ECG Test Research Articles

Impact of the COVID-19 pandemic on cardiology services at a tertiary cardiac centre in a low- and middle-income country in Asia

Abstract Background The COVID-19 pandemic resulted in reduced numbers of patients presenting with and undergoing procedures for cardiac conditions worldwide. This impact, specifically looking at the changes in patient visits, admissions and procedure volumes, has not been recorded thus far, in terms of a South Asian LMIC setting. Purpose We aimed to assess the impact of the pandemic on emergency room (ER) visits, cardiology admissions, out-patient and in-patient procedures at a LMIC tertiary cardiac centre. Methods Data on ER visits, specific in-patient and out-patient procedures (echocardiography, exercise stress tests, electrocardiography [ECG]) were collected via hospital electronic records from January to December 2020, and compared with corresponding data for the same months in 2019. The difference or deficits were expressed as a percentage (%Δ). Data for each quarter were compared using paired t-test. A p value <0.05 was considered significant. Results There were significantly reduced numbers of out-patient visits (Δ −31.2%; p=0.007), ER visits (%Δ −59.5%; p=0.0), in-patient admissions (Δ −33.1%; p=0.005), total out-patient procedures (%Δ −31.9%; p=0.008) and catheterization volumes (%Δ-29.7%; p=0.001) in 2020, as compared with 2019 (Table 1 & Figure 1). Among out-patient procedures, adult trans-thoracic echo, ECG and stress tests showed greatest deficits in April 2020. No trans-oesophageal echocardiograms were performed in April to July 2020. The greatest deficits were observed in April 2020, as compared with 2019 (out-patient visits: Δ-92.7%; out-patient procedures: %Δ-94.5%; in-patient admissions: %Δ-85.9%; catheterization procedures: %Δ-85.2%), except for ER visits, where the greatest deficit was seen in June 2020: %Δ-90.7%). Numbers continued to remain extremely low in May 2020, coinciding with the nation-wide lockdown measures. Out-patient visits, procedures and in-patient admissions have gradually increased since July 2020. However, the greatest impact seems to have been on ER visits, continued to remain low, with significantly reduced volumes in both 2nd and 3rd quarters of 2020. The lowest deficits in outpatient visits (Δ-4.9%), ER visits (Δ-31.9%) and out-patient procedures (Δ-0.9%) were seen in December 2020, while for in-patient admissions (Δ-7.9%) and catheterization procedures (Δ-6.5%) this was in October 2020. Conclusion There was a significant reduction of out-patient and in-patient cardiology services volumes in 2020, with the greatest reduction in April and May, coinciding with a general “lockdown”. ER visits were the most greatly affected. Trends show a steady increase in out-patient and catheterization procedures, beginning from July, but have not yet reached pre-COVID volumes, even by the end of 2020. These findings indicate that, the pandemic has resulted in significantly fewer ER visits; however, patients still present as outpatients, both for procedures and catheterization. Funding Acknowledgement Type of funding sources: None. Table 1Figure 1

Exercise ECG Testing and Stress Cardiac Magnetic Resonance for Risk Prediction in Patients With Chronic Coronary Syndrome.

Vasodilator stress cardiac magnetic resonance (VS-CMR) has become crucial in the workup of patients with known or suspected chronic coronary syndrome (CCS). Whether traditional exercise ECG testing (ExECG) contributes prognostic information beyond VS-CMR is unclear. We retrospectively included 288 patients with known or suspected CCS who had undergone ExECG and subsequent VS-CMR in our institution. Clinical, ExECG, and VS-CMR variables were recorded. We defined the serious adverse events (SAE) as a combined endpoint of acute coronary syndrome, admission for heart failure, or all-cause death. During a mean follow-up of 4.2 ± 2.15 yr, we registered 27 SAE (15 admissions for acute coronary syndrome, eight admissions for heart failure, and four all-cause deaths). Once adjusted for clinical, ExECG, and VS-CMR parameters associated with SAE, the only independent predictors were HRmax in ExECG (HR = 0.98: 95% CI, 0.96-0.99; P = .01) and more extensive stress-induced perfusion defects (PDs, number of segments) in VS-CMR (HR = 1.19: 95% CI, 1.07-1.34; P < .01). Adding HRmax significantly improved the predictive power of the multivariable model for SAE, including PDs (continuous reclassification improvement index: 0.47: 95% CI, 0.10-0.81; P < .05). The annualized SAE rate was 1% (if PD < 2 segments and HRmax > 130 bpm), 2% (if PD < 2 segments and HRmax ≤ 130 bpm), 3.2% (if PD ≥ 2 segments and HRmax > 130 bpm), and 6.3% (if PD ≥ 2 segments and HRmax ≤ 130 bpm), P < .01, for the trend. In patients on β-blocker therapy, however, only PDs in VS-CMR, but not HRmax, predicted SAE. We conclude that ExECG contributes significantly to prognostic information beyond VS-CMR in patients with known or suspected CCS.

