predictors of cardiac avulsion or tear (CA/T) with tamponade and vascular avulsion or tear (VA/T) after transvenous lead extraction (TLE) in the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) registry.Methods and results: A total of 3555 consecutive patients of whom 3510 underwent TLE at 73 centres in 19 European countries were enrolled. Among 58 patients (1.7%) with procedure-related major complications, 49 (84.5%) patients (30 CA/T and 19 VA/T) presented cardiovascular complications requiring pericardiocentesis, chest tube positioning and/or surgical repair. The mortality was 20% in patients with tamponade due to CA/T and 31.6% in patients with VA/T. Pericardiocentesis as first manoeuvre followed by rescue surgical repair was highly effective in case of CA/T (93.8%). At multivariate analysis, CA/T with tamponade was more common in RIATA lead extraction, female patients, leads with a mean dwelling time more than 10 years, and when ≥3 leads were extracted or multiple sheaths required. Occlusion or critical stenosis of superior venous access and the leads mean dwelling time more than 10 years were independent predictors for VA/T, while mechanical dilatation was an independent predictor of a lower incidence of this complication as compared to the use of powered sheaths.Conclusions: In the ELECTRa registry, RIATA lead extraction and superior venous access occlusion/thrombosis are two new independent predictors for cardiac tamponade and major vascular complications, respectively. The use of mechanical sheaths seems to be associated with a lower incidence of VA/T. A strategy of pericardiocentesis followed by a rescue surgical approach seems to be reasonable in order to treat a CA/T with tamponade.
Published: 2018

10. Beat-to-beat P-wave morphological variability in patients with paroxysmal atrial fibrillation: an in silico study

Author: Ali Gharaviri, Ulrich Schotten, Angelo Auricchio, Mark Potse, Rolf Krause, Maria Luce Caputo, François Regoli, Giulio Conte, Simone Pezzuto, Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Institute of Computational Science (ICS), Department of Physiology [Maastricht], Maastricht University [Maastricht], Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), This work was also supported by the Swiss National Supercomputing Centre (CSCS) under project ID s778., University of Zurich, Pezzuto, Simone, Promovendi CD, Fysiologie, RS: CARIM - R2.11 - Experimental atrial fibrillation, Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), and Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest
Subjects: Time Factors, medicine.medical_treatment, Action Potentials, 030204 cardiovascular system & hematology, Cosine distance, Correlation, INITIATION, Electrocardiography, 0302 clinical medicine, 2737 Physiology (medical), Heart Rate, Atrial Fibrillation, Medicine, ComputingMilieux_MISCELLANEOUS, CATHETER ABLATION, medicine.diagnostic_test, Paroxysmal atrial fibrillation, Models, Cardiovascular, Magnetic Resonance Imaging, Inhomogeneous conduction, medicine.anatomical_structure, Cardiology and Cardiovascular Medicine, Biological system, Electrophysiologic Techniques, Cardiac, MRI, P-wave variability, In silico, MODELS, P-wave morphology, Beat (acoustics), Catheter ablation, 610 Medicine & health, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, MECHANISMS, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Physiology (medical), Heart rate, Humans, Computer Simulation, Heart Atria, Atrium (architecture), business.industry, Sinoatrial node, Fibrosis, TISSUE, LINK, business, 030217 neurology & neurosurgery
Abstract: Aims P-wave beat-to-beat morphological variability can identify patients prone to paroxysmal atrial fibrillation (AF). To date, no computational study has been carried out to mechanistically explain such finding. The aim of this study was to provide a pathophysiological explanation, by using a computer model of the human atria, of the correlation between P-wave beat-to-beat variability and the risk of AF.Methods and results A physiological variability in the earliest activation site (EAS), on a beat-to-beat basis, was introduced into a computer model of the human atria by randomizing the EAS location. A methodology for generating multi-scale, spatially-correlated regions of heterogeneous conduction was developed. P-wave variability in the presence of such regions was compared with a control case. Simulations were performed with an eikonal model, for the activation map, and with the lead field approach, for P-wave computation. The methodology was eventually compared with a reference monodomain simulation. A total of 60 P-waves were simulated for each sinus node exit location (12 in total), and for each of the 15 patterns of heterogeneous conduction automatically generated by the model. A P-wave beat-to-beat variability was observed in all cases. Variability was significantly increased in presence of heterogeneous slow conducting regions, up to two-fold the variability in the control case. P-wave variability increased non-linearly with respect to the EAS variability and total area of slow conduction. Distribution of the heterogeneous conduction was more effective in increasing the variability when it surrounded the EAS locations and the fast conducting bundles. P-waves simulated by the eikonal approach compared excellently with the monodomain-based ones.Conclusion P-wave variability in patients with paroxysmal AF could be explained by a variability in sinoatrial node exit location in combination with slow conducting regions.
Published: 2018

11. Effect of sodium channel blockade on the 3-dimensional substrate of atrial fibrillation: a simulation study

Author: GHARAVIRI, Ali, POTSE, Mark, KRAUSE, Rolf, AURICCHIO, Angelo, SCHOTTEN, Ulrich, Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Institute of Computational Science (ICS), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Maastricht University [Maastricht], Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), and Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest
Subjects: [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [INFO.INFO-MO]Computer Science [cs]/Modeling and Simulation, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2018

12. A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: an in vivo and in silico study

Author: Francesco Maffessanti, François Regoli, Maria Luce Caputo, Giulio Conte, Jordi Heijman, Uyên Châu Nguyên, Angelo Auricchio, Frits W. Prinzen, Mark Potse, Kevin Vernooy, Masih Mafi-Rad, Rolf Krause, T. Moccetti, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: CARIM - R2.08 - Electro mechanics, MUMC+: MA Med Staf Artsass Cardiologie (9), RS: CARIM - R2 - Cardiac function and failure, RS: CARIM - R2.01 - Clinical atrial fibrillation, RS: CARIM - R2.04 - Arrhythmogenisis and cardiogenetics, Fysiologie, Department of Physiology [Maastricht], Maastricht University [Maastricht], Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Radboud University Medical Center [Nijmegen], Cardiovascular Research Institute Maastricht (CARIM), Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Institute of Computational Science (ICS), Università della Svizzera italiana = University of Italian Switzerland (USI), Center for Computational Medicine in Cardiology [Lugano], This work was granted access to HPC resources of CEA-TGCC under GENCI allocation x2016037379 and was supported by grants from the Swiss National Science Foundation under project 32003B_165802, from the Swiss Heart Foundation, and by a restricted grant of Biologic Delivery Systems, Division of Biosense Webster a Johnson & Johnson Company. U.C.N. received a Kootstra Talent Fellowship research grant from Maastricht University Medical Center þ and was additionally funded by a research grant from the Dutch Heart Foundation [grant #2015T61]., ANR-10-IAHU-0004,LIRYC,L'Institut de Rythmologie et modélisation Cardiaque(2010), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, University of Zurich, and Nguyên, Uyên Châu
Subjects: Male, Time Factors, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Action Potentials, 02 engineering and technology, PROPAGATION, 030204 cardiovascular system & hematology, Ventricular Function, Left, Voltage amplitude, Electrocardiography, 2737 Physiology (medical), 0302 clinical medicine, Heart Rate, Interquartile range, Aged, 80 and over, medicine.diagnostic_test, Left bundle branch block, Cardiac Pacing, Artificial, Models, Cardiovascular, Middle Aged, Magnetic Resonance Imaging, Treatment Outcome, Cardiology, HEART-FAILURE, Female, CARDIAC RESYNCHRONIZATION THERAPY, Electrophysiologic Techniques, Cardiac, Cardiology and Cardiovascular Medicine, Adult, Intra-cardiac electrogram, Bundle of His, medicine.medical_specialty, Bundle-Branch Block, 0206 medical engineering, Cardiac resynchronization therapy, 610 Medicine & health, Heart failure, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Physiology (medical), Internal medicine, Heart rate, medicine, Humans, Computer Simulation, Endocardium, Aged, business.industry, Magnetic resonance imaging, Computer models, medicine.disease, 020601 biomedical engineering, MODEL, CONDUCTION, Ventricular Function, Right, Anisotropy, Activation sequence, business
Abstract: Item does not contain fulltext Aims: The aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differences. Methods and results: Twenty-one patients and three computer models without scar were studied. Regional voltage amplitudes were evaluated in nine LBBB patients who underwent endocardial electro-anatomic mapping (EAM). Pacing-induced voltage differences were evaluated in 12 patients who underwent epicardial EAM during intrinsic rhythm and right ventricular (RV) pacing. Three computer models customized for LBBB patients were created. Changes in voltage amplitudes after an LBBB (intrinsic), a normal synchronous, an RV pacing, and a left ventricular pacing activation sequence were assessed in the computer models. Unipolar voltage amplitudes in patients were approximately 4.5 mV (4.4-4.7 mV, approximately 33%) lower in the septum when compared with other segments. A normal synchronous activation sequence in the computer models normalized voltage amplitudes in the septum. Pacing-induced differences were larger in electrograms with higher voltage amplitudes during intrinsic rhythm and furthermore larger and more variable at the epicardium [mean absolute difference: 3.6-6.2 mV, 40-53% of intrinsic value; interquartile range (IQR) differences: 53-63% of intrinsic value] compared to the endocardium (mean absolute difference: 3.3-3.8 mV, 28-30% of intrinsic value; IQR differences: 37-40% of intrinsic value). Conclusion: In patients and computer models without scar, lower septal unipolar voltage amplitudes are exclusively associated with an LBBB activation sequence. Pacing substantially affects voltage amplitudes, particularly at the epicardium.
Published: 2018

13. Fast simulation of standard 12-lead ECG and 3D ventricular activation

Author: Pezzuto, Simone, Kaľavský, Peter, Potse, Mark, Prinzen, Frits W., Auricchio, Angelo, Krause, Rolf, Faculty of Informatics [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Center for Computational Medicine in Cardiology [Lugano], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Maastricht University [Maastricht], Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2, Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, and Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)
Subjects: [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2017

14. Evaluation of a Rapid Anisotropic Model for ECG Simulation

Author: Simone Pezzuto, Peter Kal'avský, Mark Potse, Frits W. Prinzen, Angelo Auricchio, Rolf Krause, Faculty of Informatics [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Center for Computational Medicine in Cardiology [Lugano], Institute of Measurement Science (IMS), Slovak Academy of Sciences (SAS), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Maastricht University [Maastricht], Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Swiss National Supercomputing Centre (CSCS) project IDs s397, s598, s669, Sciex-NMS fellowship 'CATION', project code 14.158, Theo Rossi de Montelera Foundation, Metis Foundation Sergio Mantegazza, Fidinam Foundation, Horten Foundation, PASC Initiative, Switzerland, Biologic Delivery Systems, a Division of Biosense Webster, a Johnson & Johnson Company, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), RS: CARIM - R2.08 - Electro mechanics, Fysiologie, CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2, Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], University of Zurich, and Pezzuto, Simone
Subjects: CARDIAC ELECTROPHYSIOLOGY, Computer science, Physiology, Interface (computing), 0206 medical engineering, 610 Medicine & health, 02 engineering and technology, 030204 cardiovascular system & hematology, 11171 Cardiocentro Ticino, lcsh:Physiology, Computational science, lead fields, ACTIVATION, 03 medical and health sciences, 2737 Physiology (medical), 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, eikonal model, Physiology (medical), Convergence (routing), EXCITATION, Methods, Graphics, MESH: Mathematical Computing, Simulation, Sequence, bidomain modeling, lcsh:QP1-981, Cardiac electrophysiology, Eikonal equation, ECG, Bidomain model, 1314 Physiology, electrophysiology, 020601 biomedical engineering, BIDOMAIN EQUATIONS, MESH: Cardiac Electrophysiology, TISSUE, Scalability, patient-specific modeling, HEART-FAILURE, OPTIMAL MONODOMAIN APPROXIMATIONS
Abstract: International audience; State-of-the-art cardiac electrophysiology models that are able to deliver physiologically motivated activation maps and electrocardiograms (ECGs) can only be solved on high-performance computing architectures. This makes it nearly impossible to adopt such models in clinical practice. ECG imaging tools typically rely on simplified models, but these neglect the anisotropic electric conductivity of the tissue in the forward problem. Moreover, their results are often confined to the heart-torso interface. We propose a forward model that fully accounts for the anisotropic tissue conductivity and produces the standard 12-lead ECG in a few seconds. The activation sequence is approximated with an eikonal model in the 3d myocardium, while the ECG is computed with the lead-field approach. Both solvers were implemented on graphics processing units and massively parallelized. We studied the numerical convergence and scalability of the approach. We also compared the method to the bidomain model in terms of ECGs and activation maps, using a simplified but physiologically motivated geometry and 6 patient-specific anatomies. The proposed methods provided a good approximation of activation maps and ECGs computed with a bidomain model, in only a few seconds. Both solvers scaled very well to high-end hardware. These methods are suitable for use in ECG imaging methods, and may soon become fast enough for use in interactive simulation tools.
Published: 2017

