Validation of an Arrhythmogenic Right Ventricular Cardiomyopathy Risk-Prediction Model in a Chinese Cohort

BACKGROUND: The novel arrhythmogenic right ventricular cardiomyopathy (ARVC)-associated ventricular arrhythmias (VAs) risk-prediction model endorsed by Cadrin-Tourigny et al. was recently developed to estimate visual VA risk and was identified to be more effective for predicting ventricular events than the International Task Force Consensus (ITFC) criteria, and the Heart Rhythm Society (HRS) criteria. Data regarding its application in Asians are lacking. OBJECTIVES: We aimed to perform an external validation of this algorithm in the Chinese ARVC population. METHODS: The study enrolled 88 ARVC patients who received implantable cardioverter-defibrillator (ICD) from January 2005 to January 2020. The primary endpoint was appropriate ICD therapies. The novel prediction model was used to calculate a priori predicted VA risk that was compared with the observed rates. RESULTS: During a median follow-up of 3.9 years, 57 (64.8%) patients received the ICD therapy. Patients with implanted ICDs for primary prevention had non-significantly lower rates of ICD therapy than secondary prevention (5-year event rate: 0.46 (0.13-0.66) and 0.80 (0.64-0.89); log-rank p = 0.098). The validation study revealed the C-statistic of 0.833 (95% confidence interval (CI) 0.615-1.000), and the predicted and the observed patterns were similar in primary prevention patients (mean predicted-observed risk: -0.07 (95% CI -0.21, 0.09)). However, in secondary prevention patients, the C-statistic was 0.640 (95% CI 0.510-0.770) and the predicted risk was significantly underestimated (mean predicted-observed risk: -0.32 (95% CI -0.39, -0.24)). The recalibration analysis showed that the performance of the prediction model in secondary prevention patients was improved, with the mean predicted-observed risk of -0.04 (95% CI -0.10, 0.03). CONCLUSIONS: The novel risk-prediction model had a good fitness to predict arrhythmic risk in Asian ARVC patients for primary prevention, and for secondary prevention patients after recalibration of the baseline risk

Corak Pemikiran Dan Gerakan Aktivis Perempuan (Melacak Pandangan Keagamaan Aisyiyah Periode 1917–1945)

This paper discusses the patterns of religious thought of the women activistsin the early period of Aisyiyah. The women activists are Siti Walidah, Siti Bariyah, SitiAisyah, Siti Badilah, Siti Munjiyah, Siti Badilah, Siti Hayyinah, dan Siti Umniyah.Through ahistorical approach, the author founds a link between colonialism that occurin Muslim countries and the revival of the spirit of women activists in mobilizing theMuslims society. The author also asserts that the thought of Aisyiyah leaders includingin the Islamic modernism that mean are Islamists a progresive religion, Islam is areligion of liberation, enlighten and advance. This understanding is very influential inthe development of Aisyiyah recently. The formers of Aisyiyah aware of the importanceof women\u27s participation and role in Islamic Da\u27wah join with men to accelerate therealization of a prosperous society.Key words: Thought, women activists, AisyiyahMakalah ini membahas tentang corak pemikiran keagamaan perempuan aktivisgerakan Aisyiyah pada periode awal. Mereka adalah Siti Walidah, Siti Bariyah, SitiAisyah, Siti Badilah, Siti Munjiyah, Siti Badilah, Siti Hayyinah, dan Siti Umniyah.Melalui pendekatan historis, penulis menemukan kaitan antara gelombang kolonialismeyang terjadi di negara-negara muslim dengan semangat kebangkitan kaum perempuandalam menggerakkan kaum muslim khususnya kaum perempuan. Penulis jugamenegaskan bahwa pemikiran para tokoh Aisyiyah termasuk paham modernisme Islamyaitu Islam sebagai agama yang berkemajuan, agama dengan ajaran yang membebaskan,mencerahkan dan memajukan. Pemahaman ini sangat berpengaruh dalamperkembangan dakwah ‘Aisyiyah ke depan. Para tokoh Aisyiyah menyadari akanpentingnya perempuan berpartisipasi dan berperan dalam Dakwah Islam bersamasamadengan laki-laki untuk mempercepat terwujudnya masyarakat sejahtera