Cardio-pulmonary function among children with mild or asymptomatic COVID-19 infection needing certification for return-to-play.

AimTo explore the cardio‐pulmonary function of children returning to play sports after mild or asymptomatic SARS‐CoV‐2 infection.MethodsThis is a consecutive case series conducted at the Institute for Maternal and Child Health, Trieste, Italy. Paediatric patients who accessed the Institute for cardiologic and pneumological evaluation before the return‐to‐play competitive sports were recruited, according to the Italian Sports Medical Federation recommendations. Echocardiogram, electrocardiogram, treadmill ECG test and pulmonary function tests were performed.ResultsOne hundred and thirty‐two patients (aged 8–17 years old, mean age 12.8 ± 2.5) were recruited. Among these, 127 children were considered for the final analysis (49.6% females). Out of 127, 84 (66.1%) had a mild symptomatic form of SARS‐CoV‐2 infection, while 43 (33.9%) were asymptomatic. The main referred symptoms were fever (n = 37, 44%), asthenia (n = 14, 16.7%), rhinitis (n = 16, 19%), ageusia (n = 19, 22.6%), anosmia (n = 24, 28.6%), sore throat (n = 3, 3.6%), cough (n = 9, 10.7%), arthralgia‐myalgia (n = 11, 13.1%), headache (n = 23, 27.4%) and gastrointestinal symptoms (n = 7, 8.3%). No child presented evidence of cardio‐pulmonary function impairment after an average time of 77.3 days (SD 35) from SARS‐CoV‐2 swab positivity and a median of 68 days (IQ1 52, IQ3 92.5).ConclusionThis preliminary study suggests that, in the absence of specific symptoms, the diagnostic yield of cardio‐pulmonary tests before returning to play sports may be very low.

Correlation between scores and outcome in Acute Coronary Syndrome patients

A proper analysis for the connection between baseline characteristics and the incidence of death and death-plus-myocardial (re)infarction at 30 days was done by [1]. The most important baseline features associated with death in analysis were age, heart rate, systolic blood pressure, ST-segment depression, signs of pump failure, and elevated levels of biomarkers. A risk estimation score was developed from this analysis [1].Over the last 10 years, multiple methods of risk stratification for ACS patients have been developed. Different scores are now available based on initial clinical history, ECG, and laboratory tests that enable early risk stratification on admission. Even among patients with ST-elevation myocardial infarction (STEMI), for whom initial therapeutic options are well defined, patient risk characteristics impact short and long term medical decision making [2].The TIMI risk score [3] is validated predictor of short term mortality.so we aimed to Correlate between TIMI score and in hospital outcomes in Acute Coronary Syndrome patients and concluded that the higher the TIMI score the higher adverse in hospital clinical cardiovascular outcomes.

Incidence of Acute Myocardial Infarction in Northern Tanzania: A Modeling Approach Within a Prospective Observational Study.