15. Rapid estimation of 3D ventricular activation from electroanatomic mapping

Author: Pezzuto, Simone, Kalavsky, Peter, Potse, Mark, Regoli, François, Caputo, Maria Luce, Conte, Giulio, Moccetti, Tiziano, Prinzen, Frits W., Auricchio, Angelo, Krause, Rolf, Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Maastricht University [Maastricht], Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, and Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux]
Subjects: [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Abstract: International audience; Purpose Heart failure patients are often affected by a ventricular conduction disorder. Accurate characterization of the tridimensional (3D) activation sequence of the ventricles is fundamental for an effective personalized therapy. Electroanatomical mapping provides the activation times at the endocardium, with limited coverage due to anatomical constraints. Our aim is to develop a robust tool to generate a complete 3D, biventricular activation map from a limited number of endocardial measurements.Method In 6 candidates to cardiac resynchronization therapy a high density endocardial activation map of the right and left ventricle was obtained. High resolution propagating activation was simulated in patient-tailored anatomical heart models using the anisotropic eikonal equation and realistic fiber orientation. Subsequently, the mean square error between the measured and simulated activation times was minimized by varying early activation site(s) and local anisotropic conduction velocities.Results. A close correlation was achieved between the simulated and measured activation time for a single patient (Panel A) while detailed 3D activation maps were achieved (panel B and C). In all cases, the optimal parameters were identified within few minutes and the full activation sequence was computed in less than 2 seconds. A 0.9 to 0.95 Pearson correlation between measured and simulated activation times was obtained in all cases. The mathematical formulation is flexible in terms of the number of activation sites and a possible delay between them, in order to mimic the presence of a partially working Purkinje network.Conclusion Our methodology is able to generate in a clinically affordable computational time (few minutes) reliable, patient-specific, fully volumetric activation map of both ventricles using a local workstation or a laptop.
Published: 2016

16. Slow septal conduction is key in LBBB patient-specific models

Author: Sánchez, Carlos, Potse, Mark, D'Ambrosio, Gabriele, Illner, Annekatrin, Regoli, François, Caputo, Maria Luce, Conte, Giulio, Moccetti, Tiziano, Caiani, Enrico G., Prinzen, Frits W., Krause, Rolf, Auricchio, Angelo, Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano [Milan] (POLIMI), Department of Physiology, Maastricht University, Department of Physiology, and Maastricht University [Maastricht]-Maastricht University [Maastricht]
Subjects: [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, cardiovascular diseases
Abstract: International audience; PURPOSE: Left-bundle-branch block (LBBB) is a heterogeneous ventricular electrical disorder. Patient-specific models were created to characterize myocardial electrical properties in heart failure patients with LBBB.METHODS: The database consisted of 10 patients diagnosed with LBBB with no scars as detected by cardiac magnetic resonance imaging (CMR). The ECG criteria proposed by Strauss et al. were used for LBBB diagnosis. Realistic individual anatomical models were created from CMR images. Properties such as early activation sites, tissue conductivity, and ionic current dynamics in ventricular cells were tuned to match both clinically recorded ECG and intracardiac ventricular activation sequence. Electrical activity in the ventricles was simulated using a reaction-diffusion equation. The Ten Tusscher-Panfilov 2006 model was used to simulate cell electrophysiology. Intracardiac electrograms and 12-lead ECGs were computed by solving the bidomain equation.SUMMARY: Left ventricular endocardial activation was completed in about 80-90 ms. In order to match the recorded electrical activation sequence and the QRS morphology, the conduction velocity needed to be increased slightly in some of the models. Most of the 10 patient-specific models presented similarities in their tuning: reduction of cell surface-to-volume ratio to mimic hypertrophy and increase conduction velocity, and reduction of potassium currents and heterogeneous distribution of their densities to match the T wave. Specific regional properties in the septum of very slow conduction, particularly in the cross-fiber direction (see example in the Figure), were essential to simulate the prolonged trans-septal delay from the right to the left ventricle in some LBBB patients.CONCLUSION: Despite notable prolongation of trans-septal time in LBBB patients, conduction velocity in the working myocardium is not impaired in all patients. Patient-specific simulation may help in characterizing myocardial properties, and possibly in patient selection for the most appropriate electrical or biological therapy.
Published: 2016

17. Reduction in Kv Current Enhances the Temporal Dispersion of the Action Potential in Diabetic Myocytes: Insights From a Novel Repolarization Algorithm

Author: Marcello Rota, Ramaswamy Kannappan, Sergio Signore, Annarosa Leri, Andrea Sorrentino, Antonio Cannatà, Piero Anversa, Marianna Meo, Alex Matsuda, Olivier Meste, Marco Luciani, Polina Goichberg, Yu Zhou, Harvard Medical School [Boston] (HMS), Laboratoire d'Informatique, Signaux, et Systèmes de Sophia-Antipolis (I3S) / Equipe SIGNAL, Signal, Images et Systèmes (Laboratoire I3S - SIS), Laboratoire d'Informatique, Signaux, et Systèmes de Sophia Antipolis (I3S), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA)-Laboratoire d'Informatique, Signaux, et Systèmes de Sophia Antipolis (I3S), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), New York Medical College, Department of Physiology, and Université Paris Diderot - Paris 7 (UPD7)
Subjects: 0301 basic medicine, Blood Glucose, Male, Patch-Clamp Techniques, Potassium Channels, Diabetic Cardiomyopathies, Action Potentials, 030204 cardiovascular system & hematology, Arrhythmias, Electrocardiography, 0302 clinical medicine, Heart Rate, Diabetic cardiomyopathy, Myocyte, Myocytes, Cardiac, Arrhythmia and Electrophysiology, Original Research, diabetes, Signal Processing, Computer-Assisted, Potassium channel, Cardiology, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Female, Cardiology and Cardiovascular Medicine, Algorithm, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, Algorithms, medicine.drug, medicine.medical_specialty, QT interval, Diabetes Mellitus, Experimental, 03 medical and health sciences, Internal medicine, medicine, Repolarization, Animals, Patch clamp, repolarization, business.industry, variability, Arrhythmias, Cardiac, medicine.disease, Streptozotocin, electrophysiology, Mice, Inbred C57BL, Electrophysiology, Kinetics, 030104 developmental biology, Endocrinology, Animal Models of Human Disease, Potassium, business, Basic Science Research
Abstract: Background Diabetes is associated with prolongation of the QT interval of the electrocardiogram and enhanced dispersion of ventricular repolarization, factors that, together with atherosclerosis and myocardial ischemia, may promote the occurrence of electrical disorders. Thus, we tested the possibility that alterations in transmembrane ionic currents reduce the repolarization reserve of myocytes, leading to action potential ( AP ) prolongation and enhanced beat‐to‐beat variability of repolarization. Methods and Results Diabetes was induced in mice with streptozotocin ( STZ ), and effects of hyperglycemia on electrical properties of whole heart and myocytes were studied with respect to an untreated control group (Ctrl) using electrocardiographic recordings in vivo, ex vivo perfused hearts, and single‐cell patch‐clamp analysis. Additionally, a newly developed algorithm was introduced to obtain detailed information of the impact of high glucose on AP profile. Compared to Ctrl, hyperglycemia in STZ ‐treated animals was coupled with prolongation of the QT interval, enhanced temporal dispersion of electrical recovery, and susceptibility to ventricular arrhythmias, defects observed, in part, in the Akita mutant mouse model of type I diabetes. AP was prolonged and beat‐to‐beat variability of repolarization was enhanced in diabetic myocytes, with respect to Ctrl cells. Density of Kv K + and L‐type Ca 2+ currents were decreased in STZ myocytes, in comparison to cells from normoglycemic mice. Pharmacological reduction of Kv currents in Ctrl cells lengthened AP duration and increased temporal dispersion of repolarization, reiterating features identified in diabetic myocytes. Conclusions Reductions in the repolarizing K + currents may contribute to electrical disturbances of the diabetic heart.
Published: 2016

18. Meta-Analysis of Cell-based CaRdiac stUdiEs (ACCRUE) in patients with acute myocardial infarction based on individual patient data

Author: Gyongyosi, M., Wojakowski, W., Lemarchand, P., Lunde, K., Tendera, M., Bartunek, J., Marban, E., Assmus, B., Henry, T.D., Traverse, J.H., Moye, L.A., Surder, D., Corti, R., Huikuri, H., Miettinen, J., Wohrle, J., Obradovic, S., Roncalli, J., Malliaras, K., Pokushalov, E., Romanov, A., Kastrup, J., Bergmann, M.W., Atsma, D.E., Diederichsen, A., Edes, I., Benedek, I., Benedek, T., Pejkov, H., Nyolczas, N., Pavo, N., Bergler-Klein, J., Pavo, I.J., Sylven, C., Berti, S., Navarese, E.P., Maurer, G., ACCRUE Investigators, Department of Cardiology [Vienna], Medizinische Universität Wien = Medical University of Vienna, Third Division of Cardiology, Medical University of Silesia, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Department of Cardiology, Rikshospitalet-Oslo University Hospital [Oslo], department organization Studies, Boston College (BC), Cedars-Sinai Medical Center, Department of Medicine III, Goethe-Universität Frankfurt am Main, Dpt of Neurology [Minneapolis], University of Minnesota [Twin Cities] (UMN), University of Minnesota System-University of Minnesota System, Minneapolis Heart Institute, University of Minnesota System-University of Minnesota System-Abbott Northwestern Hospital, Coordinating Center for Clinical Trials, The University of Texas Health Science Center at Houston (UTHealth), Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Milieux aquatiques, écologie et pollutions (UR MALY), Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA), Medical Research Center Oulu, University of Oulu, Cardiology Department [Ulm], Universität Ulm - Ulm University [Ulm, Allemagne], Clinic of Emergency Medicine, Military Medical Academy [Serbia], Service de cardiologie [Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], State Research Institute of Circulation Pathology, Department of Drug Design and Pharmacology [Copenhagen] (ILF), Faculty of Health and Medical Sciences, University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU), Asklepios Klinik St. Georg, Cardiology Department [Leiden], Leiden University Medical Center (LUMC), Cardiology Department [Odense], Odense University Hospital (OUH), Cardiology Department [Debrecen], University of Debrecen, Cardiology Department [Târgu Mureș], University of Medicine and Pharmacy of Târgu Mureș, University Clinic for Cardiology, Medical Centre [Budapest], Hungarian Defense Forces -Ministry of Defence [Budapest], Karolinska Institutet [Stockholm], Invasive Cardiology [Pisa], National Research Council Institute of Clinical Physiology (CNR-IFC), Internal Medicine [Düsseldorf], Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]-Division of Cardiology, Pulmonology and Vascular Medicine, TIME and LateTIME were supported by a grant from the National Heart, Lung, and Blood Institute under the cooperative agreement 5 UM1 HL087318-01. Part of the study was supported by European Union structural funds (Innovative Economy Operational Program POIG.01.01.02-00-109/09-00) to Dr Wojakowski., Medical University of Silesia (SUM), Unité de recherche de l'institut du thorax (ITX-lab), Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), University of Copenhagen = Københavns Universitet (UCPH)-University of Copenhagen = Københavns Universitet (UCPH), Lemarchand, Patricia, University of Zurich, Gyongyosi, M, Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), University of Minnesota [Twin Cities], University of Zürich [Zürich] (UZH), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Odense University Hospital, and Heinrich-Heine-Universität Düsseldorf [Düsseldorf]-Division of Cardiology, Pulmonology and Vascular Medicine
Subjects: Male, Time Factors, MESH: Chi-Square Distribution, Databases, Factual, Physiology, analysis, MESH: Myocardial Contraction, Myocardial Infarction, heart failure, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, MESH: Stroke Volume, Ventricular Function, Left, MESH: Ventricular Function, Left, MESH: Proportional Hazards Models, 0302 clinical medicine, Recurrence, Risk Factors, MESH: Risk Factors, Myocardial infarction, Prospective Studies, MESH: Bone Marrow Transplantation, Stroke, Bone Marrow Transplantation, Randomized Controlled Trials as Topic, MESH: Treatment Outcome, MESH: Aged, 0303 health sciences, Ejection fraction, MESH: Middle Aged, Ventricular Remodeling, Hazard ratio, MESH: Regeneration, Stroke volume, Middle Aged, MESH: Recovery of Function, 3. Good health, MESH: Myocardial Infarction, Treatment Outcome, Cardiology, Female, MESH: Cerebrovascular Disorders, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, MESH: Myocardium, 610 Medicine & health, MESH: Ventricular Remodeling, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, meta, Disease-Free Survival, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, stem cells, Internal medicine, medicine, Humans, Regeneration, cardiovascular diseases, Ventricular remodeling, [SDV.BC] Life Sciences [q-bio]/Cellular Biology, outcome assessment, End-systolic volume, MESH: Kaplan-Meier Estimate, 030304 developmental biology, Aged, Proportional Hazards Models, Chi-Square Distribution, MESH: Humans, business.industry, Myocardium, MESH: Time Factors, Stroke Volume, Recovery of Function, 1314 Physiology, medicine.disease, Myocardial Contraction, MESH: Databases, Factual, anterior wall myocardial infarction, MESH: Male, MESH: Prospective Studies, MESH: Recurrence, meta-analysis, Cerebrovascular Disorders, MESH: Randomized Controlled Trials as Topic, Heart failure, MESH: Disease-Free Survival, business, MESH: Female
Abstract: Rationale : The meta-Analysis of Cell-based CaRdiac study is the first prospectively declared collaborative multinational database, including individual data of patients with ischemic heart disease treated with cell therapy. Objective : We analyzed the safety and efficacy of intracoronary cell therapy after acute myocardial infarction (AMI), including individual patient data from 12 randomized trials (ASTAMI, Aalst, BOOST, BONAMI, CADUCEUS, FINCELL, REGENT, REPAIR-AMI, SCAMI, SWISS-AMI, TIME, LATE-TIME; n=1252). Methods and Results : The primary end point was freedom from combined major adverse cardiac and cerebrovascular events (including all-cause death, AMI recurrance, stroke, and target vessel revascularization). The secondary end point was freedom from hard clinical end points (death, AMI recurrence, or stroke), assessed with random-effects meta-analyses and Cox regressions for interactions. Secondary efficacy end points included changes in end-diastolic volume, end-systolic volume, and ejection fraction, analyzed with random-effects meta-analyses and ANCOVA. We reported weighted mean differences between cell therapy and control groups. No effect of cell therapy on major adverse cardiac and cerebrovascular events (14.0% versus 16.3%; hazard ratio, 0.86; 95% confidence interval, 0.63–1.18) or death (1.4% versus 2.1%) or death/AMI recurrence/stroke (2.9% versus 4.7%) was identified in comparison with controls. No changes in ejection fraction (mean difference: 0.96%; 95% confidence interval, −0.2 to 2.1), end-diastolic volume, or systolic volume were observed compared with controls. These results were not influenced by anterior AMI location, reduced baseline ejection fraction, or the use of MRI for assessing left ventricular parameters. Conclusions : This meta-analysis of individual patient data from randomized trials in patients with recent AMI revealed that intracoronary cell therapy provided no benefit, in terms of clinical events or changes in left ventricular function. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01098591.
Published: 2015

