The HF-CGM study: An analysis of cardiogoniometric axes in patients with cardiac resynchronization therapy

Goal: The HF-CGM is a proof-of-principle study to investigate whether cardiogoniometry (CGM), a three-dimensional electrocardiographic method, can differentiate between pacing modes in patients with cardiac resynchronization therapy (CRT). Methods: At a tertiary cardiology center, CGM recordings were performed using four pacing modes: no pacing; right ventricular (RV) pacing; left ventricular (LV) pacing, and biventricular (BIV) pacing. Three orthogonal CGM planes orientated to the long axis (XY), the frontal plane (YZ), and the short axis (XZ) of the heart were constructed, and the direction of the QRS-axis was calculated for each pacing mode in each plane. During BIV pacing, the direction of CGM QRS-axis was compared between patients with optimal and nonoptimal 12-lead pacing variables. Results: Twenty-two participants (aged 71.5 ± 10.8; 77.3% male, LVEF 29 ± 7%) were consecutively recruited. Only QRS-axis measured in the XY plane could significantly distinguish between all three pacing modes versus no pacing. Mean QRS-axis in the XY plane with pacing off and during RV pacing was leftward and basal; LV pacing was apical; and BIV pacing was rightward and basal. There was a statistically significant difference in the direction of the QRS-axis between patients with optimal versus nonoptimal paced QRS morphology in the XY plane (rightward and basal versus inconsistent). Significance : CGM recorded in the XY plane can accurately detect differences between ventricular pacing sites. It may also be able to identify patients with a CRT device in situ who have optimal response

Electrocardiographic characteristics in patients with heart failure and normal ejection fraction: a systematic review and meta‐analysis

Background: Little is known about ECG abnormalities in patients with heart failure and normal ejection fraction (HeFNEF) and how they relate to different etiologies or outcomes. Methods and Results: We searched the literature for peer‐reviewed studies describing ECG abnormalities in HeFNEF other than heart rhythm alone. Thirty five studies were identified and 32,006 participants. ECG abnormalities reported in patients with HeFNEF include atrial fibrillation (prevalence 12%–46%), long PR interval (11%–20%), left ventricular hypertrophy (LVH, 10%–30%), pathological Q waves (11%–18%), RBBB (6%–16%), LBBB (0%–8%), and long JTc (3%–4%). Atrial fibrillation is more common in patients with HeFNEF compared to those with heart failure and reduced ejection fraction (HeFREF). In contrast, long PR interval, LVH, Q waves, LBBB, and long JTc are more common in patients with HeFREF. A pooled effect estimate analysis showed that QRS duration ≥120 ms, although uncommon (13%–19%), is associated with worse outcomes in patients with HeFNEF. Conclusions: There is high variability in the prevalence of ECG abnormalities in patients with HeFNEF. Atrial fibrillation is more common in patients with HeFNEF compared to those with HeFREF. QRS duration ≥120 ms is associated with worse outcomes in patients with HeFNEF. Further studies are needed to address whether ECG abnormalities correlate with different phenotypes in HeFNEF

Total severity score and age predict long-term hospitalization in COVID-19 pneumonia

BackgroundSevere COVID-19 pneumonia implies increased oxygen demands and length of hospitalization (LOS). We aimed to assess a possible correlation between LOS and COVID-19 patients' clinical laboratory data of admission, including the total severity score (TSS) from chest computed tomography (CT).MethodsData were assessed retrospectively at the General Hospital “Agios Pavlos” in Greece. Clinical laboratory data, TSS, and LOS were recorded.ResultsA total of 317 patients, 136 women and 181 men, with a mean age of 66.58 ± 16.02 years were studied. Significant comorbidities were hypertension (56.5%), dyslipidemia (33.8%), type 2 diabetes mellitus (22.7%), coronary heart disease (12.9%), underlying pulmonary disease (10.1%), and malignancy (4.4%). Inpatient time was related to age (p < 0.001), TSS (p < 0.001), time from symptom onset to hospitalization (p = 0.006), inhaled oxygen fraction (p < 0.001), fibrinogen (p = 0.024), d-dimers (p < 0.001), and C-reactive protein (p = 0.025), as well as a history of hypertension (p < 0.001) and type 2 diabetes mellitus (p < 0.008). The multivariate analysis showed a significant association of the LOS with age (p < 0.001) and TSS (p < 0.001) independent of the above-mentioned factors.ConclusionEarly identification of disease severity using the TSS and patients' age could be useful for inpatient resource allocation and for maintaining vigilance for those requiring long-term hospitalizations