Echocardiographic Predictors of All-Cause Mortality in Patients with Hypertrophic Cardiomyopathy following Pacemaker Implantation

Objectives. To examine the association between the echocardiographic parameters measured as left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDD) and long-term risk of all-cause mortality in adults with hypertrophic cardiomyopathy (HCM) following pacemaker implantation. Methods. A total of 94 adult patients with HCM who underwent pacemaker implantation from November 2002 to June 2013 in our Arrhythmia Center for symptomatic bradycardia and did not receive an implantable cardiac defibrillator (ICD) or cardiac resynchronization therapy (CRT) during follow-up were retrospectively extracted. Results. After careful examination of the medical records, we retrospectively evaluated the clinical characteristics of 74 patients with LAD records (58.1 ± 14.9 years) and 76 patients with LVEDD records (57.6 ± 15.2 years). Based on the receiver-operating characteristic (ROC) curve, the values of LAD = 44 mm and LVEDD = 43 mm were identified to predict the all-cause mortality. In the Kaplan–Meier survival, LAD ≥44 mm and LVEDD ≥43 mm were both significantly associated with all-cause mortality (log-rank test P<0.05). Cox regression analysis indicated that LAD ≥44 mm (HR 3.580; 95% CI = 1.055–12.148; P=0.041) was an independent predictor of all-cause mortality, while LVEDD ≥43 mm was not significantly associated with all-cause mortality. LVOTO was also significantly associated with all-cause mortality (HR = 0.166; 95% CI = 0.036–0.771; P=0.022). Conclusions. In HCM patients with pacemaker implantation, LAD ≥44 mm was an independent predictor of all-cause mortality

Validation of an Arrhythmogenic Right Ventricular Cardiomyopathy Risk-Prediction Model in a Chinese Cohort

Background: The novel arrhythmogenic right ventricular cardiomyopathy (ARVC)-associated ventricular arrhythmias (VAs) risk-prediction model endorsed by Cadrin-Tourigny et al. was recently developed to estimate visual VA risk and was identified to be more effective for predicting ventricular events than the International Task Force Consensus (ITFC) criteria, and the Heart Rhythm Society (HRS) criteria. Data regarding its application in Asians are lacking. Objectives: We aimed to perform an external validation of this algorithm in the Chinese ARVC population. Methods: The study enrolled 88 ARVC patients who received implantable cardioverter-defibrillator (ICD) from January 2005 to January 2020. The primary endpoint was appropriate ICD therapies. The novel prediction model was used to calculate a priori predicted VA risk that was compared with the observed rates. Results: During a median follow-up of 3.9 years, 57 (64.8%) patients received the ICD therapy. Patients with implanted ICDs for primary prevention had non-significantly lower rates of ICD therapy than secondary prevention (5-year event rate: 0.46 (0.13–0.66) and 0.80 (0.64–0.89); log-rank p = 0.098). The validation study revealed the C-statistic of 0.833 (95% confidence interval (CI) 0.615–1.000), and the predicted and the observed patterns were similar in primary prevention patients (mean predicted–observed risk: −0.07 (95% CI −0.21, 0.09)). However, in secondary prevention patients, the C-statistic was 0.640 (95% CI 0.510–0.770) and the predicted risk was significantly underestimated (mean predicted–observed risk: −0.32 (95% CI −0.39, −0.24)). The recalibration analysis showed that the performance of the prediction model in secondary prevention patients was improved, with the mean predicted–observed risk of −0.04 (95% CI −0.10, 0.03). Conclusions: The novel risk-prediction model had a good fitness to predict arrhythmic risk in Asian ARVC patients for primary prevention, and for secondary prevention patients after recalibration of the baseline risk

