Integrated proteomic profiling identifies amino acids selectively cytotoxic to pancreatic cancer cells

Pancreatic adenocarcinoma (PDAC) is one of the most deadly cancers, characterized by extremely limited therapeutic options and a poor prognosis, as it is often diagnosed during late disease stages. Innovative and selective treatments are urgently needed, since current therapies have limited efficacy and significant side effects. Through proteomics analysis of extracellular vesicles, we discovered an imbalanced distribution of amino acids secreted by PDAC tumor cells. Our findings revealed that PDAC cells preferentially excrete proteins with certain preferential amino acids, including isoleucine and histidine, via extracellular vesicles. These amino acids are associated with disease progression and can be targeted to elicit selective toxicity to PDAC tumor cells. Both in vitro and in vivo experiments demonstrated that supplementation with these specific amino acids effectively eradicated PDAC cells. Mechanistically, we also identified XRN1 as a potential target for these amino acids. The high selectivity of this treatment method allows for specific targeting of tumor metabolism with very low toxicity to normal tissues. Furthermore, we found this treatment approach is easy-to-administer and with sustained tumor-killing effects. Together, our findings reveal that exocytosed amino acids may serve as therapeutic targets for designing treatments of intractable PDAC and potentially offer alternative treatments for other types of cancers.

Topological aspects of multi-kantiferromagnetism in cubic rare-earth compounds

We advertise rare-earth intermetallics with high-symmetry crystal structures and competing interactions as a possible materials platform hosting spin structures with non-trivial topological properties. Focusing on the series of cubicRCu compounds, whereR= Ho, Er, Tm, the bulk properties of these systems display exceptionally rich magnetic phase diagrams hosting an abundance of different phase pockets characteristic of antiferromagnetic order in the presence of delicately balanced interactions. The electrical transport properties exhibit large anomalous contributions suggestive of topologically non-trivial winding in the electronic and magnetic structures. Neutron diffraction identifies spontaneous long-range magnetic order in terms of commensurate and incommensurate variations of(ππ0)antiferromagnetism with the possibility for various multi-kconfigurations. Motivated by general trends in these materials, we discuss the possible existence of topologically non-trivial winding in real and reciprocal space in the class ofRCu compounds including antiferromagnetic skyrmion lattices. Putatively bringing together different limits of non-trivial topological winding in the same material, the combination of properties inRCu systems promises access to advanced functionalities.

Multiconfiguration afocal freeform telescopes

An approach to designing multiconfiguration afocal telescopes is developed and demonstrated. Freeform surfaces are used to maximize the achievable diffraction-limited zoom ratio while staying in a compact volume for a two-position multiconfiguration afocal optical system. The limitations of these systems with three-mirror beam paths are discussed and subsequently overcome by introducing an additional degree of freedom. In a four-mirror beam path system, the goal of a 5x zoom ratio is achieved with a compensated exit pupil and diffraction-limited performance. A significant benefit in optical performance when using freeform surfaces is shown compared to more conventional surface types.

Workflow for modeling of generalized mid-spatial frequency errors in optical systems

We propose a workflow for modeling generalized mid-spatial frequency (MSF) errors in optical imaging systems. This workflow enables the classification of MSF distributions, filtering of bandlimited signatures, propagation of MSF errors to the exit pupil, and performance predictions that differentiate performance impacts due to the MSF distributions. We demonstrate the workflow by modeling the performance impacts of MSF errors for both transmissive and reflective imaging systems with near-diffraction-limited performance.

Who Benefited the Most? Effectiveness of a Lifestyle Intervention Against Cognitive Decline in Older Women and Men - Secondary Analysis of the AgeWell.de-trial

INTRODUCTION

Differences between women and men matter in the prevalence and risk factors of dementia. We aimed to examine potential sex differences regarding the effectiveness by running a secondary analysis of the AgeWell.de trial, a cluster-randomized multicenter multi-domain lifestyle intervention to reduce cognitive decline.