Prevalence, predictors and prognostic implications of PR interval prolongation in patients with heart failure

Aims: To determine the prevalence, incidence, predictors and prognostic implications of PR interval prolongation in patients referred with suspected heart failure. Methods and Results: Consecutive patients referred with suspected heart failure were prospectively enrolled. After excluding patients with implantable cardiac devices and atrial fibrillation, 1420 patients with heart failure and reduced ejection fraction (HeFREF) [age: median 71 (interquartile range IQR: 63-78) years; men: 71%; NT-ProBNP: 1319 (583-3378) ng/L], 1094 with heart failure and normal ejection fraction (HeFNEF) [age: 76 (70-82) years; men: 47%; NT-ProBNP: 547 (321-1171) ng/L], and 1150 without heart failure [age: 68 (60-75) years; men: 51%; NT-ProBNP: 86 (46-140) ng/L] were included. The prevalence of first degree heart block [heart-rate corrected PR interval (PRc) >200 ms] was higher in patients with heart failure (21% HeFREF, 20% HeFNEF, 9% without heart failure). In patients with HeFREF or HeFNEF, longer baseline PRc was associated with greater age, male sex, and longer QRS duration and, in those with HeFREF, treatment with amiodarone or digoxin. Patients with heart failure in the longest PRc quartile had worse survival compared to shorter PRc quartiles but PRc was not independently associated with survival in multivariable analysis. For patients without heart failure, shorter baseline PRc was independently associated with worse survival. Conclusion: PRc prolongation is common in patients with HeFREF or HeFNEF and associated with worse survival, although not an independent predictor of outcome. The results of clinical trials investigating the therapeutic potential of shortening the PR interval by pacing are awaited

Contrast Enhanced Micro-Computed Tomography Resolves the 3-Dimensional Morphology of the Cardiac Conduction System in Mammalian Hearts

The general anatomy of the cardiac conduction system (CCS) has been known for 100 years, but its complex and irregular three-dimensional (3D) geometry is not so well understood. This is largely because the conducting tissue is not distinct from the surrounding tissue by dissection. The best descriptions of its anatomy come from studies based on serial sectioning of samples taken from the appropriate areas of the heart. Low X-ray attenuation has formerly ruled out micro-computed tomography (micro-CT) as a modality to resolve internal structures of soft tissue, but incorporation of iodine, which has a high molecular weight, into those tissues enhances the differential attenuation of X-rays and allows visualisation of fine detail in embryos and skeletal muscle. Here, with the use of a iodine based contrast agent (I2KI), we present contrast enhanced micro-CT images of cardiac tissue from rat and rabbit in which the three major subdivisions of the CCS can be differentiated from the surrounding contractile myocardium and visualised in 3D. Structures identified include the sinoatrial node (SAN) and the atrioventricular conduction axis: the penetrating bundle, His bundle, the bundle branches and the Purkinje network. Although the current findings are consistent with existing anatomical representations, the representations shown here offer superior resolution and are the first 3D representations of the CCS within a single intact mammalian heart

