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Sakellaropoulou A, Giannopoulos G, Tachmatzidis D, Letsas KP, Antoniadis A, Asvestas D, Filos D, Mililis P, Efremidis M, Chouvarda I, Vassilikos VP. Association of beat-to-beat P-wave analysis index to the extent of left atrial low-voltage areas in patients with paroxysmal atrial fibrillation. Hellenic J Cardiol 2024:S1109-9666(24)00115-5. [PMID: 38777086 DOI: 10.1016/j.hjc.2024.05.011] [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: 10/08/2023] [Revised: 04/16/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Left atrial (LA) fibrosis has been shown to be associated with atrial fibrillation (AF) recurrence. Beat-to-beat (B2B) index is a non-invasive classifier, based on B2B P-wave morphological and wavelet analysis, shown to be associated with AF incidence and recurrence. In this study, we tested the hypothesis that the B2B index is associated with the extent of LA low-voltage areas (LVAs) on electroanatomical mapping. METHODS Patients with paroxysmal AF scheduled for pulmonary vein isolation, without evident structural remodeling, were included. Pre-ablation electroanatomical voltage maps were used to calculate the surface of LVAs (<0.5 mV). B2B index was compared between patients with small versus large LVAs. RESULTS 35 patients were included (87% male, median age 62). The median surface area of LVAs was 7.7 (4.4-15.8) cm2 corresponding to 5.6 (3.3-12.1) % of LA endocardial surface. B2B index was 0.57 (0.52-0.59) in patients with small LVAs (below the median) compared to 0.65 (0.56-0.77) in those with large LVAs (above the median) (p = 0.009). In the receiver operator characteristic curve analysis for predicting large LVAs, the c-statistic was 0.75 (p = 0.006) for B2B index and 0.81 for the multivariable model including B2B index (multivariable p = 0.04) and P-wave duration. CONCLUSION In patients with paroxysmal AF without overt atrial myopathy, B2B P-wave analysis appears to be a useful non-invasive correlate of low-voltage areas-and thus fibrosis-in the LA. This finding establishes a pathophysiological basis for B2B index and its potential usefulness in the selection process of patients who are likely to benefit most from further invasive treatment.
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Affiliation(s)
- Antigoni Sakellaropoulou
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece.
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Tachmatzidis
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos P Letsas
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Antonios Antoniadis
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Asvestas
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Dimitrios Filos
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Mililis
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Michael Efremidis
- 2nd Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Ioanna Chouvarda
- Laboratory of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios P Vassilikos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Zimmermann D, Malberg H, Schmidt M. Novel Metric for Non-Invasive Beat-to-Beat Blood Pressure Measurements Demonstrates Physiological Blood Pressure Fluctuations during Pregnancy. SENSORS (BASEL, SWITZERLAND) 2024; 24:3151. [PMID: 38794005 PMCID: PMC11125072 DOI: 10.3390/s24103151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
Beat-to-beat (B2B) variability in biomedical signals has been shown to have high diagnostic power in the treatment of various cardiovascular and autonomic disorders. In recent years, new techniques and devices have been developed to enable non-invasive blood pressure (BP) measurements. In this work, we aim to establish the concept of two-dimensional signal warping, an approved method from ECG signal processing, for non-invasive continuous BP signals. To this end, we introduce a novel BP-specific beat annotation algorithm and a B2B-BP fluctuation (B2B-BPF) metric novel for BP measurements that considers the entire BP waveform. In addition to careful validation with synthetic data, we applied the generated analysis pipeline to non-invasive continuous BP signals of 44 healthy pregnant women (30.9 ± 5.7 years) between the 21st and 30th week of gestation (WOG). In line with established variability metrics, a significant increase (p < 0.05) in B2B-BPF can be observed with advancing WOGs. Our processing pipeline enables robust extraction of B2B-BPF, demonstrates the influence of various factors such as increasing WOG or exercise on blood pressure during pregnancy, and indicates the potential of novel non-invasive biosignal sensing techniques in diagnostics. The results represent B2B-BP changes in healthy pregnant women and allow for future comparison with those signals acquired from women with hypertensive disorders.
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Affiliation(s)
| | | | - Martin Schmidt
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany; (D.Z.)