METHODS

Intention-to-treat analyses of women (n=433) and men (n=386) aged 60 to 77 years were used for models including interactions between intervention group allocation and sex followed by subgroup analysis stratified by sex on primary and secondary outcomes. Further, the same procedure was repeated for age groups (60-69 vs. 70-77) within sex-specific subgroups to assess the effectiveness in different age groups.

TRIAL REGISTRATION

German Clinical Trials Register (ref. number: DRKS00013555).

RESULTS

No differences were found between women and men in the effectiveness of the intervention on cognitive performance. However, women benefitted from the intervention regarding depressive symptoms while men did not. Health-related quality of life was enhanced for younger intervention participants (60-69 years) in both women and men.

CONCLUSION

The AgeWell.de intervention was able to improve depressive symptoms in women and health-related quality of life in younger participants. Female participants between 60 and 69 years benefited the most. Results support the need of better individually targeted lifestyle interventions for older adults.

Exit pupil quality analysis and optimization in freeform afocal telescope systems

Afocal telescopes are often used as foreoptics to existing imaging systems to allow for application flexibility. To properly combine an afocal telescope with an existing imaging system, the exit pupil of the afocal telescope and the entrance pupil of the imaging system must be coincident. Additionally, the exit pupil of the afocal telescope must be well-formed; that is, it must be the correct size and shape to mitigate pupil-matching challenges. This work introduces processes for designing freeform afocal telescopes with an emphasis on understanding how to analyze and control the exit pupil quality of such systems. The included 3-mirror design examples demonstrate the advantages of using freeform surfaces in afocal systems and quantify the tradeoffs required to improve the exit pupil quality.

Chronic hand eczema in Europe: Patient experiences and perspectives (CHEPEP) in qualitative interviews

BACKGROUND

Chronic hand eczema (CHE) is a very common skin disease among the European population. It causes itch and pain and, in more severe cases, seriously impairs hand functioning at work and in private life.

OBJECTIVES

To explore perspectives of people with lived experience on CHE-related problems, wishes and goals.

METHODS

Following a qualitative approach, we conducted topic-guided interviews in five European countries and applied template analysis to identify recurrent themes among patients with CHE.

RESULTS

We interviewed 60 patients in seven outpatient dermatological and occupational medicine clinics in Croatia, Denmark, Germany, the Netherlands and Spain. Five main themes were identified: (1) knowledge about the disease and its course, (2) preventive behaviour, (3) hand eczema therapy, (4) impact on everyday life and (5) attitudes towards CHE and healthcare. Participants did not feel well informed about CHE, especially about causes, triggers and treatment options. Preventive measures were experienced as more or less effective but also cumbersome. Experiences with therapy were diverse. Treatment satisfaction depended on the results and on the perceived support from the treatment teams. Participants found it important to be taken seriously, to receive practical advice, to try out additional treatments or examinations, find new hope and have occupational perspectives. They wished that others could better understand the physical and emotional burden of CHE. Patient support groups were not mentioned. Participants found it important to learn to take care of themselves and accept life with CHE.

CONCLUSIONS

Due to its annoying symptoms, high visibility and impaired functioning at work and in private life, CHE has a high emotional and social impact. Some people may require support to learn coping with CHE and its prevention. Patients wish for information about causes and triggers. They value physicians who listen to them and keep looking for solutions.

Global Protected Areas as refuges for amphibians and reptiles under climate change

Protected Areas (PAs) are the cornerstone of biodiversity conservation. Here, we collated distributional data for >14,000 (~70% of) species of amphibians and reptiles (herpetofauna) to perform a global assessment of the conservation effectiveness of PAs using species distribution models. Our analyses reveal that >91% of herpetofauna species are currently distributed in PAs, and that this proportion will remain unaltered under future climate change. Indeed, loss of species' distributional ranges will be lower inside PAs than outside them. Therefore, the proportion of effectively protected species is predicted to increase. However, over 7.8% of species currently occur outside PAs, and large spatial conservation gaps remain, mainly across tropical and subtropical moist broadleaf forests, and across non-high-income countries. We also predict that more than 300 amphibian and 500 reptile species may go extinct under climate change over the course of the ongoing century. Our study highlights the importance of PAs in providing herpetofauna with refuge from climate change, and suggests ways to optimize PAs to better conserve biodiversity worldwide.

