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ObjectiveThe characteristics of discrete intracardiac electrograms in selective left bundle branch (SLBB) pacing (SLBBP) have not been described in detail previously. This study aimed to examine the effect of different high-pass filter (HPF) settings on discrete ventricular components in an intracardiac electrogram (EGM) and to analyze its possible mechanisms.MethodsThis study included 95 patients with indications of permanent cardiac pacing. EGMs were collected at four different HPF settings (30, 60, 100, and 200 Hz) with a low-pass filter at 500 Hz, and their possible mechanisms were analyzed.ResultsLBBP was successfully achieved in 92.6% (88/95) of patients. SLBBP was achieved in 80 patients. The occurrence rates of discrete EGM were 18.9%, 40.0%, 74.7%, and 84.2% for HPF settings of 30 Hz, 60 Hz, 100 Hz, and 200 Hz, respectively. The analysis of discrete ECG detection showed significant differences between the different HPF settings. By using the discrete EGM as the SLBB capture golden standard, the results of EGMs revealed that the 30 Hz HPF has a sensitivity of 23% and specificity of 100%. The 60 Hz HPF had a sensitivity of 48% and a specificity of 100%. The 100 Hz HPF had a sensitivity of 89% and a specificity of 100%. The 200 Hz HPF had a sensitivity of 100% and specificity of 100%.ConclusionsAn optimal HPF setting of 200 Hz is recommended for discrete electrogram detection. A discrete EGM should exhibit an isoelectric interval. A steep deflection and spinous ventricular EGM morphology nearly identify an intrinsic EGM morphology.

BACKGROUND AND PURPOSE Sleep disturbance and cognitive impairment are common and related in the elderly population worldwide. The aim of the present study was to explore the association between sleep disturbance and motoric cognitive risk (MCR) syndrome, which is characterized by subjective cognitive complaints and objective slow gait in older individuals without dementia or any mobility disability in the community-dwelling elderly Chinese population. METHODS We recruited 940 participants aged ≥65 years from November 2016 to March 2017 in the Ningbo Community Study on Aging (NCSA). Self-reported sleep duration and sleep-quality variables, comprehensive geriatric evaluation, as well as indicators for diagnosing MCR syndrome were evaluated in this cross-sectional study. RESULTS Multiple logistic regression analysis showed that a 1-SD increase in night (1.1 h) and 24-h sleep duration (1.3 h) was associated, respectively, with a 21% (95% confidence interval [CI], 1%-47%; p = 0.04) and 30% (95% CI, 3%-64%; p = 0.03) higher odds of having MCR syndrome. Considering sleep duration as a categorical variable, longer night-sleep duration (>8.5 h) was associated with MCR syndrome (OR, 2.03; p = 0.02) compared to shorter night-sleep duration (

Geriatric Nutritional Risk Index (GNRI) is a promising tool for predicting nutrition-related complications. This meta-analysis sought to determine the prognostic utility of GNRI in elderly patients with heart failure. We comprehensively searched the PubMed and Embase databases from their inception to July 2019. Original studies investigating the prognostic value of GNRI in patients with heart failure were included. Outcome of interests were all-cause mortality and major cardiovascular events. The prognostic value of GNRI was expressed as risk ratios (RR) with 95% confidence intervals (CI) for the lowest versus the highest GNRI category or continuous GNRI analysis. Eleven articles (10 studies) involving 10,589 elderly heart failure patients were included. Meta-analysis indicated that heart failure patients with the lowest GNRI had an increased risk of all-cause mortality (RR 2.11; 95% CI 1.72–2.58) and major cardiovascular events (RR 2.00; 95% CI 1.24–3.22) after adjustment for confounding. In addition, each unit reduction in GNRI significantly increased 6% risk of all-cause mortality. Lower GNRI independently predicts all-cause mortality and major cardiovascular events in elderly patients with heart failure. Determination of nutritional status using GNRI may improve risk stratification in elderly patients with heart failure.

Transcatheter aortic valve replacement (TAVR) is a revolutionized treatment for severe aortic valve stenosis. Although new and improved TAVR devices are constantly being developed, cardiac conduction abnormalities post-TAVR requiring permanent pacemaker implantation (PPMI) still occur frequently. Previously, pre-existing right bundle branch block (RBBB) has been shown to be predictive of PPMI after TAVR, while occurrence of new left bundle branch block (LBBB) was associated with a higher rate of PPMI. However, less attention has been paid to the clinical values of new-onset RBBB post-TAVR. To our knowledge, this is the first report focus on the association of new-onset RBBB and PPMI after TAVR. Sometimes only changes in the right bundle branch can be detected, but the patient may have co-existing severe conduction block at this time, which caused adverse events including Adams-Stokes syndrome. New-onset RBBB post-TAVR may also have important clinical implications.