BackgroundRigorous incidence data for acute myocardial infarction (AMI) in sub‐Saharan Africa are lacking. Consequently, modeling studies based on limited data have suggested that the burden of AMI and AMI‐associated mortality in sub‐Saharan Africa is lower than in other world regions.Methods and ResultsWe estimated the incidence of AMI in northern Tanzania in 2019 by integrating data from a prospective surveillance study (681 participants) and a community survey of healthcare‐seeking behavior (718 participants). In the surveillance study, adults presenting to an emergency department with chest pain or shortness of breath were screened for AMI with ECG and troponin testing. AMI was defined by the Fourth Universal Definition of AMI criteria. Mortality was assessed 30 days following enrollment via in‐person or telephone interviews. In the cluster‐based community survey, adults in northern Tanzania were asked where they would present for chest pain or shortness of breath. Multipliers were applied to account for AMI cases that would have been missed by our surveillance methods. The estimated annual incidence of AMI was 172 (207 among men and 139 among women) cases per 100 000 people. The age‐standardized annual incidence was 211 (263 among men and 170 among women) per 100 000 people. The estimated annual incidence of AMI‐associated mortality was 87 deaths per 100 000 people, and the age‐standardized annual incidence was 102 deaths per 100 000 people.ConclusionsThe incidence of AMI and AMI‐associated mortality in northern Tanzania is much higher than previously estimated and similar to that observed in high‐income countries.

Counseling of Patients with Severe Psychiatric Conditions and Referral to Smoking Cessations Programs

Background: Cigarette smoking and Nicotine dependence are highly prevalent in patients with severe and chronic mental illness. Psychiatric patients consume more cigarettes than general population. Smokers with chronic mental illness can quit smoking with appropriate intervention by smoking cessations programs. These patients can benefit from pharmacotherapy, but consideration should be given for possible interaction with patients’ psychiatric medications. Tobacco use and dependence need to be formally documents on electronic medical records and be offered a referral to smoking cessations programs.&#x0D; Method: All patients in a community rehabilitation service ward in Northwest London were interviewed to identify the type, quantity, and duration of their tobacco. Their electronic clinical records were reviewed to confirm their age, ICD 10 Primary Diagnosis, ICD10 Tobacco dependence diagnosis, medications they take, record of ECG tests and presence of cardiopulmonary problems. Then their records were checked if they were given advice regarding their smoking habit, desire to quit smoking and agreement to be referred to a smoking cessation program.&#x0D; Results and Discussion: Half of the total number of patients in the community psychiatric rehabilitation were cigarette smokers. Majority of the smokers had history of polysubstance abuse. Recording of current smoking status were not regularly update. Patients who had recorded status of being a smoker were all referred to a smoking cessation program and majority had counseling by the healthcare professionals in their unit. Attending the smoking cessation program in those patients have as good outcomes as general population.&#x0D; Conclusions: A substantial number of patients in psychiatric rehabilitation units smoke cigarettes. If their smoking status is accurately documented, they would be referred to a formal smoking cessation program.

Defining cardiac involvement in idiopathic inflammatory myopathies: a systematic review.

Recent advances in cardiac MRI (CMR) and other diagnostic techniques have made it easier to identify subclinical cardiac inflammation and dysfunction in the idiopathic inflammatory myopathies (IIM). Herein, we systematically review the literature regarding cardiac involvement in IIM. We searched Medline and EMBASE from 1990 to 2020 using keywords related to IIM and cardiac disease. We included English language studies in adults with any immune-mediated, inflammatory muscle pathology. We identified 10 425 potentially relevant abstracts, of which 29 were included. Most frequently these included patients with PM or DM without symptomatic myocarditis. Five categories of cardiac investigation were used in these patients: cardiac enzyme testing, ECG, transthoracic echocardiography, CMR and nuclear medicine testing. Patients with clinical myocarditis had universally abnormal cardiac troponin levels and ECG. Elevated cardiac troponin T was more common than cardiac troponin I and may correlate with disease activity, whereas cardiac troponin I was more specific for cardiac involvement. Non-specific ECG changes were common. The major finding on transthoracic echocardiography was abnormal ejection fraction. Gross systolic dysfunction was unusual, but subclinical systolic dysfunction was reported in several studies. Abnormal diastolic function was common and may be associated with disease duration. Late gadolinium enhancement (reflecting regional necrosis or scarring) and abnormal myocardial mapping parameters (reflecting myocardial inflammation, fibrosis and oedema) were frequently identified on CMR, suggesting significant subclinical myocardial pathology (despite typically normal ejection fraction). Abnormal cardiac investigations are commonly found in asymptomatic IIM patients, which has potential prognostic and treatment implications.

