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1. Significance of prolonged QTc in acute exacerbations of COPD requiring hospitalization

Author

Van Oekelen O, Vermeersch K, Everaerts S, Vandenberk B, Willems R, and Janssens W

Subjects
COPD — acute exacerbation — cardiovascular morbidity — prolonged QT interval — ECG, Diseases of the respiratory system, RC705-779
Abstract

Oliver Van Oekelen,1,* Kristina Vermeersch,1,2,* Stephanie Everaerts,1,2 Bert Vandenberk,3,4 Rik Willems,3,4 Wim Janssens1,2 1Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium; 2Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases, KU Leuven, Leuven, Belgium; 3Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; 4Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium *These authors contributed equally to this work Background: A prolonged QT interval is associated with increased risk of Torsade de Pointes and cardiovascular death. The prevalence and clinical relevance of QT prolongation in acute exacerbations of COPD (AECOPD), with high risk for cardiac morbidity and mortality, is currently unclear. Methods: A dual cross-sectional study strategy was therefore designed. A retrospective study evaluated 140 patients with an AECOPD requiring hospitalization, half of which had prolonged QTc on the admission ECG. Univariate and multivariate analyses were conducted to determine associated factors; Kaplan–Meier and Cox regression analyses to assess prognostic significance. A prospective study evaluated 180 pulmonary patients with acute respiratory problems requiring hospitalization, to determine whether a prolonged QTc at admission represents an AECOPD-specific finding and to investigate the change in QTc-duration during hospitalization. Results: Retrospectively, hypokalemia, cardiac troponin T and conductance abnormalities on ECG were significantly and independently associated with QTc prolongation. A prolonged QTc was associated with increased all-cause mortality (HR 2.698 (95% CI 1.032–7.055), p=0.043), however, this association was no longer significant when corrected for age, FEV1 and cardiac troponin T. Prospectively, QTc prolongation was observed in 1/3 of the patients diagnosed with either an AECOPD, lung cancer, pulmonary infection or miscellaneous acute pulmonary disease, and was not more prevalent in AECOPD. The QTc-duration decreased significantly during hospitalization in patients with and without COPD. Conclusion: A prolonged QTc is a marker of underlying cardiovascular disease during an AECOPD. It is not COPD-specific, but a common finding during the acute phase of a pulmonary disease requiring urgent hospital admission. Keywords: COPD, acute exacerbation, cardiovascular morbidity, prolonged QT interval, ECG, Bazett

Published
2018

2. Present criteria for prophylactic ICD implantation: Insights from the EU-CERT-ICD (Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in EUrope) project

Author

Zabel, M., Schlögl, S., Lubinski, A., Svendsen, J. H., Bauer, A., Arbelo, E., Brusich, S., Conen, D., Cygankiewicz, I., Dommasch, M., Flevari, P., Galuszka, J., Hansen, J., Hasenfuß, G., Hatala, R., Huikuri, H. V., Kenttä, T., Kuczejko, T., Haarmann, H., Harden, M., Iovev, S., Kääb, S., Kaliska, G., Katsimardos, A., Kasprzak, J. D., Qavoq, D., Lüthje, L., Malik, M., Novotny, T., Pavlovic, N., Perge, P., Röver, C., Schmidt, G., Shalganov, T., Sritharan, R., Svetlosak, M., Sallo, Z., Szavits-Nossan, J., Traykov, V., Vandenberk, B., Velchec, V., Vos, M. A., Willich, S. N., Friede, T., Willems, R., Merkely, B., Sticherling, C., and investigators, the EU-CERT-ICD study

Subjects
Statistics - Applications
Abstract

BACKGROUND. The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. It is urgently needed to better identify patients who benefit from prophylactic ICD therapy. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) completed in 2019 will assess this issue. SUMMARY. The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicenter observational cohort study done in 44 centers across 15 European countries. A total of 2327 patients with heart failure due to ischemic heart disease or dilated cardiomyopathy indicated for primary prophylactic ICD implantation were recruited between 2014 and 2018 (>1500 patients at first ICD implantation, >750 patients non-randomized non-ICD control group). The primary endpoint was all-cause mortality, first appropriate shock was co-primary endpoint. At baseline, all patients underwent 12-lead ECG and Holter-ECG analysis using multiple advanced methods for risk stratification as well as documentation of clinical characteristics and laboratory values. The EU-CERT-ICD data will provide much needed information on the survival benefit of preventive ICD therapy and expand on previous prospective risk stratification studies which showed very good applicability of clinical parameters and advanced risk stratifiers in order to define patient subgroups with above or below average ICD benefit. CONCLUSION. The EU-CERT-ICD study will provide new and current data about effectiveness of primary prophylactic ICD implantation. The study also aims for improved risk stratification and patient selection using clinical risk markers in general, and advanced ECG risk markers in particular., Comment: 22 pages, 3 figures

Published
2019
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3. Predictors of and outcomes in arrhythmic mitral valve prolapse

Author

L'hoyes, W, primary, Robyns, T, additional, Moura-Ferreira, S, additional, De Meester, P, additional, Dresselaers, T, additional, Herregods, M C, additional, Rega, F, additional, Masci, P G, additional, Willems, R, additional, Bogaert, J, additional, and Vandenberk, B, additional

Published
2023
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4. Long‐term outcome after upgrade to cardiac resynchronization therapy: A propensity score‐matched analysis

Author

Trenson, Sander, primary, Voros, Gabor, additional, Martens, Pieter, additional, Ingelaere, Sebastian, additional, Betschart, Pascal, additional, Voigt, Jens‐Uwe, additional, Dupont, Matthias, additional, Breitenstein, Alexander, additional, Steffel, Jan, additional, Willems, Rik, additional, Ruschitzka, Frank, additional, Mullens, Wilfried, additional, Winnik, S., additional, and Vandenberk, B., additional

Published
2023
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5. QRS complex and T wave planarity for the prediction of death and appropriate shocks in recipients of prophylactic implantable defibrillators

Author

Novotny, T, primary, Hnatkova, K, additional, Andrsova, I, additional, Vandenberk, B, additional, Sprenkeler, D J, additional, Junttila, J, additional, Reichlin, T, additional, Schloegl, S, additional, Friede, T, additional, Bauer, A, additional, Willems, R, additional, Schmidt, G, additional, Sticherling, C, additional, Zabel, M, additional, and Malik, M, additional

Published
2023
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7. Myocardial Fibrosis at Cardiac MRI Helps Predict Adverse Clinical Outcome in Patients with Mitral Valve Prolapse