Objective. Current findings on the association between MMP-9 rs3918242 and susceptibility to myocardial infarction (MI) are inconsistent, and their definite relationship is discussed in this meta-analysis. Methods. Eligible literatures reporting MMP-9 rs3918242 and susceptibility to MI were searched in PubMed, Cochrane Library, CNRI, and VIP using keywords such as “MMP-9”, “matrix metallopeptidase-9” and “myocardial infarction”, “acute myocardial infarction”, “AMI”, and “polymorphism”. Data from eligible literatures were extracted for calculating OR and corresponding 95% CI using RevMan 5.3 and STATA12.0. Results. Ten independent literatures reporting MMP-9 rs3918242 and susceptibility to MI were enrolled. Compared with subjects carrying CT&TT genotype of MMP-9 rs3918242, susceptibility to MI was lower in those carrying CC genotype ( OR = 1.49 , 95 % CI = 1.19 – 1.86 , P = 0.0004 ). Such a significance was observed in the overdominant ( OR = 1.27 , 95 % CI = 1.14 – 1.41 , P < 0.0001 ) and allele genetic models ( OR = 1.43 , 95 % CI = 1.17 – 1.74 , P = 0.0005 ) as well. This finding was also valid in the Asian population. Conclusions. Mutation on MMP-9 rs3918242 has a potential relevance with susceptibility to MI.

Transcatheter aortic valve replacement (TAVR) is a revolutionized treatment for severe aortic valve stenosis. Although new and improved TAVR devices are constantly being developed, cardiac conduction abnormalities post-TAVR requiring permanent pacemaker implantation (PPMI) still occur frequently1. Previously, pre-existing right bundle branch block (RBBB) has been shown to be predictive of PPMI after TAVR compared with patients without RBBB2, while occurrence of new left bundle branch block (LBBB) was associated with a higher rate of PPMI3. However, less attention has been paid to the clinical values of new onset non-LBBB conduction disturbances such as RBBB, left anterior fascicular block (LAFB) or atrioventricular block (AVB). To our knowledge, this is the first report focus on the association of new-onset non-LBBB and PPMI after TAVR. The study was approved by the Ethics Committee of HwaMei Hospital, University of Chinese Academy of Sciences. This article is protected by copyright. All rights reserved.

BackgroundIn the treatment of coronary heart disease, target vessel revascularization (TVR) has attracted increasing attention as an efficient means of percutaneous coronary intervention (PCI). The purpose of this study was to explore the association between stent diameter and TVR in patients undergoing PCI.MethodsThis was a secondary retrospective analysis involving patients with PCI with at least one stent implanted. Information was obtained from the Dryad Digital Repository. Multivariable logistic regression models, interaction analyses, subgroup analyses and piecewise linear regression models were used to evaluate the association between stent diameter and TVR.ResultsA total of 2522 patients were eventually enrolled in this study, of which 122 (4.8%) had undergone TVR. Significant positive associations were observed between stent diameter and TVR (continuous: odds ratio [OR] 0.485, 95% confidence interval [CI] 0.305–0.773, P = 0.002; categorical variable: T2 vs. T1, OR 0.541, 95% CI 0.348–0.843; T3 vs. T1, OR 0.520, 95% CI 0.334–0.809; P for trend = 0.005). The association remained stable in the fully adjusted model (continuous: OR 0.526, 95% CI 0.306–0.902, P = 0.020; categorical variable: T2 vs. T1, OR 0.510, 95% CI 0.310–0.839; T3 vs. T1, OR 0.585, 95% CI 0.352–0.973; P for trend = 0.042). Among the subgroups of differing clinical presentations, stent diameter was a powerful protective factor for TVR, especially in the delayed PCI group (P for interaction = 0.002). The association was highly consistent across all the other subgroups studied (all P for interaction > 0.05). In the piecewise linear regression model, the need for TVR decreased with an increase in stent diameter when this ranged between 2.5 and 2.9 mm (OR 0.01, 95% CI: 0.01–0.13, P ConclusionsA large stent diameter is a powerful protective factor for TVR in PCI patients, especially in the delayed PCI group. This “bigger-is-better” protective effect is remarkable in stents with diameter 2.5–2.9 mm.

Conflicting results have been reported on the association between blood level of interleukin-6 and adverse outcomes in patients with acute coronary syndrome (ACS). The current meta-analysis aimed to evaluate the predictive utility of elevated blood interleukin-6 level in patients with ACS. A systematically literature search was performed using PubMed and Embase databases up to December 31, 2019. Observational studies or post hoc analysis of randomized controlled trials investigating the values of blood interleukin-6 level for predicting major adverse cardiovascular events (MACE including death, re-infarction, revascularization, angina, heart failure, malignant arrhythmia, or stroke), all-cause mortality or cardiovascular mortality in ACS patients were eligible. The predictive values were summarized by pooling the multivariable-adjusted risk ratio (RR) and 95% confidence intervals (CI) for the highest versus lowest category of interleukin-6 level. Thirteen studies enrolling 30,289 patients with ACS were included. When comparing the highest with lowest category of interleukin-6 level, the pooled RR was 1.29 (95% CI 1.12–1.48) for MACE, 1.50 (95% CI 1.35–1.67) for all-cause mortality, and 1.55 (95% CI 1.06–2.28) for cardiovascular mortality, respectively. Moreover, the predictive values of interleukin-6 level on MACE were consistently found in different study designs, subtypes of patients, sample sizes, follow-up duration, and cutoff value of interleukin-6 elevation subgroups. Increased blood level of interleukin-6may be independently associated with higher risk of MACE, cardiovascular and all-cause mortality in patients with ACS. Measurement of blood interleukin-6 level has potential to improve risk stratification of ACS.