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Hua C, Jiang C, Wang Z, Liu X, Fu H, Lin J, Lv Q, Dong J, Ma C, Du X. Association between anti-SSA autoantibodies and conduction disturbances in heart failure. Heart Rhythm 2024:S1547-5271(24)02673-0. [PMID: 38848863 DOI: 10.1016/j.hrthm.2024.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Conduction disturbances play an important role in the occurrence and development of heart failure (HF). Studies suggest autoantibodies may attack conduction system. However, it is unclear whether autoantibodies are associated with conduction disturbances in patients with HF. OBJECTIVE Assess whether anti-SSA, anti-Ro/Sjögren's syndrome-related antigen A antibodies known for congenital atrioventricular block, is associated with conduction disturbances in patients with HF METHODS: This retrospective observational study used data from patients with HF who admitted to Beijing Anzhen Hospital between January 2018 and June 2022. We included patients who had anti-SSA tested and had electrocardiogram (ECG) examination during hospitalization. Conduction disturbances, including atrioventricular block (AVB), bundle branch block (BBB), and intraventricular conduction delay were confirmed by a cardiologist blinded to the anti-SSA status. Univariate and multivariable logistic regression analyses were performed to assess the association between anti-SSA and conduction disturbances. RESULTS 766 patients were included in this study, 70(9.1%) of whom were anti-SSA positive. Subjects who were anti-SSA positive showed a higher prevalence of AVB (20% vs 10.6%) and BBB (27.3 % vs 10.9 %), including both left bundle branch block (LBBB) and right bundle branch block (RBBB) (all P<0.05). After adjusting for known risk factors, anti-SSA were independently associated with AVB (OR 2.42 (1.18-5.43), P = 0.03) and BBB (OR 3.15(1.68-5.89), P<0.001). CONCLUSION Anti-SSA is independently associated with AVB and BBB in patients with HF. We need to study the role of autoantibodies in the development of conduction abnormalities in patient with HF to generate possible targeted treatments.
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Affiliation(s)
- Chang Hua
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Zhiyan Wang
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xinru Liu
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Hao Fu
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Jing Lin
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Anzhen Hospital, Beijing, China; Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Changsheng Ma
- Department of Cardiology, Anzhen Hospital, Beijing, China
| | - Xin Du
- Department of Cardiology, Anzhen Hospital, Beijing, China; Heart Health Research Center (HHRC), Beijing, China.
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Lazăr-Höcher AI, Cozma D, Cirin L, Cozgarea A, Faur-Grigori AA, Catană R, Tudose DG, Târtea G, Crișan S, Gaiță D, Luca CT, Văcărescu C. A Comparative Analysis of Apical Rocking and Septal Flash: Two Views of the Same Systole? J Clin Med 2024; 13:3109. [PMID: 38892820 PMCID: PMC11172686 DOI: 10.3390/jcm13113109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/11/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Heart failure (HF) is a complex medical condition characterized by both electrical and mechanical dyssynchrony. Both dyssynchrony mechanisms are intricately linked together, but the current guidelines for cardiac resynchronization therapy (CRT) rely only on the electrical dyssynchrony criteria, such as the QRS complex duration. This possible inconsistency may result in undertreating eligible individuals who could benefit from CRT due to their mechanical dyssynchrony, even if they fail to fulfill the electrical criteria. The main objective of this literature review is to provide a comprehensive analysis of the practical value of echocardiography for the assessment of left ventricular (LV) dyssynchrony using parameters such as septal flash and apical rocking, which have proven their relevance in patient selection for CRT. The secondary objectives aim to offer an overview of the relationship between septal flash and apical rocking, to emphasize the primary drawbacks and benefits of using echocardiography for evaluation of septal flash and apical rocking, and to offer insights into potential clinical applications and future research directions in this area. Conclusion: there is an opportunity to render resynchronization therapy more effective for every individual; septal flash and apical rocking could be a very useful and straightforward echocardiography resource.