Author

Figliozzi, S, Georgiopoulos, G, Lopes, P, Bauer, K, Moura-Ferreira, S, Tondi, L, Mushtaq, S, Censi, S, Pavon, A, Bassi, I, Servato, M, Teske, A, Biondi, F, Filomena, D, Pica, S, Torlasco, C, Muraru, D, Monney, P, Quattrocchi, G, Maestrini, V, Agati, L, Monti, L, Pedrotti, P, Vandenberk, B, Squeri, A, Lombardi, M, Ferreira, A, Schwitter, J, Aquaro, G, Chiribiri, A, Rodríguez Palomares, J, Yilmaz, A, Andreini, D, Florian, A, Leiner, T, Abecasis, J, Badano, L, Bogaert, J, Masci, P, Figliozzi, Stefano, Georgiopoulos, Georgios, Lopes, Pedro M, Bauer, Klemens B, Moura-Ferreira, Sara, Tondi, Lara, Mushtaq, Saima, Censi, Stefano, Pavon, Anna Giulia, Bassi, Ilaria, Servato, Maria Luz, Teske, Arco J, Biondi, Federico, Filomena, Domenico, Pica, Silvia, Torlasco, Camilla, Muraru, Denisa, Monney, Pierre, Quattrocchi, Giuseppina, Maestrini, Viviana, Agati, Luciano, Monti, Lorenzo, Pedrotti, Patrizia, Vandenberk, Bert, Squeri, Angelo, Lombardi, Massimo, Ferreira, António M, Schwitter, Juerg, Aquaro, Giovanni Donato, Chiribiri, Amedeo, Rodríguez Palomares, José F, Yilmaz, Ali, Andreini, Daniele, Florian, Anca, Leiner, Tim, Abecasis, João, Badano, Luigi, Bogaert, Jan, Masci, Pier-Giorgio, Figliozzi, S, Georgiopoulos, G, Lopes, P, Bauer, K, Moura-Ferreira, S, Tondi, L, Mushtaq, S, Censi, S, Pavon, A, Bassi, I, Servato, M, Teske, A, Biondi, F, Filomena, D, Pica, S, Torlasco, C, Muraru, D, Monney, P, Quattrocchi, G, Maestrini, V, Agati, L, Monti, L, Pedrotti, P, Vandenberk, B, Squeri, A, Lombardi, M, Ferreira, A, Schwitter, J, Aquaro, G, Chiribiri, A, Rodríguez Palomares, J, Yilmaz, A, Andreini, D, Florian, A, Leiner, T, Abecasis, J, Badano, L, Bogaert, J, Masci, P, Figliozzi, Stefano, Georgiopoulos, Georgios, Lopes, Pedro M, Bauer, Klemens B, Moura-Ferreira, Sara, Tondi, Lara, Mushtaq, Saima, Censi, Stefano, Pavon, Anna Giulia, Bassi, Ilaria, Servato, Maria Luz, Teske, Arco J, Biondi, Federico, Filomena, Domenico, Pica, Silvia, Torlasco, Camilla, Muraru, Denisa, Monney, Pierre, Quattrocchi, Giuseppina, Maestrini, Viviana, Agati, Luciano, Monti, Lorenzo, Pedrotti, Patrizia, Vandenberk, Bert, Squeri, Angelo, Lombardi, Massimo, Ferreira, António M, Schwitter, Juerg, Aquaro, Giovanni Donato, Chiribiri, Amedeo, Rodríguez Palomares, José F, Yilmaz, Ali, Andreini, Daniele, Florian, Anca, Leiner, Tim, Abecasis, João, Badano, Luigi, Bogaert, Jan, and Masci, Pier-Giorgio

Abstract

Background: Patients with mitral valve prolapse (MVP) may develop adverse outcomes even in the absence of mitral regurgitation or left ventricular (LV) dysfunction. Purpose: To investigate the prognostic value of mitral annulus disjunction (MAD) and myocardial fibrosis at late gadolinium enhancement (LGE) cardiac MRI in patients with MVP without moderate-to-severe mitral regurgitation or LV dysfunction. Materials and Methods: In this longitudinal retrospective study, 118 144 cardiac MRI studies were evaluated between October 2007 and June 2020 at 15 European tertiary medical centers. Follow-up was from the date of cardiac MRI examination to June 2020; the minimum and maximum follow-up intervals were 6 months and 156 months, respectively. Patients were excluded if at least one of the following conditions was present: cardiomyopathy, LV ejection fraction less than 40%, ischemic heart disease, congenital heart disease, inflammatory heart disease, moderate or worse mitral regurgitation, participation in competitive sport, or electrocardiogram suggestive of channelopathies. In the remainder, cardiac MRI studies were reanalyzed, and patients were included if they were aged 18 years or older, MVP was diagnosed at cardiac MRI, and clinical information and electrocardiogram monitoring were available within 3 months from cardiac MRI examination. The end point was a composite of adverse outcomes: sustained ventricular tachycardia (VT), sudden cardiac death (SCD), or unexplained syncope. Multivariable Cox regression analysis was performed. Results: A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 women) were included. Over a median follow-up of 3.3 years, 18 patients (4%) reached the study end point. LGE presence (hazard ratio, 4.2 [95% CI: 1.5, 11.9]; P = .006) and extent (hazard ratio, 1.2 per 1% increase [95% CI: 1.1, 1.4]; P = .006), but not MAD presence (P = .89), were associated with clinical outcome. LGE presence had incremental prognostic value over MVP severi

Published
2023

9. PATIENTS WITH NON-ISCHEMIC CARDIOMYOPATHY AND MID-WALL STRIAE HAVE SIMILAR OUTCOMES AS PATIENTS WITH ISCHEMIC CARDIOMYOPATHY: A PROPENSITY-MATCHED ANALYSIS

Author

Ballantyne, B., primary, Vandenberk, B., additional, Dykstra, S., additional, Labib, D., additional, Chew, D., additional, Heydari, B., additional, Lydell, C., additional, Howarth, A., additional, Fine, N., additional, Howlett, J., additional, White, J., additional, and Miller, R., additional

Published
2022
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11. A machine learning algorithm for electrocardiographic fQRS quantification validated on multi-center data

Author

Villa, A. (Amalia), Vandenberk, B. (Bert), Kenttä, T. (Tuomas), Ingelaere, S. (Sebastian), Huikuri, H. V. (Heikki V.), Zabel, M. (Markus), Friede, T. (Tim), Sticherling, C. (Christian), Tuinenburg, A. (Anton), Malik, M. (Marek), Van Huffel, S. (Sabine), Willems, R. (Rik), Varon, C. (Carolina), Villa, A. (Amalia), Vandenberk, B. (Bert), Kenttä, T. (Tuomas), Ingelaere, S. (Sebastian), Huikuri, H. V. (Heikki V.), Zabel, M. (Markus), Friede, T. (Tim), Sticherling, C. (Christian), Tuinenburg, A. (Anton), Malik, M. (Marek), Van Huffel, S. (Sabine), Willems, R. (Rik), and Varon, C. (Carolina)

Abstract

Fragmented QRS (fQRS) is an electrocardiographic (ECG) marker of myocardial conduction abnormality, characterized by additional notches in the QRS complex. The presence of fQRS has been associated with an increased risk of all-cause mortality and arrhythmia in patients with cardiovascular disease. However, current binary visual analysis is prone to intra- and inter-observer variability and different definitions are problematic in clinical practice. Therefore, objective quantification of fQRS is needed and could further improve risk stratification of these patients. We present an automated method for fQRS detection and quantification. First, a novel robust QRS complex segmentation strategy is proposed, which combines multi-lead information and excludes abnormal heartbeats automatically. Afterwards extracted features, based on variational mode decomposition (VMD), phase-rectified signal averaging (PRSA) and the number of baseline-crossings of the ECG, were used to train a machine learning classifier (Support Vector Machine) to discriminate fragmented from non-fragmented ECG-traces using multi-center data and combining different fQRS criteria used in clinical settings. The best model was trained on the combination of two independent previously annotated datasets and, compared to these visual fQRS annotations, achieved Kappa scores of 0.68 and 0.44, respectively. We also show that the algorithm might be used in both regular sinus rhythm and irregular beats during atrial fibrillation. These results demonstrate that the proposed approach could be relevant for clinical practice by objectively assessing and quantifying fQRS. The study sets the path for further clinical application of the developed automated fQRS algorithm.