Elite athletes with COVID-19 — Predictors of the course of disease

ObjectivesThe aim of the study was to identify predictors determining the course of COVID-19 and antibody response in elite athletes. DesignObservational study. MethodsRoutine medical screening with physical examination, resting ECG, and laboratory tests including antibody response was performed 12–68 days after the diagnosis of COVID-19 in 111 athletes of different sports. ResultsClinical symptoms were observed in 84% of subjects. The severity of COVID-19 was mild in 82% of athletes and moderate in 2% of cases. Athletes aged above 26 and male were more likely to develop symptomatic COVID-19. Asymptomatic subjects were younger and predominantly female. In 18% of subjects, symptoms were still present 20 (12–68) days (median and range) since positive diagnosis. Antibody response was observed in 88% of athletes, and its magnitude correlated with time since diagnosis of COVID-19 (RT-PCR), fatigue, fever, and conjunctivitis. There were no differences in antibody response between groups distinguished by sports discipline (p = 0.50), and sex (p = 0.59), and antibody response did not correlate with BMI (p = 0.12), age (p = 0.13), the number of symptoms (p = 0.43) or their duration (p = 0.19). ConclusionsThe severity of COVID-19 in elite athletes is predominantly mild and without complications. Athletes can return to sport after two symptom-free weeks and additional heart screening is usually not required. Determination of antibodies has been shown to be a useful indicator of a previous COVID-19 disease, and some symptoms can be used as predictors of antibody response.

The importance of ventilatory thresholds to define aerobic exercise intensity in cardiac patients and healthy subjects.

BackgroundAlthough structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1) and second ventilatory thresholds (VT2) in cardiac patients, sedentary subjects, and athletes comparing VT1 and VT2 with EI defined by recommendations.MethodsWe prospectively enrolled 350 subjects (mean age: 50.7±12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, and 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2, peak heart rate (HR), and HR reserve were obtained at VT1 and VT2 and compared with the EI definition proposed by the recommendations.ResultsVO2 at VT1 corresponded to high rather than moderate EI in 67.1% and 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most cardiac patients had VO2 values at VT2 corresponding to very‐high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory thresholds and recommended EI domains was observed in healthy subjects and athletes (90% and 93.9%, respectively).ConclusionsEI definition based on percentages of peak HR and peak VO2 may misclassify the effective EI, and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold–based rather than a range‐based approach is advisable to define an appropriate level of EI.

Detection of cardiac autonomic neuropathy in type II diabetic patients using heart rate recovery

Background Cardiac autonomic neuropathy is one of the most insidious complications of diabetes mellitus. It can be detected by abnormality in heart rate recovery, which is defined as decline in heart rate within the first few minutes following a graded exercise stress test. Aim To detect cardiac autonomic neuropathy in type II diabetic patients using heart rate recovery. Patients and methods This study included 45 individuals, 30 diabetic patients in case group and 15 healthy individuals as a control. All participants underwent history taking, clinical examination, laboratory investigations (FBS, PPBS, HbA1c, kidney function test and liver enzymes), comprehensive transthoracic echocardiographic examination, 24 h Holter monitor and exercise ECG test to assess heart rate recovery. Results 30 diabetic patients (7 male and 23 females, with mean age 40±3.5 years) and 15 healthy individuals (4 males and 11 females with mean age 36±5.8 years) participated in this study. Cases group had significant increase in FBS, PPBS, HbA1c and serum creatinine compared to control group. Patients had significant decrease in PNN50, SDNN, LF and HF in the 24 h Holter monitoring as well as significant delay in heart rate recovery at 1st and 2nd minutes compared to control group. Glycemic control and duration of diabetes were the most predictors to abnormal heart rate recovery. Conclusion Heart rate recovery derived from exercise ECG test could be considered as an easy, low cost and widely available tool for detection of cardiac autonomic neuropathy.