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Boulmpou A, Teperikidis E, Papadopoulos CΕ, Patoulias DI, Charalampidis P, Mouselimis D, Tsarouchas A, Boutou A, Giannakoulas G, Vassilikos V. The role of cardiopulmonary exercise testing in risk stratification and prognosis of atrial fibrillation: a scoping review of the literature. Acta Cardiol 2023; 78:274-287. [PMID: 36448316 DOI: 10.1080/00015385.2022.2148894] [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: 08/18/2022] [Revised: 11/01/2022] [Accepted: 11/12/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) is a significant tool for evaluating exercise capacity in healthy individuals and in various pulmonary and cardiovascular conditions, quantifying symptoms and predicting outcomes. Atrial fibrillation (AF) poses a significant burden on patients and health systems; a research marathon is ongoing for discovering the pathophysiologic substrate, natural history, prognostic tools and optimal treatment strategies for AF. Among the plethora of variables measured during CPET, there is a series of parameters of interest concerning AF. METHODS We conducted a scoping review aiming to identify significant CPET-related parameters linked to AF, as well as indicate the impact of other cardiac disease-related variables. We searched PubMed from its inception to 12 January 2022 for reports underlining the contribution of CPET in the assessment of patients with AF. Only clinical trials, observational studies and systematic reviews were included, while narrative reviews, expert opinions and other forms of manuscripts were excluded. RESULTS In our scoping review, we report a group of heterogeneous, thus noteworthy parameters relevant to the potential contribution of CPET in AF. CPET helps phenotype AF populations, evaluates exercise capacity after cardioversion or catheter ablation, and assesses heart rate response to exercise; peak VO2 and VE/VCO2, commonly measured indices during CPET, also serve as prognostic tools in patients with AF and heart failure. CONCLUSIONS CPET seems to hold a clinically important predictive value for future cardiovascular events both in patients with pre-existing cardiac conditions and in healthy individuals. CPET variables may play a fundamental role in the prediction of future AF-related events.
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Affiliation(s)
- Aristi Boulmpou
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Teperikidis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christodoulos Ε Papadopoulos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Ioannis Patoulias
- Second Propaedeutic Department of Internal Medicine, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Charalampidis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- St Luke's Hospital, Thessaloniki, Greece
| | - Dimitrios Mouselimis
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, Ippokratio General Hospital, Thessaloniki, Greece
| | - Georgios Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tachmatzidis D, Tsarouchas A, Mouselimis D, Filos D, Antoniadis AP, Lysitsas DN, Mezilis N, Sakellaropoulou A, Giannopoulos G, Bakogiannis C, Triantafyllou K, Fragakis N, Letsas KP, Asvestas D, Efremidis M, Lazaridis C, Chouvarda I, Vassilikos VP. P-Wave Beat-to-Beat Analysis to Predict Atrial Fibrillation Recurrence after Catheter Ablation. Diagnostics (Basel) 2022; 12:diagnostics12040830. [PMID: 35453877 PMCID: PMC9028701 DOI: 10.3390/diagnostics12040830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
The identification of patients prone to atrial fibrillation (AF) relapse after catheter ablation is essential for better patient selection and risk stratification. The current prospective cohort study aims to validate a novel P-wave index based on beat-to-beat (B2B) P-wave morphological and wavelet analysis designed to detect patients with low burden AF as a predictor of AF recurrence within a year after successful catheter ablation. From a total of 138 consecutive patients scheduled for AF ablation, 12-lead ECG and 10 min vectorcardiogram (VCG) recordings were obtained. Univariate analysis revealed that patients with higher B2B P-wave index had a two-fold risk for AF recurrence (HR: 2.35, 95% CI: 1.24–4.44, p: 0.010), along with prolonged P-wave, interatrial block, early AF recurrence, female gender, heart failure history, previous stroke, and CHA2DS2-VASc score. Multivariate analysis of assessable predictors before ablation revealed that B2B P-wave index, along with heart failure history and a history of previous stroke or transient ischemic attack, are independent predicting factors of atrial fibrillation recurrence. Further studies are needed to assess the predictive value of the B2B index with greater accuracy and evaluate a possible relationship with atrial substrate analysis.
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Affiliation(s)
- Dimitrios Tachmatzidis
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
- Correspondence:
| | - Anastasios Tsarouchas
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
| | - Dimitrios Mouselimis
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
| | - Dimitrios Filos
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (D.F.); (I.C.)
| | - Antonios P. Antoniadis
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
| | | | - Nikolaos Mezilis
- St. Luke’s Hospital Thessaloniki, 552 36 Thessaloniki, Greece; (D.N.L.); (N.M.)
| | - Antigoni Sakellaropoulou
- Electrophysiology Laboratory, 2nd Department of Cardiology, Evangelismos General Hospital of Athens, 106 76 Athens, Greece; (A.S.); (K.P.L.); (D.A.); (M.E.)
| | - Georgios Giannopoulos
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
| | - Constantinos Bakogiannis
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
| | - Konstantinos Triantafyllou
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
| | - Nikolaos Fragakis
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
| | - Konstantinos P. Letsas
- Electrophysiology Laboratory, 2nd Department of Cardiology, Evangelismos General Hospital of Athens, 106 76 Athens, Greece; (A.S.); (K.P.L.); (D.A.); (M.E.)
| | - Dimitrios Asvestas
- Electrophysiology Laboratory, 2nd Department of Cardiology, Evangelismos General Hospital of Athens, 106 76 Athens, Greece; (A.S.); (K.P.L.); (D.A.); (M.E.)
| | - Michael Efremidis
- Electrophysiology Laboratory, 2nd Department of Cardiology, Evangelismos General Hospital of Athens, 106 76 Athens, Greece; (A.S.); (K.P.L.); (D.A.); (M.E.)
| | - Charalampos Lazaridis
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
| | - Ioanna Chouvarda
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (D.F.); (I.C.)
| | - Vassilios P. Vassilikos
- 3rd Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece; (A.T.); (D.M.); (A.P.A.); (G.G.); (C.B.); (K.T.); (N.F.); (C.L.); (V.P.V.)
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