Cardiac Activity Research Articles

Early-Life Sodium Restriction Programs Autonomic Dysfunction and Salt- Sensitivity in Male C57BL/6J Mice.

Preterm birth increases the risk of cardiometabolic disease in adulthood. Infants born during the second trimester of pregnancy, a critical period of hypothalamic development, are at risk of sodium (Na) depletion due to renal immaturity and large urine Na losses. We previously demonstrated in male mice that Na restriction during the equivalent mouse hypothalamic development period (PD21-PD42) programs long-term changes in energy balance via increased thermogenic sympathetic nervous activity. We therefore hypothesized that early-life Na restriction programs changes in cardiovascular control via altered autonomic activity. C57BL/6J male mice were supplied a low (0.04%) Na or supplemented (0.30%) Na diet from PD21-PD42, before return to standard (0.15%) Na diet. Hemodynamic and autonomic functions were assessed by radiotelemetry and acute administration of autonomic antagonists before and after all animals were switched to a high Na diet (HSD; 1% Na) at 12 weeks of age. Mice were additionally treated with the angiotensin II type 1 receptor (AT1R) antagonist, losartan, for two weeks. On standard diet, early-life Na restriction resulted in small but significantly different hemodynamic responses to autonomic blockers without effect on systolic blood pressure (SBP) or heart rate (HR). HSD increased SBP in 0.04% but not 0.30% Na mice, accompanied by increased cardiac sympathetic activity. Losartan had a greater BP lowering effect in early life Na-restricted mice. Our findings suggest Na restriction during a critical hypothalamic developmental period programs long-term changes in autonomic control of cardiovascular functions and may offer insight into the increased risk of cardiovascular disease in former preterm infants.

Sympathetic nerve activity and response to physiological stress in Takotsubo syndrome.

The prevailing hypothesis posits that Takotsubo syndrome (TTS) is caused by massive sympathetic activation, yet supporting evidence remains inconsistent. The objectives of the present study were to determine whether sympathetic activity and reactivity are enhanced in the recovery phase of TTS, and to evaluate the effect of selective β1-receptor blockade on sympathetic reactivity. We conducted a case-control study that included 18 female patients with TTS and 13 age- and sex-matched controls. Muscle sympathetic nerve activity was measured through microneurography of the peroneal nerve at rest and during the cold pressor test. In the TTS group, recordings were repeated after randomisation to intravenous metoprolol or placebo. In 10 TTS patients, cardiac sympathetic activity was assessed using iodine123-metaiodobenzylguanidine scintigraphy. Blood samples were collected during hospitalisation. Microneurography was performed a median of 27.5days after patient admission. There were no significant differences in burst incidence, burst frequency, burst height or burst area between the TTS patients and the controls at rest, during stress or after administration of intravenous metoprolol. Iodine123-metaiodobenzylguanidine scintigraphy was performed a median of 12.5days after admission, revealing decreased early 1.54 ± 0.13 and late 1.40 ± 0.13 heart-to-mediastinum ratios, and an increased washout rate of 41.8 ± 12.1%. Catecholamine metabolites were comparable between the study groups. General sympathetic hyperactivity or hyperreactivityunlikelycontributesto TTS, as catecholamine levels and muscle sympathetic nerve activity at rest and during stress were similar between the TTS patients and the controls.As scintigraphy showed increased cardiac sympathetic activity, a pathological cardiac adrenergic response and vulnerability to sympathetic activationmay be crucial for the development of the syndrome.

The effectiveness of cryostimulation exposure on sleep and recovery in male athletes: Timing considerations.

The objectives of the study were (i) to evaluate the effects of whole-body cryostimulation (WBC) after training as an effective tool to improve sleep and recovery and (ii) to determine which exposure schedule for WBC (immediately after training vs. 1h before bedtime) is the most appropriate to improve sleep and recovery. Twenty-two well-trained male athletes or triathletes (23.1±3.5-years) were recruited in this controlled crossover protocol. Each participant completed the three experimental sessions, each composed of a running training session and one night of sleep analysis. Depending on the experimental condition, subjects were exposed-or not (CONT)-to WBC immediately after training (CRYO 7 p.m.) or 1h before going to bed (CRYO 10 p.m.). All participants were randomly assigned to each condition, spaced seven days apart. Sleep was monitored via actimetry, cerebral activity recordings, heart rate variability, body core temperature, and perceptual measurements. WBC after training did not modify subjective or objective sleep parameters compared to the control condition. However, WBC significantly improved cardiac parasympathetic activity. More specifically, it was more activated during the night following the CRYO 10 p.m. condition than in the other experimental conditions. Core body temperature (CBT) 1h after bedtime was the lowest in the CRYO 10 p.m. condition. This study confirmed the effectiveness of WBC as a recovery technique after intense evening training. We suggest that WBC may exhibit the most significant benefit on recovery if the session is performed 1h before bedtime, acting on subsequent parasympathetic activation and CBT drop.