Audit of the Aetiological Investigations Performed in Children with Sensorineural Hearing Loss At Salford

Objective: This project aims to look at the Audiovestibular Physician’s practice at Salford and how closely it aligns with the gold standard guidelines set in the protocol lately published by the British Association of Audiological Physicians. Method: An audit was done retrospectively on 20 patients suffering from sensorineural hearing loss. As such, patient notes were utilised to ascertain which aetiological investigations have been completed and which were not. Any inadequacy in the aetiological work up has been dissected to help know the underlying reasons. Results: All patients had a thorough history taken and were comprehensively physically examined. 95% of patients underwent imaging in the form of MRI/CT. 80% received CMV testing. 75% underwent ECG testing. 60% received family hearing tests. Only 35% had ophthalmology examinations and 25% underwent urine and genetic testing. Conclusion: In some cases, the low compliance rates were due to the Audiovestibular Physician not ordering the investigation as part of the aetiological work up. This could be improved with the use of a dedicated checklist to act as an aid to the physician. Moreover, genetic counselling has been proposed to attempt to boost the compliance rates with genetic testing and similarly, leaflets briefing patients’ families about the importance of undergoing hearing tests themselves is another promising proposition to help improve the adherence

Efficacy and safety of ciprofol for the sedation/anesthesia in patients undergoing colonoscopy: Phase IIa and IIb multi-center clinical trials

ObjectiveCiprofol is a new intravenous anesthetic agent similar to propofol that has the pharmacodynamic characteristics of a rapid rate of onset and recovery in pre-clinical experiments. The aims of the present clinical trials were to compare the efficacy and safety of ciprofol emulsion for sedation or general anesthesia during colonoscopy and to define optimal doses for a subsequent phase III clinical trial. MethodsA phase IIa multi-center, open-label, non-randomized, positive control, dose-escalating study was performed to determine a recommended phase IIb dose (RP2D) of ciprofol to induce sedation or anesthesia in patients undergoing colonoscopy. Phase IIb was also a multi-center clinical trial, but the patients were randomized into 3 groups at a ratio of 1:1:1. It was a double-blinded, propofol controlled study that administered ciprofol 0.4 mg/kg (n = 31) and 0.5 mg/kg (n = 32) or propofol at 2.0 mg/kg (n = 31), with the aim of establishing the optimal dose of ciprofol. The primary endpoint was the colonoscopy success rate. Secondary endpoints were the duration of colonoscope insertion, recovery time, number of top-up doses needed, and the total dose of ciprofol or propofol required to maintain adequate sedation or anesthesia. In addition, we evaluated the satisfaction of sedation/anesthesia from the endoscopists, anesthetists and patients’ points of view. Safety was assessed according to the incidence of AEs including serious AEs and drug related AEs and the assessment of vital signs, a 12-lead ECG and laboratory tests. ResultsIn the phase IIa trial, the colonoscopy success rates in the 0.2–0.5 mg/kg ciprofol and propofol 2.0 mg/kg groups were 100% and all doses were safe and well tolerated. Ciprofol doses of 0.4 mg/kg and 0.5 mg/kg are recommended for subsequent IIb phases. In the phase IIb trial, a 100% success rate was reconfirmed in all the dosage groups. The mean time of colonoscope insertion in the ciprofol 0.4 mg/kg, ciprofol 0.5 mg/kg and propofol 2.0 mg/kg groups were 1.9, 1.5 and 1.5 min, the mean recovery times from colonoscope withdrawal were 6.1, 5.1, and 4.3 min, and the times to discharge were 11.8, 11.2 and 10.6 min, respectively. The satisfaction ratings of anesthetists in the ciprofol 0.5 mg/kg group (9.5 ± 0.8) were higher than in the ciprofol 0.4 mg/kg (9.2 ± 1.0) and propofol 2.0 mg/kg (9.2 ± 0.9) groups. The incidence of sedation and anesthesia-related AEs was highest in the propofol 2.0 mg/kg group (25.8%), followed by the ciprofol 0.5 mg/kg group (21.9%), and was least in the ciprofol 0.4 mg/kg group (16.1%) (P = 0.750). ConclusionsCiprofol was safe and well tolerated at doses ranging from 0.1 mg/kg to 0.5 mg/kg. Ciprofol 0.4-0.5 mg/kg induced equivalent sedation/anesthesia and had a similar safety profile to propofol 2.0 mg/kg during colonoscopy without producing serious AEs.

