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Bertrand É, Caru M, Harvey A, Andelfinger G, Laverdiere C, Krajinovic M, Sinnett D, Jacquemet V, Curnier D. QTc intervals at rest and during exercise assessed by group correction formulas in survivors of childhood acute lymphoblastic leukemia. J Electrocardiol 2024; 83:80-94. [PMID: 38382343 DOI: 10.1016/j.jelectrocard.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/07/2023] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Early signs of subclinical cardiac damage must be identified before they turn into clinical manifestations. Tailoring a formula is relevant for precise QTc evaluation in childhood acute lymphoblastic leukemia (ALL) survivors considering they are at risk of long-term cardiac problems. Therefore, we aim to develop group heart rate correction formulas for QT intervals in childhood ALL survivors at rest and during exercise, and to assess the applicability of these methods across a variety of risk groups exposed to diverse chemotherapy dosages. METHODS Two hundred and fifty childhood ALL survivors in the PETALE study were classified into 3 groups depending on their prognostic risk group. ECG measurements (QT and RR intervals) were made at rest and during a cardiopulmonary exercise test. QT correction for heart rate was applied using 5 different formulas, which included 2 previously published formulas and 3 group-specific formulas for each sex. RESULTS The QT/RR relation showed 2 different curves between rest and during exercise, which was worse for females. Group-specific QTc formulas allowed adequate heart rate-corrected QT interval, independently of the cumulative dose of doxorubicin received during treatment. Group-specific formulas showed significantly shorter QTc intervals than QTc from Bazett's formula. QTc (Bazett's formula) values surpassed the established clinical norm in 22 males (11%) and 22 females (11%), with a majority occurring during exercise, affecting 15 males (7.5%) and 10 females (5%). CONCLUSION This study shows the applicability of personalized group correction of QT/RR data in childhood ALL survivors. Our comprehensive assessments (spanning rest, exercise, and recovery) is an effective approach for risk stratification of cardiac complications in childhood ALL survivors.
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Affiliation(s)
- Émilie Bertrand
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Sainte-Justine University Health Center, Research Center, Montreal, Quebec, Canada
| | - Maxime Caru
- Department of Pediatrics, Division of Hematology and Oncology, Department of Public Health Sciences, Pennsylvania State Health Children's Hospital, Hershey, PA, USA
| | - Audrey Harvey
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Sainte-Justine University Health Center, Research Center, Montreal, Quebec, Canada
| | - Gregor Andelfinger
- Sainte-Justine University Health Center, Research Center, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Caroline Laverdiere
- Sainte-Justine University Health Center, Research Center, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center, Research Center, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center, Research Center, Montreal, Quebec, Canada; Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Vincent Jacquemet
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Daniel Curnier
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Sainte-Justine University Health Center, Research Center, Montreal, Quebec, Canada.
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Vanthienen J, Petrov MV, Luu TM, Cloutier A, Raaijmakers A, Staessen JA, Zhang Z, Salaets T, Laenen A, Smits A, Nuyt AM, Flahault A, Allegaert K. The QT c-Bazett Interval in Former Very Preterm Infants in Adolescence and Young Adulthood is Not Different from Term-Born Controls. Drug Saf 2023; 46:897-904. [PMID: 37505401 PMCID: PMC10442256 DOI: 10.1007/s40264-023-01335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Although relevant for precision pharmacovigilance, there are conflicting data on whether former preterm birth is associated with QTc-Bazett prolongation in later life. METHODS To explore QTc-Bazett interval differences between former preterm and/or extremely low birth weight (ELBW) cases and term-born controls in adolescence and young adulthood, we analyzed pooled individual data after a structured search on published cohorts. To test the absence of a QTc-Bazett difference, a non-inferiority approach was applied (one-sided, upper limit of the 95% confidence interval [CI] mean QTc-Bazett difference, 5 and 10 ms). We also investigated the impact of characteristics, either perinatal or at assessment, on QTc-Bazett in the full dataset (cases and controls). Data were reported as median and range. RESULTS The pooled dataset contained 164 former preterm and/or ELBW (cases) and 140 controls born full-term from three studies. The median QTc-Bazett intervals were 409 (335-490) and 410 (318-480) ms in cases and controls. The mean QTc-Bazett difference was 1 ms, with an upper 95% CI of 6 ms (p > 0.05 and p < 0.01 for 5 and 10 ms, respectively). In the full dataset, females had a significantly longer QTc-Bazett than males (415 vs. 401 ms; p < 0.0001). CONCLUSIONS QTc-Bazett intervals are not significantly different between former preterm and/or ELBW cases and term-born controls, and we rejected a potential prolongation > 10 ms in cases. When prescribing QTc-prolonging drugs, pharmacovigilance practices in this subpopulation should be similar to the general public (NCT05243537).