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Affiliation(s)
- Alexandra-Iulia Lazăr-Höcher
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
| | - Dragoș Cozma
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Liviu Cirin
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
| | - Andreea Cozgarea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.-I.L.-H.); (L.C.); (A.C.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Adelina-Andreea Faur-Grigori
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
| | - Rafael Catană
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
| | - Dănuț George Tudose
- Institute of Cardiovascular Diseases C.C. Iliescu, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania;
| | - Georgică Târtea
- Department of Physiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Simina Crișan
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Dan Gaiță
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
| | - Cristina Văcărescu
- Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania; (A.-A.F.-G.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 13A Gheorghe Adam Street, 300310 Timisoara, Romania
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3
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Catrina BI, Batar F, Manitiu I, Prodan L, Tanasescu C, Filip T. Concepts of Cardiac Dyssynchrony and Dynamic Approach. Diagnostics (Basel) 2024; 14:937. [PMID: 38732350 PMCID: PMC11083078 DOI: 10.3390/diagnostics14090937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/12/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Cardiac conduction involves electrical activity from one myocyte to another, creating coordinated contractions in each. Disruptions in the conducting system, such as left bundle branch block (LBBB), can result in premature activation of specific regions of the heart, leading to heart failure and increased morbidity and mortality. Structural alterations in T-tubules and the sarcoplasmic reticulum can lead to dyssynchrony, a condition that can be treated by cardiac resynchronization therapy (CRT), which stands as a cornerstone in this pathology. The heterogeneity in patient responses underscored the necessity of improving the diagnostic approach. Vectocardiography, ultra-high-frequency ECG, 3D echocardiography, and electrocardiographic imaging seem to offer advanced precision in identifying optimal candidates for CRT in addition to the classic diagnostic methods. The advent of His bundle pacing and left bundle branch pacing further refined the approach in the treatment of dyssynchrony, offering more physiological pacing modalities that promise enhanced outcomes by maintaining or restoring the natural sequence of ventricular activation. HOT-CRT emerges as a pivotal innovation combining the benefits of CRT with the precision of His bundle or left bundle branch area pacing to optimize cardiac function in a subset of patients where traditional CRT might fall short.
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Affiliation(s)
- Bianca Iulia Catrina
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Pathophysiology Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Florina Batar
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Physiology Pathophysiology Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Ioan Manitiu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Cardiology Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Liliana Prodan
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Pathophysiology Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Ciprian Tanasescu
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
- Clinical Surgical Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania
| | - Teodora Filip
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania; (F.B.); (I.M.); (C.T.); (T.F.)
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4
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Chen Z, Zhou X, Ma X, Chen K. Recruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart. Front Physiol 2022; 13:1045740. [PMID: 36589433 PMCID: PMC9798297 DOI: 10.3389/fphys.2022.1045740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a leading health burden around the world. Although pharmacological development has dramatically advanced medication therapy in the field, hemodynamic disorders or mechanical desynchrony deteriorated by intra or interventricular conduction abnormalities remains a critical target beyond the scope of pharmacotherapy. In the past 2 decades, nonpharmacologic treatment for heart failure, such as cardiac resynchronization therapy (CRT) via biventricular pacing (BVP), has been playing an important role in improving the prognosis of heart failure. However, the response rate of BVP-CRT is variable, leaving one-third of patients not benefiting from the therapy as expected. Considering the non-physiological activation pattern of BVP-CRT, more efforts have been made to optimize resynchronization. The most extensively investigated approach is by stimulating the native conduction system, e.g., His-Purkinje conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). These emerging CRT approaches provide an alternative to traditional BVP-CRT, with multiple proof-of-concept studies indicating the safety and efficacy of its utilization in dyssynchronous heart failure. In this review, we summarize the mechanisms of dyssynchronous HF mediated by conduction disturbance, the rationale and acute effect of CSP for CRT, the recent advancement in clinical research, and possible future directions of CSP.