A portable elliptical dichroism spectrometer targeting secondary structural features of tumorous protein for pancreatic cancer detection

Stereochemical analysis is essential for understanding the complex function of biomolecules. Various direct and indirect approaches can be used to explore the allosteric configuration. However, the size, cost, and delicate nature of these systems limit their biomedical usage. Here, we constructed elliptical dichroism (ED) spectrometer for biomedical applications, whose performance is validated by experiment and theoretical simulation (Jones/Mueller calculus and time-dependent density-functional theory). Instead of complicated control of circular polarization, ED spectrometer adopted the absorbance of left- and right-oriented elliptically polarized light. With a simplified design, we demonstrated the potential of ED spectrometry as an alternative for secondary structural analysis of biomolecules, their conformation and chirality. It not only provides a portable, low-cost alternative to the sophisticated instruments currently used for structural analysis of biomolecules but also provides superior translational features: low sample consumption(200 μl), easy operation, and multiple working modes, for noninvasive cancer detection.

Temporal trends and outcomes in ST-segment elevation myocardial infarction: a cardiac magnetic resonance imaging study over the course of 15 years

Aims

Development of evidence-based treatments in ST-elevation myocardial infarction (STEMI) patients during the last 30 years have been associated with improved outcome; however, there are data suggesting a plateauing since around 2008 (1). Moreover, contemporary data are very scarce regarding the temporal trends of infarct outcomes. This study sought to describe the temporal trends in infarct severity at myocardial tissue level over the course of 15 years by means of cardiac magnetic resonance imaging (MRI).

Methods

This study analyzed STEMI patients treated with percutaneous coronary intervention (PCI) in our Medical University who underwent a cardiac MRI between 2005 and 2021. The 15-year study period was divided into sequential 2-years blocks. Infarct characteristics were measured using MRI at 3 days [IQR 2–5] after PCI.

Results

A total of 844 STEMI patients (17% female) with a median age of 57 (interquartile range [IQR]: 51–66) years were included. The rate of evidence-based treatments was high for aspirin (99%), P2Y12i (99%), beta-blockers (91%), ACEi/ATi (92%) and statins (100%) and did not change significantly over the study period (p>0.05) with the exception for ACEi/ATi (p=0.03) and prasugrel (p<0.001), which increased and clopidogrel, which decreased during the study course (p<0.001). TIMI risk score did not change over the study period (p=0.43). Overall median infarct size was 16 [9–25]% and did not change (p=0.39) significantly. MVO, a marker of severe reperfusion injury, was also comparable (p=0.16). Accordingly, LV ejection fraction remained virtually unchanged (p=0.23)

Conclusion

Although further implementation of evidence-based treatments was seen also during the last 15 years, there has been no effect on infarct size, reperfusion injury and LV ejection fraction for patients who undergo primary PCI due to STEMI. Novel treatment strategies are needed to address this unmet therapeutic need.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Austrian Science Fund (FWF)Austrian Society of Cardiology

Prognostic significance of left ventricular functional parameters in relation to infarct location after ST-elevation myocardial infarction

Aims

In survivors of ST-elevation myocardial infarction (STEMI), the impact of infarct location on the prognostic significance of left ventricular functional parameters is not well established. The aim of this study was to investigate the prognostic relevance of left ventricular (LV) functional parameters in relation to infarct location in STEMI patients treated with contemporary primary percutaneous coronary intervention (PCI).

Methods

This observational study analyzed 803 patients with STEMI that underwent a cardiac magnetic resonance imaging scan in median 3 (interquartile range [IQR]: 2–5) days after primary PCI. The following LV functional parameters were evaluated: LV ejection fraction, LV global longitudinal strain, fast manual long-axis strain (LAS) and mitral annular plane systolic excursion (MAPSE). Primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as composite of death, re-infarction and congestive heart failure.