The relationship between children with ADHD and motor skills

The research attempted to study the relationship between Attention Deficit Disorder and Hyperactivity Disorder and Movement skills. Research’s aim was to examine whether children with ADHD have movement disabilities and to compare their movement with the one of children without ADHD. In the past, researches have shown that there is a correlation between movement disabilities such as Developmental Disorder of Motor Coordination with Learning Disabilities and ADHD. It seems that children with movement disorders, face also learning or behavioral problems. In the present study, we tested 200 children's movement skills using two internationally recognized moving tests, the Bruininks-Oseretsky Test of Motor Proficiency-2 and the Test of Gross Motor Development-Urlich. 100 children who participated in the survey had ADHD and other 100 did not. The statistical analysis showed that there are significant differences in the movement skills of children with ADHD and children without. Τhe differences were evident in both motor tests. In fine motor (Bruininks-Oseretsky Test of Motor Proficiency-2) children without ADHD had better results (p <0,000) than children with ADHD. In the case of Test-Gross Motor Development-Urlich, children with ADHD appear to have better results than children with ADHD (p <0,015). In addition, factors that may affect children's results in Motor Testing such as engaging in athletic activity have been examined. Research findings are useful for studies as it seems that children with ADHD has disabilities in movement skills when they are compared to children of the same age without ADHD. This weakness can affect a child's social life, as movement is an important part of his everyday life. Previous research has shown that children with movement disabilities have low self-esteem or have experienced school bullying. Consequently, the findings of this research are considered particularly important as the correlation of ADHD and Motor Skills can affect many areas of a child's life (education, psychology, educational attainment, economy).Η έρευνα μελέτησε τη σχέση της Διαταραχής Ελλειμματικής Προσοχής και Υπερκινητικότητας (ΔΕΠ-Υ) στα παιδιά με τις βασικές Κινητικές Δεξιότητες. Η ΔΕΠ-Υ αποτελεί μία από τις πιο συχνά εμφανιζόμενες διαταραχές στο μαθητικό πληθυσμό. Από την άλλη η κίνηση είναι αναπόσπαστο κομμάτι της ζωής ενός παιδιού. Σκοπός της έρευνας ήταν να εξετάσει τις κινητικές δεξιότητες των παιδιών ΔΕΠ-Υ και να συγκρίνει το κινητικό τους επίπεδο με το επίπεδο παιδιών ίδιας ηλικίας που δεν έχουν τη διαταραχή. Στο παρελθόν, έρευνες έχουν δείξει ότι υπάρχει συσχέτιση μεταξύ των κινητικών δυσκολιών με τις Μαθησιακές Δυσκολίες και τη ΔΕΠ-Υ. Φαίνεται ότι, τα παιδιά με προβλήματα μάθησης ή συμπεριφοράς συχνά αντιμετωπίζουν δυσκολίες που αφορούν τις κινητικές τους δεξιότητες. Στην παρούσα έρευνα, εξετάστηκαν οι κινητικές δεξιότητες 200 παιδιών με τη βοήθεια δύο διεθνώς αναγνωρισμένων κινητικών δοκιμασιών, του Bruininks- Oseretsky Test of Motor Proficiency-2 και του Test of Gross Motor Development- Urlich. Τα 100 παιδιά που πήραν μέρος στην έρευνα, είχαν διαγνωσμένη ΔΕΠ-Υ και τα άλλα 100 όχι. Από την στατιστική ανάλυση προέκυψε ότι υπάρχουν σημαντικές διαφορές στις κινητικές δεξιότητες των παιδιών με ΔΕΠ-Υ και των παιδιών χωρίς. Μάλιστα οι διαφορές ήταν εμφανείς και στις δύο κινητικές δοκιμασίες. Εξετάστηκαν, η λεπτή κινητικότητα (Bruininks- Oseretsky Test of Motor Proficiency-2) όπου τα παιδιά χωρίς ΔΕΠ-Υ είχαν στατιστικά σημαντικές διαφορές από τα παιδιά με ΔΕΠ-Υ (p<0,000) και η αδρή κινητικότητα, (Test of Gross Motor Development- Urlich) όπου τα παιδιά χωρίς ΔΕΠ-Υ τα πήγαν καλύτερα από τα παιδιά με ΔΕΠ-Υ (p<0,015). Ακόμα, εξετάστηκαν παράγοντες που μπορεί να επηρεάσουν την επίδοση των παιδιών στις Κινητικές Δοκιμασίες όπως το φύλο, η ηλικία και η ενασχόλησή τους με κάποια εξωσχολική αθλητική δραστηριότητα. Τα ευρήματα της έρευνας αποτελούν υλικό προς μελέτη για την επιστήμη καθώς βρέθηκε ότι τα παιδιά με ΔΕΠ-Υ είχαν στατιστικά σημαντικές διαφορές στις κινητικές δοκιμασίες από τα παιδιά ίδιας ηλικίας που δεν έχουν τη διαταραχή. Η αδυναμία αυτή μπορεί να επηρεάσει την κοινωνική ζωή ενός παιδιού καθώς η κίνηση συνδέεται με πληθώρα δραστηριοτήτων. Από προηγούμενες έρευνες προέκυψε ότι παιδιά με κινητικές δυσκολίες έχουν χαμηλή αυτοεκτίμηση ή υφίσταται σχολικό εκφοβισμό-bullying. Συνεπώς, τα ευρήματα της παρούσας έρευνας θεωρούνται ιδιαιτέρως σημαντικά καθώς η συσχέτιση της ΔΕΠ-Υ και των Κινητικών Δεξιότητων μπορεί να επηρεάσει πολλούς τομείς στη ζωή ενός παιδιού (εκπαιδευτικό, ψυχολογικό, μορφωτικό, οικονομικό)