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Affiliation(s)
- Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Keping Chen,
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5
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Wong B, McDonald K, Keane D. Time to rechallenge primary prevention ICD guidelines. ESC Heart Fail 2022; 9:3694-3697. [PMID: 36002953 PMCID: PMC9773725 DOI: 10.1002/ehf2.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Bethany Wong
- UCD School of MedicineHealth Sciences CentreBelfieldDublinIreland,Cardiology DepartmentSt Vincent's HospitalElm ParkDublinIreland
| | - Kenneth McDonald
- UCD School of MedicineHealth Sciences CentreBelfieldDublinIreland,Cardiology DepartmentSt Vincent's HospitalElm ParkDublinIreland
| | - David Keane
- UCD School of MedicineHealth Sciences CentreBelfieldDublinIreland
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6
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Gould J, Claridge S, Jackson T, Sieniewicz BJ, Sidhu BS, Porter B, Elliott MK, Mehta V, Niederer S, Chadwick H, Kamdar R, Adhya S, Patel N, Hamid S, Rogers D, Nicolson W, Chan CF, Whinnett Z, Murgatroyd F, Lambiase PD, Rinaldi CA. Standard care vs. TRIVEntricular pacing in Heart Failure (STRIVE HF): a prospective multicentre randomized controlled trial of triventricular pacing vs. conventional biventricular pacing in patients with heart failure and intermediate QRS left bundle branch block. Europace 2022; 24:796-806. [PMID: 35079787 PMCID: PMC9071069 DOI: 10.1093/europace/euab267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Indexed: 11/25/2022] Open
Abstract
AIMS To determine whether triventricular (TriV) pacing is feasible and improves CRT response compared to conventional biventricular (BiV) pacing in patients with left bundle branch block (LBBB) and intermediate QRS prolongation (120-150 ms). METHODS AND RESULTS Between October 2015 and November 2019, 99 patients were recruited from 11 UK centres. Ninety-five patients were randomized 1:1 to receive TriV or BiV pacing systems. The primary endpoint was feasibility of TriV pacing. Secondary endpoints assessed symptomatic and remodelling response to CRT. Baseline characteristics were balanced between groups. In the TriV group, 43/46 (93.5%) patients underwent successful implantation vs. 47/49 (95.9%) in the BiV group. Feasibility of maintaining CRT at 6 months was similar in the TriV vs. BiV group (90.0% vs. 97.7%, P = 0.191). All-cause mortality was similar between TriV vs. BiV groups (4.3% vs. 8.2%, P = 0.678). There were no significant differences in echocardiographic LV volumes or clinical composite scores from baseline to 6-month follow-up between groups. CONCLUSION Implantation of two LV leads to deliver and maintain TriV pacing at 6 months is feasible without significant complications in the majority of patients. There was no evidence that TriV pacing improves CRT response or provides additional clinical benefit to patients with LBBB and intermediate QRS prolongation and cannot be recommended in this patient group. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT02529410.
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Affiliation(s)
- Justin Gould
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK.,King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Simon Claridge
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK.,King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Thomas Jackson
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK.,King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Benjamin J Sieniewicz
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK.,King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Baldeep S Sidhu
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK.,King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Bradley Porter
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK.,King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Mark K Elliott
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK.,King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Vishal Mehta
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK.,King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Steven Niederer
- King's College London, Westminster Bridge Road, London, SE1 7EH, UK
| | - Humra Chadwick
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK
| | - Ravi Kamdar
- Croydon University Hospital, 530, London Road, Croydon, CR7 7YE, UK
| | - Shaumik Adhya
- Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK
| | - Nikhil Patel
- Eastbourne District General Hospital, King's Drive, Eastbourne, East Sussex, BN21 2UD, UK
| | - Shoaib Hamid
- Queen Elizabeth Hospital, Stadium Road, London, SE18 4QH, UK
| | - Dominic Rogers