Results

Three hundred and sixty nine patients (46%) had anterior STEMI. These patients had lower LV functional parameters including LV ejection fraction (p<0.001), LV global longitudinal strain (p<0.001), LAS (p<0.001) and MAPSE (p<0.014). MACE was evaluated at a median of 13 (IQR: 12–37) months after STEMI and occurred in 78 patients (10%). In receiver operating curve analysis, the predictive value of LV ejection fraction, LV global longitudinal strain, LAS and MAPSE was 0.59 (p=0.013), 0.64 (p<0.001), 0.67 (p<0.001) and 0.66 (p<0.001), respectively. When divided according to infarct location, MACE occurred in 47 (13%) anterior STEMI patients, and in 31 (7%) non-anterior STEMI patients, respectively. Area under the curve for the prediction of MACE in anterior vs. non-anterior STEMI was 0.59 vs 0.55 for LV ejection fraction, 0.61 vs 0.63 for LV global longitudinal strain, 0.69 vs 0.62 for LAS and both 0.66 for MAPSE. In multivariable analysis, LAS was independently associated with an increased risk of MACE (hazard ratio: 1.20; 95% confidence interval: 1.10–1.30; p<0.001) in anterior STEMI, whereas in non-anterior STEMI, LV global longitudinal strain was an independent predictor of MACE (hazard ratio: 1.22; 95% confidence interval: 1.08–1.38; p=0.002).

Conclusion

Fast manual LAS emerged as independent predictor of MACE in anterior STEMI treated with contemporary primary PCI whereas LV global longitudinal strain was independently associated with MACE in non-anterior STEMI.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Austrian Society of Cardiology

Periodic Repolarization Dynamics derived from 10-second ECG recordings predicts mortality in patients after myocardial infarction

Background

Periodic repolarization dynamics (PRD) is an electrocardiographic biomarker that quantifies low-frequency (LF), sympathetic-activity associated instabilities of repolarization. PRD is a strong predictor of mortality in patients after myocardial infarction (MI). The main limitation of PRD is the requirement of ECGs with a duration of ≥20 minutes. Calculation of PRD using 10-second ECGs would be advantageous allowing the implementation in everyday clinical practice.

Purpose

We aimed to develop and validate a modified version of PRD, originating from 10-second ECGs, which we called PRDshort.

Methods

First, the beat-to-beat change in the direction of repolarization, called dT° was measured for 30-minute ECGs (Figure 1) and PRD was quantified as the amplitude of LF periodicities (≤0.1 Hz) within dT°. We randomly selected segments with a duration of 10 seconds. For each of these segments we calculated several parameters based on dT° and RR-interval. To overcome the issue that the wavelength of PRD is longer than 10 seconds, we performed signal-simulation and machine learning analysis. We simulated 100.000 dT°-signals using different assumptions for the level of PRD, heart rate, respiratory rate, number of premature ventricular contractions and the level of artifacts. Thereafter we used machine learning to calculate PRD from single 10-second ECG recordings (Figure 1). This method was finally validated in a cohort including 455 patients after MI. The primary endpoint was 3-year mortality. The prognostic power of PRD was evaluated using Kaplan-Meier and Cox-regression analyses.

Results

The Pearson's correlation coefficients between PRD and PRDshort were 0.80 (0.79–0.80) in the simulated data and 0.75 (0.70–0.78) in the post-MI cohort. In the post-MI cohort 47 patients died within 27±11 months of follow-up. The median left-ventricular ejection fraction (LVEF) was 50±15%. PRDshort was significantly higher in non-survivors (6.8±5.7 deg2) than survivors (4.9±3.0 deg2; p<0.001). Dichotomization of PRDshort at the median value of ≥/<5.0 deg2 identified a high-risk group with a 3-year mortality rate of 21.0% (13.4–27.9%) compared to a mortality rate of 6.5% (2.7–10.2%; HR=3.2; 1.6–6.2; p<0.001; Figure 2) among patients with PRDshort <5.0 deg2. In multivariable analysis, PRDshort was independent from GRACE-score >140 and LVEF ≤35% (HR 2.7; 1.4–5.2; p=0.003). In ROC analysis the predictive value of PRDshort didn't differ significantly from that of the original PRD (p=0.263). PRDshort ≥5.0 deg2 detected 33 out of the 34 deaths originally identified by PRD.