Published
2022

14. Appropriate shocks and mortality in patients with versus without diabetes with prophylactic implantable cardioverter defibrillators

Author

Junttila, M. J. (M. Juhani), Pelli, A. (Ari), Kenttä, T. V. (Tuomas V.), Friede, T. (Tim), Willems, R. (Rik), Bergau, L. (Leonard), Malik, M. (Marek), Vandenberk, B. (Bert), Vos, M. A. (Marc A.), Schmidt, G. (Georg), Merkely, B. (Bela), Lubinski, A. (Andrzej), Svetlosak, M. (Martin), Braunschweig, F. (Frieder), Harden, M. (Markus), Zabel, M. (Markus), Huikuri, H. V. (Heikki V.), Sticherling, C. (Christian), Junttila, M. J. (M. Juhani), Pelli, A. (Ari), Kenttä, T. V. (Tuomas V.), Friede, T. (Tim), Willems, R. (Rik), Bergau, L. (Leonard), Malik, M. (Marek), Vandenberk, B. (Bert), Vos, M. A. (Marc A.), Schmidt, G. (Georg), Merkely, B. (Bela), Lubinski, A. (Andrzej), Svetlosak, M. (Martin), Braunschweig, F. (Frieder), Harden, M. (Markus), Zabel, M. (Markus), Huikuri, H. V. (Heikki V.), and Sticherling, C. (Christian)

Abstract

Objective: Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The exact mechanisms leading to sudden death in diabetes are not well known. We compared the incidence of appropriate shocks and mortality in patients with versus without diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included in the retrospective EU-CERT-ICD registry. Research design and methods and results: A total of 3,535 patients from 12 European EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patients (28%) had a history of diabetes. All patients had an ICD implanted for primary SCD prevention. End points were appropriate shock and all-cause mortality. Mean follow-up time was 3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted hazard ratio [HR] 0.77 [95% CI 0.62–0.96], P = 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11–1.53], P = 0.001). Conclusions: All-cause mortality is higher in patients with diabetes than in patients without diabetes with primary prophylactic ICDs. Subsequently, patients with diabetes have a lower incidence of appropriate ICD shocks, indicating that the excess mortality might not be caused primarily by ventricular tachyarrhythmias. These findings suggest a limitation of the potential of prophylactic ICD therapy to improve survival in patients with diabetes with impaired left ventricular function.

Published
2020

15. Rationale and design of the EU-CERT-ICD prospective study: comparative effectiveness of prophylactic ICD implantation

Author

Zabel, Markus, Sticherling, Christian, Willems, Rik, Lubinski, Andrzej, Bauer, Axel, Bergau, Leonard, Braunschweig, Frieder, Brugada, Josep, Brusich, Sandro, Conen, David, Cygankiewicz, Iwona, Flevari, Panagiota, Taborsky, Milos, Hansen, Jim, Hasenfuss, Gerd, Hatala, Robert, Huikuri, Heikki V, Iovev, Svetoslav, Kaeaeb, Stefan, Kaliska, Gabriela, Kasprzak, Jaroslaw D, Luethje, Lars, Malik, Marek, Novotny, Tomas, Pavlovic, Nikola, Schmidt, Georg, Shalganov, Tchavdar, Sritharan, Rajeeva, Schloegl, Simon, Traykov, Vassil, Tuinenburg, Anton E, Velchev, Vasil, Vos, Marc A, Willich, Stefan N, Friede, Tim, Svendsen, Jesper Hastrup, Merkely, Bela, Seegers, J, Munoz-Exposito, P, Tichelbacker, T, Kirovo, A, Joerss, K, Macken, J, Misdaq, M, Rudolph, K, Mueller, A, Dommasch, M, Sinnecker, D, Sinner, M, Dissmann, R, Burmester, U, Behrens, S, Gregor, M, Stefanow, S, Rueb, N, Wolpert, C, Bimmel, D, Lieberz, C, Maier, L, Schwinger, R, Blaschke, F, Pieske, B, Groenefeld, G, Klein, G, Gardiwal, A, Szeplaki, G, Perge, P, Nossan, J Szavits, Rotkvic, L, Manola, S, Vinter, O, Benko, I, Brusic, S, Avdovic, E, Klasan, M, Bakotic, Z, Anic, A, Kowalczyk, E, Kucejko, T, Czechowska, A, Wybor, K, Ptaszynski, P, Qavoq, H, Guzik, P, Krauze, T, Sterlinski, M, Svetlosak, M, Martinek, J, Thamsborg, K, Schloett-Hyldelund, IM, Laage-Petersen, J, Vandenberk, B, van Soest, S, Giesebart, S, Kozak, M, Galuszka, J, Wijers, S, Dunnink, A, Sprenkeler, D, Arbelo, E, Trucco, E, Vidorreta, S, Kentta, T, Pelli, A, Huikuri, P, Koski, P, Karlsson, H, Ersgaard, D, Platonov, P, Klingenheben, T, Scharfe, M, Reinhold, T, Cree, M, Hnatkova, K, Gerhardt, J, Rizas, K, Hamm, W, Roever, C, Harden, M, Kessel, B, Berg, A, Apel, S, Walker, F, Kirchhof, N, Goerlitz, A, Molitor, A, Heinrich, J, Annetzberger, S, Fuchs, B, Landwehr, A, Merk, A, Wilke, A, Hennecke, C, and Mansch, R

Subjects
Science & Technology, Cardiac & Cardiovascular Systems, SEX-DIFFERENCES, SEATTLE HEART-FAILURE, RISK STRATIFICATION, EJECTION FRACTION, Sudden cardiac death, Risk factors, MYOCARDIAL-INFARCTION, CARDIOVERTER-DEFIBRILLATOR THERAPY, Implantable cardioverter defibrillator, Cardiovascular System & Cardiology, APPROPRIATE SHOCKS, Mortality, PRIMARY PREVENTION, PROPORTIONAL RISK, Life Sciences & Biomedicine
Abstract

AIMS: The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) aims to assess its current clinical value. METHODS AND RESULTS: The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non-randomized control group). The primary endpoint is all-cause mortality; the co-primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost-effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12-lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years. CONCLUSIONS: The EU-CERT-ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers. ispartof: ESC HEART FAILURE vol:6 issue:1 pages:182-193 ispartof: location:England status: published

Published
2019

16. Present criteria for prophylactic ICD implantation:insights from the EU-CERT-ICD (Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in EUrope) project