Assessment of Cardiac Autonomic Function by Short-Term Sensor-Based and Long-Term Heart Rate Variability Analyses in Individuals with Spinal Cord Injury After Long-Term Table Tennis Training

This study aimed to examine the acute and chronic effects of an exercising table tennis program on cardiac Autonomic Nervous System (ANS) and functional capacity in people with tetraplegia. Twenty males with tetraplegia (C6–C7), with a mean age of 38.50 ± 4.04 years old, were randomly assigned into two equal groups: A, who followed a 6-month exercise training program with table tennis 3 times per week, and B, who remained untrained. Additionally, 11 healthy sedentary men (group C) with a mean age of 39.71 ± 5.87 years old participated in the study as healthy controls. At baseline, all participants underwent a short-term (5 min) and a long-term (24 h ambulatory) ECG monitoring to evaluate the heart rate variability (HRV) indices and a maximal arm ergometric and dynamometric testing of the upper limbs. Moreover, the acute cardiac autonomic responses to maximal arm cycle exercise test were evaluated by Polar S810i sensor chest strap. At the end of the 6-month study, all parameters were revaluated only in groups A and B. At baseline, there was no statistically significant difference between the two patient groups. However, intra-group changes at the end of the 6-month study regarding the 24-h HRV monitoring indicated that group A statistically increased the standard deviation of R-R intervals (SDNN) by 13.9% (p = 0.007), the standard deviation of R-R intervals calculated every 5 min (SDANN) by 8.4% (p = 0.007), the very low frequency (VLF) by 7.1% (p = 0.042), and the low frequency [LF (ms2)] by 10.5% (p = 0.009), which almost reached the levels of group C. Favorable improvements were also noticed at the end of the study for group A in maximal exercise time of the upper limbs by 80.4% (p < 0.001) and maximal strength of the right hand by 27.8% (p < 0.001). Linear regression analysis after training showed that maximal exercise time was positively correlated with SDNN (r = 0.663, p = 0.036) and with LF (ms2) (r = 0.623, p = 0.045). Our results indicate that a 6-month table tennis training program is efficient and can improve cardiac ANS activity mainly by increasing sympathovagal balance.

An ultrasensitive multimodal intracranial pressure biotelemetric system enabled by exceptional point and iontronics.

The accurate monitoring of vital physiological parameters, exemplified by heart rate, respiratory rate, and intracranial pressure (ICP), is of paramount importance, particularly for managing severe cranial injuries. Despite the rapid development of implantable ICP sensing systems over the past decades, they still suffer from, for example, wire connection, low sensitivity, poor resolution, and the inability to monitor multiple variables simultaneously. Here, we propose an ultrasensitive multimodal biotelemetric system that amalgamates an iontronic pressure transducer with exceptional point (EP) operation for the monitoring of ICP signals. The proposed system can exhibit extraordinary performance regarding the detection of minuscule ICP fluctuation, demonstrated by the sensitivity of 115.95 kHz/mmHg and the sensing resolution down to 0.003 mmHg. Our system excels not only in the accurate quantification of ICP levels but also in distinguishing respiration and cardiac activities from ICP signals, thereby achieving the multimodal monitoring of ICP, respiratory, and heart rates within a single system. Our work may provide a pragmatic avenue for the real-time wireless monitoring of ICP and thus hold great potential to be extended to the monitoring of other vital physiological indicators.

Exploring the therapeutic mechanisms of heart failure with Chinese herbal medicine: a focus on miRNA-mediated regulation

Heart failure (HF) is a clinical condition caused by abnormalities in the heart’s structure or function, primarily manifested as diminished ability of the heart to pump blood, which leads to compensatory activation of neurohormones and increased left ventricular filling pressure. HF is one of the fastest-growing cardiovascular diseases globally in terms of incidence and mortality, negatively impacting patients’ quality of life and imposing significant medical and economic burdens. Despite advancements in the treatment of HF, hospitalization and mortality remain rates high. In China, Chinese herbal medicine (CHM) has historically played a prominent role in addressing HF, with significant proven efficacy. MicroRNA (miRNA) exerts a pivotal regulatory influence on the maintenance of regular cardiac activity and the progression of HF. MiRNAs, a category of single-stranded RNA molecules, are characterized by their inability to code for proteins. They regulate gene expression by binding to the 3′-untranslated region (3′-UTR) of target mRNAs, thereby influencing the onset and progression of various diseases. Abnormal expression of specific miRNAs is closely associated with HF pathological processes, such as cardiomyocyte apoptosis, myocardial fibrosis, and cardiac hypertrophy. This abnormal expression can influence the pathological progression of HF through the regulation of miRNA expression. This article reviews the regulatory role of miRNAs in HF pathology discusses how CHM compounds and their active ingredients can ameliorate HF pathology through the regulation of miRNA expression. In conclusion, miRNAs represent promising therapeutic targets for HF, and CHM provides a novel strategy for treatment through the regulation of miRNA expression. Future studies must delve deeper into the precise mechanisms by which CHM modulates miRNAs and fully explore its potential for clinical application in HF treatment.