Validation of an Arrhythmogenic Right Ventricular Cardiomyopathy Risk-Prediction Model in a Chinese Cohort

Background: The novel arrhythmogenic right ventricular cardiomyopathy (ARVC)-associated ventricular arrhythmias (VAs) risk-prediction model endorsed by Cadrin-Tourigny et al. was recently developed to estimate visual VA risk and was identified to be more effective for predicting ventricular events than the International Task Force Consensus (ITFC) criteria, and the Heart Rhythm Society (HRS) criteria. Data regarding its application in Asians are lacking. Objectives: We aimed to perform an external validation of this algorithm in the Chinese ARVC population. Methods: The study enrolled 88 ARVC patients who received implantable cardioverter-defibrillator (ICD) from January 2005 to January 2020. The primary endpoint was appropriate ICD therapies. The novel prediction model was used to calculate a priori predicted VA risk that was compared with the observed rates. Results: During a median follow-up of 3.9 years, 57 (64.8%) patients received the ICD therapy. Patients with implanted ICDs for primary prevention had non-significantly lower rates of ICD therapy than secondary prevention (5-year event rate: 0.46 (0.13&ndash;0.66) and 0.80 (0.64&ndash;0.89); log-rank p = 0.098). The validation study revealed the C-statistic of 0.833 (95% confidence interval (CI) 0.615&ndash;1.000), and the predicted and the observed patterns were similar in primary prevention patients (mean predicted&ndash;observed risk: &minus;0.07 (95% CI &minus;0.21, 0.09)). However, in secondary prevention patients, the C-statistic was 0.640 (95% CI 0.510&ndash;0.770) and the predicted risk was significantly underestimated (mean predicted&ndash;observed risk: &minus;0.32 (95% CI &minus;0.39, &minus;0.24)). The recalibration analysis showed that the performance of the prediction model in secondary prevention patients was improved, with the mean predicted&ndash;observed risk of &minus;0.04 (95% CI &minus;0.10, 0.03). Conclusions: The novel risk-prediction model had a good fitness to predict arrhythmic risk in Asian ARVC patients for primary prevention, and for secondary prevention patients after recalibration of the baseline risk

Meta-analysis of Fragmented QRS as an Electrocardiographic Predictor for Arrhythmic Events in Patients with Brugada Syndrome

Fragmented QRS (fQRS) is an electrocardiographic marker related to ventricular fibrillation (VF) and sudden cardiac death (SCD) in various clinical settings. Current data regarding the prognostic significance of fQRS in Brugada syndrome (BrS) are contradictory. This meta-analysis aimed to evaluate the presence of fQRS as a risk stratification tool in BrS. Electronic databases (PubMed, EMBASE, and Cochrane Library) were searched until May 2016. Eight observational studies accumulating data on 1,637 BrS patients (mean age: 47 ± 11 years) were included in this meta-analysis. The mean follow-up duration ranged from 21 to 96 months. fQRS was found to be an independent predictor of future arrhythmic events in BrS (RR:3.88, 95% CI 2.26 to 6.65, p &lt; 0.00001) with moderate heterogeneity (I2 = 54%, P = 0.03). When analyzing VF as independent end-point, the RR for VF was 3.61, and its 95% CI was 2.11 to 6.18, p &lt; 0.00001. This meta-analysis showed that BrS patients with fQRS are at high risk for future arrhythmic events. The presence of fQRS warrants prospective evaluation as valid arrhythmogenic risk marker in BrS

Comorbid Hypertension Reduces the Risk of Ventricular Arrhythmia in Chronic Heart Failure Patients with Implantable Cardioverter-Defibrillators