Author

Zabel, M. (Markus), Schloegl, S. (Simon), Lubinski, A. (Andrzej), Svendsen, J. H. (Jesper Hastrup), Bauer, A. (Axel), Arbelo, E. (Elena), Brusich, S. (Sandro), Conen, D. (David), Cygankiewicz, I. (Iwona), Dommasch, M. (Michael), Flevari, P. (Panagiota), Galuszka, J. (Jan), Hansen, J. (Jim), Hasenfuss, G. (Gerd), Hatala, R. (Robert), Huikuri, H. V. (Heikki V.), Kentta, T. (Tuomas), Kucejko, T. (Tomasz), Haarmann, H. (Helge), Harden, M. (Markus), Iovev, S. (Svetoslav), Kaab, S. (Stefan), Kaliska, G. (Gabriela), Katsimardos, A. (Andreas), Kasprzak, J. D. (Jaroslaw D.), Qavoq, D. (Dariusz), Luethje, L. (Lars), Malik, M. (Marek), Novotny, T. (Tomas), Pavlovic, N. (Nikola), Perge, P. (Peter), Roever, C. (Christian), Schmidt, G. (Georg), Shalganov, T. (Tchavdar), Sritharan, R. (Rajeeva), Svetlosak, M. (Martin), Sallo, Z. (Zoltan), Szavits-Nossan, J. (Janko), Traykov, V. (Vassil), Vandenberk, B. (Bert), Velchev, V. (Vasil), Vos, M. A. (Marc A.), Willich, S. N. (Stefan N.), Friede, T. (Tim), Willems, R. (Rik), Merkely, B. (Bela), and Sticherling, C. (Christian)

Subjects
Sudden cardiac death, Risk factors, Implantable cardioverter defibrillator, Mortality
Abstract

Background: The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. It is urgently needed to better identify patients who benefit from prophylactic ICD therapy. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) completed in 2019 will assess this issue. Summary: The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicenter observational cohort study done in 44 centers across 15 European countries. A total of 2327 patients with heart failure due to ischemic heart disease or dilated cardiomyopathy indicated for primary prophylactic ICD implantation were recruited between 2014 and 2018 (>1500 patients at first ICD implantation, >750 patients non-randomized non-ICD control group). The primary endpoint was all-cause mortality, and first appropriate shock was co-primary endpoint. At baseline, all patients underwent 12‑lead ECG and Holter-ECG analysis using multiple advanced methods for risk stratification as well as documentation of clinical characteristics and laboratory values. The EU-CERT-ICD data will provide much needed information on the survival benefit of preventive ICD therapy and expand on previous prospective risk stratification studies which showed very good applicability of clinical parameters and advanced risk stratifiers in order to define patient subgroups with above or below average ICD benefit. Conclusion: The EU-CERT-ICD study will provide new and current data about effectiveness of primary prophylactic ICD implantation. The study also aims for improved risk stratification and patient selection using clinical risk markers in general, and advanced ECG risk markers in particular.

Published
2019

17. Rationale and design of the EU‐CERT‐ICD prospective study:comparative effectiveness of prophylactic ICD implantation

Author

Zabel, M. (Markus), Sticherling, C. (Christian), Willems, R. (Rik), Lubinski, A. (Andrzej), Bauer, A. (Axel), Bergau, L. (Leonard), Braunschweig, F. (Frieder), Brugada, J. (Josep), Brusich, S. (Sandro), Conen, D. (David), Cygankiewicz, I. (Iwona), Flevari, P. (Panagiota), Taborsky, M. (Milos), Hansen, J. (Jim), Hasenfuss, G. (Gerd), Hatala, R. (Robert), Huikuri, H. V. (Heikki V.), Iovev, S. (Svetoslav), Kaeaeb, S. (Stefan), Kaliska, G. (Gabriela), Kasprzak, J. D. (Jaroslaw D.), Luethje, L. (Lars), Malik, M. (Marek), Novotny, T. (Tomas), Pavlovic, N. (Nikola), Schmidt, G. (Georg), Shalganov, T. (Tchavdar), Sritharan, R. (Rajeeva), Schloegl, S. (Simon), Nossan, J. S. (Janko Szavits), Traykov, V. (Vassil), Tuinenburg, A. E. (Anton E.), Velchev, V. (Vasil), Vos, M. A. (Marc A.), Willich, S. N. (Stefan N.), Friede, T. (Tim), Svendsen, J. H. (Jesper Hastrup), Merkely, B. (Bela), Seegers, J. (J.), Munoz-Exposito, P. (P.), Tichelbacker, T. (T.), Kirovo, A. (A.), Sritharan, R. (R.), Joerss, K. (K.), Macken, J. (J.), Misdaq, M. (M.), Rudolph, K. (K.), Schmidt, G. (G.), Mueller, A. (A.), Dommasch, M. (M.), Sinnecker, D. (D.), Sinner, M. (M.), Bauer, A. (A.), Dissmann, R. (R.), Burmester, U. (U.), Behrens, S. (S.), Gregor, M. (M.), Stefanow, S. (S.), Rueb, N. (N.), Wolpert, C. (C.), Bimmel, D. (D.), Lieberz, C. (C.), Maier, L. (L.), Schwinger, R. (R.), Blaschke, F. (F.), Pieske, B. (B.), Groenefeld, G. (G.), Klein, G. (G.), Gardiwal, A. (A.), Merkely, B. (B.), Szeplaki, G. (G.), Perge, P. (P.), Nossan, J. S. (J. Szavits), Rotkvic, L. (L.), Pavlovic, N. (N.), Manola, S. (S.), Vinter, O. (O.), Benko, I. (I.), Brusic, S. (S.), Avdovic, E. (E.), Klasan, M. (M.), Bakotic, Z. (Z.), Anic, A. (A.), Lubinski, A. (A.), Kowalczyk, E. (E.), Kucejko, T. (T.), Czechowska, A. (A.), Wybor, K. (K.), Cygankiewicz, I. (I.), Ptaszynski, P. (P.), Kasprzak, J. (J.), Qavoq, H. (H.), Guzik, P. (P.), Krauze, T. (T.), Sterlinski, M. (M.), Hatala, R. (R.), Svetlosak, M. (M.), Kaliska, G. (G.), Martinek, J. (J.), Thamsborg, K. (K.), Hansen, J. (J.), Schloett-Hyldelund, I. M. (I. M.), Laage-Petersen, J. (J.), Willems, R. (R.), Vandenberk, B. (B.), van Soest, S. (S.), Traykov, V. (V.), Iovev, S. (S.), Shalganov, T. (T.), Sticherling, C. (C.), Conen, D. (D.), Giesebart, S. (S.), Novotny, T. (T.), Kozak, M. (M.), Taborsky, M. (M.), Galuszka, J. (J.), Tuinenburg, A. E. (A. E.), Wijers, S. (S.), Dunnink, A. (A.), Sprenkeler, D. (D.), Brugada, J. (J.), Arbelo, E. (E.), Trucco, E. (E.), Vidorreta, S. (S.), Huikuri, H. (H.), Kentta, T. (T.), Pelli, A. (A.), Huikuri, P. (P.), Koski, P. (P.), Braunschweig, F. (F.), Karlsson, H. (H.), Ersgaard, D. (D.), Platonov, P. (P.), Klingenheben, T. (T.), Scharfe, M. (M.), Reinhold, T. (T.), Cree, M. (M.), Hnatkova, K. (K.), Gerhardt, J. (J.), Rizas, K. (K.), Hamm, W. (W.), Roever, C. (C.), Harden, M. (M.), Kessel, B. (B.), Berg, A. (A.), Apel, S. (S.), Walker, F. (F.), Kirchhof, N. (N.), Goerlitz, A. (A.), Molitor, A. (A.), Heinrich, J. (J.), Annetzberger, S. (S.), Fuchs, B. (B.), Landwehr, A. (A.), Merk, A. (A.), Wilke, A. (A.), Hennecke, C. (C.), Mansch, R. (R.), Zabel, M. (Markus), Sticherling, C. (Christian), Willems, R. (Rik), Lubinski, A. (Andrzej), Bauer, A. (Axel), Bergau, L. (Leonard), Braunschweig, F. (Frieder), Brugada, J. (Josep), Brusich, S. (Sandro), Conen, D. (David), Cygankiewicz, I. (Iwona), Flevari, P. (Panagiota), Taborsky, M. (Milos), Hansen, J. (Jim), Hasenfuss, G. (Gerd), Hatala, R. (Robert), Huikuri, H. V. (Heikki V.), Iovev, S. (Svetoslav), Kaeaeb, S. (Stefan), Kaliska, G. (Gabriela), Kasprzak, J. D. (Jaroslaw D.), Luethje, L. (Lars), Malik, M. (Marek), Novotny, T. (Tomas), Pavlovic, N. (Nikola), Schmidt, G. (Georg), Shalganov, T. (Tchavdar), Sritharan, R. (Rajeeva), Schloegl, S. (Simon), Nossan, J. S. (Janko Szavits), Traykov, V. (Vassil), Tuinenburg, A. E. (Anton E.), Velchev, V. (Vasil), Vos, M. A. (Marc A.), Willich, S. N. (Stefan N.), Friede, T. (Tim), Svendsen, J. H. (Jesper Hastrup), Merkely, B. (Bela), Seegers, J. (J.), Munoz-Exposito, P. (P.), Tichelbacker, T. (T.), Kirovo, A. (A.), Sritharan, R. (R.), Joerss, K. (K.), Macken, J. (J.), Misdaq, M. (M.), Rudolph, K. (K.), Schmidt, G. (G.), Mueller, A. (A.), Dommasch, M. (M.), Sinnecker, D. (D.), Sinner, M. (M.), Bauer, A. (A.), Dissmann, R. (R.), Burmester, U. (U.), Behrens, S. (S.), Gregor, M. (M.), Stefanow, S. (S.), Rueb, N. (N.), Wolpert, C. (C.), Bimmel, D. (D.), Lieberz, C. (C.), Maier, L. (L.), Schwinger, R. (R.), Blaschke, F. (F.), Pieske, B. (B.), Groenefeld, G. (G.), Klein, G. (G.), Gardiwal, A. (A.), Merkely, B. (B.), Szeplaki, G. (G.), Perge, P. (P.), Nossan, J. S. (J. Szavits), Rotkvic, L. (L.), Pavlovic, N. (N.), Manola, S. (S.), Vinter, O. (O.), Benko, I. (I.), Brusic, S. (S.), Avdovic, E. (E.), Klasan, M. (M.), Bakotic, Z. (Z.), Anic, A. (A.), Lubinski, A. (A.), Kowalczyk, E. (E.), Kucejko, T. (T.), Czechowska, A. (A.), Wybor, K. (K.), Cygankiewicz, I. (I.), Ptaszynski, P. (P.), Kasprzak, J. (J.), Qavoq, H. (H.), Guzik, P. (P.), Krauze, T. (T.), Sterlinski, M. (M.), Hatala, R. (R.), Svetlosak, M. (M.), Kaliska, G. (G.), Martinek, J. (J.), Thamsborg, K. (K.), Hansen, J. (J.), Schloett-Hyldelund, I. M. (I. M.), Laage-Petersen, J. (J.), Willems, R. (R.), Vandenberk, B. (B.), van Soest, S. (S.), Traykov, V. (V.), Iovev, S. (S.), Shalganov, T. (T.), Sticherling, C. (C.), Conen, D. (D.), Giesebart, S. (S.), Novotny, T. (T.), Kozak, M. (M.), Taborsky, M. (M.), Galuszka, J. (J.), Tuinenburg, A. E. (A. E.), Wijers, S. (S.), Dunnink, A. (A.), Sprenkeler, D. (D.), Brugada, J. (J.), Arbelo, E. (E.), Trucco, E. (E.), Vidorreta, S. (S.), Huikuri, H. (H.), Kentta, T. (T.), Pelli, A. (A.), Huikuri, P. (P.), Koski, P. (P.), Braunschweig, F. (F.), Karlsson, H. (H.), Ersgaard, D. (D.), Platonov, P. (P.), Klingenheben, T. (T.), Scharfe, M. (M.), Reinhold, T. (T.), Cree, M. (M.), Hnatkova, K. (K.), Gerhardt, J. (J.), Rizas, K. (K.), Hamm, W. (W.), Roever, C. (C.), Harden, M. (M.), Kessel, B. (B.), Berg, A. (A.), Apel, S. (S.), Walker, F. (F.), Kirchhof, N. (N.), Goerlitz, A. (A.), Molitor, A. (A.), Heinrich, J. (J.), Annetzberger, S. (S.), Fuchs, B. (B.), Landwehr, A. (A.), Merk, A. (A.), Wilke, A. (A.), Hennecke, C. (C.), and Mansch, R. (R.)