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Affiliation(s)
- Jill Vanthienen
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Marine Vassilev Petrov
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Thuy Mai Luu
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Anik Cloutier
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Anke Raaijmakers
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Pediatrics, ZNA Hospitals Antwerp, Antwerp, Belgium
| | - Jan A Staessen
- Non-Profit Research Institute Alliance for the Promotion of Preventive Medicine, Mechlin, Belgium
- Biomedical Sciences Group, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Zhenyu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Thomas Salaets
- Division of Pediatric Cardiology, Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Center (L-BioStat), KU Leuven, Leuven, Belgium
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Anne-Monique Nuyt
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Adrien Flahault
- Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC, Canada
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands.
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Manabe M, Fujino M, Kusuki H, Sadanaga T, Hata T, Bouda H, Miyata M, Yoshikawa T. Effect of Hypothermia on Myocardial Depolarization and Repolarization in Neonates with Hypoxic-Ischemic Encephalopathy Due to Asphyxia. Pediatr Cardiol 2022; 43:1792-1798. [PMID: 35670814 DOI: 10.1007/s00246-022-02916-x] [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: 12/31/2021] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
Abstract
Therapeutic hypothermia (TH) is effective for neonatal hypoxic-ischemic encephalopathy (HIE). The combination of abnormal myocardial repolarization and fatal arrhythmia in patients with accidental hypothermia has prompted clinical validation of the proarrhythmic potential of TH. However, to our knowledge, there have been few clinical studies on myocardial depolarization and repolarization abnormalities caused by TH in neonates. Therefore, we investigated the effects of TH on neonatal myocardial depolarization and repolarization by capturing the waveform changes in electrocardiograms (ECGs) associated with body temperature (BT) before and after TH. We included three neonates with HIE diagnosed at birth who were treated with TH in our hospital. The heart rate, RR interval, P wave duration, PR interval, QRS duration, QT interval, corrected QT (QTc) interval by Fridericia's formula, J point-T end (JT) interval, corrected JT (JTc) interval by Fridericia's formula, T peak-T end (Tpe) interval, Tpe/QT, and QRS/QTc were calculated retrospectively using an ECG. The correlations of ECG parameters recorded concurrently with 33 samples in which BT measurements were confirmed were performed. BT and heart rate were positively correlated (R: 0.589, p = 0.0003). BT was negatively correlated with Tpe/QT (R: - 0.470, p = 0.0058), the QTc interval (R: - 0.680, p < 0.0001), and the corrected JT interval (R: - 0.697, p < 0.0001). TH does not affect atrial or ventricular depolarization but prolongs the ventricular repolarization process in a temperature-dependent manner.