- Northen General Hospital, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK
| | - William Nicolson
- Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9QP, UK
| | - Cheuk F Chan
- East Surrey Hospital, Canada Avenue, Redhill, RH1 5RH, UK
| | | | | | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, City of London, EC1A 7BE, UK
| | - Christopher A Rinaldi
- Guy's & St. Thomas' Hospitals, Westminster Bridge Road, London, SE1 7EH, UK.,King's College London, Westminster Bridge Road, London, SE1 7EH, UK
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7
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Novel electrocardiographic dyssynchrony criteria that may improve patient selection for cardiac resynchronization therapy. J Geriatr Cardiol 2022; 19:31-43. [PMID: 35233221 PMCID: PMC8832041 DOI: 10.11909/j.issn.1671-5411.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an evidence-based effective therapy of symptomatic heart failure with reduced ejection fraction refractory to optimal medical treatment associated with intraventricular conduction disturbance, that results in electrical dyssynchrony and further deterioration of systolic ventricular function. However, the non-response rate to CRT is still 20%−40%, which can be decreased by better patient selection. The main determinant of CRT outcome is the presence or absence of significant ventricular dyssynchrony and the ability of the applied CRT technique to eliminate it. The current guidelines recommend the determination of QRS morphology and QRS duration and the measurement of left ventricular ejection fraction for patient selection for CRT. However, QRS morphology and QRS duration are not perfect indicators of electrical dyssynchrony, which is the cause of the not negligible non-response rate to CRT and the missed CRT implantation in a significant number of patients who have the appropriate substrate for CRT. Using imaging modalities, many ventricular dyssynchrony criteria were devised for the detection of mechanical dyssynchrony, but their utility in patient selection for CRT is not yet proven, therefore their use is not recommended for this purpose. Moreover, CRT can eliminate only mechanical dyssynchrony due to underlying electrical dyssynchrony, for this reason ECG has a greater role in the detection of ventricular dyssynchrony than imaging modalities. To improve assessment of electrical dyssynchrony, we devised two novel ECG dyssynchrony criteria, which can estimate interventricular and left ventricular intraventricular dyssynchrony in order to improve patient selection for CRT. Here we discuss the results achieved by the application of these new ECG dyssynchrony criteria, which proved to be useful in predicting the CRT response in patients with nonspecific intraventricular conduction disturbance pattern (the second greatest group of CRT candidates), and the significance of other new ECG dyssynchrony criteria in the potential improvement of CRT outcome.
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8
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Stretti L, Zippo D, Coats AJS, Anker MS, von Haehling S, Metra M, Tomasoni D. A year in heart failure: an update of recent findings. ESC Heart Fail 2021; 8:4370-4393. [PMID: 34918477 PMCID: PMC9073717 DOI: 10.1002/ehf2.13760] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022] Open
Abstract
Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin‐converting enzyme inhibitors or an angiotensin receptor‐neprilysin inhibitor, beta‐blockers, mineralocorticoid receptor antagonists, and sodium‐glucose co‐transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM‐AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo‐controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR‐Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer‐related HF, also occurred. Coronavirus disease 2019 (COVID‐19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.
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Affiliation(s)
- Lorenzo Stretti
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Dauphine Zippo
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Markus S Anker
- Department of Cardiology (CBF), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Marco Metra
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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9