Abstract

Aims: The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU‐CERT‐ICD) aims to assess its current clinical value. Methods and results: The EU‐CERT‐ICD is a prospective investigator‐initiated non‐randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non‐randomized control group). The primary endpoint is all‐cause mortality; the co‐primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost‐effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12‐lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years. Conclusions: The EU‐CERT‐ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers.

Published
2019

18. Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy:combined registry data from eleven European countries

Author

Sticherling, C. (Christian), Arendacka, B. (Barbora), Svendsen, J. H. (Jesper Hastrup), Wijers, S. (Sofieke), Friede, T. (Tim), Stockinger, J. (Jochem), Dommasch, M. (Michael), Merkely, B. (Bela), Willems, R. (Rik), Lubinski, A. (Andrzej), Scharfe, M. (Michael), Braunschweig, F. (Frieder), Svetlosak, M. (Martin), Zürn, C. S. (Christine S.), Huikuri, H. (Heikki), Flevari, P. (Panagiota), Lund-Andersen, C. (Caspar), Schaer, B. A. (Beat A.), Tuinenburg, A. E. (Anton E.), Bergau, L. (Leonard), Schmidt, G. (Georg), Szeplaki, G. (Gabor), Vandenberk, B. (Bert), Kowalczyk, E. (Emilia), Eick, C. (Christian), Junttila, J. (Juhani), Conen, D. (David), and Zabel, M. (Markus)

Subjects
Cardiac resynchronization therapy, Sudden cardiac death, Primary prevention, Sex differences, Heart failure, Women, Implantable defibrillator, Ventricular fibrillation
Abstract

Aims: Therapy with an implantable cardioverter defibrillator (ICD) is established for the prevention of sudden cardiac death (SCD) in high risk patients. We aimed to determine the effectiveness of primary prevention ICD therapy by analysing registry data from 14 centres in 11 European countries compiled between 2002 and 2014, with emphasis on outcomes in women who have been underrepresented in all trials. Methods and results: Retrospective data of 14 local registries of primary prevention ICD implantations between 2002 and 2014 were compiled in a central database. Predefined primary outcome measures were overall mortality and first appropriate and first inappropriate shocks. A multivariable model enforcing a common hazard ratio for sex category across the centres, but allowing for centre-specific baseline hazards and centre specific effects of other covariates, was adjusted for age, the presence of ischaemic cardiomyopathy or a CRT-D, and left ventricular ejection fraction ≤25%. Of the 5033 patients, 957 (19%) were women. During a median follow-up of 33 months (IQR 16–55 months) 129 women (13%) and 807 men (20%) died (HR 0.65; 95% CI: [0.53, 0.79], P-value