19. Patient-specific modelling of cardiac electrophysiology in heart-failure patients

Author: Stefano Muzzarelli, Mark Potse, Angelo Auricchio, Romina Murzilli, Frits W. Prinzen, Enrico G. Caiani, Rolf Krause, Wilco Kroon, François Regoli, Dorian Krause, University of Zurich, Potse, Mark, Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria), Center for Computational Medicine in Cardiology (CCMC), Università della Svizzera italiana = University of Italian Switzerland (USI), Institute of Computational Science, Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Department of Bioengineering [Politecnico Milano], Politecnico di Milano [Milan] (POLIMI), Department of Physiology, Maastricht University, Department of Physiology, Maastricht University [Maastricht]-Maastricht University [Maastricht], Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Fysiologie, and RS: CARIM - R2 - Cardiac function and failure
Subjects: Male, Action Potentials, 02 engineering and technology, 030204 cardiovascular system & hematology, Ventricular Function, Left, Electrocardiography, 0302 clinical medicine, 2737 Physiology (medical), Heart Rate, medicine.diagnostic_test, Cardiac electrophysiology, Left bundle branch block, Models, Cardiovascular, Articles, Left bundle-branch block, Cardiology, Female, Electrical conduction system of the heart, Electrophysiologic Techniques, Cardiac, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Bundle-Branch Block, 0206 medical engineering, 610 Medicine & health, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Heart Conduction System, Predictive Value of Tests, Physiology (medical), Internal medicine, Heart rate, medicine, Humans, Computer Simulation, cardiovascular diseases, Endocardium, Aged, Heart Failure, Bundle branch block, business.industry, Computer models, Numerical Analysis, Computer-Assisted, medicine.disease, 020601 biomedical engineering, Heart failure, business, Conduction disorders
Abstract: Aims Left-ventricular (LV) conduction disturbances are common in heart-failure patients and a left bundle-branch block (LBBB) electrocardiogram (ECG) type is often seen. The precise cause of this pattern is uncertain and is probably variable between patients, ranging from proximal interruption of the left bundle branch to diffuse distal conduction disease in the working myocardium. Using realistic numerical simulation methods and patient-tailored model anatomies, we investigated different hypotheses to explain the observed activation order on the LV endocardium, electrogram morphologies, and ECG features in two patients with heart failure and LBBB ECG. Methods and results Ventricular electrical activity was simulated using reaction-diffusion models with patient-specific anatomies. From the simulated action potentials, ECGs and cardiac electrograms were computed by solving the bidomain equation. Model parameters such as earliest activation sites, tissue conductivity, and densities of ionic currents were tuned to reproduce the measured signals. Electrocardiogram morphology and activation order could be matched simultaneously. Local electrograms matched well at some sites, but overall the measured waveforms had deeper S-waves than the simulated waveforms. Conclusion Tuning a reaction-diffusion model of the human heart to reproduce measured ECGs and electrograms is feasible and may provide insights in individual disease characteristics that cannot be obtained by other means.
Published: 2014

20. Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis

Author: Svend Aakhus, Michal Plewka, Jan G.P. Tijssen, Jay H. Traverse, Wojciech Wojakowski, R. Goekmen Turan, Sandra Erbs, Alexander Hirsch, Robert D. Simari, Timothy D. Henry, Stefan Grajek, Daniel Sürder, Jan J. Piek, Michal Tendera, Heikki V. Huikuri, Kai C. Wollert, Volker Schächinger, Ronak Delewi, Feng Cao, Ketil Lunde, Felix Zijlstra, Roberto Corti, Birgit Assmus, Jerome Roncalli, Stefan Janssens, Patricia Lemarchand, Cardiology, University of Zurich, Delewi, Ronak, Amsterdam Cardiovascular Sciences, Department of Cardiology, University of Amsterdam [Amsterdam] (UvA), Department of Medicine III, Goethe-Universität Frankfurt am Main, Third Division of Cardiology, Medical University of Silesia (SUM), Service de cardiologie [Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Rikshospitalet-Oslo University Hospital [Oslo], Department of Internal Medicine/Cardiology, Universität Leipzig [Leipzig], Department of Internal Medicine, University Hospital Rostock, University hospital of Zurich [Zurich], Minneapolis Heart Institute, University of Minnesota [Twin Cities] (UMN), University of Minnesota System-University of Minnesota System-Abbott Northwestern Hospital, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Fourth Military Medical University (FMMU)-Xijing Hospital, University of Oulu, Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Mayo Graduate School of Medicine, Mayo Clinic, Gasthuisberg University Hospital, Division of Molecular and Translational Cardiology, Hannover Medical School [Hannover] (MHH), Chair and Department of Cardiology, Medical University of Łódź (MUL), First Department of Cardiology, Poznań University School of the Medical Sciences, Thorax center, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Medical University of Silesia, Lemarchand, Patricia, Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Unité de recherche de l'institut du thorax (ITX-lab)
Subjects: Adult, medicine.medical_specialty, Cardiac Volume, medicine.medical_treatment, Myocardial Infarction, Diastole, Infarction, 610 Medicine & health, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, 030204 cardiovascular system & hematology, Ventricular Function, Left, Cell therapy, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, Ventricular Dysfunction, Left, 03 medical and health sciences, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Internal medicine, Humans, ST segment, Medicine, Myocardial infarction, [SDV.BC] Life Sciences [q-bio]/Cellular Biology, Aged, Bone Marrow Transplantation, Randomized Controlled Trials as Topic, 030304 developmental biology, 0303 health sciences, Ejection fraction, Surrogate endpoint, business.industry, Percutaneous coronary intervention, Stroke Volume, Stroke volume, Middle Aged, medicine.disease, 3. Good health, ST-segment elevation myocardial infarction, Treatment Outcome, Cardiology, ventricular function, Cardiology and Cardiovascular Medicine, business, metaanalysis
Abstract: Aims The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials. Methods and results We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to different pre-specified subgroups [age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct-related artery, LV end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number] and three different endpoints [change in LVEF, LVEDVI, and LV end-systolic volume index (ESVI)]. Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC-treated patients compared with controls: [2.55% increase, 95% confidence interval (CI) 1.83-3.26, P < 0.001]. Cell therapy significantly reduced LVEDVI and LVESVI (-3.17 mL/m(2), 95% CI: -4.86 to -1.47, P < 0.001; -2.60 mL/m(2), 95% CI -3.84 to -1.35, P < 0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age < 55, 3.38%, 95% CI: 2.36-4.39) compared with older patients (age >= 55 years, 1.77%, 95% CI: 0.80-2.74, P 0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF, < 40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI: 4.27-6.33 in patients with LVEF,40% compared with 1.45%, 95% CI: 0.60 to 2.31 in LVEF >= 40%, P < 0.001. Noclear interaction was observed between other subgroups and outcomes. Conclusion Intracoronary BMC infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. Younger patients and patients with a more severely depressed LVEF at baseline derived most benefit from this adjunctive therapy.
Published: 2014

21. Anatomically-induced Fibrillation in a 3D model of the Human Atria

Author: Ali Gharaviri, Ulrich Schotten, Sander Verheule, Angelo Auricchio, Rolf Krause, Mark Potse, Simone Pezzuto, Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Institute of Computational Science (ICS), Faculty of Informatics [Lugano], Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Department of Physiology [Maastricht], Maastricht University [Maastricht], This work was granted access to HPC resources of TGCC-CEA and IDRIS under GENCI allocation 2018- A0030307379, Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), and Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest
Subjects: 0301 basic medicine, Fibrillation, Chemistry, 3d model, Atrial fibrillation, 030204 cardiovascular system & hematology, Structural remodeling, medicine.disease, [INFO.INFO-MO]Computer Science [cs]/Modeling and Simulation, Rapid pacing, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine, Biophysics, Electrical Remodeling, In patient, medicine.symptom
Abstract: International audience; Atrial fibrillation (AF) requires both a trigger and a sub-strate that can maintain a complex reentrant activity. In patients and in experimental models this substrate is provided by both electrical and structural remodeling. Since these processes overlap in time it is impossible to assess their individual contributions to AF maintenance experimentally. Therefore we studied the effect of electrical re-modeling alone on AF initiation in a realistic numerical model of the human atria. We attempted to initiate AF by rapid pacing in 10 different locations, both with and without electrical remodeling. The protocols were repeated twice, with small variations in calcium conductivity, so that in total 30 simulations with and 30 simulations without remodeling were performed. In models with electrical remodeling, functional conduction block at structural in-homogeneities induced AF in 27 % of the simulations. In models without electrical remodeling, AF could not be induced. We conclude that in the complex anatomy of the atria electrical remodeling alone increases the probability of AF substantially. This finding supports a mechanism whereby electrical remodeling, which occurs relatively fast, accelerates the slower but irreversible structural remodeling process.