Conclusion

This is the first description of a method to calculate PRD from 10-second ECG recordings. The prognostic value of PRDshort was comparable to that of PRD in post-MI patients with preserved LVEF. As normal 12-lead ECG-recordings are ubiquitous in every hospital and doctor's office this method may allow the wide application of PRD as risk stratification tool in everyday clinical practice.

Funding Acknowledgement

Type of funding sources: None.

The effectiveness of a telemedical program for COVID-19 positive high-risk patients in domestic isolation

Background

For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience.

Purpose

The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system.

Methods

Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive high-risk patients (age >65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7).

After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission.

The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation.

Results

A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3–80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70–79 years. Subjectively, the patients felt safe due to close monitoring.

Conclusion

The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Region of the Tyrol

Neutrophile-lymphocyte ratio and outcome in takotsubo syndrome

Introduction

Takotsubo syndrome (TTS) is an important form of acute heart failure with significant risk of acute complications and death. In this analysis we sought to identify predictors for in-hospital clinical outcome in TTS patients by concentrating on routine laboratory parameters at admission.

Methods

In this analysis from the Austrian national TTS registry, univariable and multivariable analyses were performed to identify significant predictors for severe in-hospital complications requiring immediate invasive treatment or leading to irreversible damage, such as cardiogenic shock, intubation, stroke, arrhythmias and death. Furthermore, the influence of identified predictors with long-term survival was evaluated.

Results

A total of 338 patients (median age 72 years, 86.9% female) from 6 centres were included. Severe in-hospital complications occurred in 14.5% of patients, including cardiogenic shock (9.8%), death (3.3%) and intubation (1.2%), respectively. Patients with complications during the hospital stay had more prevalent chronic kidney disease (CKD), were less often previous smokers and TTS was less often preceded by an emotional trigger. C-reactive protein and neutrophile lymphocyte ratio (NLR) was higher in patients with complications, and midventricular ballooning and reduced left ventricular ejection fraction (LVEF) were more prevalent. In multivariable analysis, high NLR (OR 1.04 [95% CI 1.02–1.07], p=0.009) and low LVEF (OR 0.92 [0.90–0.95] per %, p<0.001) remained significant predictors for severe in-hospital complications. Both the highest NLR tercile and the lowest LVEF tercile were associated with significantly reduced 5-year survival.

Discussion

Low LVEF and high NLR at admission were independently associated with increased in-hospital complications and reduced long-term survival in TTS patients. NLR is a new easy-to-measure tool to predict worse short and long-term outcome after TTS.

Funding Acknowledgement

Type of funding sources: None.

Association between inflammation and left ventricular thrombus formation following ST-elevation myocardial infarction

Background

Current evidence suggests a link between the inflammatory state and left ventricular thrombus (LVT) formation following ST-elevation myocardial infarction (STEMI). However, a comprehensive study investigating the association between inflammatory biomarkers and LVT diagnosed by cardiac magnetic resonance (CMR) is lacking.

Purpose

The present study aimed to investigate the association of biochemical markers of inflammation with LVT as assessed by CMR imaging among patients with STEMI.

Methods

We studied 309 patients with acute STEMI treated with primary percutaneous coronary intervention (pPCI) from the prospective MARINA-STEMI cohort study. Concentrations of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), white blood cell count (WBCc), fibrinogen and D-dimer were measured two days after STEMI. Infarct characteristics and presence of LVT were assessed with the use of contrast-enhanced CMR at a median of 4 (interquartile range [IQR] 3–5) days after pPCI.