An audit during COVID-19: monitoring of CMHT-patient contact and physical health assessments in a rural Welsh setting

AimsThe enforcement of lockdowns and restrictions on non-essential contact have changed Community Mental Health Team (CMHT) practice. Therefore, this audit carried out its 4th cycle of physical health monitoring for patients on antipsychotics with severe mental illness (SMI) under the CMHT during the period of the COVID-19 pandemic in order to observe its impact on physical health monitoring. In addition, with the increased use of telepsychiatry substituting routine face-to-face appointments during the pandemic, this audit also reviews the effect of lockdown on maintenance of contact between CMHT and people with SMI.Primary Objective: to compare the current clinical practice with the standards derived from NICE guidelines which include parameters like weight, body-mass index, blood pressure, ECG and blood tests, then compare with the previous three audit cycles, which collected identical data.Secondary Objective: to monitor amount of contact between healthcare staff and people with SMI on antipsychotics during the three months of Welsh lockdown and compare current clinical practice with the clinical practice achieved in the identical period in 2019.MethodMethod for Primary Objective: Clinical practice on physical health checks were split into 10 standards derived from the NICE guidelines (NICEQS80, Quality Standard 6). Data collection surrounding physical health checks of patients on antipsychotics from 26th June 2019 to 26th June 2020 were collected and compared with the previous three audit cycles, which collected identical data.Method for Secondary Objective: Retrospective data surrounding amount and type of contact between CMHT and people with SMI was collected from 26th March 2020 to 26th June 2020, a period of enforced lockdown in Wales, and compared with the identical period in 2019.ResultThe audit iterates trends over the last 4 cycles (2016/2017, 2017/2018, 2018/2019 and 2019/2020). The current audit cycle increased in 2/10 standards and decreased in 8/10 standards, compared with the average compliance in the 3 previous audit cycles. Out of the 10 derived standards, certain standards fared worse than others.There was a 79% increase in the number of staff-patient contact during the lockdown period. The majority of the contact in 2019 was face-to-face (84.31%), however, as expected, in 2020 the majority of the contact was non face-to-face (61.75%). However, this was accompanied by an 85.79%ConclusionDespite being in a pandemic, patient contact was maintained. Physical health monitoring has decreased in the majority of standards, therefore greater attention is needed to address this. Recommendations are provided in the audit.

Evaluation of the Effectiveness of Telemedicine in the Management of Cardiovascular Diseases in Primary Health Care in Cameroon: An Interventional Study.

This study aimed to evaluate the effectiveness of tele-expertise (tele-ECG) in primary health care in Cameroon for the management of patients with cardiovascular diseases or risk factors. It is a controlled multicenter study carried out in Cameroon's two health facilities where tele-ECG has been implemented (intervention centers) and two other where telemedicine has been not implemented (control centers). Patients having cardiovascular risk factors or diseases received usual primary health care in the control centers. In contrast, they received usual primary health care and could perform an ECG associated with cardiologists' remote expertise (tele-ECG) in the intervention centers. The primary outcome was to evaluate the rate of patients' access to an ECG test and to cardiologist' expertise. Telemedicine is effective for the management of patients with cardiovascular diseases in primary health care. It could improve healthcare providers' clinical processes, clinical outcomes of patients and their satisfaction.

Exercise-optimized programming after S-ICD implantation contributes to a lower risk of inappropriate shocks in the latest generation S-ICDs