22. Validation of a Novel Computer Model of Endo-epicardial Electrical Dissociation and Transmural Conduction during Atrial Fibrillation

Author: Gharaviri, Ali, Potse, Mark, Krause, Rolf, Auricchio, Angelo, Schotten, Ulrich, Center for Computational Medicine in Cardiology [Lugano], Università della Svizzera italiana = University of Italian Switzerland (USI), Institute of Computational Science (ICS), Institut de Mathématiques de Bordeaux (IMB), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux], Modélisation et calculs pour l'électrophysiologie cardiaque (CARMEN), Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1 (UB)-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-IHU-LIRYC, Université Bordeaux Segalen - Bordeaux 2-CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Department of Physiology [Maastricht], Maastricht University [Maastricht], Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS), and Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Université Bordeaux Segalen - Bordeaux 2-Université Sciences et Technologies - Bordeaux 1-Université de Bordeaux (UB)-Institut Polytechnique de Bordeaux (Bordeaux INP)-Centre National de la Recherche Scientifique (CNRS)-Inria Bordeaux - Sud-Ouest
Subjects: [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [INFO.INFO-MO]Computer Science [cs]/Modeling and Simulation, ComputingMilieux_MISCELLANEOUS
Abstract: International audience

23. Mitral Annular Disjunction in the Context of Mitral Valve Prolapse: Identifying the At-Risk Patient.

Author: Van der Bijl P, Stassen J, Haugaa KH, Essayagh B, Basso C, Thiene G, Faletra FF, Edvardsen T, Enriquez-Sarano M, Nihoyannopoulos P, Ajmone Marsan N, Chandrashekhar YS, and Bax JJ
Subjects: Humans, Risk Factors, Risk Assessment, Multimodal Imaging, Treatment Outcome, Catheter Ablation, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac physiopathology, Arrhythmias, Cardiac therapy, Arrhythmias, Cardiac diagnostic imaging, Arrhythmias, Cardiac diagnosis, Mitral Valve Prolapse diagnostic imaging, Mitral Valve Prolapse surgery, Mitral Valve Prolapse physiopathology, Mitral Valve Prolapse complications, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve surgery, Predictive Value of Tests
Abstract: Mitral annular disjunction (MAD), a separation between the left atrium/mitral valve annulus and the left ventricular myocardium, is frequently seen in patients with arrhythmic mitral valve prolapse. Although an association exists between MAD and ventricular arrhythmias, little is known regarding the identification of individuals at high risk. Multimodality imaging including echocardiography, computed tomography, cardiac magnetic resonance, and positron emission tomography can play an important role in both the diagnosis and risk stratification of MAD. Due to a paucity of data, clinical decision making in a patient with MAD is challenging and remains largely empirical. Although MAD itself can be corrected surgically, the prevention and treatment of associated arrhythmias may require medical therapy, catheter ablation, and an implantable cardioverter-defibrillator. Prospective data are required to define the role of implantable cardioverter-defibrillators, targeted catheter ablation, and surgical correction in selected, at-risk patients., Competing Interests: Funding Support and Author Disclosures The Department of Cardiology of Leiden University Medical Center has received research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic. Dr Stassen has received grants from the European Society of Cardiology (Training Grant App000064741). Dr Haugaa has received grants from the Norwegian Research Council (ProCardio #309762, #288438, #298736). Dr Faletra has received speaker fees from Philips Healthcare. Dr Enriquez-Sarano has received consulting fees from Artivion, ChemImage, Edwards Lifesciences, and HighLife. Dr Marsan has received speaker fees from Abbott Vascular and GE Healthcare. Dr Bax has received speaker fees from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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24. Atrioventricular optimization improves cardiac resynchronization response in patients with long interventricular electrical delays: A pooled analysis of the SMART-AV and SMART-CRT trials.

Author: Gold MR, Auricchio A, Leclercq C, Wold N, Stein KM, and Ellenbogen KA
Subjects: Humans, Female, Male, Aged, Treatment Outcome, Prospective Studies, Algorithms, Echocardiography, Stroke Volume physiology, Middle Aged, Electrocardiography, Heart Conduction System physiopathology, Cardiac Resynchronization Therapy methods, Heart Failure therapy, Heart Failure physiopathology
Abstract: Background: The utility of atrioventricular (AV) optimization (AVO) algorithms remains in question. A substudy of the SMART-AV trial found that patients with prolonged interventricular delays ≥70 ms were more likely to benefit from cardiac resynchronization therapy (CRT) with AVO. The SMART-CRT trial evaluated AVO on the basis of these results, but the study was underpowered., Objective: To increase statistical power, data from SMART-AV patients meeting the inclusion criterion of interventricular delay ≥70 ms were pooled with data from SMART-CRT to reassess AVO., Methods: SMART-CRT and SMART-AV were prospective, randomized, multicenter clinical trials. Patients in both studies were randomized to be programmed with an AVO algorithm (SmartDelay) or fixed AV delay (120 ms). Paired echocardiograms obtained at baseline and 6 months were compared, with CRT response defined as ≥15% reduction in left ventricular end-systolic volume., Results: A total of 451 complete patient data sets were pooled and analyzed. The baseline demographics between studies did not differ statistically in terms of age, sex, left ventricular ejection fraction, or left ventricular end-systolic volume. The AVO group had a greater proportion of CRT responders (SmartDelay, 73.9%; fixed, 63.1%; P = .014) and greater changes in measures of reverse remodeling. SmartDelay patients with a recommended sensed AV delay outside the nominal range (100-120 ms) had 2.3 greater odds of CRT response than fixed AV delay patients., Conclusion: Greater CRT response and measures of reverse remodeling were observed in patients with SmartDelay enabled vs a fixed AV delay. This study supports the use of SmartDelay in patients with a CRT indication and interventricular delay ≥70 ms., Competing Interests: Disclosures Dr Gold: research support from Abbott, Boston Scientific, and Medtronic; consulting fees from Boston Scientific, EBR, and Medtronic; and honoraria for lectures from Boston Scientific and Medtronic. Dr Auricchio: consultant with Boston Scientific, Backbeat, Biosense Webster, Cairdac, Corvia, Daiichi-Sankyo, Medtronic, Merit, Microport CRM, and Philips; received speaker fees from Daiichi-Sankyo, Boston Scientific, Biosense Webster, Medtronic, Microport CRM, and Philips; participates in clinical trials sponsored by Boston Scientific, Medtronic, Microport CRM, and Zoll Medical; and has intellectual properties assigned to Boston Scientific, Biosense Webster, and Microport CRM. Dr Leclercq: compensation for lectures for Abbott, Biotronik, Boston Scientific, Medtronic, and Microport. Mr Wold and Dr Stein are employees of Boston Scientific. Dr Ellenbogen: research support from Medtronic and Boston Scientific; consultation fees from Abbott; and honoraria for lectures from Boston Scientific and Medtronic., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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25. Sudden cardiac death after early-onset myocardial infarction. A multicentre longitudinal cohort study with 20 years' follow-up.

Author: Bricoli S, Magnani G, Ardissino M, Maglietta G, Celli P, Ferrario M, Canosi U, Cernetti C, Negri F, Merlini PA, Tubaro M, Berzuini C, Manzalini C, Moschini L, Ponte E, Pozzi R, Buratti S, Botti A, Barocelli F, Biagi A, Bonura R, Bearzot L, Moccetti T, Crocamo A, Notarangelo MF, Moscarella E, Calabrò P, Niccoli G, and Ardissino D
Abstract: Background: Sudden cardiac death (SCD) is a serious consequence of a myocardial infarction (MI), but identifying patients at risk of developing SCD remains a major clinical challenge especially in the case of juvenile MI. The aim of this study was to identify predictors of SCD after early-onset MI using long-term follow-up data relating to a large nationwide patient cohort., Methods: The Italian Genetic Study on Early-onset MI enrolled 2,000 patients experiencing a first MI before the age of 45 years, who were followed up for a median of 19.9 years. Fine-Gray proportional hazard models were used to assess the associations between their clinical, demographic and index event data and the occurrence of SCD., Results: SCD occurred in 195 patients, who were more frequently males, hypertensive and/or diabetic; had a history of previous thromboembolic events with a greater atherosclerotic burden; and had a lower left ventricular ejection fraction (LVEF) after the index event. Multivariable analysis showed that the independent predictors of SCD were diabetes, hypertension, previous thromboembolic events, higher Syntax score, and a lower LVEF. There was no clear evidence of the clustering of SCD events during follow-up. SCD was the first post-MI clinical event in 101 patients; the remaining 94 experienced SCD after a non-fatal MI or hospitalisation for coronary revascularisation., Conclusions: SCD frequently occurs during the 20 years after early-onset MI. The nature of the identified predictors and the absence of clustering suggests that the pathophysiological basis of SCD may be related to progressive coronary atherosclerosis., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Published: 2024
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26. Predictors of work inability after acute myocardial infarction in Switzerland.

Author: Barresi F, Foster-Witassek F, Rickli H, Pedrazzini G, Roffi M, Puhan M, Dressel H, and Radovanovic D
Subjects: Humans, Switzerland epidemiology, Female, Male, Middle Aged, Adult, Registries, Aged, Risk Factors, Sex Factors, Myocardial Infarction epidemiology, Return to Work statistics & numerical data
Abstract: This study aimed to examine whether acute myocardial infarction (AMI) patients in Switzerland return to work and identify factors associated therewith. Data of 4315 working-age AMI patients enrolled in the Swiss AMIS Plus registry between 01/2006 and 09/2021 with 1-year follow-up and self-reported work status were analyzed. Patient characteristics were compared between those who did not reduce their work hours, those who reduced, and those who were no longer working 1 year after AMI. Multinomial logistic regression was used to analyze independent predictors of working ability. Of the patients, 3204 (74.3%) did not reduce their work hours, 592 (13.7%) reduced and 519 (12.0%) were no longer working 1 year after AMI. Women were more likely to reduce or stop working. Patients who did not reduce were more frequently young and male. Multinomial logistic regression showed that work reduction was associated with female sex and a Killip class > 2 at admission whereas stopping work was associated with female sex and comorbidities. A high rate of AMI patients in Switzerland (88%) return to work 1 year after AMI. Approximately 1 in 8 did not return to work and approximately 1 in 7 reduced their work hours. Important factors associated with reducing or no longer working after AMI were female sex, older age and a higher proportion of comorbidities., (© 2024. The Author(s).)
Published: 2024
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27. Treatment and outcomes of patients with chronic lung disease and acute myocardial infarction: Insights from the nationwide AMIS plus registry.

Author: Beckmann C, Foster-Witassek F, Brutsche M, Maeder MT, Eberli F, Roffi M, Pedrazzini G, Radovanovic D, and Rickli H
Subjects: Humans, Female, Male, Aged, Middle Aged, Chronic Disease, Switzerland epidemiology, Non-ST Elevated Myocardial Infarction therapy, Non-ST Elevated Myocardial Infarction epidemiology, Non-ST Elevated Myocardial Infarction mortality, Purinergic P2Y Receptor Antagonists therapeutic use, Aged, 80 and over, Lung Diseases epidemiology, Cerebrovascular Disorders epidemiology, Cerebrovascular Disorders therapy, Recurrence, Treatment Outcome, Cause of Death, Registries, Hospital Mortality, Myocardial Infarction epidemiology, Myocardial Infarction therapy, Percutaneous Coronary Intervention statistics & numerical data
Abstract: Background: Limited data are available on patients with chronic lung disease (CLD) presenting with acute myocardial infarction (AMI). We aimed to analyse baseline characteristics, treatment and outcome of those patients enrolled in the Swiss nationwide prospective AMIS Plus registry., Methods: All AMI patients enrolled between January 2002 and December 2021 with data on CLD, as defined in the Charlson Comorbidity Index, were included. The primary endpoints were in-hospital mortality and major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, reinfarction and cerebrovascular events. Baseline characteristics, in-hospital treatments and outcomes were analysed using descriptive statistics and logistic regression., Results: Among 53,680 AMI patients enrolled during this time, 5.8% had CLD. Compared with patients without CLD, CLD patients presented more frequently with non-ST-elevation myocardial infarction (MI) and type 2 MI (12.8% vs. 6.5%, p < 0.001). With respect to treatment, CLD patients were less likely to receive P2Y12 inhibitors (p < 0.001) and less likely to undergo percutaneous coronary interventions (68.7% vs. 82.5%; p < 0.001). In-hospital mortality declined in AMI patients with CLD over time (from 12% in 2002 to 7.3% in 2021). Multivariable regression analysis showed that CLD was an independent predictor for MACCE (adjusted OR was 1.28 [95% CI 1.07-1.52], p = 0.006)., Conclusion: Patients with CLD and AMI were less likely to receive evidence-based pharmacologic treatments, coronary revascularization and had a higher incidence of MACCE during their hospital stay compared to those without CLD. Over 20 years, in-hospital mortality was significantly reduced in AMI patients, especially in those with CLD., (© 2024 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.)
Published: 2024
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28. Managing Implanted Cardiac Electronic Devices in Patients With Severe Tricuspid Regurgitation: JACC State-of-the-Art Review.