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Chakraborty P, Suszko AM, Viswanathan K, Sheikholeslami K, Spears D, Adler A, Woo A, Rakowski H, Chauhan VS. Microvolt QRS Alternans in Hypertrophic Cardiomyopathy: A Novel Risk Marker of Late Ventricular Arrhythmias. J Am Heart Assoc 2021; 10:e022036. [PMID: 34854315 PMCID: PMC9075383 DOI: 10.1161/jaha.121.022036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Unlike T‐wave alternans (TWA), the relation between QRS alternans (QRSA) and ventricular arrhythmia (VA) risk has not been evaluated in hypertrophic cardiomyopathy (HCM). We assessed microvolt QRSA/TWA in relation to HCM risk factors and late VA outcomes in HCM. Methods and Results Prospectively enrolled patients with HCM (n=130) with prophylactic implantable cardioverter‐defibrillators underwent digital 12‐lead ECG recordings during ventricular pacing (100–120 beats/min). QRSA/TWA was quantified using the spectral method. Patients were categorized as QRSA+ and/or TWA+ if sustained alternans was present in ≥2 precordial leads. The VA end point was appropriate implantable cardioverter‐defibrillator therapy over 5 years of follow‐up. QRSA+ and TWA+ occurred together in 28% of patients and alone in 7% and 7% of patients, respectively. QRSA magnitude increased with pacing rate (1.9±0.6 versus 6.2±2.0 µV; P=0.006). Left ventricular thickness was greater in QRSA+ than in QRSA− patients (22±7 versus 20±6 mm; P=0.035). Over 5 years follow‐up, 17% of patients had VA. The annual VA rate was greater in QRSA+ versus QRSA− patients (5.8% versus 2.0%; P=0.006), with the QRSA+/TWA− subgroup having the greatest rate (13.3% versus 2.6%; P<0.001). In those with <2 risk factors, QRSA− patients had a low annual VA rate compared QRSA+ patients (0.58% versus 7.1%; P=0.001). Separate Cox models revealed QRSA+ (hazard ratio [HR], 2.9 [95% CI, 1.2–7.0]; P=0.019) and QRSA+/TWA− (HR, 7.9 [95% CI, 2.9–21.7]; P<0.001) as the most significant VA predictors. TWA and HCM risk factors did not predict VA. Conclusions In HCM, microvolt QRSA is a novel, rate‐dependent phenomenon that can exist without TWA and is associated with greater left ventricular thickness. QRSA increases VA risk 3‐fold in all patients, whereas the absence of QRSA confers low VA risk in patients with <2 risk factors. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02560844.
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Affiliation(s)
- Praloy Chakraborty
- Division of Cardiology Peter Munk Cardiac Center University Health Network Toronto Ontario Canada
| | - Adrian M Suszko
- Division of Cardiology Peter Munk Cardiac Center University Health Network Toronto Ontario Canada
| | - Karthik Viswanathan
- Division of Cardiology Peter Munk Cardiac Center University Health Network Toronto Ontario Canada
| | - Kimia Sheikholeslami
- Division of Cardiology Peter Munk Cardiac Center University Health Network Toronto Ontario Canada
| | - Danna Spears
- Division of Cardiology Peter Munk Cardiac Center University Health Network Toronto Ontario Canada
| | - Arnon Adler
- Division of Cardiology Peter Munk Cardiac Center University Health Network Toronto Ontario Canada
| | - Anna Woo
- Division of Cardiology Peter Munk Cardiac Center University Health Network Toronto Ontario Canada
| | - Harry Rakowski
- Division of Cardiology Peter Munk Cardiac Center University Health Network Toronto Ontario Canada
| | - Vijay S Chauhan
- Division of Cardiology Peter Munk Cardiac Center University Health Network Toronto Ontario Canada
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10
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Wang Q, Li B, Chen K, Yu F, Su H, Hu K, Liu Z, Wu G, Yan J, Su G. Machine learning-based risk prediction of malignant arrhythmia in hospitalized patients with heart failure. ESC Heart Fail 2021; 8:5363-5371. [PMID: 34585531 PMCID: PMC8712774 DOI: 10.1002/ehf2.13627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS Predicting the risk of malignant arrhythmias (MA) in hospitalized patients with heart failure (HF) is challenging. Machine learning (ML) can handle a large volume of complex data more effectively than traditional statistical methods. This study explored the feasibility of ML methods for predicting the risk of MA in hospitalized HF patients. METHODS AND RESULTS We evaluated the baseline data and MA events of 2794 hospitalized HF patients in the HF cohort in Anhui Province and randomly divided the study population into training and validation sets in a 7:3 ratio. The Lasso-logistic regression, multivariate adaptive regression splines (MARS), classification and regression tree (CART), random forest (RF), and eXtreme gradient boosting (XGBoost) algorithms were used to construct risk prediction models in the training set, and model performance was verified in the validation set. The area under the receiver operating characteristic curve (AUC) and Brier score were employed to evaluate the discrimination and calibration of the model, respectively. Clinical utility of the Lasso-logistic regression model was analysed using decision curve analysis (DCA). The median (Q1, Q3) age of the study population was 70 (61, 77) years, and 39.5% were female. MA events occurred in 117 patients (4.2%) during hospitalization. In the training set (n = 1964), the AUC of the XGBoost model was 0.998 [95% confidence interval (CI) 0.997-1.000], which was higher than the other models (all P < 0.001). In the validation set (n = 830), there was no significant difference in AUC of Lasso-logistic model 1 [AUC: 0.867 (95% CI 0.819-0.915)], Lasso-logistic model 2 [AUC: 0.828 (95% CI 0.764-0.892)], MARS model [AUC: 0.852 (95% CI 0.793-0.910)], RF model [AUC: 0.804 (95% CI 0.726-0.881)], and XGBoost model [AUC: 0.864 (95% CI 0.810-0.918); all P > 0.05], which were higher than that of CART model [AUC: 0.743 (95% CI 0.661-0.824); all P < 0.05]. Brier scores for all prediction models were less than 0.05. DCA results showed that the Lasso-logistic model had a net clinical benefit. Oral antiarrhythmic drug, left bundle branch block, serum magnesium, d-dimer, and random blood glucose were significant predictors in half or more of the models. CONCLUSIONS The current study findings suggest that ML models based on the Lasso-logistic regression, MARS, RF, and XGBoost algorithms can effectively predict the risk of MA in hospitalized HF patients. The Lasso-logistic model had better clinical interpretability and ease of use than the other models.
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Affiliation(s)
- Qi Wang
- Division of CardiologyJinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityNo. 105 Jiefang RoadJinan250013China
- Heart Failure Center, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiChina
| | - Bin Li
- Division of CardiologyJinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityNo. 105 Jiefang RoadJinan250013China
| | - Kangyu Chen
- Heart Failure Center, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiChina
| | - Fei Yu
- Heart Failure Center, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiChina
| | - Hao Su
- Heart Failure Center, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiChina
| | - Kai Hu
- Heart Failure Center, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiChina
| | - Zhiquan Liu
- Heart Failure Center, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiChina
| | - Guohong Wu
- Heart Failure Center, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiChina
| | - Ji Yan
- Heart Failure Center, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiChina
| | - Guohai Su
- Division of CardiologyJinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityNo. 105 Jiefang RoadJinan250013China
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11
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Young WJ, Warren HR, Mook-Kanamori DO, Ramírez J, van Duijvenboden S, Orini M, Tinker A, van Heemst D, Lambiase PD, Jukema JW, Munroe PB, Noordam R. Genetically Determined Serum Calcium Levels and Markers of Ventricular Repolarization: A Mendelian Randomization Study in the UK Biobank. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2021; 14:e003231. [PMID: 33887147 PMCID: PMC8208093 DOI: 10.1161/circgen.120.003231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND ECG markers of ventricular depolarization and repolarization are associated with an increased risk of arrhythmia and sudden cardiac death. Our prior work indicated lower serum calcium concentrations are associated with longer QT and JT intervals in the general population. Here, we investigate whether serum calcium is a causal risk factor for changes in ECG measures using Mendelian randomization (MR). METHODS Independent lead variants from a newly performed genome-wide association study for serum calcium in >300 000 European-ancestry participants from UK Biobank were used as instrumental variables. Two-sample MR analyses were performed to approximate the causal effect of serum calcium on QT, JT, and QRS intervals using an inverse-weighted method in 76 226 participants not contributing to the serum calcium genome-wide association study. Sensitivity analyses including MR-Egger, weighted-median estimator, and MR pleiotropy residual sum and outlier were performed to test for the presence of horizontal pleiotropy. RESULTS Two hundred five independent lead calcium-associated variants were used as instrumental variables for MR. A decrease of 0.1 mmol/L serum calcium was associated with longer QT (3.01 ms [95% CI, 2.03 to 3.99]) and JT (2.89 ms [1.91 to 3.87]) intervals. A weak association was observed for QRS duration (secondary analyses only). Results were concordant in all sensitivity analyses. CONCLUSIONS These analyses support a causal effect of serum calcium levels on ventricular repolarization, in a middle-aged population of European-ancestry where serum calcium concentrations are likely stable and chronic. Modulation of calcium concentration may, therefore, directly influence cardiovascular disease risk.