Published
2018

20. Scholarly publishing depends on peer reviewers

Author

Fernandez-Llimos F., Berti A.D., Yeung D., Yusuff K.B., El Zowalaty M.E., Adane E.D., Al-Aqeel S., Al-Jumaili A.A., Alili-Idrizi E., Andelkovic M., Aranha A., Arief M., Arkaravichien W., Armoiry X., Attarabeen O.F., Ayoub N., Bajorek B.V., Beninger P., Billups S.J., Bowen J.F., Bouwmeester C., Campbell P., Chan V., Connor S.E., Danziger L.H., Dawood O.T., Dunnenberger M., Elrouby S., Fakih S., Abu Farha R.K., Figueiredo I.V., Foroutan N., Forsythe L.E., Frail C.K., Friesner D., Funk K., Gaither C., Gallimore C.E., Gan V., Garcia B.H., Gaskins J.L., Gastelurrutia M.A., Gatwood J., Genord C.K., Gilliam E., Goodbar N.H., Gossell-Williams M., Grundy Q., Guenette L., Hadi M.A., Hallit S., Hammond D.A., Hawasli R.S., Herdeiro M.T., Hermansyah A., Hincapie A.L., Hoehns J.D., Hossain L.N., Hudspeth B., Ibrahim M.I.B.M., Islahudin F., Jacobsen R., Jones M., Kälvemark Sporrong S., Kantelhardt P., Katangwe T., Katoue M.G., King S.R., Kinnear M., Kouladjian O'Donnell L., Kovacevic S.V., Krass I., Kraus S.K., Lakic D., Larson D., LeMay K., Loh B.C., Lowres N., Luetsch K., Lunghi C., Lyra D.P., Jr., Ma C.S., MacDonald E.A., Mancuso M.A., Mazhar F., McCarthy L., McComb M., McFarland M.S., Mehralian G., Merks P., Modun D., Mohammed M.A., Motulsky A., Mukattash T.L., Nabhani-Gebara S., Najafi S., Ni W., Nitadpakorn S., Ogbo P.U., Palaian S., Patel R.J., Payne M.H., Peaslee A.K., Pereira L.R., Perry T.D., Phan Y., Plage S., Prybylski J.P., Quffa L.H., Raka L., Ramos-Esquivel A., Ramsbottom H., Rayes I.K., Rodriguez J.V., Rosenthal M., Sadowski C.A., Sage A., Salgado T.M., Saw P.S., Schafer K.M., Schutte T., Shafie A.A., Shah R.M., Sharma A., Shehnaz S.I., Shiyanbola O.O., Siitonen P., Skinner I., Snyder M.E., Stewart D., Strang A., Stranges P.M., Sultana K., Surbhi S., Suzen H.S., Swieczkowski D., Tasaka C.L., Taylor A.M., Theberge C.R., Travlos D.V., Turner J.R., Vandenberk B., Wettergreen S.A., White C.M., Wietholter J.P., Wirth F., Young A., Zembles T., Pharmacy Practice 2017 peer reviewers, Fernandez-Llimos F., Berti A.D., Yeung D., Yusuff K.B., El Zowalaty M.E., Adane E.D., Al-Aqeel S., Al-Jumaili A.A., Alili-Idrizi E., Andelkovic M., Aranha A., Arief M., Arkaravichien W., Armoiry X., Attarabeen O.F., Ayoub N., Bajorek B.V., Beninger P., Billups S.J., Bowen J.F., Bouwmeester C., Campbell P., Chan V., Connor S.E., Danziger L.H., Dawood O.T., Dunnenberger M., Elrouby S., Fakih S., Abu Farha R.K., Figueiredo I.V., Foroutan N., Forsythe L.E., Frail C.K., Friesner D., Funk K., Gaither C., Gallimore C.E., Gan V., Garcia B.H., Gaskins J.L., Gastelurrutia M.A., Gatwood J., Genord C.K., Gilliam E., Goodbar N.H., Gossell-Williams M., Grundy Q., Guenette L., Hadi M.A., Hallit S., Hammond D.A., Hawasli R.S., Herdeiro M.T., Hermansyah A., Hincapie A.L., Hoehns J.D., Hossain L.N., Hudspeth B., Ibrahim M.I.B.M., Islahudin F., Jacobsen R., Jones M., Kalvemark Sporrong S., Kantelhardt P., Katangwe T., Katoue M.G., King S.R., Kinnear M., Kouladjian O'Donnell L., Kovacevic S.V., Krass I., Kraus S.K., Lakic D., Larson D., LeMay K., Loh B.C., Lowres N., Luetsch K., Lunghi C., Lyra D.P., Ma C.S., MacDonald E.A., Mancuso M.A., Mazhar F., McCarthy L., McComb M., McFarland M.S., Mehralian G., Merks P., Modun D., Mohammed M.A., Motulsky A., Mukattash T.L., Nabhani-Gebara S., Najafi S., Ni W., Nitadpakorn S., Ogbo P.U., Palaian S., Patel R.J., Payne M.H., Peaslee A.K., Pereira L.R., Perry T.D., Phan Y., Plage S., Prybylski J.P., Quffa L.H., Raka L., Ramos-Esquivel A., Ramsbottom H., Rayes I.K., Rodriguez J.V., Rosenthal M., Sadowski C.A., Sage A., Salgado T.M., Saw P.S., Schafer K.M., Schutte T., Shafie A.A., Shah R.M., Sharma A., Shehnaz S.I., Shiyanbola O.O., Siitonen P., Skinner I., Snyder M.E., Stewart D., Strang A., Stranges P.M., Sultana K., Surbhi S., Suzen H.S., Swieczkowski D., Tasaka C.L., Taylor A.M., Theberge C.R., Travlos D.V., Turner J.R., Vandenberk B., Wettergreen S.A., White C.M., Wietholter J.P., Wirth F., Young A., Zembles T., and Internal medicine

Subjects
lcsh:RS1-441, Pharmaceutical Science, Economic shortage, Pharmacy, 030226 pharmacology & pharmacy, lcsh:Pharmacy and materia medica, 03 medical and health sciences, 0302 clinical medicine, Periodicals as topic, Open access publishing, Political science, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), Original Research, Final version, business.industry, Research, mesh:Periodicals as Topic, lcsh:RM1-950, mesh:Open Access Publishing, Public relations, lcsh:Therapeutics. Pharmacology, Ask price, Publishing, 030221 ophthalmology & optometry, business
Abstract

The peer-review crisis is posing a risk to the scholarly peer-reviewed journal system. Journals have to ask many potential peer reviewers to obtain a minimum acceptable number of peers accepting reviewing a manuscript. Several solutions have been suggested to overcome this shortage. From reimbursing for the job, to eliminating pre-publication reviews, one cannot predict which is more dangerous for the future of scholarly publishing. And, why not acknowledging their contribution to the final version of the article published? PubMed created two categories of contributors: authors [AU] and collaborators [IR]. Why not a third category for the peer-reviewer? published

Published
2018

25. P1223Prediction model for shock risk and mortality in ICD patients

Author

Bergau, L, primary, Willems, R, additional, Tuinenburg, A, additional, Vos, M A, additional, Flevari, P, additional, Luethje, L, additional, Fischer, T H, additional, Vandenberk, B, additional, Sprenkeler, D, additional, Roever, C, additional, Hasenfuss, G, additional, Lehnart, S E, additional, Friede, T, additional, and Zabel, M, additional

Published
2018
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35. The 13th Belgian Heart Rhythm Meeting: Arrhythmias for Every Cardiologist: Programme Committee: Ivan BLANKOFF; Marnix GOETHALS; Georges H. MAIRESSE, Hugo VAN HERENDAEL: 10th and 11th October, 2019 – Sheraton Brussels Airport Hotel and Congress...