Author: Hahn RT, Wilkoff BL, Kodali S, Birgersdotter-Green UM, Ailawadi G, Addetia K, Andreas M, Auricchio A, Ehlert F, George I, Gupta A, Harrison R, Ho EC, Kusumoto F, Latib A, O'Gara P, Patton KK, Pinney S, Zeitler EP, Mack MJ, Leon MB, and Epstein LM
Subjects: Humans, Heart Valve Prosthesis Implantation methods, Heart Valve Prosthesis Implantation adverse effects, Severity of Illness Index, Tricuspid Valve Insufficiency surgery, Defibrillators, Implantable adverse effects, Pacemaker, Artificial adverse effects
Abstract: Orthotopic transcatheter tricuspid valve replacement (TTVR) devices have been shown to be highly effective in reducing tricuspid regurgitation (TR), and interest in this therapy is growing with the recent commercial approval of the first orthotopic TTVR. Recent TTVR studies report preexisting cardiac implantable electronic device (CIED) transvalvular leads in ∼35% of patients, with entrapment during valve implantation. Concerns have been raised regarding the safety of entrapping leads and counterbalanced against the risks of transvenous lead extraction (TLE) when indicated. This Heart Valve Collaboratory consensus document attempts to define the patient population with CIED lead-associated or lead-induced TR, describe the risks of lead entrapment during TTVR, delineate the risks and benefits of TLE in this setting, and develop a management algorithm for patients considered for TTVR. An electrophysiologist experienced in CIED management should be part of the multidisciplinary heart team and involved in shared decision making., Competing Interests: Funding Support and Author Disclosures Dr Hahn has received speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, Medtronic, Philips Healthcare, and Siemens Healthineers; and has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Edwards Lifesciences, Medtronic, and Novartis. Dr Wilkoff has served as a consultant, speaker, and researcher for Abbott, Biotronik, Boston Scientific, Medtronic, Philips, Cook, and Xcardia. Dr Kodali has served on the scientific advisory board for Microinterventional Devices, Dura Biotech, Thubrikar Aortic Valve, and Supira; has served as a consultant for Meril Lifesciences, Admedus, Medtronic, and Boston Scientific; has served on the steering committee for Edwards Lifesciences and Abbott Vascular; has received honoraria from Meril Lifesciences, Admedus, Abbott Vascular, and Dura Biotech; and has owned equity in Dura Biotech, Thubrikar Aortic Valve, Supira, and MID. Dr Birgersdotter-Green has received speaker honoraria from Abbott, Biotronik, Boston Scientific, Medtronic, and Philips Healthcare. Dr Ailawadi has served as a consultant for Edwards Lifesciences, Medtronic, Abbott Structural, Philips Healthcare, Anteris, W.L. Gore & Associates, Jena Valve, and Arthrex. Dr Andreas has served as a proctor and consultant for and has received speaker honoraria from Edwards Lifesciences, Abbott, and Medtronic; and has received institutional research grants from Edwards Lifesciences, Abbott, Medtronic, and LSI Solutions. Dr Auricchio has received consulting fees from Boston Scientific, Cairdac, EP Solutions, Medtronic, Philips, Radcliffe Publishers, and XSpline; has received payment or honoraria from Boston Scientific, Medtronic, Microport CRM, and Philips; and has patents with Boston Scientific, Biosense Webster, and Microport CRM. Dr George has received consulting honoraria from Zimmer Biomet, Atricure, Neosurgery, Neptune Medical, Abbvie, Johnson & Johnson, DurVena, Boston Scientific, Edwards Lifesciences, Medtronic, Help-TheraX, 3ive, Encompass, Summus Medical, Abbott St Jude Medical, BCI, and Xeltis; has served on the advisory board for Edwards Surgical, Medtronic Surgical, Medtronic Structural Mitral & Tricuspid, Trisol Medical, Valcare Medical, DurVena, Abbvie, Johnson & Johnson, Foldax Medical, Zimmer Biomet, Neosurgery, Abbvie, Boston Scientific, Summus Medical, and BCI; has held equity in Valcare Medical, DurVena, CardioMech, VDyne, MitreMedical, MITRx, and BCI; and has received institutional funding to Columbia University from Edwards Lifesciences, Medtronic, Abbott Vascular, Boston Scientific, and JenaValve. Dr Harrison has served as a speaker for Philips Healthcare. Dr Ho has received institutional consulting contracts for which he receives no direct compensation with Edwards Lifesciences, Abbott, and GE Healthcare; has received research support from Philips; and has served as an advisor for which he receives no direct compensation for Medtronic, NeoChord, Tioga, Laza Medical, ValGen, Half Moon Medical, VDyne, and Anteris. Dr Latib has served as a consultant and/or advisory board member for Edwards Lifesciences, Abbott, Medtronic, Boston Scientific, Shifamed, NeoChord, VDyne, and Philips. Dr O’Gara has received consulting agreements from Edwards Lifesciences, and Medtronic. Dr Pinney has received consulting fees from Abbott, ADI, Ancora Heart, CareDx, Cordio, Medtronic, Procyrion, Restore Medical, Transmedics, and ValGen; and has received speaker fees from Impulse Dynamics. Dr Zeitler has received consulting and travel support from Medtronic and Biosense Webster; has received nonfinancial research support from Biosense Webster and Sanofi; and has received research support from the National Institutes of Health. Dr Mack has served as the co-principal investigator or study chair for clinical trials sponsored by Abbott, Edwards Lifesciences, and Medtronic. Dr Leon has received institutional research support from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic; and has served as a consultant or advisory board member for Abbott, Boston Scientific, W.L. Gore & Associates, Medtronic, and Meril Life, Dr Epstein has received consultant fees from Boston Scientific, Medtronic, and The Spectranetics Corp. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Published: 2024
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29. Optimizing CO2 field flooding during sternotomy: In vitro confirmation of the Karolinska studies.

Author: Puthettu M, Vandenberghe S, Balafas S, Di Serio C, Singjeli G, Pagnamenta A, and Demertzis S
Subjects: Humans, Dissent and Disputes, Floods, Hand, Sternotomy, Carbon Dioxide
Abstract: Although CO2 field-flooding was first used during cardiac surgery more than 60 years ago, its efficacy is still disputed. The invisible nature of the gas and the difficulty in determining the "safe" quantity to protect the patient are two of the main obstacles to overcome for its validation. Moreover, CO2 concentration in the chest cavity is highly sensitive to procedural aspects, such suction and hand movements. Based on our review of the existing literature, we identified four major factors that influence the intra-cavity CO2 concentration during open-heart surgery: type of delivery device (diffuser), delivery CO2 flow rate, diffuser position around the wound cavity, and its orientation inside the cavity. In this initial study, only steady state conditions were considered to establish a basic understanding on the effect of the four above-mentioned factors. Transient factors, such as suction or hand movements, will be reported separately., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Puthettu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Published: 2024
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30. Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC.

Author: Adamo M, Chioncel O, Pagnesi M, Bayes-Genis A, Abdelhamid M, Anker SD, Antohi EL, Badano L, Ben Gal T, Böhm M, Delgado V, Dreyfus J, Faletra FF, Farmakis D, Filippatos G, Grapsa J, Gustafsson F, Hausleiter J, Jaarsma T, Karam N, Lund L, Lurz P, Maisano F, Moura B, Mullens W, Praz F, Sannino A, Savarese G, Tocchetti CG, van Empel VPM, von Bardeleben RS, Yilmaz MB, Zamorano JL, Ponikowski P, Barbato E, Rosano GMC, and Metra M
Subjects: Humans, Quality of Life, Tricuspid Valve surgery, Treatment Outcome, Tricuspid Valve Insufficiency diagnosis, Tricuspid Valve Insufficiency epidemiology, Tricuspid Valve Insufficiency therapy, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure therapy, Heart Valve Prosthesis Implantation
Abstract: Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management., (© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Published: 2024
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31. Prevention of venous thromboembolism in right heart-sided electrophysiological procedures: results of an European Heart Rhythm Association survey.

Author: Mugnai G, Farkowski M, Tomasi L, Roten L, Migliore F, de Asmundis C, Conte G, Boveda S, and Chun JKR
Subjects: Humans, Anticoagulants therapeutic use, Fibrinolytic Agents therapeutic use, Heparin, Aspirin, Surveys and Questionnaires, Venous Thromboembolism epidemiology, Venous Thromboembolism prevention & control, Pulmonary Embolism prevention & control, Pulmonary Embolism drug therapy
Abstract: Limited data are available regarding venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), following right-sided ablations and electrophysiological (EP) studies. Compared to left-sided procedures, no guidelines on antithrombotic management strategies for the prevention of DVT and PE are available. The main purpose of the present European Heart Rhythm Association (EHRA) survey is to report the current management of right-sided EP procedures, focusing on anticoagulation and prevention of VTE. An online survey was conducted using the EHRA infrastructure. A total of 244 participants answered a 19-items questionnaire on the periprocedural management of EP studies and right-sided catheter ablations. The right femoral vein is the most common access for EP studies and right-sided procedures. An ultrasound-guided approach is employed by more than 2/3 of respondents. Intravenous heparin is not commonly given by the majority of participants. About 1/3 of participants (34%) routinely prescribe VTE prophylaxis during (mostly aspirin and low molecular weight heparin) and 1/4 of respondents (25%) commonly prescribe VTE prophylaxis after discharge (mostly aspirin). Of note, respectively 13% and 9% of participants observed at least one DVT and one PE related to right-sided ablation or EP study within the last year in their center. The present survey shows that only a minority of operators routinely gives intraprocedural intravenous heparin and prescribes VTE prophylaxis after right-sided EP procedures. Compared to left-sided procedures like atrial fibrillation (AF) ablation, there are no consistent systematic antithrombotic management strategies., Competing Interests: Conflict of interest: M.F. received speaker and consultation fees from Pfizer and Boehringer Ingelheim Poland. L.R. has received speaker and consulting fees from Abbott and Medtronic and a research grant to the institution from Medtronic. C.d.A. received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Livanova, Boston Scientific, Atricure, Acutus Medical, and Daiichi Sankyo. G.C. has received honoraria fees from Biosense Webster and Boston Scientific and research grants from Boston Scientific. S.B. is a consultant for Medtronic, Boston Scientific, Microport, and Zoll. J.K.R.C. received speaker, consultation, teaching, and proctoring honoraria from Medtronic, Boston Scientific, and Biosense Webster., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Published: 2023
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32. Carcinoid heart disease: another step into the knowledge of a rare disease.

Author: Pavon AG and Guglielmo M
Subjects: Humans, Rare Diseases, Carcinoid Heart Disease diagnosis, Carcinoid Heart Disease diagnostic imaging, Tricuspid Valve Insufficiency
Abstract: Competing Interests: Competing interests: None declared.
Published: 2023
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33. Leadless Pacemaker Implantation in Patients With a Prior Conventional Pacing System.

Author: Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, and Breitenstein A
Abstract: Background: Leadless pacing has been established as an alternative approach to transvenous devices for selected patients. Often, leadless pacemaker (LP) implantation is a de novo procedure, but in an increasing number of patients, an LP is used after previous implantation of a conventional pacing system (CPS)., Methods: A retrospective analysis was conducted of the efficacy and safety of LP implantation in the context of a previously implanted CPS, from 2 large Swiss centres., Results: A total of 257 consecutive patients undergoing LP implantation were included. They were divided into 2 groups: group 1 consisted of 233 patients who did not have a previous CPS, and group 2 consisted of 24 patients with an in situ CPS. In group 2, a total of 20 patients (83%) required transvenous lead extraction due to infection, malfunction, or other reasons. In 3 patients with device-related infection, lead extraction and LP implantation was performed as a single procedure, whereas in the remaining 11 cases, a time window occurred between the 2 procedures (median: 11.5 days; range: 2-186 days). Electrical device parameters at implantation and during follow-up did not differ between the 2 groups (mean: 12.5 ± 9.3 months). Eight major periprocedural complications (3.1%) were encountered (4 pericardial effusions, 3 instances of femoral bleeding, and 1 instance of intra-abdominal bleeding) in the entire cohort within a 30-day period. No complications occurred in the group with a previous device. No infections were registered, even when complete extraction of an infected CPS was performed prior to LP implantation., Conclusions: Implantation of an LP in patients with a prior CPS (with or without extraction of the previous system) was effective and safe in our population of patients., (© 2023 The Authors.)
Published: 2023
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34. Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment: The VIVID Registry.