Results

In total, 309 STEMI patients (18% female) with a median age of 57 (IQR 52–65) years were included. An LVT was observed in 8% (n=24) of the overall cohort and in 15% of patients with an anterior STEMI. Hs-CRP (OR: 2.16, 95% CI: 1.54–3.02, p<0.001), IL-6 (OR: 2.38, 95% CI: 1.48–3.81, p<0.001) and fibrinogen levels (OR: 2.05, 95% CI: 1.40–3.00, p<0.001) were significantly associated with presence of LVT. Among all assessed inflammatory biomarkers, only hs-CRP was independently associated with LVT after adjustment for markers of inflammation and CMR parameters (OR: 1.77, 95% CI: 1.21–2.59, p=0.004).

Conclusion

In patients with STEMI treated with pPCI, inflammatory markers (hs-CRP, IL-6 and fibrinogen) are associated with the presence of LVT. However, only hs-CRP was independently associated with the occurrence of LVT, highlighting the key role of CRP as clinical risk marker for LVT formation in STEMI patients treated with pPCI.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Austrian Science Fund (FWF)Austrian Society of Cardiology

Telemedical cardiac risk assessment by implantable cardiac monitors in post-infarction patients with autonomic dysfunction (SMART-MI-DZHK9): gender differences and outcomes

Background

Cardiac autonomic dysfunction identifies high-risk patients after myocardial infarction (MI). Telemedical cardiac risk assessment by implantable cardiac monitors (ICM) after MI was recently identified as an effective method to early detect subclinical, but prognostically relevant serious arrhythmic events (SArE). Clinical complications in female patients after MI usually present with atypical symptoms. Therefore, early detection of prognostically relevant SArE in females would be of great clinical interest.

Purpose

In this pre-specified analysis of the SMART-MI trial we aimed to assess the impact of gender on detection of SArE and subsequent clinical complications.

Methods

SMART-MI was a prospective, randomised trial. Survivors of acute MI with preserved left-ventricular ejection fraction (LVEF 36–50%) and abnormal periodic repolarization dynamics (≥5.75deg2) and/or deceleration capacity (≤2.5ms) were randomly assigned to ICM-based telemedical monitoring or conventional follow-up. Primary endpoint was time to detection of SArE defined as the composite of atrial fibrillation ≥6 minutes, atrioventricular block ≥IIb, or fast non-sustained (>187 bpm;≥40 beats)/sustained ventricular tachycardia/fibrillation. Clinical complications were defined as the composite of mortality, stroke, systemic arterial thromboembolism, and hospitalization for decompensated heart failure. The effect of intervention on the primary endpoint was tested using Cox-regression analysis. The effect of SArE on clinical complications was evaluated by introducing SArE as time-dependent covariate.

Results

Between May 12, 2016, and July 20, 2020, 1305 individuals were screened and 400 patients were randomly assigned to ICM-implantation (N=201; 49 females) or conventional follow-up (control group; N=199; 29 females). During a median follow-up of 21±23 months, SArE were detected in 60 (30%; 12 females) patients in the ICM and 12 (6%; 1 female) patients in the control group. In both males and females ICM-implantation was associated with a higher detection rate of SArE (HR 6.33; 3.28–12.23; p<0.001 in males and HR 8.49; 1.10–65.66; p=0.040 in females; p-interaction = 0.790; Figure 1). In both male and female patients, detection of SArE was prognostic for subsequent clinical complications (HR 3.64; 1.89–7.02; p<0.001 in males and HR 16.19; 4.76–55.11 in females; p<0.001). The association between SArE and clinical complications was significantly higher in females than males. Among the 13 females with detected SArE, 6 developed clinical complications within a median period of 25±18 months, compared to 12 complications out of 59 SArE within 18±13 months among males (Figure 2; p-interaction = 0.030).