Postmortem ICD interrogation in mode of death classification

© 2018 Wiley Periodicals, Inc. Background: The definition of sudden death due to arrhythmia relies on the time interval between onset of symptoms and death. However, not all sudden deaths are due to arrhythmia. In patients with an implantable cardioverter defibrillator (ICD), postmortem device interrogation may help better distinguish the mode of death compared to a time-based definition alone. Objective: This study aims to assess the proportion of “sudden” cardiac deaths in patients with an ICD that have confirmed arrhythmia. Methods: We conducted a literature search for studies using postmortem ICD interrogation and a time-based classification of the mode of death. A modified QUADAS-2 checklist was used to assess risk of bias in individual studies. Outcome data were pooled where sufficient data were available. Results: Our search identified 22 studies undertaken between 1982 and 2015 with 23,600 participants. The pooled results (excluding studies with high risk of bias) suggest that ventricular arrhythmias are present at the time of death in 76% of “sudden” deaths (95% confidence interval [CI] 67–85; range 42–88). Conclusion: Postmortem ICD interrogation identifies 24% of “sudden” deaths to be nonarrhythmic. Postmortem device interrogation should be considered in all cases of unexplained sudden cardiac death

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

Background: Placenta accreta spectrum (PAS) disorders may be associated with significant mortality and morbidity for both mother and fetus. Purpose/Hypothesis: To identify MRI risk factors for poor peripartum outcome in gravid patients at risk for PAS. Study Type: Prospective. Population: One hundred gravid women (mean age: 34.9 years) at third trimester, with placenta previa. Field Strength/Sequence: T2-SSTSE (single-shot turbo spin echo), T2-TSE, T1-TSEFS (TSE images with fat-suppression) at 1.5T. Assessment: Fifteen MRI features considered indicative of PAS were recorded by three radiologists and were tested for any association with the following adverse peripartum maternal and neonatal events: increased operation time, profound blood loss, hysterectomy, bladder repair, ICU admission, prematurity, low birthweight, and 5-minute APGAR score &amp;lt;7. Statistical Tests: Kappa (K) coefficients were computed as a measure of agreement between intraoperative information/histology and MRI results as well as for interobserver agreement; chi-square and Fisher&apos;s exact tests were used to explore the association of the MRI signs with clinical complications. A score was calculated by adding all recorded MRI signs and its predictive ability was tested using receiver operating characteristic (ROC) analysis, against all complications, separately; odds ratios (ORs) for optimal cutoffs were determined with logistic regression analysis. Results: There was excellent agreement (K &amp;gt;0.75, P &amp;lt; 0.001) between MRI and intraoperative findings for invasive placenta, bladder and parametrial involvement. Intraplacental T2 dark bands, myometrial disruption, uterine bulge, and hypervascularity at the utero-placental interface or parametrium, showed significant association (P &amp;lt; 0.005) with poor clinical outcome for both mother and fetus. The MRI score showed significant predictive ability for each adverse maternal event (area under the curve [AUC]: 0.85–0.97, P &amp;lt; 0.001). The presence of ≥3 MRI signs was the cutoff point for a complicated delivery (OR: 19.08, 95% confidence interval [CI]: 6.05–60.13) and ≥6 MRI signs was the cutoff point for massive bleeding (OR: 90.93, 95% CI: 11.3–729.23), hysterectomy (OR: 72.5, 95% CI: 17.9–293.7), or extensive bladder repair (OR: 58.74, 95% CI: 7.35–469.32). The MRI score was not significant for predicting adverse neonatal events including preterm delivery (P = 0.558), low birthweight (P = 0.097), and 5-minute Apgar score (P = 0.078). Data Conclusion: Preoperative identification of specific MRI features may predict peripartum course in high-risk patients for PAS. Level of Evidence: 1. Technical Efficacy: Stage 5. J. Magn. Reson. Imaging 2019;50:602–618. © 2018 International Society for Magnetic Resonance in Medicin