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Affiliation(s)
- Masahiko Manabe
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Fujino
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hirofumi Kusuki
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | | | - Tadayoshi Hata
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan. .,Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
| | - Hiroko Bouda
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Masafumi Miyata
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Algaze CA, Deitch AM, Chubb H, Aziz PF, Collins RT. Importance of Formula-Specific Centile Thresholds for Evaluation of Heart Rate-Corrected QT Prolongation in Williams Syndrome. Am J Cardiol 2022; 183:99-104. [PMID: 36114024 DOI: 10.1016/j.amjcard.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Patients with Williams syndrome (WS) have a 25- to 100-fold higher risk of sudden death and prolonged heart rate-corrected QT (QTc). A recent study using the Fridericia formula for QT correction suggested that prolongation is principally an issue of heart rate. We used multiple published heart rate correction formulas to reevaluate the prevalence of QTc prolongation in our original dataset from our 2010 study at the Children's Hospital of Philadelphia. The ninety-eighth centile for QTc and corrected JT Interval (JTc) of the control population for each formula were used to set the threshold for prolongation. Prevalence comparison was done with Fisher's exact test. Predictors of longer QTc/JTc were assessed using linear regression models adjusting for age, gender, and heart rate. Adjusted odds of QTc/JTc prolongation were evaluated with conditional logistic regression models matched based on age and heart rate. There were 482 electrocardiograms from 188 patients with WS and 1,522 from normal controls. Patients with WS were younger, with higher heart rates and shorter RR and QRS intervals. WS was associated with longer QTc/JTc compared with controls. There were higher odds of prolonged QTc/JTc in patients with WS than controls using both Bazett and Fridericia formulas. In conclusion, this study confirms the higher prevalence of QTc prolongation in WS compared with controls and highlights the importance of setting appropriate formula-specific upper thresholds for QTc prolongation for accurate diagnosis.
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Affiliation(s)
- Claudia A Algaze
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
| | - Anna M Deitch
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Henry Chubb
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Peter F Aziz
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - R Thomas Collins
- Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
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Orchard JJ, Orchard JW, Raju H, La Gerche A, Puranik R, Davis A, Drezner JA, Semsarian C. Analysis of athlete QT intervals by age: Fridericia and Hodges heart rate corrections outperform Bazett for athlete ECG screening. J Electrocardiol 2022; 74:59-64. [PMID: 36027674 DOI: 10.1016/j.jelectrocard.2022.08.002] [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: 06/28/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac screening of elite athletes including a 12‑lead electrocardiogram (ECG) is recommended by numerous international bodies. Current athlete ECG interpretation guidelines recommend the Bazett method to correct the QT interval (QTc). OBJECTIVE This study sought to investigate normative QTc changes by age using athlete screening ECGs and different QT correction methods in a population of elite cricketers. METHODS Initial cardiac screening ECGs from an existing database of elite Australian cricketers aged 14-35 years were examined. Average QT interval, QTcB (corrected QT-Bazett), QTcF (Fridericia), QTcH (Hodges), and heart rate (HR) were analyzed by age and sex. RESULTS A total of 1310 athletes (66% male, 34% female) were included with mean age 19.1 years and mean heart rate 66.9 bpm (range 38-121 bpm). With increasing age, HR decreased and absolute QT increased. The pattern of QTc change with age differed depending on the method of correction: Bazett correction (QTcB) demonstrated a "dish-shaped" or broad U-shaped appearance; while Fridericia and Hodges corrections showed a linear increase in QTc from young to older age. The Bazett method had a stronger correlation of HR with QTc (R2 = 0.32) than either Fridericia (R2 = 0.0007) or Hodges (R2 = 0.009) methods. CONCLUSIONS The Bazett method is not the most accurate QT correction in athletes, especially during adolescence. In elite cricketers, QTcB revealed a drop in QTc from adolescence to early adulthood due to mis-correction of the QT interval. The Fridericia method has the smoothest correction of HR and least QT variation by age and may be preferred for athlete screening.