Abstract Funding Acknowledgements Type of funding sources: None. Background Implantable cardioverter-defibrillator (ICD) therapy is associated with the risk of inappropriate shocks (IAS). IAS, defined as any shock on a different rhythm than VT or VF, cause psychological stress, decrease the quality of life and may provoke ventricular arrhythmias. In the subcutaneous ICD (S-ICD) the majority of IAS are caused by T-wave oversensing (TWOS), often during exercise. Exercise-optimized programming during an exercise ECG test (X-ECG) after implantation has shown to be successful in reducing IAS in patients known with TWOS. In recent years, new discrimination algorithms in the latest generation S-ICDs have significantly reduced the risk of TWOS. The benefit of performing an X-ECG in these latest generation S-ICDs to reduce IAS is unclear. Purpose We aim to describe the effect of exercise-optimized programming after S-ICD implantation on inappropriate shock rate in the latest generation S-ICDs. Methods In this retrospective multicenter study, data were collected from two experienced S-ICD hospitals in the Netherlands. All patients underwent an S-ICD implantation of second or third generation between February 2015 and December 2020. Patients younger than 21 years were excluded. Patients with an X-ECG after implantation were compared with patients without X-ECG after implantation. Total number of patients with IAS and cause of the first IAS were evaluated. Results In total, 262 patients were included in the X-ECG group and 61 in the no X-ECG group. The median follow-up time was 22 months in the X-ECG group (IQR 9-33) and 23 months in the no X-ECG group (IQR 12-33, P = 0.9). Mean age was 51 ± 15 years and 61 ± 15 years respectively (P&amp;lt; 0.001). Primary prevention indication was similar in both groups (56% for the X-ECG group versus 49% for the no X-ECG group, P = 0.4). A total of 8 patients (3.1%) experienced IAS in the X-ECG group; 3 first shocks (1.15%) were due to TWOS, 2 (0.8%) were given on a SVT and 3 (1.15%) on other non-cardiac activity. In the no X-ECG group, 6 patients (9.8%) experienced IAS; 1 first shock (1.6%) was due to TWOS, 4 (6.6%) were given on a SVT and 1 (1.6%) on other non-cardiac activity. Patients with an X-ECG had a significantly lower risk of IAS compared to patients in the no X-ECG group (hazard ratio 0.32; 95% CI 0.1 to 0.9; P = 0.027). The Kaplan-Meier estimate of IAS-free survival for the X-ECG group was 61 months (95% CI 59 to 62) and 50 months (95% CI 46 to 55) for the no X-ECG group. Results are shown in the figure. Conclusion This study shows that, in the latest generation S-ICDs, exercise-optimized programming after S-ICD implantation results in a significantly lower risk of IAS in adults. Patients with an X-ECG after S-ICD implantation were younger, which may have affected the outcome. Further prospective data with more equal groups is necessary. Until then, we recommend considering exercise testing after S-ICD implantation in the latest generation S-ICDs. Abstract Figure.

The importance of first and second ventilatory thresholds to define aerobic exercise intensity in cardiac patients and in healthy subjects: what is essential can be visible to the eyes

Abstract Funding Acknowledgements Type of funding sources: None. Background. Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1) and second ventilatory threshold (VT2) in cardiac patients, sedentary subjects and athletes comparing VT1 and VT2 with EI defined by recommendations. Methods. We prospectively enrolled 350 subjects (mean age: 50.7 ± 12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2, peak heart rate (HR), and HR reserve were obtained at VT1 and VT2, and compared with EI definition proposed by the recommendations. Results. VO2 at VT1 corresponded to high rather than moderate EI in 67.1% and in 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most of cardiac patients had VO2 values at VT2 corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory-thresholds and recommended EI domains was observed in healthy subjects and in athletes (90% and 93.9%, respectively). Conclusions. EI definition based on percentages of peak HR and peak VO2 may misclassify the effective EI and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable in order to define an appropriate level of EI. Abstract Figure.

Development of AI-based method to detect the subtle ECG deviations from the population ECG norm

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Academy of Science of Ukraine Background Electrocardiogram (ECG) is still the primary source for the diagnostic and prognostic information about cardiovascular diseases. The concept of "normal ECG" parameters is crucial for the reliable diagnosis, since it provides reference for the ECG under examination. With the development of new methods and tools for ECG feature extraction and classification based on artificial intelligence (AI), it becomes possible to identify subtle changes in the heart activity to detect possible abnormalities at the early stage. The challenge of this work is to identify the deviations in ECG of clinically healthy persons from the conditional "population" norm . Methods The normal ECG is described as a feature vector composed of the time-magnitude parameters of signal-averaged ECG (SAECG). To define the subjects that possibly have variations from the "population" norm, the outlier detection approach is proposed: first the cloud of the vectors , constructed from the set of normal ECG"s , obtained from young, clinically similar healthy persons was created in feature space. Then, a particular ECG is considered deviant and requires the attention of the clinician when it is considered an outlier of the cloud of normal ECGs. In the experiment, SAECGs from the group of 139 young subjects (male, age 18-28 years) with no reported cardiovascular problems are used to extract 34 features from SAECG leads (magnitudes and durations of ECG waves, duration of ECG segments, etc.). ECGs were routinely previewed by qualified physicians, and no obvious anomalies were noticed. The Isolation Forest anomaly detection method is used with variable numbers of trees and different contamination parameters. Results The ratio of outliers were changed from 5 to 10% (7-12 subjects) with various numbers of estimator trees. Seven outlier SAECGs were repeatedly appearing for various settings. Out of these, 4 subjects were the oldest persons in group examined , and 3 others had a rare ventricular premature beats during routine ECG examination. Conclusion The proposed method is promising for application in routine and express ECG tests since it is able to quantify the subtle deviations from the normal ECG group.