Inter- and intra-examiner reliability of short-term measurement of heart rate variability on rest in patients hospitalized with COVID-19

Measures reflecting cardiac sympathovagal activity, particularly those associated with heart rate variability (HRV), are widely recognized and utilized in both scientific and clinical contexts. This study aimed to assess the inter- and intra-examiner reliability of short-term HRV parameters in patients hospitalized with coronavirus disease 2019 (COVID-19). A total of 103 patients (both sexes) diagnosed with COVID-19 were included in the study. HRV was analyzed using both linear and nonlinear methods. Reliability was evaluated through intraclass correlation coefficient (ICC2.1), minimum detectable change (MDC), standard error of measurement (SEM), and coefficient of variation (CV). According to Fleiss’ criteria, excellent reliability was demonstrated, with ICC values ranging from 0.970 to 0.999 for Examiner 1, and from 0.956 to 0.999, for Examiner 2. In the inter-examiner analysis, the ICCs of HRV parameters ranged from 0.972 to 0.999. SEM values for intra-examiner reliability for Examiner 1 ranged from 0.02 to 5.64, with MDC values from 0.05 to 15.64, and CV (%) from 0.28 to 8.04. For Examiner 2, SEM values ranged from 0.02 to 8.18, MDC values from 0.05 to 22.68, and CV (%) from 0.24 to 8.14. For inter-examiner reliability, SEM values ranged from 0.02 to 6.17, MDC from 0.06 to 17.11, and CV (%) from 0.34 to 9.81. Across all analyses, CVs for HRV parameters remained below 10%. Considering different time points and different examiners, short-term resting HRV measurements in patients hospitalized with COVID-19, as evaluated using a portable heart rate device, exhibit high reliability.

The research of influence factors that possibly lead to cardiovascular disease

Abstract. The emergence of cardiac disease is influenced by numerous variables. Every year a large percentage of people around the world die from heart attacks. This study was to look at how important clinical variables are connected to the chance of having CVD. The analysis used a Kaggle dataset with details from 70,000 patients and 10 different variables. The study examined how factors such as age, gender and changes in cardiac activity during exercise affect overall heart health. Multiple linear regression models were used to analyze these effects. The results show a significant correlation between these factors and an increased risk of heart disease. This emphasizes the importance of these predictors in clinical assessments. It can be concluded from this study that regular medical check-ups, early prevention and treatment should be carried out for these vulnerable groups. The general prevalence of heart disease in the nation can be decreased by implementing these strategies. According to the study, personalized health strategies have the potential to improve CVD outcomes and strengthen preventive measures. All of the experimental results suggest that continued documentation and study of these pathogenic factors in medical diagnostics and experiments could aid in drug development as well as improve medical technology and help more patients with cardiovascular disease recover.

Acute effects of bolus water intake on post-exercise orthostatic hypotension and cardiovascular hemodynamics.

Water intake is known to be effective in preventing orthostatic hypotension (OH). However, it is unknown whether water intake would be effective in acutely preventing exercise-induced OH. Fourteen adults (men/women: 7/7, age: 20 ± 8years) were recruited. Each subject underwent two protocols with and without 500ml water intake using a randomized crossover design (Water vs. Control). Participants underwent 30min of cycle ergometry at the 60-70% predicted VO2 max. OH and hemodynamics were assessed before and after exercise, and immediately (Water 1) and 20min (Water 2) after the water intake. OH was evaluated with a 1-min standing test as the criteria for systolic blood pressure (SBP) < 90mmHg. A cross-spectral analysis for RR and SBP variability was used to evaluate the cardiac autonomic activity and baroreflex sensitivity. In both protocols, the incidence of OH increased after the exercise. The incidence of OH was lower in Water than in Control at Water 1 (OR: 0.093, 95% CI: 0.015-0.591). Heart rate was lower and SBP was higher in Water than in Control at Water 1 and 2 (P < 0.05). High-frequency power of RR variability and transfer function gains in Water were normalized and higher than in Control at Water 1 and 2 (P < 0.05). The ratio of low- to high-frequency power of RR variability in Water was normalized and lower in Water than in Control at Water 1 (P < 0.05). Our findings indicate that water intake may prevent acute exercise-induced OH, accompanied by normalized cardiac autonomic activity and baroreflex sensitivity.