Author: Simonato M, Whisenant BK, Unbehaun A, Kempfert J, Ribeiro HB, Kornowski R, Erlebach M, Bleiziffer S, Windecker S, Pilgrim T, Tomii D, Guerrero M, Ahmad Y, Forrest JK, Montorfano M, Ancona M, Adam M, Wienemann H, Finkelstein A, Villablanca P, Codner P, Hildick-Smith D, Ferrari E, Petronio AS, Shamekhi J, Presbitero P, Bruschi G, Rudolph T, Cerillo A, Attias D, Nejjari M, Abizaid A, Felippi de Sá Marchi M, Horlick E, Wijeysundera H, Andreas M, Thukkani A, Agrifoglio M, Iadanza A, Baer LM, Nanna MG, and Dvir D
Subjects: Humans, Female, Middle Aged, Aged, Aged, 80 and over, Male, Mitral Valve diagnostic imaging, Mitral Valve surgery, Constriction, Pathologic etiology, Treatment Outcome, Cardiac Catheterization adverse effects, Hemodynamics, Registries, Prosthesis Design, Heart Valve Prosthesis Implantation adverse effects, Heart Valve Prosthesis, Atrial Fibrillation, Bioprosthesis
Abstract: Background: Mitral valve-in-valve (ViV) is associated with suboptimal hemodynamics and rare left ventricular outflow tract (LVOT) obstruction., Objectives: This study aimed to determine whether device position and asymmetry are associated with these outcomes., Methods: Patients undergoing SAPIEN 3 (Edwards Lifesciences) mitral ViV included in the VIVID (Valve-in-Valve International Data) Registry were studied. Clinical endpoints are reported according to Mitral Valve Academic Research Consortium definitions. Residual mitral valve stenosis was defined as mean gradient ≥5 mm Hg. Depth of implantation (percentage of transcatheter heart valve [THV] atrial to the bioprosthesis ring) and asymmetry (ratio of 2 measures of THV height) were evaluated., Results: A total of 222 patients meeting the criteria for optimal core lab evaluation were studied (age 74 ± 11.6 years; 61.9% female; STS score = 8.3 ± 7.1). Mean asymmetry was 6.2% ± 4.4%. Mean depth of implantation was 19.0% ± 10.3% atrial. Residual stenosis was common (50%; mean gradient 5.0 ± 2.6 mm Hg). LVOT obstruction occurred in 7 cases (3.2%). Implantation depth was not a predictor of residual stenosis (OR: 1.19 [95% CI: 0.92-1.55]; P = 0.184), but more atrial implantation was protective against LVOT obstruction (0.7% vs 7.1%; P = 0.009; per 10% atrial, OR: 0.48 [95% CI: 0.24-0.98]; P = 0.044). Asymmetry was found to be an independent predictor of residual stenosis (per 10% increase, OR: 2.30 [95% CI: 1.10-4.82]; P = 0.027)., Conclusions: Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction. Technical considerations to reduce postdeployment THV asymmetry should be considered., Competing Interests: Funding Support and Author Disclosures Dr Whisenant is a consultant for Edwards Lifesciences. Dr Unbehaun is a proctor for Edwards Lifesciences. Dr Erlebach has received speaker honoraria from Medtronic and Abbott; and is a proctor for Abbott. Dr Guerrero has received institutional research grant support from Edwards Lifesciences. Dr Bruschi is a consultant for Abbott. Dr Rudolph has received speaker honoraria from Edwards Lifesciences; and is a proctor for Edwards Lifesciences. Dr Andreas is a consultant for Edwards Lifesciences, Abbott, Medtronic, Boston Scientific, Zoll, and AbbVie; and has received institutional research grants from Edwards Lifesciences, Abbott, Medtronic, and LSI. Dr Dvir is a consultant for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Published: 2023
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35. Fewer Worsening Heart Failure Events With HeartLogic on top of Standard Care: a Propensity-Matched Cohort Analysis.

Author: Feijen M, Beles M, Tan YZ, Cordon A, Dupont M, Treskes RW, Caputo ML, VAN Bockstal K, Auricchio A, Egorova AD, Maes E, Beeres SLMA, and Heggermont WA
Subjects: Humans, Male, Aged, Female, Retrospective Studies, Cohort Studies, Hospitalization, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure therapy, Defibrillators, Implantable
Abstract: Background: The implantable cardiac defibrillator-based HeartLogic algorithm aims to detect impending fluid retention in patients with heart failure (HF). Studies show that HeartLogic is safe to integrate into clinical practice. The current study investigates whether HeartLogic provides clinical benefit on top of standard care and device telemonitoring in patients with HF., Methods: A multicenter, retrospective, propensity-matched cohort analysis was performed in patients with HF and implantable cardiac defibrillators, and it compared HeartLogic to conventional telemonitoring. The primary endpoint was the number of worsening HF events. Hospitalizations and ambulatory visits due to HF were also evaluated., Results: Propensity score matching yielded 127 pairs (median age 68 years, 80% male). Worsening HF events occurred more frequently in the control group (2; IQR 0-4) compared to the HeartLogic group (1; IQR 0-3; P = 0.004). The number of HF hospitalization days was higher in controls than in the HeartLogic group (8; IQR 5-12 vs 5; IQR 2-7; P = 0.023), and ambulatory visits for diuretic escalation were more frequent in the control group than in the HeartLogic group (2; IQR 0-3 vs 1; IQR 0-2; P = 0.0001)., Conclusion: Integrating the HeartLogic algorithm in a well-equipped HF care path on top of standard care is associated with fewer worsening HF events and shorter duration of fluid retention-related hospitalizations., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
Published: 2023
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36. Leadless Pacemaker Implantation, Focusing on Patients With Conduction System Disorders Post-Transcatheter Aortic Valve Replacement: A Retrospective Analysis.

Author: Jelisejevas J, Regoli F, Hofer D, Conte G, Oezkartal T, Saguner AM, Caputo ML, Grazioli L, Steffel J, Auricchio A, and Breitenstein A
Abstract: Background: Impairment of the conduction system is a common complication of transcatheter aortic valve replacement (TAVR), which is typically performed in elderly patients. A leadless pacemaker (LP) may be a suitable option in this frail population, but the available scientific data concerning the efficacy and safety of leadless pacing after TAVR are sparse. The purpose of this analysis was to evaluate the efficacy and safety of LP implantation in patients with relevant bradycardias after TAVR, compared to other indications., Methods: Consecutive patients were retrospectively enrolled. Demographics, background heart diseases, interventional parameters, and follow-up data were collected., Results: A total of 257 consecutive patients who underwent LP implantation were included. In 26 patients, the device was implanted due to bradycardias after TAVR (TAVR group), whereas the remaining 231 patients were in the population without previous TAVR (non-TAVR group). The mean implantation duration (56 ± 22 minutes in the TAVR group vs 48 ± 20 minutes in the non-TAVR group; P = not significant [NS]) and the implantation success rate (100% in the TAVR group vs 98.7% in the non-TAVR group; P = NS) were similar in the 2 cohorts. No significant differences occurred in pacing parameters (sensing, impedance, and threshold, respectively) between the 2 groups, either at implantation or during follow-up. A total of 8 major periprocedural complications (3.1% of patients in total; 3.8% in the TAVR group vs 3.0% in the non-TAVR group; P = NS) occurred within 30 days, without significant difference between the 2 groups., Conclusions: LP implantation appears to be safe and effective in patients after TAVR, and therefore, this procedure is a suitable option for this often old and frail population., (© 2023 The Authors.)
Published: 2023
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37. Twenty-year trends in the prevalence of modifiable cardiovascular risk factors in young acute coronary syndrome patients hospitalized in Switzerland.

Author: Mahendiran T, Hoepli A, Foster-Witassek F, Rickli H, Roffi M, Eberli F, Pedrazzini G, Jeger R, Radovanovic D, and Fournier S
Subjects: Young Adult, Humans, Risk Factors, Prevalence, Switzerland epidemiology, Obesity diagnosis, Obesity epidemiology, Heart Disease Risk Factors, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome epidemiology, Cardiovascular Diseases, Diabetes Mellitus diagnosis, Diabetes Mellitus epidemiology, Hypertension diagnosis, Hypertension epidemiology, Dyslipidemias diagnosis, Dyslipidemias epidemiology
Abstract: Aims: Modifiable cardiovascular risk factors (RFs) play a key role in the development of coronary artery disease. We evaluated 20-year trends in RF prevalence among young adults hospitalized with acute coronary syndromes (ACS) in Switzerland., Methods and Results: Data were analysed from the Acute Myocardial Infarction in Switzerland (AMIS) Plus registry from 2000 to 2019. Young patients were defined as those aged <50 years. Among 58 028 ACS admissions, 7073 (14.1%) were young (median 45.6 years, IQR 42.0-48.0), of which 91.6% had at least one modifiable RF and 59.0% had at least two RFs. Smoking was the most prevalent RF (71.4%), followed by dyslipidaemia (57.3%), hypertension (35.9%), obesity (21.7%), and diabetes (10.1%). Compared with older patients, young patients were more likely to be obese (21.7% vs. 17.4%, P < 0.001) and active smokers (71.4% vs. 33.9%, P < 0.001). Among young patients, between 2000 and 2019, there was a significant increase in the prevalence of hypertension from 29.0% to 51.3% and obesity from 21.2% to 27.1% (both Ptrend < 0.001) but a significant decrease in active smoking from 72.5% to 62.5% (Ptrend = 0.02). There were no significant changes in the prevalence of diabetes (Ptrend = 0.32) or dyslipidaemia (Ptrend = 0.067)., Conclusion: Young ACS patients in Switzerland exhibit a high prevalence of RFs and are more likely than older patients to be obese and smokers. Between 2000 and 2019, RF prevalence either increased or remained stable, except for smoking which decreased but still affected approximately two-thirds of young patients in 2019. Public health initiatives targeting RFs in young adults in Switzerland are warranted., Competing Interests: Conflict of interest All authors declare no conflict of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Published: 2023
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38. Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest: A Predefined Analysis of the TTM2 Randomized Clinical Trial.

Author: Lilja G, Ullén S, Dankiewicz J, Friberg H, Levin H, Nordström EB, Heimburg K, Jakobsen JC, Ahlqvist M, Bass F, Belohlavek J, Olsen RB, Cariou A, Eastwood G, Fanebust HR, Grejs AM, Grimmer L, Hammond NE, Hovdenes J, Hrecko J, Iten M, Johansen H, Keeble TR, Kirkegaard H, Lascarrou JB, Leithner C, Lesona ME, Levis A, Mion M, Moseby-Knappe M, Navarra L, Nordberg P, Pelosi P, Quayle R, Rylander C, Sandberg H, Saxena M, Schrag C, Siranec M, Tiziano C, Vignon P, Wendel-Garcia PD, Wise MP, Wright K, Nielsen N, and Cronberg T
Abstract: Importance: The Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens., Objectives: To investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA., Design, Setting, and Participants: This study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing., Interventions: Randomization 1:1 to temperature control with targeted hypothermia at 33 °C or targeted normothermia and early treatment of fever (37.8 °C or higher)., Main Outcomes and Measures: Functional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes., Results: At 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P = .46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,-0.33 to 1.05; P = .37) and SDMT (mean difference, 0.06; 95% CI,-0.16 to 0.27; P = .62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%)., Conclusions: In this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common., Trial Registration: ClinicalTrials.gov Identifier: NCT02908308.
Published: 2023
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39. Cardiac device infection: removing barriers to timely and adequate treatment.

Author: Atar D, Auricchio A, and Blomström-Lundqvist C
Subjects: Humans, Defibrillators, Implantable adverse effects, Heart Diseases
Published: 2023
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40. Electrocardiographic imaging to guide ablation of ventricular arrhythmias and agreement between two different systems.