Aims: Low blood pressure (BP) has been shown to be associated with increased mortality in patients with chronic heart failure. This study was designed to evaluate the relationships between diagnosed hypertension and the risk of ventricular arrhythmia (VA) and all-cause death in chronic heart failure (CHF) patients with implantable cardioverter-defibrillators (ICD), including those with preserved left ventricular ejection fraction (HFpEF) and indication for ICD secondary prevention. We hypothesized that a stable hypertension status, along with an increasing BP level, is associated with a reduction in the risk of VA in this population, thereby limiting ICD efficacy. Methods: We retrospectively enrolled 964 CHF patients, with hypertension diagnosis and hospitalized BP measurements obtained before ICD implantation. The primary outcome measure was defined as the composite of SCD, appropriate ICD therapy, and sustained VT. The secondary endpoint was time to death or heart transplantation (HTx). We performed multivariable Cox proportional hazard regression and entropy balancing to calculate weights to control for baseline imbalances with or without hypertension. The Fine–Gray subdistribution hazard model was used to confirm the results. The effect of random BP measurements on the primary outcome was illustrated in the Cox model with inverse probability weighting. Results: The 964 patients had a mean (SD) age of 58.9 (13.1) years; 762 (79.0%) were men. During the interrogation follow-up [median 2.81 years (interquartile range: 1.32–5.27 years)], 380 patients (39.4%) reached the primary outcome. A total of 244 (45.2%) VA events in non-hypertension patients and 136 (32.1%) in hypertension patients were observed. A total of 202 (21.0%) patients died, and 31 (3.2%) patients underwent heart transplantation (incidence 5.89 per 100 person-years; 95% CI: 5.16–6.70 per 100 person-years) during a median survival follow-up of 4.5 (IQR 2.8–6.8) years. A lower cumulative incidence of VA events was observed in hypertension patients in the initial unadjusted Kaplan–Meier time-to-event analysis [hazard ratio (HR): 0.65, 95% confidence interval (CI): 0.53–0.80]. The protective effect was robust after entropy balancing (HR: 0.71, 95% CI: 0.56–0.89) and counting death as a competing risk (HR: 0.71, 95% CI: 0.51–1.00). Hypertension diagnosis did not associate with all-cause mortality in this population. Random systolic blood pressure was negatively associated with VA outcomes (p = 0.065). Conclusions: In hospitalized chronic heart failure patients with implantable cardioverter-defibrillators, the hypertension status and higher systolic blood pressure measurements are independently associated with a lower risk of combined endpoints of ventricular arrhythmia and sudden cardiac death but not with all-cause mortality. Randomized controlled trials are needed to confirm the protective effect of hypertension on ventricular arrhythmia in chronic heart failure patients

Efficacy of Wenxin Keli Plus Amiodarone versus Amiodarone Monotherapy in Treating Recent-Onset Atrial Fibrillation

Background. Use of amiodarone (AMIO) in atrial fibrillation (AF) has significant side effects over prolonged periods. Wenxin Keli (WXKL), a Chinese herb extract, has been shown to be effective in atrial-selective inhibiting peak INa and hence beneficial in treating atrial arrhythmias, including atrial fibrillation. The aim of this randomized controlled trial was to evaluate potential effects of AMIO plus WXKL on conversion rate and time in patients with recent-onset AF. Methods. A total of 41 patients (71 ± 12 years, 44% male) with recent-onset (<48 h) AF eligible for conversion were randomized to receive either intravenous amiodarone (loading dose 5 mg/kg in 1 hour followed by 50 mg/h; n=21) or amiodarone with same dosage plus oral WXKL 18 g thrice daily (n=20) for 24 hours. Results. Conversion rate at 24 hours was of no difference between the two groups (75.0% vs. 81.0%, P=0.72); however, conversion time was markedly shorter in the AMIO + WXKL group compared to the AMIO group (291 ± 235 minutes vs. 725 ± 475 minutes, P=0.003). There were no serious adverse events during the study. Conclusion. Administration of amiodarone plus WXKL for recent-onset AF conversion was safe and effective, with faster sinus rhythm restoration compared with amiodarone alone