Electrocardiographic Changes in Second and Third Trimester in Bangladesh: A Comparative Study

Background: During pregnancy, there are notable changes in cardiovascular function to meet the increasing needs of the developing baby. The objective of this study was to compare ECG in pregnant women during their second and third trimesters with a control group of non-pregnant women in Bangladesh. This study aims to offer valuable insights into the cardiovascular changes that happen during pregnancy. This study's findings are important for maternal health research and clinical practice in Bangladesh and beyond. Objective: The purpose of this study is to analyze and compare the ECG variations in women during the second and third trimesters of pregnancy. Methods: The study took place in the gynecology Department at CMH Saidpur, Bangladesh. This study was conducted from March 2023 to August 2023. During this period, 75 pregnant patients in their 2nd trimester and 75 patients in their 3rd trimester were chosen as cases from antenatal outdoor, while 75 non-pregnant women of the same age were selected as the control group. We use the purposive sampling method. Results: During pregnancy, there were notable changes in BMI, heart rate, and PR interval. BMI decreased in the second trimester and increased in the third trimester.22.67% were nulliparous and 77.33% were multiparous in 2nd trimester. In the third trimester, 26.67% were nulliparous and 73.33% multiparous. So, no significant difference in parity. Heart rate increased in both trimesters, while the PR interval shortened in both trimesters. No significant changes were observed in the durations of the QRS complex or QT interval. In our study, the QTc interval displayed a significant rise. ST depression, which may suggest decreased blood flow, was exclusively seen in pregnant women, particularly in the third trimester. Conclusion: We found no significant changes in age, but BMI, heart rate, and PR interval were significantly different from the control group throughout pregnancy. No significant QRS complex or QT interval duration changes were identified. The QTc interval rose. ST depression, more prominent in the third trimester, only affected pregnant women. As shown by ST depression, pregnancy may change cardiac function, electrical activity, and ischemia.

Remote ischemic peri-conditioning suppressed cardiac sympathetic nerve activity especially in the non-culprit lesion in patients with acute myocardial infarction

Abstract Background Remote ischemic periconditioning (RIPC) has demonstrated cardioprotective effects and improved clinical outcomes as an adjunct to emergent percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). However, it remains to be elucidated whether RIPC affects the cardiac sympathetic nerve activity in patients with AMI. Purpose The purpose of this study is to investigate the effect of RIPC on cardiac sympathetic nerve activity (CSNA) in the culprit and non-culprit lesion respectively in patients with AMI. Methods We randomly assigned 157 patients with suspected AMI undergoing emergent PCI to receive transient limb ischemia (by inflating a cuff at 200 mmHg for 4×5 minutes: RIPC group, n=77) or no procedure (control group, n=80). After excluding inappropriate patients such as those with other diagnosis than AMI, we analyzed 122 patients (62 patients in RIPC and 60 in control group). CSNA was assessed in the culprit and non-culprit lesion respectively by the cardiac MIBG SPECT imaging. Results Patients in RIPC and control group had similar demographic and clinical characteristics at baseline. Patients in RIPC group tended to show higher late uptake only in the non-culprit lesion at discharge. At 1 year after discharge, patients in RIPC group demonstrated significantly higher late uptake (p=0.021) and lower washout rate (p=0.013) than those in control group in the non-culprit lesion. Regarding the culprit lesion, only washout rate tended to be lower in RIPC group at 1 year after discharge. Conclusion(s): Remote ischemic peri-conditioning showed suppressive effect on cardiac sympathetic nerve activity especially in the non-culprit lesion in patients with acute myocardial infarction.SPECT parameters in RIPC and control

Unravelling cardiomyopathies: a comprehensive analysis of phenotypic diversity, endomyocardial biopsy patterns, and the impact of Gremlin-1 on clinical prognosis