Significance of extended sports cardiology screening of elite handball referees.

The significance of cardiology screening of referees is not well established. Cardiovascular risk factors and diseases were examined in asymptomatic Hungarian elite handball referees undergoing extended screening: personal/family history, physical examination, 12-lead ECG, laboratory tests, body-composition analysis, echocardiography, and cardiopulmonary exercise testing. Holter-ECG (n = 8), blood pressure monitorization (n = 10), cardiac magnetic resonance imaging (CMR; n = 27) and computer tomography (CCT; n = 4) were also carried out if needed. We examined 100 referees (age: 29.6±7.9years, male: 64, training: 4.3±2.0 hours/week), cardiovascular risk factors were: positive medical history: 24%, overweight: 10%, obesity: 3%, dyslipidaemia: 41%. Elevated resting blood pressure was measured in 38%. Stress-ECG was positive due to ECG-changes in 16%, due to elevated exercise blood pressure in 8%. Echocardiography and/or CMR identified abnormalities in 19%. A significant number of premature ventricular contractions was found on the Holter-ECG in two cases. The CCT showed myocardial bridge or coronary plaques in one-one case. We recommended lifestyle changes in 58%, new/modified antihypertensive or lipid-lowering therapy in 5%, iron-supplementation in 22%. By our results, a high percentage of elite Hungarian handball referees had cardiovascular risk factors or diseases, which, combined with physical and psychological stress, could increase the possibility of cardiovascular events. Our study draws attention to the importance of cardiac screening in elite handball referees.

Cardiac Disorder Classification by Electrocardiogram Sensing Using Deep Neural Network

Cardiac disease is the leading cause of death worldwide. Cardiovascular diseases can be prevented if an effective diagnostic is made at the initial stages. The ECG test is referred to as the diagnostic assistant tool for screening of cardiac disorder. The research purposes of a cardiac disorder detection system from 12-lead-based ECG Images. The healthcare institutes used various ECG equipment that present results in nonuniform formats of ECG images. The research study proposes a generalized methodology to process all formats of ECG. Single Shoot Detection (SSD) MobileNet v2-based Deep Neural Network architecture was used to detect cardiovascular disease detection. The study focused on detecting the four major cardiac abnormalities (i.e., myocardial infarction, abnormal heartbeat, previous history of MI, and normal class) with 98% accuracy results were calculated. The work is relatively rare based on their dataset; a collection of 11,148 standard 12-lead-based ECG images used in this study were manually collected from health care institutes and annotated by the domain experts. The study achieved high accuracy results to differentiate and detect four major cardiac abnormalities. Several cardiologists manually verified the proposed system’s accuracy result and recommended that the proposed system can be used to screen for a cardiac disorder.

Left Ventricular Noncompaction-A Systematic Review of Risk Factors in the Pediatric Population.

Left ventricular noncompaction (LVNC) is a heterogeneous, often hereditary group of diseases, which may have diverse clinical manifestations. This article reviews the risk factors for unfavorable outcomes of LVNC in children, as well as discuss the diagnostic methods and the differences between pediatric and adult LVNC. Through a systematic review of the literature, a total of 1983 articles were outlined; 23 of them met the inclusion criteria. In echocardiography the following have been associated with adverse outcomes in children: Left ventricular ejection fraction, end-diastolic dimension, left ventricular posterior wall compaction, and decreased strains. T-wave abnormalities and increased spatial peak QRS-T angle in ECG, as well as arrhythmia, were observed in children at greater risk. Cardiac magnetic resonance is a valuable tool to identify those with systolic dysfunction and late gadolinium enhancement. Genetic testing appears to help identify children at risk, because mutations in particular genes have been associated with worse outcomes. ECG and imaging tests, such as echocardiography and magnetic resonance, help outline risk factors for unfavorable outcomes of LVNC in children and in identifying outpatients who require more attention. Refining the current diagnostic criteria is crucial to avoid inadequate restrain from physical activity.