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Affiliation(s)
- Jessica J Orchard
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - John W Orchard
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Andre La Gerche
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Melbourne, Australia; National Centre for Sports Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, Australia
| | - Rajesh Puranik
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Angus Davis
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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de Veld L, van der Lely N, Hermans BJM, van Hoof JJ, Wong L, Vink AS. QTc prolongation in adolescents with acute alcohol intoxication. Eur J Pediatr 2022; 181:2757-2770. [PMID: 35482092 PMCID: PMC9192465 DOI: 10.1007/s00431-022-04471-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/30/2022] [Accepted: 04/09/2022] [Indexed: 01/24/2023]
Abstract
In adults, alcohol intoxication is associated with prolongation of the QT interval corrected for heart rate (QTc). The QTc is influenced by age and sex. Although alcohol intoxication is increasingly common in adolescents, there are no data on the prevalence of QTc prolongation in adolescents with alcohol intoxication. This study aimed to determine the prevalence of QTc prolongation in adolescents with alcohol intoxication and identify at-risk adolescents. In this observational study including adolescents aged 10-18 years, heart rate and QT interval were automatically assessed from an electrocardiogram (ECG) at alcohol intoxication using a validated algorithm. The QTc was calculated using both the Bazett formula (QTcB) and Fridericia formula (QTcF). If present, an ECG recorded within 1 year of the date of admission to the emergency department was obtained as a reference ECG. A total of 317 adolescents were included; 13.3% had a QTcB and 7.9% a QTcF longer than the sex- and age-specific 95th-percentile. None of the adolescents had a QTcB or QTcF > 500 ms, but 11.8% of the adolescents with a reference ECG had a QTcB prolongation of > 60 ms, while no adolescents had a QTcF prolongation of > 60 ms. QTc prolongation was mainly attributable to an increase in heart rate rather than QT prolongation, which underlies the differences between QTcB and QTcF. Male sex and hypokalaemia increased the likelihood of QTc prolongation.Conclusion: QTc prolongation was seen in approximately 10% of the adolescents presenting with alcohol intoxication, and although no ventricular arrhythmias were observed in this cohort, QTc prolongation increases the potential for malignant QT-related arrhythmias. Clinicians must be aware of the possibility of QTc prolongation during alcohol intoxication and make an effort to obtain an ECG at presentation, measure the QT interval, and give an adequate assessment of the findings. We advocate admitting adolescents with alcohol intoxication and QTc prolongation. During hospital admission, we recommend limiting exposure to QTc-prolonging medication, increasing potassium levels to a high-normal range (4.5-5.0 mmol/L) and obtaining a reference ECG at discharge.
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Affiliation(s)
- Loes de Veld
- Erasmus School of Health Policy and Management, Erasmus University, Postbus 1738, 3000, Rotterdam, DR, Netherlands. .,Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands.
| | - Nico van der Lely
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands ,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ben J. M. Hermans
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Joris J. van Hoof
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands
| | - Lichelle Wong
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands
| | - Arja Suzanne Vink
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands ,Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Andršová I, Hnatkova K, Šišáková M, Toman O, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Influence of heart rate correction formulas on QTc interval stability. Sci Rep 2021; 11:14269. [PMID: 34253795 PMCID: PMC8275798 DOI: 10.1038/s41598-021-93774-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
Monitoring of QTc interval is mandated in different clinical conditions. Nevertheless, intra-subject variability of QTc intervals reduces the clinical utility of QTc monitoring strategies. Since this variability is partly related to QT heart rate correction, 10 different heart rate corrections (Bazett, Fridericia, Dmitrienko, Framingham, Schlamowitz, Hodges, Ashman, Rautaharju, Sarma, and Rabkin) were applied to 452,440 ECG measurements made in 539 healthy volunteers (259 females, mean age 33.3 ± 8.4 years). For each correction formula, the short term (5-min time-points) and long-term (day-time hours) variability of rate corrected QT values (QTc) was investigated together with the comparisons of the QTc values with individually corrected QTcI values obtained by subject-specific modelling of the QT/RR relationship and hysteresis. The results showed that (a) both in terms of short-term and long-term QTc variability, Bazett correction led to QTc values that were more variable than the results of other corrections (p < 0.00001 for all), (b) the QTc variability by Fridericia and Framingham corrections were not systematically different from each other but were lower than the results of other corrections (p-value between 0.033 and < 0.00001), and (c) on average, Bazett QTc values departed from QTcI intervals more than the QTc values of other corrections. The study concludes that (a) previous suggestions that Bazett correction should no longer be used in clinical practice are fully justified, (b) replacing Bazett correction with Fridericia and/or Framingham corrections would improve clinical QTc monitoring, (c) heart rate stability is needed for valid QTc assessment, and (d) development of further QTc corrections for day-to-day use is not warranted.
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Affiliation(s)
- Irena Andršová
- Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Rd, Shepherd's Bush, London, W12 0NN, England, UK
| | - Martina Šišáková
- Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Ondřej Toman
- Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Peter Smetana
- Wilhelminenspital der Stadt Wien, Montleartstraße 37, 1160, Vienna, Austria
| | - Katharina M Huster
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Rd, Shepherd's Bush, London, W12 0NN, England, UK. .,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic.
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