Author: Parreira L, Carmo P, Nunes S, Marinheiro R, Mesquita D, Zubarev S, Chmelevsky M, Hitchen R, Ferreira A, Pinho J, Marques L, Chambel D, Amador P, Caria R, and Adragão P
Subjects: Humans, Electrocardiography methods, Arrhythmias, Cardiac diagnosis, Heart, Diagnostic Imaging, Heart Ventricles diagnostic imaging, Heart Ventricles surgery, Catheter Ablation, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular surgery
Abstract: Background and Aim: A recent study using an epicardial-only electrocardiographic imaging (ECGI), suggests that the agreement of ECGI activation mapping and that of the contact mapping for ventricular arrhythmias (VA) is poor. The aim of this study was to assess the diagnostic value of two endo-epicardial ECGI systems using different cardiac sources and the agreement between them., Methods: We performed 69 ECGI procedures in 52 patients referred for ablation of VA at our center. One system based on the extracellular potentials was used in 26 patients, the other based on the equivalent double layer model in 9, and both in 17 patients. The first uses up to 224 leads and the second just the 12‑lead ECG. The localization of the VA was done using a segmental model of the ventricles. A perfect match (PM) was defined as a predicted location within the same anatomic segment, whereas a near match (NM) as a predicted location within the same segment or a contiguous one., Results: 44 patients underwent ablation, corresponding to 58 ECGI procedures (37 with the first and 21 with the second system). The percentage of PMs and NMs was not significantly different between the two systems, respectively 76% and 95%, p = 0.077, and 97% and 100%, p = 1.000. In 14 patients that underwent ablation and had the ECGI performed with both systems, raw agreement for PMs was 79%, p = 0.250 for disagreement., Conclusions: ECGI systems were useful to identify the origin of the VAs, and the results were reproducible regardless the cardiac source., Competing Interests: Declaration of Competing Interest Rebecca Hitchen is technical support of Catheter Precision, Joana Pinho is technical support of Biosense Webster, and Lia Marques is technical support of Abbott., (Copyright © 2023 Elsevier Inc. All rights reserved.)
Published: 2023
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41. The evolving state of cardiac resynchronization therapy and conduction system pacing: 25 years of research at EP Europace journal.

Author: Ellenbogen KA, Auricchio A, Burri H, Gold MR, Leclercq C, Leyva F, Linde C, Jastrzebski M, Prinzen F, and Vernooy K
Subjects: Humans, Stroke Volume, Ventricular Function, Left, Cardiac Conduction System Disease, Heart Conduction System, Cardiac Resynchronization Therapy
Abstract: Cardiac resynchronization therapy (CRT) was proposed in the 1990s as a new therapy for patients with heart failure and wide QRS with depressed left ventricular ejection fraction despite optimal medical treatment. This review is aimed first to describe the rationale and the physiologic effects of CRT. The journey of the landmark randomized trials leading to the adoption of CRT in the guidelines since 2005 is also reported showing the high level of evidence for CRT. Different alternative pacing modalities of CRT to conventional left ventricular pacing through the coronary sinus have been proposed to increase the response rate to CRT such as multisite pacing and endocardial pacing. A new emerging alternative technique to conventional biventricular pacing, conduction system pacing (CSP), is a promising therapy. The different modalities of CSP are described (Hirs pacing and left bundle branch area pacing). This new technique has to be evaluated in clinical randomized trials before implementation in the guidelines with a high level of evidence., Competing Interests: Conflict of interest: Kenneth A. Ellenbogen: Consultant and honoraria from Medtronic, Boston Scientific, Abbott and Biotronik, C. Leclercq: Lecture and honoraria from Abbott Medtronic, Boston Scientific, Biotronik, F. Leyva; No relevant conflicts, C. Linde: honoraria from Medtronic, Impulse Dynamic, A Auricchio: Consultant and honoraria to Boston Scientific, Cairdac, Corvia, MicroportCRM, Medtronic, XSpline; K Vernooy: Boston Scientific, Medtronic, Phillips, Biosense Webster, Abbott, F Prinzen; No relevant conflicts other than research support, M Jastrzebski: Consultant and speaker honoraria form Medtronic, Abbott and Biotronik; M Gold: Consultant: Boston Scientific and Medtronic; Haran Burri: Consultant and honoraria; Abbott, Biotronik, Boston Scientific, Medtronic and Microport., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Published: 2023
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42. Impact of chronic kidney disease and diabetes on clinical outcomes in women undergoing PCI.

Author: Spirito A, Itchhaporia D, Sartori S, Camenzind E, Chieffo A, Dangas GD, Galatius S, Jeger RV, Kandzari DE, Kastrati A, Kim HS, Kimura T, Leon MB, Mehta LS, Mikhail GW, Morice MC, Nicolas J, Pileggi B, Serruys PW, Smits PC, Steg PG, Stone GW, Valgimigli M, Vogel B, von Birgelen C, Weisz G, Wijns W, Windecker S, and Mehran R
Subjects: Female, Humans, Death, Risk Factors, Treatment Outcome, Randomized Controlled Trials as Topic, Coronary Artery Disease complications, Diabetes Mellitus epidemiology, Drug-Eluting Stents adverse effects, Myocardial Infarction etiology, Percutaneous Coronary Intervention adverse effects, Renal Insufficiency, Chronic complications
Abstract: Background: For women undergoing drug-eluting stent (DES) implantation, the individual and combined impact of chronic kidney disease (CKD) and diabetes mellitus (DM) on outcomes is uncertain., Aims: We sought to assess the impact of CKD and DM on prognosis in women after DES implantation., Methods: We pooled patient-level data on women from 26 randomised controlled trials comparing stent types. Women receiving DES were stratified into 4 groups based on CKD (defined as creatine clearance <60 mL/min) and DM status. The primary outcome at 3 years after percutaneous coronary intervention was the composite of all-cause death or myocardial infarction (MI); secondary outcomes included cardiac death, stent thrombosis and target lesion revascularisation., Results: Among 4,269 women, 1,822 (42.7%) had no CKD/DM, 978 (22.9%) had CKD alone, 981 (23.0%) had DM alone, and 488 (11.4%) had both conditions. The risk of all-cause death or MI was not increased in women with CKD alone (adjusted hazard ratio [adj. HR] 1.19, 95% confidence interval [CI]: 0.88-1.61) nor DM alone (adj. HR 1.27, 95% CI: 0.94-1.70), but was significantly higher in women with both conditions (adj. HR 2.64, 95% CI: 1.95-3.56; interaction p-value <0.001). CKD and DM in combination were associated with an increased risk of all secondary outcomes, whereas alone, each condition was only associated with all-cause death and cardiac death., Conclusions: Among women receiving DES, the combined presence of CKD and DM was associated with a higher risk of the composite of death or MI and of any secondary outcome, whereas alone, each condition was associated with an increase in all-cause and cardiac death.
Published: 2023
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43. Insertable cardiac monitoring results in higher rates of atrial fibrillation diagnosis and oral anticoagulation prescription after ischaemic stroke.

Author: Boriani G, Auricchio A, Botto GL, Joseph JM, Roberts GJ, Grammatico A, Nabutovsky Y, and Piccini JP
Subjects: Humans, Female, Aged, United States epidemiology, Male, Medicare, Anticoagulants adverse effects, Prescriptions, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Stroke diagnosis, Stroke epidemiology, Stroke etiology, Brain Ischemia diagnosis, Brain Ischemia epidemiology, Brain Ischemia prevention & control, Ischemic Stroke
Abstract: Aims: After an ischaemic stroke, atrial fibrillation (AF) detection allows for improved secondary prevention strategies. This study aimed to compare AF detection and oral anticoagulant (OAC) initiation in patients with an insertable cardiac monitor (ICM) vs. external cardiac monitor (ECM) after ischaemic stroke., Methods and Results: Medicare Fee-for-Service (FFS) insurance claims and Abbott Labs device registration data were used to identify patients hospitalized with an ischaemic stroke in 2017-2019 who received an ICM or ECM within 3 months. Patients with continuous Medicare FFS insurance and prescription drug enrolment in the prior year were included. Patients with prior AF, atrial flutter, cardiac devices, or OAC were excluded. Insertable cardiac monitor and ECM patients were propensity score matched 1:4 on demographics, comorbidities, and stroke hospitalization characteristics. The outcomes of interest were AF detection and OAC initiation evaluated with Kaplan-Meier and Cox proportional hazard regression analyses. A total of 5702 Medicare beneficiaries (ICM, n = 444; ECM, n = 5258) met inclusion criteria. The matched cohort consisted of 2210 Medicare beneficiaries (ICM, n = 442; ECM, n = 1768) with 53% female, mean age 75 years, and mean CHA₂DS₂-VASc score 4.6 (1.6). Insertable cardiac monitor use was associated with a higher probability of AF detection [(hazard ratio (HR) 2.88, 95% confidence interval (CI) (2.31, 3.59)] and OAC initiation [HR 2.91, CI (2.28, 3.72)] compared to patients monitored only with ECM., Conclusion: Patients with an ischaemic stroke monitored with an ICM were almost three times more likely to be diagnosed with AF and to be prescribed OAC compared to patients who received ECM only., Competing Interests: Conflict of interest: G.B. received small speaker’s fees from Abbott, Bayer, Boston, Boehringer, Daiichi Sankyo, Janssen, and Sanofi, outside of the submitted work. A.A, is a consultant to Abbott, Boston Scientific, Cairdac, EP Solutions, Hylomorph, Medtronic, and XSpline; has received speaker fees from Boston Scientific, Medtronic, Microport CRM, and Philips; participates in clinical trials sponsored by Abbott, Boston Scientific, EPD-Philips, EP Solutions, Medtronic, Philips, and XSpline; and holds intellectual properties with Boston Scientific, Biosense Webster, and Microport CRM. G.L.B. has received speaker fees (small amount) from Abbott, Biotronik, Boston Scientific, Medtronic, and Microport CRM. J.P.P. is supported by R01AG074185 from the National Institutes of Aging. He also receives grants from Abbott, the American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips and serves as a consultant to Abbott, Abbvie, ARCA biopharma, Bayer, Boston Scientific, Element Science, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, Sanofi, Philips, and Up-to-Date. J.M.J., G.J.R., A.G., and Y.N. are employed by Abbott., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Published: 2023
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44. Patients With AMI and Severely Reduced LVEF, a Well-Defined, Still Extremely Vulnerable Population (Insights from AMIS Plus Registry).

Author: Roberto M, Hoepli A, Cattaneo M, Radovanovic D, Rickli H, Erne P, Pedrazzini GB, and Moccetti M
Subjects: Humans, Ventricular Function, Left, Stroke Volume, Vulnerable Populations, Registries, Ventricular Dysfunction, Left, Myocardial Infarction epidemiology, Myocardial Infarction therapy
Abstract: Left ventricular ejection fraction (LVEF) represents one of the strongest predictors of both in-hospital and long-term prognosis in acute myocardial infarction (AMI). Temporal trends data coming from real-world experiences focused on patients with AMI with severely reduced LVEF (i.e., <30%) are lacking. In a total of 48,543 screened patients with AMI included in the Acute Myocardial Infarction in Switzerland Plus Registry between 2005 and 2020, data on LVEF were available for 23,510 patients. Study patients were classified according to LVEF as patients with AMI with or without severely reduced LVEF (i.e., patients with LVEF <30% and ≥30%, respectively). Overall, 1,657 patients with AMI (7%) displayed severely reduced LVEF. The prevalence of severe LVEF reduction constantly decreased over the study period (from 11% to 4%, p <0.001). In the subgroup of patients with severely reduced LVEF, a significant increase in revascularization rate was observed (from 61% to 84%, p <0.001); however, in-hospital mortality did not significantly decrease and remained well above 20% over the study period (from 23% to 26%, p = 0.65). At discharge, prescription of optimal cardioprotective therapy (defined as an association of renin-angiotensin-aldosterone-system inhibitors, β-blocker, and mineral corticoid receptor antagonist) remained low across the study period (from 17% in 2011 to 20%, p = 0.96). In conclusion, patients with AMI with severely reduced LVEF remain a fragile subgroup of patients with an in-hospital mortality that did not significantly decrease and remained well above 20% over the study period. Moreover, access at discharge to optimal cardioprotective therapy remains suboptimal. Efforts are, therefore, needed to improve prognosis and access to guidelines-directed therapies in this fragile population., Competing Interests: Declaration of Competing Interest Dr. Rickli reports institutional research grants from Biotronik, Boston, Braun, Terumo, and Medtronic, all outside the submitted work. The remaining authors have no conflicts of interest to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)
Published: 2023
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45. Cardiac surgery simulation: step-by-step Nicks procedure in a preclinical model.

Author: Toto F, Torre T, Pozzoli A, Biroova S, Ferrari E, and Demertzis S
Subjects: Humans, Animals, Swine, Aortic Valve surgery, Mitral Valve surgery, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Cardiac Surgical Procedures, Heart Valve Prosthesis Implantation
Abstract: We demonstrate the Nicks operation, one of the posterior aortic root enlargement procedures, on a preclinical model (porcine heart). The goal of this operation is to facilitate the implementation of a suitably sized aortic prosthetic valve. The procedure is performed by making a longitudinal incision through the non-coronary sinus without entering the fibrous body between the aortic valve and the anterior leaflet of the mitral valve and inserting a patch to enlarge the annulus., (© The Author 2023. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Published: 2023
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46. Cost-effectiveness analysis of pressure-controlled intermittent coronary sinus occlusion in elective percutaneous coronary intervention.