Conclusion

Telemedical monitoring with ICM was highly effective in early detection of subclinical, prognostically relevant SArE in both female and male patients. However, the association of a detected SArE with a subsequent clinical complication was significantly higher among females.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsches Zentrum für Herz und Kreislaufforschung (DZHK) and Medtronic Bakken Research Center

QRS duration as an independent risk factor for appropriate shocks and mortality in patients with prophylactic implantable cardioverter-defibrillator

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Community’s 7th Framework Programme FP7/2007-2013

Background

The implantable cardioverter defibrillator (ICD) is an established therapy for the prevention of sudden cardiac death (SCD) in high-risk heart failure patients. However, improvements in risk stratification are necessary to increase the efficiency of ICD use. We performed an analysis of the retrospective EU-CERT-ICD registry with respect to QRS duration and effects of cardiac resynchronisation therapy (CRT) on outcomes.

Methods/Results

A total of 5033 patients (81% males) from 14 European centres had an ICD implanted for primary prophylaxis. Mean age at the time of ICD implantation was 64±11 years and ischemic cardiomyopathy was the underlying pathology in 65% of patients. CRT was used in 43% of the patients. The median follow-up was 2.7 years (IQR 1.4-4.6 years). Predefined primary endpoints were all-cause mortality, first appropriate and first inappropriate shocks. The effect of covariates on the cumulative primary endpoints were assessed through hazard ratios in the Fine and Gray subdistributional hazard models (accounting for the competing risks) stratified by centres.

Because of resynchronization by the device, the analysis considered a different influence of QRS on outcomes in the CRT-D and the ICD groups. We observed an increase in the cumulative incidence of the first appropriate shock with increasing QRS values for patients implanted with only an ICD (HR 1.12 per 10ms increase, p<0.001). In patients with CRT-D, increasing QRS values related to a (statistically non-significant) decrease in the cumulative incidence of the first appropriate shocks (HR 0.96 per 10ms, p=0.299).

Since a wide QRS is an indication for CRT-D therapy, high QRS values cluster among those patients with implanted CRT-D, while among patients with QRS under 130ms standard ICD implantations are more frequent. This can explain the observed increase in the cumulative incidence of the first appropriate shocks for increasing QRS values up to 130ms in the ICD-group and its decrease for increasing QRS values over 130ms in the CRT-D group.

Regarding all-cause mortality, hazard ratios for age, LVEF, NYHA, ICM, AF, diabetes and sex category agreed with the results obtained in previously published meta-analyses.

Increased QRS values are associated with higher mortality in the ICD group (HR 1.09 per 10ms increase, p<0.001), but not in the CRT-D group (HR 0.99 per 10ms increase, p=0.695).

Conclusion

In our study, we confirmed QRS duration as an independent risk factor for appropriate ICD shocks and all-cause mortality in patients with ICD for primary prophylaxis. However, this was only observed in patients with single- or dual-chamber ICD, while there was no correlation in CRT-D patients. The findings suggest that CRT-D exerts a protective effect regarding the occurrence of first appropriate shock and all-cause mortality for patients with QRS values higher than 130 ms and indication for resynchronization.

Topological magnon band structure of emergent Landau levels in a skyrmion lattice

The motion of a spin excitation across topologically nontrivial magnetic order exhibits a deflection that is analogous to the effect of the Lorentz force on an electrically charged particle in an orbital magnetic field. We used polarized inelastic neutron scattering to investigate the propagation of magnons (i.e., bosonic collective spin excitations) in a lattice of skyrmion tubes in manganese silicide. For wave vectors perpendicular to the skyrmion tubes, the magnon spectra are consistent with the formation of finely spaced emergent Landau levels that are characteristic of the fictitious magnetic field used to account for the nontrivial topological winding of the skyrmion lattice. This provides evidence of a topological magnon band structure in reciprocal space, which is borne out of the nontrivial real-space topology of a magnetic order.

Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry

AIMS

The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.

METHODS AND RESULTS

1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.

CONCLUSION

Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.