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Affiliation(s)
- William J. Young
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust (W.J.Y., M.O., P.D.L.)
| | - Helen R. Warren
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- NIHR Barts Cardiovascular Biomedical Research Unit (H.R.W., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - Dennis O. Mook-Kanamori
- Department of Clinical Epidemiology (D.O.M.-K.), Leiden University Medical Center, the Netherlands
- Department of Public Health and Primary Care (D.O.M.-K.), Leiden University Medical Center, the Netherlands
| | - Julia Ramírez
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - Stefan van Duijvenboden
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - Michele Orini
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust (W.J.Y., M.O., P.D.L.)
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - Andrew Tinker
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- NIHR Barts Cardiovascular Biomedical Research Unit (H.R.W., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - Diana van Heemst
- Department of Internal Medicine (D.v.H., R.N.), Leiden University Medical Center, the Netherlands
| | - Pier D. Lambiase
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust (W.J.Y., M.O., P.D.L.)
- Institute of Cardiovascular Sciences, University of College London, United Kingdom (J.R., S.v.D., M.O., P.D.L.)
| | - J. Wouter Jukema
- Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands (J.W.J.)
| | - Patricia B. Munroe
- Clinical Pharmacology Department, William Harvey Research Institute (W.J.Y., H.R.W., J.R., S.v.D., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- NIHR Barts Cardiovascular Biomedical Research Unit (H.R.W., A.T., P.B.M.), Barts and the London School of Medicine and Dentistry, Queen Mary University of London
| | - Raymond Noordam
- Department of Internal Medicine (D.v.H., R.N.), Leiden University Medical Center, the Netherlands
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12
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Tomasoni D, Adamo M, Metra M. December 2020 at a glance: focus on COVID-19, comorbidities and palliative care. Eur J Heart Fail 2021; 22:2173-2174. [PMID: 33556231 PMCID: PMC8013496 DOI: 10.1002/ejhf.1527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/25/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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13
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Q waves in ischemic cardiomyopathy. Int J Cardiovasc Imaging 2021; 37:2085-2092. [PMID: 33517554 DOI: 10.1007/s10554-021-02172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
Q waves may be observed in the absence of non-viable tissue. However, their scintigraphic translation in patients with ischemic cardiomyopathy (ICM) has not been properly assessed. This study sought to establish the determinants of Q waves in the absence of non-viable tissue and the diagnostic accuracy in this population. A retrospective study enrolling 487 consecutive patients (67.0 [57.4 - 75.4] years), with ICM, LVEF < 40% and narrow QRS who underwent stress-rest 99 m-Tc SPECT was conducted. A 17-segment model for myocardium was used: Myocardium was divided in basal (1 to 6), mid (7 to 12), apical (13 to 16) and apex (17) segments. Non-viable tissue was defined as a severe perfusion defect without systolic thickening. Patients with Q waves (65.7%) had more non-viable tissue, more extensive scar and less ischemia. Q waves had a moderate correlation with non-viable tissue (AUC = 0.63) and were associated with the extension of the scar. After excluding patients with non-viable tissue in any myocardial segment, Q waves were observed in 51.9% of the patients, of which 78.1% had a scar fulfilling viability criteria. The presence of Q waves was associated with the location of these scars in a base-to-apex axis (OR = 1.88 [1.35-2.62] for segment towards the apex) and their extent (OR = 1.19 [1.05 - 1.35] for each segment). In patients with ICM, Q waves discriminate poorly viable from non-viable tissue. Q waves in this population may be due to extensive scars fulfilling viability criteria located in apical segments.
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14
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Vernooy K, Brunner-La Rocca HP. The importance of electrocardiographic follow-up in heart failure. Eur J Heart Fail 2020; 22:2380-2382. [PMID: 33179385 DOI: 10.1002/ejhf.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/08/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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