Intraplacental Fetal Vessel Diameter May Help Predict for Placental Invasiveness in Pregnant Women at High Risk for Placenta Accreta Spectrum Disorders

Background: Prenatal identification of placenta accreta spectrum (PAS) disorder is essential for treatment planning. More objective means for predicting PAS and clinical outcome may be provided by MRI descriptors. Purpose: To investigate the association of intraplacental fetal vessel (IFV) diameter at MRI with PAS and peripartum complications. Materials and Methods: Between March 2016 and October 2019, 160 gravid women suspected of having PAS underwent placental MRI as part of a prospective trial. Secondary analysis was performed by two experienced genitourinary radiologists for presence and maximum diameter of IFVs. Relative risk ratios were computed to test the association of IFVs with presence and depth of PAS invasiveness. Receiver operating characteristic analysis was used to evaluate the ability of IFV diameter to help predict PAS, placenta percreta, and peripartum complications and for comparison of the area under the curve (AUC) versus that from other combined MRI predictors of PAS (eg, myometrial thinning, intraplacental T2-hypointense bands, uterine bulge, serosal hypervascularity, and signs of extrauterine placental spread). Intraoperative and histopathologic findings were the reference standard. Results: A total of 155 women were evaluated (mean age, 35 years ± 5 [standard deviation]; mean gestational age, 32 weeks ±3). PAS was diagnosed in 126 of 155 women (81%) (placental percreta in 68 of 126 [54%]). At delivery, 30 of 126 women (24%) experienced massive blood loss (.2000 mL). IFVs were detected at MRI in 109 of 126 women with PAS (86%) and in 67 of 68 women with placental percreta (98%). The relative risk ratio was 2.4 (95% CI: 1.6, 3.4; P &lt;.001) for PAS and 10 (95% CI: 1.5, 70.4; P &lt;.001) for placental percreta when IFVs were visible. IFVs of 2 mm or greater were associated with PAS (AUC, 0.81; 95% CI: 0.67, 0.95; P = .04). IVFs of 3 mm or greater were associated with placenta percreta (AUC, 0.81; 95% CI: 0.73, 0.89; P , .001) and with peripartum complications, including massive bleeding (AUC, 0.80; 95% CI: 0.71, 0.89; P , .001). Combining assessment of IFVs with other MRI descriptors improved the ability of MRI to predict PAS (AUC, 0.94 vs 0.89; P = .009). Conclusion: Assessment of intraplacental fetal vessels with other MRI descriptors improved the ability of MRI to help predict PAS. Vessel diameter of 3 mm or greater was predictive of placenta percreta and peripartum complications. © 2021 Radiological Society of North America Inc.. All rights reserved