Author

De Pooter, J., Calle, S., Gauthey, A., Coeman, M., Philipsen, T., Keffer, J., Gheeraert, P., Kayaert, P., Marchandise, S., Timmermans, F., Van Heuverswyn, F., Le Polain de Waroux, J. B., Garweg, C., Vandenberk, B., Haemers, P., Ector, J., Willems, R., Scavee, C., Garnir, Q., and Wauters, A.

Published
2019
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40. Tensor-based detection of T wave alternans in multilead ECG signals

Author

Goovaerts, G., Carolina Varon, Vandenberk, B., Willems, R., Huffel, S., and Murray, A

Subjects
SISTA
Abstract

In this study, a new method for the detection of T wave alternans in multichannel ECG signals is introduced. The use of tensors (multidimensional matrices) allows us to combine the information present in all channels, making detection more robust. To construct a 3D tensor from a 2D ECG signal, the T wave is first roughly segmented. The intervals are then placed after each other to obtain a 3D structure with dimensions time, space and heartbeats. The tensor is decomposed using Canonical Polyadic Decomposition. The result is 1 rank-one tensor consisting of 3 loading vectors (which match the 3 dimensions of the original tensor). The third loading vector corresponds to the heartbeats dimension and gives information about the behavior of the T wave in different heartbeats. The Fourier transform of this loading vector can then be used to examine the presence of TWA. The methods have been tested on a subset of the T wave alternans database available on Physionet. Results show a very clear distinction between loading vectors of signals from both groups: the power of the loading vector in the TWA group is on average 100 times larger than in the control group. This suggests that tensors are an effective way of detecting TWA in multilead signals. ispartof: pages:185-188 ispartof: Proc. of the 41st Annual Computing in Cardiology vol:41 issue:January pages:185-188 ispartof: Computing in Cardiology 2014 location:Cambridge, USA date:7 Sep - 10 Sep 2014 status: published

41. Myocardial Fibrosis at Cardiac MRI Helps Predict Adverse Clinical Outcome in Patients with Mitral Valve Prolapse

Author

Stefano Figliozzi, Georgios Georgiopoulos, Pedro M. Lopes, Klemens B. Bauer, Sara Moura-Ferreira, Lara Tondi, Saima Mushtaq, Stefano Censi, Anna Giulia Pavon, Ilaria Bassi, Maria Luz Servato, Arco J. Teske, Federico Biondi, Domenico Filomena, Silvia Pica, Camilla Torlasco, Denisa Muraru, Pierre Monney, Giuseppina Quattrocchi, Viviana Maestrini, Luciano Agati, Lorenzo Monti, Patrizia Pedrotti, Bert Vandenberk, Angelo Squeri, Massimo Lombardi, António M. Ferreira, Juerg Schwitter, Giovanni Donato Aquaro, Amedeo Chiribiri, José F. Rodríguez Palomares, Ali Yilmaz, Daniele Andreini, Anca Florian, Tim Leiner, João Abecasis, Luigi Paolo Badano, Jan Bogaert, Pier-Giorgio Masci, Figliozzi, S, Georgiopoulos, G, Lopes, P, Bauer, K, Moura-Ferreira, S, Tondi, L, Mushtaq, S, Censi, S, Pavon, A, Bassi, I, Servato, M, Teske, A, Biondi, F, Filomena, D, Pica, S, Torlasco, C, Muraru, D, Monney, P, Quattrocchi, G, Maestrini, V, Agati, L, Monti, L, Pedrotti, P, Vandenberk, B, Squeri, A, Lombardi, M, Ferreira, A, Schwitter, J, Aquaro, G, Chiribiri, A, Rodríguez Palomares, J, Yilmaz, A, Andreini, D, Florian, A, Leiner, T, Abecasis, J, Badano, L, Bogaert, J, and Masci, P

Subjects
Radiology, Nuclear Medicine and imaging, myocardial fibrosis, MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, mitral valve prolapse, cardiac magnetic resonance
Abstract

Background: Patients with mitral valve prolapse (MVP) may develop adverse outcomes even in the absence of mitral regurgitation or left ventricular (LV) dysfunction. Purpose: To investigate the prognostic value of mitral annulus disjunction (MAD) and myocardial fibrosis at late gadolinium enhancement (LGE) cardiac MRI in patients with MVP without moderate-to-severe mitral regurgitation or LV dysfunction. Materials and Methods: In this longitudinal retrospective study, 118 144 cardiac MRI studies were evaluated between October 2007 and June 2020 at 15 European tertiary medical centers. Follow-up was from the date of cardiac MRI examination to June 2020; the minimum and maximum follow-up intervals were 6 months and 156 months, respectively. Patients were excluded if at least one of the following conditions was present: cardiomyopathy, LV ejection fraction less than 40%, ischemic heart disease, congenital heart disease, inflammatory heart disease, moderate or worse mitral regurgitation, participation in competitive sport, or electrocardiogram suggestive of channelopathies. In the remainder, cardiac MRI studies were reanalyzed, and patients were included if they were aged 18 years or older, MVP was diagnosed at cardiac MRI, and clinical information and electrocardiogram monitoring were available within 3 months from cardiac MRI examination. The end point was a composite of adverse outcomes: sustained ventricular tachycardia (VT), sudden cardiac death (SCD), or unexplained syncope. Multivariable Cox regression analysis was performed. Results: A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 women) were included. Over a median follow-up of 3.3 years, 18 patients (4%) reached the study end point. LGE presence (hazard ratio, 4.2 [95% CI: 1.5, 11.9]; P = .006) and extent (hazard ratio, 1.2 per 1% increase [95% CI: 1.1, 1.4]; P = .006), but not MAD presence (P = .89), were associated with clinical outcome. LGE presence had incremental prognostic value over MVP severity and sustained VT and aborted SCD at baseline (area under the receiver operating characteristic curve, 0.70 vs 0.62; P = .03). Conclusion: In contrast to mitral annulus disjunction, myocardial fibrosis determined according to late gadolinium enhancement at cardiac MRI was associated with adverse outcome in patients with mitral valve prolapse without moderate-to-severe mitral regurgitation or left ventricular dysfunction.

Published
2022

43. Fine-tuning early rhythm control strategies for atrial fibrillation-Timing matters to stay in sync.

Author

Vandenberk B and Chew DS

Subjects
Humans, Anti-Arrhythmia Agents therapeutic use, Time Factors, Atrial Fibrillation physiopathology, Atrial Fibrillation therapy, Heart Rate physiology
Abstract

Competing Interests: Disclosures D.C. reports grant support from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada. B.V. reports no relevant disclosures.

Published
2024
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46. Editorial: Artificial intelligence in cardiac rhythmology.

Author

Saglietto A, Cavallone E, Spartalis M, Vandenberk B, and Anselmino M

Abstract

Competing Interests: MA has received educational grants from Abbott, is consultant for Biosense Webster and proctor for Medtronic. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Published
2024
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48. Arrhythmic Mitral Valve Prolapse Phenotype: An Unsupervised Machine Learning Analysis Using a Multicenter Cardiac MRI Registry.