Abstract Background Cardiomyopathies are the main cause of progressive heart failure (HF) and despite outstanding advances of diagnostics and therapies, mortality remains high.1,2 The current phenotype-based classification of non-ischemic cardiomyopathies (NICM) is based on a clinical workflow including endomyocardial biopsy (EMB).3-5 Inflammation and fibrosis are essentially involved in progression of HF and lead to development of adverse cardiovascular (CV) events.6,7 The diagnostic algorithm facilitates risk stratification of HF patients but nonetheless risk factors often remain inapparent prior to disease incidence. Objective In this study we investigate EMB patters in patients with NICM and elucidate alterations associated with phenotypic diversity and progression of HF. Methods We prospectively enrolled patients with HF due to NICM in a large-scale all-comers cohort (n=703). All patients underwent guideline-based phenotypic classification including EMB, and RNA data were acquired alongside histological analyses within the myocardium. We then performed a ten-year follow-up to screen for disease progression. Results A guideline-based classification of patients with NICM resulted in a phenotyping of aetiological risk groups (Figure 1A). We found that characteristic expression of fibroinflammatory mediators within the myocardium occurred in patients with symptomatic NICM (Figure 1B). We found that elevated expression of Gremlin-1 (Grem), a potent downstream profibrotic mediator of TGFß pathway, was associated with pro-fibrotic cardiac remodelling (Figure 1C). Further, Gremlin-1 was associated with a significant decrease of left ventricular functional capacity and inversely correlated with late gadolinium enhancement (LGE) (Figure 1D&amp;E). Moreover, the expression of Gremlin-1 was enriched with pro-fibrotic and inflammatory RNA signalling pathways hinting at underlying pathophysiological cascades (Figure 2A&amp;B). Most strikingly, the expression of Gremlin-1 was independently associated with an increased CV risk during the ten-year follow-up (Figure 2C). Thus, patients with Gremlin-1+ EMB were at elevated risk to suffer from all-cause mortality and number of patients eligible for ICD implantation was critically enhanced in patients with Gremlin-1+ EMB (Figure 2D-F). In addition, the estimation of an elevated CV risk by machine learning including Gremlin-1 improved the ten-year risk stratification among all patients with NICM (Figure 2G). Thus, Gremlin-1 was associated with cardiac remodelling and disease activity in HF patients (Figure 2H). Conclusion Our results unveiled that Gremlin-1 is associated with inflammation and cardiac remodelling in patients with symptomatic cardiomyopathy and patients with Gremlin-1+ EMB are at elevated risk to develop adverse CV events. Thus, the histological evaluation of Gremlin-1 may help to identify pathophysiological cascades and improve early risk discrimination and management of HF patients.Figure 1Figure 2

The activation of cardiac sympathetic nervous system in the non-culprit lesion is a strong prognostic predictor in patients with acute myocardial infarction

Abstract Background The activation of cardiac sympathetic nervous system is associated with poor prognosis in patients with acute myocardial infarction (AMI). However, it remains to be determined whether regional assessment of cardiac sympathetic nerve activity (CSNA) in the culprit and non-culprit lesion of the cardiac MIBG SPECT imaging could have prognostic value in patients with AMI. Purpose The purpose of this study is to investigate the prognostic impact of regional CSNA in patients with AMI. Methods We prospectively enrolled 122 patients with AMI who visited our emergency department and underwent primary percutaneous coronary intervention. The late heart-to-mediastinum ratio (HMR) and washout rate (WR) was calculated to assess CSNA in the whole heart from planar images of in the cardiac MIBG imaging. The MIBG SPECT image parameters were calculated for each coronary artery, and the average WR in the culprit and non-culprit lesion were evaluated to assess the regional status of CSNA in patients with AMI. Abnormal WR in planar image was defined as 34% or more, as previously reported. The cut-off value of late HMR in planar image, WR in the culprit and non-culprit lesions were determined by ROC analysis. The primary endpoint was major adverse cardiac event (MACE) including all cause death, myocardial infarction, hospitalization for heart failure and target lesion revascularization. Results During a mean follow-up period of 3.1±1.8 years, 25 of 122 patients underwent MACE. The late HMR (p=0.004), WR in planar image (p=0.002), WR in the culprit lesion (p=0.023), and WR in the non-culprit lesion (p&amp;lt;0.001) were significantly associated with MACE at univariate Cox proportional hazard analysis. The increased WR in the non-culprit lesion (defined as 28.3% or more: AUC 0.697 [0.576-0.817]) was significantly independently associated with MACE (hazard ratio: 4.36 [1.45-13.11], p=0.009) even adjusted by late HMR, WR in planar image or WR in the culprit lesion, while decreased HMR, abnormal WR in planar image and increased WR in the culprit lesion showed no significant association with MACE in the multivariate model with WR in the non-culprit lesion. Kaplan-Meier analysis revealed that patients with increased WR in the non-culprit lesion had significantly higher risk for MACE than those without increased WR (45% vs 11% p&amp;lt;0.001). Conclusion(s) The activation of cardiac sympathetic nervous system in the non-culprit lesion is particularly associated with poor prognosis in patients with acute myocardial infarction.MACE risk by WR in non-culprit lesion

Characteristics associated with prevalent atrial fibrillation and risk profile for future atrial fibrillation among those in sinus rhythm in an elderly population in the ELSA Brasil Study