Author: Rognoni C, Segantin G, Scarsini R, Valgimigli M, Loizzi F, Costa F, and Armeni P
Subjects: Humans, Cost-Effectiveness Analysis, Quality of Life, Cost-Benefit Analysis, Quality-Adjusted Life Years, Coronary Sinus, Percutaneous Coronary Intervention methods, Heart Failure
Abstract: Objectives: Percutaneous coronary intervention (PCI) represents the standard treatment for ST-elevated myocardial infarction, nevertheless, mortality and heart failures are frequent. Pressure-controlled intermittent coronary sinus occlusion (PiCSO) might reduce infarct size showing better patients' outcomes. We evaluated the cost-effectiveness of PCI+PiCSO compared to PCI from the National Healthcare Service (NHS) perspective in Italy., Methods: A Markov model was developed to estimate life years (LYs), quality-adjusted life years (QALYs) and costs. A micro-costing analysis has been performed to inform the cost of PCI+PiCSO procedure. Sensitivity analyses were performed to test the robustness of the model results., Results: Considering a willingness-to-pay threshold of 50,000€/QALY for the ICUR and a cost for PCI+PiCSO procedure of 14,654€, the innovative strategy may be cost-effective compared to PCI alone from the Italian NHS perspective, showing an ICUR of 17,530€/QALY (ICER 14,631€/LY) over a lifetime horizon; the probabilistic sensitivity analysis showed that PCI+PiCSO is cost-effective in 78.8% of simulations.Considering the above mentioned willingness-to-pay threshold, PCI+PiCSO strategy would be cost-effective over a lifetime horizon considering a cost for PCI+PiCSO procedure lower than 28,160€., Conclusion: PCI+PiCSO procedure may be considered a cost-effective technology that allows reducing cardiac events, while improving patients' life expectancy and quality of life.
Published: 2023
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47. Clinical Outcomes in High-Gradient, Classical Low-Flow, Low-Gradient, and Paradoxical Low-Flow, Low-Gradient Aortic Stenosis After Transcatheter Aortic Valve Implantation: A Report From the SwissTAVI Registry.

Author: Wagener M, Reuthebuch O, Heg D, Tüller D, Ferrari E, Grünenfelder J, Huber C, Moarof I, Muller O, Nietlispach F, Noble S, Roffi M, Taramasso M, Templin C, Toggweiler S, Wenaweser P, Windecker S, Stortecky S, and Jeger R
Subjects: Humans, Aortic Valve diagnostic imaging, Aortic Valve surgery, Prospective Studies, Treatment Outcome, Retrospective Studies, Registries, Severity of Illness Index, Transcatheter Aortic Valve Replacement, Aortic Valve Stenosis
Abstract: Background In view of the rising global burden of severe symptomatic aortic stenosis, its early recognition and treatment is key. Although patients with classical low-flow, low-gradient (C-LFLG) aortic stenosis have higher rates of death after transcatheter aortic valve implantation (TAVI) when compared with patients with high-gradient (HG) aortic stenosis, there is conflicting evidence on the death rate in patients with severe paradoxical low-flow, low-gradient (P-LFLG) aortic stenosis. Therefore, we aimed to compare outcomes in real-world patients with severe HG, C-LFLG, and P-LFLG aortic stenosis undergoing TAVI. Methods and Results Clinical outcomes up to 5 years were addressed in the 3 groups of patients enrolled in the prospective, national, multicenter SwissTAVI registry. A total of 8914 patients undergoing TAVI at 15 heart valve centers in Switzerland were analyzed for the purpose of this study. We observed a significant difference in time to death at 1 year after TAVI, with the lowest observed in HG (8.8%) aortic stenosis, followed by P-LFLG (11.5%; hazard ratio [HR], 1.35 [95% CI, 1.16-1.56]; P <0.001) and C-LFLG (19.8%; HR, 1.93 [95% CI, 1.64-2.26]; P <0.001) aortic stenosis. Cardiovascular death showed similar differences between the groups. At 5 years, the all-cause death rate was 44.4% in HG, 52.1% in P-LFLG (HR, 1.35 [95% CI, 1.23-1.48]; P <0.001), and 62.8% in C-LFLG aortic stenosis (HR, 1.7 [95% CI, 1.54-1.88]; P <0.001). Conclusions Up to 5 years after TAVI, patients with P-LFLG have higher death rates than patients with HG aortic stenosis but lower death rates than patients with C-LFLG aortic stenosis.
Published: 2023
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48. One- and two-year clinical outcomes of treatment with resorbable magnesium scaffolds for coronary artery disease: the prospective, international, multicentre BIOSOLVE-IV registry.

Author: Wlodarczak A, Montorsi P, Torzewski J, Bennett J, Starmer G, Buck T, Haude M, Moccetti M, Wiemer M, Lee MK, and Verheye S
Subjects: Humans, Middle Aged, Aged, Magnesium therapeutic use, Prospective Studies, Absorbable Implants, Treatment Outcome, Registries, Coronary Artery Disease surgery, Coronary Artery Disease etiology, Non-ST Elevated Myocardial Infarction, Diabetes Mellitus, Thrombosis etiology, Percutaneous Coronary Intervention adverse effects
Abstract: Background: Bioresorbable scaffolds have been developed to overcome the limitations of drug-eluting stents and to reduce long-term adverse events., Aims: We aimed to assess the long-term safety and efficacy of a sirolimus-eluting resorbable magnesium scaffold to ensure its safe rollout into clinical routine., Methods: BIOSOLVE-IV is a prospective, international, multicentre registry including more than 100 centres in Europe, Asia, and Asia-Pacific. Enrolment started directly after the commercialisation of the device. Follow-up assessments are scheduled at 6 and 12 months, and annually for up to 5 years; we herein report the 24-month outcomes., Results: Overall, 2,066 patients with 2,154 lesions were enrolled. Patients were 61.9±10.5 years old, 21.6% had diabetes, and 18.5% had non-ST-elevation myocardial infarction (NSTEMI). Lesions were 14.8±4.0 mm long with a reference vessel diameter of 3.2±0.3 mm. Device and procedure success were 97.5%, and 99.1%, respectively. The 24-month target lesion failure (TLF) rate was 6.8%, mainly consisting of clinically driven target lesion revascularisations (6.0%). Patients with NSTEMI had significantly higher TLF rates than those without (9.3% vs 6.2%; p=0.025), whereas there were no significant differences observed for patients with diabetes or with type B2/C lesions (a 24-month TLF rate of 7.0% and 7.9%, respectively). The 24-month rate of definite or probable scaffold thrombosis was 0.8%. Half of the scaffold thromboses occurred after premature discontinuation of antiplatelet/anticoagulation therapy, and only one scaffold thrombosis occurred beyond the 6-month follow-up, on day 391., Conclusions: The BIOSOLVE-IV registry showed good safety and efficacy outcomes, confirming a safe rollout of the Magmaris into clinical practice.
Published: 2023
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49. Effects of Atrioventricular Optimization on Left Ventricular Reverse Remodeling With Cardiac Resynchronization Therapy: Results of the SMART-CRT Trial.

Author: Gold MR, Ellenbogen KA, Leclercq C, Lowy J, Rials SJ, Shoda M, Tomassoni G, Issa Z, Sarrazin JF, Jennings JM, Nair DG, Wold N, Yong P, Harbin MM, Stein KM, and Auricchio A
Subjects: Humans, Female, Prospective Studies, Treatment Outcome, Ventricular Function, Left physiology, Ventricular Remodeling physiology, Cardiac Resynchronization Therapy methods, Heart Failure diagnosis, Heart Failure therapy
Abstract: Background: The role of atrioventricular optimization (AVO) to improve cardiac resynchronization therapy outcomes remains controversial. Previous post hoc analyses of a multicenter trial showed that measures of electrical dyssynchrony (right ventricular-left ventricular [LV] or LV electrical delay durations) are associated with patients who benefit from AVO., Methods: This was a global, multicenter, prospective, randomized trial of de novo cardiac resynchronization therapy implant patients with an right ventricular-LV duration ≥70 ms to determine whether AVO results in greater reverse remodeling. Patients were randomized 1:1 for either an AVO algorithm (SmartDelay) that determines atrioventricular delay and pacing chamber, biventricular or LV only, or a fixed atrioventricular delay of 120 ms with biventricular pacing. Paired echocardiograms performed at baseline and 6 months were evaluated. The primary end point was echocardiographic cardiac resynchronization therapy response, defined dichotomously as a >15% reduction in LV end-systolic volume., Results: A total of 310 patients (n=120 women) were randomized and had completed 6 months of follow-up. The echocardiographic cardiac resynchronization therapy response rate did not statistically differ between the groups (SmartDelay, 74.8%; fixed, 67.7%; P =0.17). Analyses of prespecified secondary end points demonstrated significant improvements in the absolute (median: SmartDelay, -41.0 mL; fixed, -33.0 mL; P =0.01) and relative change in LV end-systolic volume (SmartDelay, -38.3%; fixed, -27.8%; P =0.03) for patients with SmartDelay optimization. Similar results were observed for the relative improvement in LV ejection fraction (SmartDelay, 46.7%; fixed, 32.1%; P =0.050); absolute improvement in LV ejection fraction trended to be higher with SmartDelay ( P =0.06)., Conclusions: Analysis of reverse remodeling parameters demonstrated that AVO via SmartDelay, relative to the nonoptimized fixed atrioventricular delay comparator group, improved absolute and relative changes in LV function in patients with longer right ventricular-LV duration., Registration: URL: https://www., Clinicaltrials: gov; Unique identifier: NCT03089281., Competing Interests: Disclosures Dr Gold reports receiving research support from Abbott, Boston Scientific, and Medtronic; consulting fees from Boston Scientific, EBR systems, and Medtronic; and honoraria for lectures from Boston Scientific and Medtronic. Dr Ellenbogen reports receiving research support from Medtronic and Boston Scientific; consultation fees from Abbott; and honoraria for lectures from Boston Scientific and Medtronic. Dr Leclercq has received compensation for lectures from Abbott, Biotronik, Boston Scientific, Medtronic, and Microport. Dr Issa is a medical advisory board member for Boston Scientific. Dr Nair reports receiving research support, consultation, advisory board, education, and training fees from Abbott, Boston Scientific, Medtronic, and Adagio and advisory board fees from Biosense Webster. Four authors (N. Wold, P. Yong, Dr Harbin, and Dr Stein) are employees of Boston Scientific. Dr Auricchio is a consultant with Boston Scientific, Backbeat, Biosense Webster, Cairdac, Corvia, Daiichi Sankyo, Medtronic, Merit, Microport CRM, and Philips; received speaker fees from Daiichi Sankyo, Boston Scientific, Biosense Webster, Medtronic, Microport CRM, and Philips; participates in clinical trials sponsored by Boston Scientific, Medtronic, Microport CRM, and Zoll Medical; and has intellectual properties assigned to Boston Scientific, Biosense Webster, and Microport CRM. The other authors report no conflicts.
Published: 2023
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50. Association Between Postresuscitation 12-Lead ECG Features and Early Mortality After Out-of-Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study.

Author: Gentile FR, Baldi E, Klersy C, Schnaubelt S, Caputo ML, Clodi C, Bruno J, Compagnoni S, Fasolino A, Benvenuti C, Domanovits H, Burkart R, Primi R, Ruzicka G, Holzer M, Auricchio A, and Savastano S
Subjects: Male, Humans, Female, Middle Aged, Aged, Coronary Angiography methods, Survival Rate, Electrocardiography methods, Out-of-Hospital Cardiac Arrest diagnosis, Out-of-Hospital Cardiac Arrest therapy, Cardiopulmonary Resuscitation methods
Abstract: Background Once the return of spontaneous circulation after out-of-hospital cardiac arrest is achieved, a 12-lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30-day survival in patients with out-of-hospital cardiac arrest. Methods and Results All the post-return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53-70 years). After correction for the return of spontaneous circulation-to-ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21-2.61]; P =0.003), female sex (HR, 1.5 [95% CI, 1.05-2.13]; P =0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43-1.87]; P <0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39-1.59]; P <0.001), and the presence of ST-segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59-1.93]; P <0.001) were independently associated with 30-day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0-4, 73%; score 5-7, 66%; score 8-26, 45%). Conclusions The post-return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out-of-hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out-of-hospital cardiac arrest.
Published: 2023
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