Author

Akyea RK, Figliozzi S, Lopes PM, Bauer KB, Moura-Ferreira S, Tondi L, Mushtaq S, Censi S, Pavon AG, Bassi I, Galian-Gay L, Teske AJ, Biondi F, Filomena D, Stylianidis V, Torlasco C, Muraru D, Monney P, Quattrocchi G, Maestrini V, Agati L, Monti L, Pedrotti P, Vandenberk B, Squeri A, Lombardi M, Ferreira AM, Schwitter J, Aquaro GD, Pontone G, Chiribiri A, Rodríguez Palomares JF, Yilmaz A, Andreini D, Florian AR, Francone M, Leiner T, Abecasis J, Badano LP, Bogaert J, Georgiopoulos G, and Masci PG

Subjects
Humans, Female, Male, Middle Aged, Retrospective Studies, Registries, Magnetic Resonance Imaging, Cine methods, Arrhythmias, Cardiac diagnostic imaging, Arrhythmias, Cardiac physiopathology, Adult, Magnetic Resonance Imaging, Mitral Valve Prolapse diagnostic imaging, Unsupervised Machine Learning, Phenotype
Abstract

Purpose To use unsupervised machine learning to identify phenotypic clusters with increased risk of arrhythmic mitral valve prolapse (MVP). Materials and Methods This retrospective study included patients with MVP without hemodynamically significant mitral regurgitation or left ventricular (LV) dysfunction undergoing late gadolinium enhancement (LGE) cardiac MRI between October 2007 and June 2020 in 15 European tertiary centers. The study end point was a composite of sustained ventricular tachycardia, (aborted) sudden cardiac death, or unexplained syncope. Unsupervised data-driven hierarchical k -mean algorithm was utilized to identify phenotypic clusters. The association between clusters and the study end point was assessed by Cox proportional hazards model. Results A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 female, 230 male) with two phenotypic clusters were identified. Patients in cluster 2 (199 of 474, 42%) had more severe mitral valve degeneration (ie, bileaflet MVP and leaflet displacement), left and right heart chamber remodeling, and myocardial fibrosis as assessed with LGE cardiac MRI than those in cluster 1. Demographic and clinical features (ie, symptoms, arrhythmias at Holter monitoring) had negligible contribution in differentiating the two clusters. Compared with cluster 1, the risk of developing the study end point over a median follow-up of 39 months was significantly higher in cluster 2 patients (hazard ratio: 3.79 [95% CI: 1.19, 12.12], P = .02) after adjustment for LGE extent. Conclusion Among patients with MVP without significant mitral regurgitation or LV dysfunction, unsupervised machine learning enabled the identification of two phenotypic clusters with distinct arrhythmic outcomes based primarily on cardiac MRI features. These results encourage the use of in-depth imaging-based phenotyping for implementing arrhythmic risk prediction in MVP. Keywords: MR Imaging, Cardiac, Cardiac MRI, Mitral Valve Prolapse, Cluster Analysis, Ventricular Arrhythmia, Sudden Cardiac Death, Unsupervised Machine Learning Supplemental material is available for this article. © RSNA, 2024.

Published
2024
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49. Serial Cardiac Magnetic Resonance Imaging in Patients with Mitral Valve Prolapse-A Single-Center Retrospective Registry.

Author

Blondeel M, L'Hoyes W, Robyns T, Verbrugghe P, De Meester P, Dresselaers T, Masci PG, Willems R, Bogaert J, and Vandenberk B

Abstract

Background: Mitral valve prolapse (MVP) and mitral annular disjunction (MAD) are common valvular abnormalities that have been associated with ventricular arrhythmias (VA). Cardiac magnetic resonance imaging (CMR) has a key role in risk stratification of VA, including assessment of late gadolinium enhancement (LGE). Methods: Single-center retrospective analysis of patients with MVP or MAD who had >1 CMR and >1 24 h Holter registration available. Data are presented in detail, including evolution of VA and presence of LGE over time. Results: A total of twelve patients had repeated CMR and Holter registrations available, of which in four (33%) patients, it was conducted before and after minimal invasive mitral valve repair (MVR). After a median of 4.7 years, four out of eight (50%) patients without surgical intervention had new areas of LGE. New LGE was observed in the papillary muscles and the mid to basal inferolateral wall. In four patients, presenting with syncope or high-risk non-sustained ventricular tachycardia (VT), programmed ventricular stimulation was performed and in two (50%), sustained monomorphic VT was easily inducible. In two patients who underwent MVR, new LGE was observed in the basal inferolateral wall of which one presented with an increased burden of VA. Conclusions: In patients with MVP and MAD, repeat CMR may show new LGE in a small subset of patients, even shortly after MVR. A subgroup of patients who presented with an increase in VA burden showed new LGE upon repeat CMR. VA in patients with MVP and MAD are part of a heterogeneous spectrum that requires further investigation to establish risk stratification strategies.

Published
2024
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50. Artificial intelligence electrocardiogram as a novel screening tool to detect a newly abnormal left ventricular ejection fraction after anthracycline-based cancer therapy.

Author

Jacobs JEJ, Greason G, Mangold KE, Wildiers H, Willems R, Janssens S, Noseworthy P, Lopez-Jimenez F, Voigt JU, Friedman P, Van Aelst L, Vandenberk B, Attia ZI, and Herrmann J

Subjects
Humans, Female, Stroke Volume, Cardiotoxicity, Ventricular Function, Left, Cohort Studies, Artificial Intelligence, Early Detection of Cancer, Electrocardiography, Antibiotics, Antineoplastic adverse effects, Anthracyclines adverse effects, Breast Neoplasms drug therapy
Abstract

Aims: Cardiotoxicity is a serious side effect of anthracycline treatment, most commonly manifesting as a reduction in left ventricular ejection fraction (EF). Early recognition and treatment have been advocated, but robust, convenient, and cost-effective alternatives to cardiac imaging are missing. Recent developments in artificial intelligence (AI) techniques applied to electrocardiograms (ECGs) may fill this gap, but no study so far has demonstrated its merit for the detection of an abnormal EF after anthracycline therapy., Methods and Results: Single centre consecutive cohort study of all breast cancer patients with ECG and transthoracic echocardiography (TTE) evaluation before and after (neo)adjuvant anthracycline chemotherapy. Patients with HER2-directed therapy, metastatic disease, second primary malignancy, or pre-existing cardiovascular disease were excluded from the analyses as were patients with EF decline for reasons other than anthracycline-induced cardiotoxicity. Primary readout was the diagnostic performance of AI-ECG by area under the curve (AUC) for EFs < 50%. Of 989 consecutive female breast cancer patients, 22 developed a decline in EF attributed to anthracycline therapy over a follow-up time of 9.8 ± 4.2 years. After exclusion of patients who did not have ECGs within 90 days of a TTE, 20 cases and 683 controls remained. The AI-ECG model detected an EF < 50% and ≤ 35% after anthracycline therapy with an AUC of 0.93 and 0.94, respectively., Conclusion: These data support the use of AI-ECG for cardiotoxicity screening after anthracycline-based chemotherapy. This technology could serve as a gatekeeper to more costly cardiac imaging and could enable patients to monitor themselves over long periods of time., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2024
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