Abstract Background Atrial fibrillation (AF) is an arrhythmia that can lead to limiting symptoms and increases the risk of stroke and heart failure (HF). Purpose To evaluate the association of clinical, electrocardiographic, and echocardiographic parameters with prevalent AF or flutter (AFF), and the risk profile for future AFF according to Charge-AF and EHR scores in an elderly population. Methods The ELSA-Brasil is a prospective cohort study designed to investigate cardiovascular disease and diabetes in 15,105 men and women, civil servants from universities or research institutions in six cities of Brazil. We included all participants in ELSA-Brasil aged 60 and over whose diagnosis of AFF could be assessed and had echocardiography performed at the study's baseline. From the initial sample with participants ≥ 60 years (n = 3,263), 400 participants were excluded due to missing data about AFF, and 775 who did not have echocardiographic studies. Results There were 88 (4.2%) participants with AFF at baseline among the 2,088 (65 ± 4.1 years; 53% women) included in this analysis. Those with AFF were older (66.8 ± 4.4 vs 65 ± 4.0 y-o) and had a higher prevalence of HF (16% vs 3.1%), previous myocardial infarction (14.8% vs 3.8%), left bundle branch block (LBBB: 4.6% vs 0,9%), prolonged QT interval (7.9% vs 2.0%), supraventricular extrasystoles (4.6% vs 1.2%), and sinus bradycardia (11.3% vs 2.9%). AFF individuals also presented larger left atrial volume index - LA (33.3 mL/m2 versus 27 mL/m2), left ventricular end-diastolic diameter (4,63 ± 0,6 cm versus 4,47 ± 0,4 cm) and lower left ventricular ejection fraction (LVEF: 63.6 ± 9.1% vs 67.4 ± 6.4%) that non-AFF (all p-values &amp;lt;0.05). In multivariable analysis, prevalent HF, LBBB, larger LA, and lower LVEF were independently associated with the presence of AFF. Among those in sinus rhythm at study baseline, both risk models showed that most individuals in our sample were at low risk. In the Charge-AF, 63% of individuals were identified as presenting low risk (&amp;lt;2.5%), and 12% of the sample was categorized as high risk, with a risk of five-year AFF greater than 5%. Similarly, in the EHR, 67% of participants were classified as low risk, and 13% were considered high risk. Conclusion We found that AFF was present in 4.2% of the subset of older participants in a cohort composed of free-living individuals in Brazil. The presence of AFF was associated with HF history, altered cardiac electrical activity, LA dilation, and worse LV systolic function. Among those with sinus rhythm, 12-13% were considered at high risk of developing AFF (&amp;gt; 5% in five years) based on two clinical scores. Clinical surveillance and monitoring of electrocardiography and echocardiography parameters may help the early identification of risk factors for AFF.

Cardiac sympathetic innervation, assessed with 123I-MIBG SPECT, predicts left ventricular function improvement in patients with newly diagnosed dilated cardiomyopathy

Abstract Introduction Beta-blockers (BB) are commonly prescribed medications for heart failure (HF) due to their ability to counteract the increased sympathetic nervous system (SNS) activity seen in HF, resulting in downregulation and desensitization of β-receptors. In patients with dilated cardiomyopathy (DCM), the introduction of BB therapy can lead to left ventricular ejection fraction (LVEF) improvement in 30-50% of cases. Single-photon emission computed tomography (SPECT) with 123I-meta-iodobenzylguanidine (MIBG) is a useful tool for assessing cardiac SNS activity. Healthy individuals typically exhibit high SPECT-MIBG uptake and low washout rate (WR) due to normal β-receptor levels and low norepinephrine (NE) levels, respectively (Fig 1A). While better SPECT-MIBG results have been associated with LVEF improvement in the general HF population, less data is available for DCM patients. Purpose This study aimed to evaluate the predictive value of MIBG-SPECT for LVEF improvement in newly diagnosed DCM patients. Methods Twenty-one DCM patients (mean age 47 ± 10 years, 90% male, baseline LVEF 29.5 ± 8.7%, left ventricular end-diastolic volume (LVEDV) 114 ± 36 ml/m2) with stable HF symptoms (NYHA class 1.8 ± 0.6) and newly diagnosed DCM underwent baseline MIBG-SPECT and echocardiography. HF therapy was initiated and up-titrated, and echocardiography was repeated at 6 months. Semi-quantitative parameters from MIBG-SPECT, including the MIBG uptake ratio from the heart and mediastinum (H/M) at 15 minutes (-15) and 4 hours (-4), as well as the WR [WR = (H/M-15 - H/M-4) / H/M-15], were evaluated. Patients were stratified based on median WR - 8.79 (IQR 5.17-12.90). Results After 6-months of HF therapy up-titration, 18 patients improved LVEF, and the mean LVEF increase was 7.7 ± 10.4%. Although, patients with WR &amp;gt; median did not differ in terms of baseline LVEF (30.2 ± 7.0 vs. 27.7 ± 9.6, p=0.52), they had worse LVEF at 6 months (32.0 ± 11.0 vs. 40.6 ± 9.2%, p=0.04). Moreover, WR at baseline strongly correlated with 6-month LVEF (R=-0.51, p=0.01) and was a significant predictor of 6-month LVEF (β=-0.55 ± 0.19, p=0.009). Moreover, WR could successfully predict LVEF improvement ≥ 10% (OR 1.27 [95%CI 1.01-1.61], p=0.03; AUC 0.82 [95%CI 0.63-0.99], p&amp;lt;0.001) with a cut-off point of 8.0 (sensitivity 88%, specificity 77%) (Fig 1B). Conclusion Most DCM patients demonstrated LVEF improvement during 6 months of HF therapy up-titration. Baseline WR from MIBG-SPECT was found to be a reliable predictor of significant LVEF improvement in this patient population.Fig1.A-SPECT-MIBG results. B-ROC curve.

A novel device for electrocardiographic imaging

Abstract Background Electrocardiographic imaging (ECGi) is a non-invasive imaging tool that allows 3D visualization and characterization of the electrical activity of the heart from measurements on the body surface by solving the so called "inverse problem of electrocardiography". This method helps overcome the limitations of the conventional12-lead ECG in diagnosing and locating heart arrythmias. We developed a textile 34-electrode imageless device (with no need for MRI or CT-scan). Purpose We aim to evaluate the feasibility and safety of the use of a novel textile imageless 34-electrode device for recording ECGi for identification of electrical activity of the heart. Methods and results The performance of a prototype data acquisition system (DAS) was evaluated in 158 individuals. Tests were conducted in three hospitals. The mean age was 43.32 years old (±17.44); mean height 167.31cm (±18.33); mean weight 70kg (±15.68). Almost 88% of the patients were in sinus rhythm. The relative frequencies of the targeted pathologies are listed in Figure 1. The collection of cardiac signals and posterior representation in virtual reality of a stereoscopic, holographic 3D-360º map, was achieved in 100% of the patients. Figure 2 shows the textile hardware with the silver dry electrodes and a screenshot of the software with an example of a voltage map in a patient in sinus rhythm. There were no adverse effects reported. The DAS is composed of 34 electrodes, being their distribution representative of the electrical activity on the torso. Several studies have discussed the minimum number of electrodes on the torso of the patient required to characterize the heart potentials from the electrical potentials on the torso surface through the inverse problem (1,2). We highlight that the representativeness condition of the electrical activity on the torso is crucial to appropriately estimate cardiac activity with the minimum number of leads on the DAS. Conclusion The use of a novel textile imageless 34-electrode device for recording ECGi for identification of electrical activity of the heart is feasible and safe.Targeted rhythmHardware and software

Autonomic Modulation in Parkinson’s Disease Using Whole-Body Cryostimulation: A Pilot Study

Background: Parkinson’s disease (PD) is a multifaceted neurodegenerative disorder that progressively affects both the central and peripheral nervous systems. This pilot study aimed to examine the effects of repeated whole-body cryostimulation (WBC) sessions on the sympathovagal balance in PD patients and correlate heart rate variability (HRV) indexes with peripheral biomarkers of the autonomic nervous system (ANS). Methods: Seventeen PD patients with mild to moderate motor severity underwent a 10-session WBC cycle over 5 consecutive days. Thirteen patients (6 males, 7 females; mean age 64.5 ± 9.01 years; mean disease duration 5.4 ± 2.3 years) completed the protocol. Cardiac autonomic activity was assessed through HRV measures including RR interval variability (RR mean, RR min, RR max), power density of high and low frequencies (HF, LF), RMSSD, and the LF/HF ratio. Systemic sympathetic activity was evaluated via circulating blood catecholamine levels. Results: Significant increases were observed in RR mean, RR min, RR max, RMSSD, and HF spectrum, indicating enhanced parasympathetic activity. Blood pressure remained stable, suggesting safety. Conclusions: These findings provide initial support to WBC as a potential “rehabilitation booster” in PD, enhancing sympathovagal balance. Further research is needed to explore the long-term benefits of WBC in PD management.

Cesarean scar pregnancy: should surgery be the preferred treatment approach?

To compare the characteristics and outcomes of non-surgical and surgical treatments for Cesarean scar pregnancy (CSP). A retrospective study conducted at a tertiary university affiliated medical center, including all women diagnosed with Cesarean scar pregnancy between 2019 and 2023. Women treated non-surgically (including: methotrexate, uterine artery embolization and balloon catheter) were compared to women treated surgically (including: hysterectomy, hysteroscopy and excision of the pregnancy with or without uterine niche repair). Demographic information, medical history, obstetric and gynecological characteristics, presenting symptoms, imaging findings, management details, surgical characteristics, and follow-up data were collected from the women's electronic medical records. Primary outcome was defined as the β-hCG levels on follow-up visit at 2weeks following treatment. 42 women were diagnosed with Cesarean scar pregnancy during the study period, of them 9 (21%) were treated non-surgically and 33 (79%) were treated surgically. Median age was 33 (30-36) year old and median BMI was 31 (27-35) kg/m2, with no statistical differences in-between the groups. Most of the women had previous two Cesarean sections (n = 12, 28%). 63% of the women were asymptomatic at the time of diagnosis. On transvaginal ultrasound examination, embryo was demonstrated in 66.7% and cardiac activity was observed in 75%. The median gestational age at diagnosis and β-hCG levels were comparable between the non-surgical and surgical treatment groups (p = 0.22, p = 0.61, respectively). In the surgical arm, the most common surgical procedure was excision of the pregnancy with uterine niche repair, that was performed in 14/42 (33%) of the women. Median hospitalization length was 3 (1-4) and 2 (1-3) days, for the non-surgical and surgical treatment groups, respectively (p = 0.51). The hemoglobin level before discharge was similar between the groups (p = 0.20). Only one woman in each group visited the emergency room before the follow-up visit (p = 0.31). β-hCG levels on follow-up were significantly lower in the surgical group compared to the non-surgical (p = 0.02). Cesarean scar pregnancy can be asymptomatic and should be suspected to enable early diagnosis. Both non-surgical and surgical treatments are viable options, with comparable hospitalization lengths; however, the surgical intervention group is expected to show a significantly faster decrease in β-hCG levels.

A Task-driven Adversarial Channel Selection Method for Binary Classification Based on Magnetocardiography.

As the number of sensors in magnetocardiography (MCG) arrays increases to capture detailed cardiac activity, some channels contribute minimally to task performance, resulting in data redundancy and resource consumption. Although existing methods can reduce the number of channels required to meet task demands, they often struggle to balance computational time and the accuracy of the selected channels and overlook the scalability of the selected channels. This limitation means that when environmental conditions change, or when sensors malfunction, redesigning channel configurations becomes necessary, which increases experimental uncertainties. This study introduces a task-driven adversarial channel selection method tailored for binary classification of MCG signals. The optimal channel combination is determined through a group-wise search using a heuristic algorithm, whose objective function is designed to maximize the difference between the classification accuracy and cosine similarity of the selected channel. In evaluations using an MCG dataset from Qilu Hospital of Shandong University, the proposed method successfully reduced the number of channels from 36 to 5 without compromising classification performance. Furthermore, it outperforms existing hybrid sequential forward search method by achieving comparable accuracy with fewer channels, while also demonstrating superior scalability compared to both hybrid sequential forward search and pearson-rank methods. This approach strikes a balance between computational consumption and accuracy, while improving the scalability of the selected channel combinations, enhancing the efficiency and practicality of the MCG system.

The sympathetic nervous system in heart failure with preserved ejection fraction.

The sympathetic nervous system (SNS) is a major mediator of cardiovascular physiology during exercise in healthy people. However, its role in heart failure with preserved ejection fraction (HFpEF), where exercise intolerance is a cardinal symptom, has remained relatively unexplored. The present review summarizes and critically explores the currently limited data on SNS changes in HFpEF patients with a particular emphasis on caveats of the data and the implications for its subsequent interpretation. While direct measurements of SNS activity in HFpEF patients is scarce, modest increases in resting levels of muscle sympathetic nerve activity are apparent, although this may be due to the co-morbidities associated with the syndrome rather than HFpEF per se. In addition, despite some evidence for dysfunctional sympathetic signaling in the heart, there is no clear evidence for elevated cardiac sympathetic nerve activity. The lack of a compelling prognostic benefit with use of β-blockers in HFpEF patients also suggests a lack of sympathetic hyperactivity to the heart. Similarly, while renal and splanchnic denervation studies have been performed in HFpEF patients, there is no concrete evidence that the sympathetic nerves innervating these organs exhibit heightened activity. Taken together, the totality of data suggests limited evidence for elevated sympathetic nerve activity in HFpEF and that any SNS perturbations that do occur are not universal to all HFpEF patients. Finally, how the SNS responds during exertion in HFpEF patients remains unknown and requires urgent investigation.