2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)
Diagnosis. Chest discomfort without persistent ST-segment elevation (NSTE-ACS) is the leading symptom initiating the diagnostic and therapeutic cascade. The pathological correlate at the myocardial level is cardiomyocyte necrosis, measured by troponin release, or, less frequently, myocardial ischaemia without cell damage (unstable angina). Individuals with unstable angina have a substantially lower risk of death and derive less benefit from an aggressive pharmacological and invasive approach.
Troponin assays. High-sensitivity troponin assays measurements are recommended over less sensitive ones, as they provide higher diagnostic accuracy at identical low cost. It should be noted that many cardiac pathologies other than MI also result in cardiomyocyte injury and, therefore, cardiac troponin elevations.
Other biomarkers. Other biomarkers may have clinical relevance in specific clinical settings when used in combination with non hs-cTn T/I. CK-MB shows a more rapid decline after MI and may provide added value for detection of early reinfarction. The routine use of copeptin as an additional biomarker for the early rule-out of MI is recommended in the increasingly uncommon setting where hs-cTn assays are not available.
Rapid ‘rule-in’ and ‘rule-out’ algorithms. Due to the higher sensitivity and diagnostic accuracy for the detection of MI at presentation, the time interval to the second cTn assessment can be shortened with the use of hs-cTn assays. It is recommended to use the 0 h/1 h algorithm (best option, blood draw at 0 h and 1 h) or the 0 h/2 h algorithm (second-best option, blood draw at 0 h and 2 h). Optimal thresholds for rule-out and rule-in were selected to allow for a minimal sensitivity and NPV of 99% and a minimal PPV of 70%. Used in conjunction with clinical and ECG findings, the 0 h/1 h and 0 h/2 h algorithm allows the identification of appropriate candidates for early discharge and outpatient management.
Confounders of hs-cTn. Beyond the presence or absence of MI, four clinical variables affect hs-cTn concentrations. The effect of age (differences in concentration between healthy very young vs. ‘healthy’ very old individuals up to 300%), renal dysfunction (differences in concentration between otherwise healthy patients with very high vs. very low eGFR up to 300%), and chest pain onset (>300%) is substantial, and modest for sex (≈40%).
Ischaemic risk assessment. Initial cTn levels add prognostic information in terms of short- and long-term mortality to clinical and ECG variables. The higher the hs-cTn levels, the greater the risk of death. Serum creatinine and eGFR should also be determined in all patients with NSTE-ACS because they affect prognosis and are key elements of the GRACE risk score, which assessment is superior to (subjective) physician assessment for the occurrence of death or MI. Natriuretic peptides may provide incremental prognostic information and may help in risk stratification.
Bleeding risk assessment. ARC-HBR is a pragmatic approach that includes the most recent trials performed in HBR patients, who were previously excluded from clinical trials of DAPT duration or intensity. The PRECISE-DAPT score may be used to guide and inform decision making on DAPT duration with a modest predictive value for major bleeding. Their value in improving patient outcomes remains unclear.
Non-invasive imaging. Even after the rule-out of MI, elective non-invasive or invasive imaging may be indicated according to clinical assessment. CCTA may be an option in patients with low-to-modest clinical likelihood of unstable angina as a normal scan excludes CAD. CCTA has a high NPV to exclude ACS (by excluding CAD) and an excellent outcome in patients presenting to the emergency department with low-to-intermediate pre-test probability for ACS and a normal CCTA. In addition, upfront imaging with CCTA reduces the need for ICA in high risk patients. Stress imaging by cardiac magnetic resonance imaging, stress echocardiography, or nuclear imaging may also be an option based on risk assessment.
Risk stratification for an invasive approach. An early routine invasive approach within 24 h of admission is recommended for NSTEMI based on hs-cTn measurements, GRACE risk score >140, and dynamic new, or presumably new, ST-segment changes as it improves major adverse cardiac events and possibly early survival. Immediate invasive angiography is required in highly unstable patients according to hemodynamic status, arrythmias, acute heart failure, or persistent chest pain. In all other clinical presentation, a selective invasive approach may be performed according to non-invasive testing or clinical risk assessment.
Revascularization strategies. The principal technical aspects of PCI in NSTE-ACS patients do not differ from the invasive assessment and revascularization strategies for other manifestations of CAD. Radial access is recommended as the preferred approach in NSTE-ACS patients undergoing invasive assessment with or without PCI. Multivessel disease is frequent in NSTE-ACS, timing and completeness of revascularization should be decided according to functional relevance of all stenoses, age, general patient condition, comorbidities, and left ventricular function.
Myocardial infarction with non-obstructive coronary arteries. MINOCA incorporates a heterogeneous group of underlying causes that may involve both coronary and non-coronary pathological conditions, with the latter including cardiac and extra-cardiac disorders. It excludes by consensus myocarditis and Takotsubo syndrome. Cardiac magnetic resonance imaging is one of the key diagnostic tools as it identifies the underlying cause in more than 85% of patients and the subsequent appropriate treatment.
Spontaneous coronary artery dissection. Defined as a non-atherosclerotic, non-traumatic, or iatrogenic separation of the coronary arterial tunics secondary to vasa vasorum hemorrhage or intimal tear, it accounts for up to 4% of all ACS, but the incidence is reported to be much higher (22–35% of ACS) in women <60 years of age. Intracoronary imaging is very useful for the diagnosis and treatment orientation. Medical treatment remains to be established.
Pre-treatment with P2Y12 receptor inhibitors. Routine pre-treatment with a P2Y12 receptor inhibitor in NSTE-ACS patients in whom coronary anatomy is not known and an early invasive management is planned is not recommended given the lack of established benefit. However, it may be considered in selected cases and according to the bleeding risk of the patient.
Post-treatment antiplatelet therapy. DAPT consisting of a potent P2Y12 receptor inhibitor in addition to aspirin is generally recommended for 12 months, irrespective of the stent type, unless there are contraindications. New scenarios have been implemented. DAPT duration can be shortened (<12 months), extended (>12 months), or modified by switching DAPT or de-escalation. These decisions depend on individual clinical judgment being driven by the patient’s ischaemic and bleeding risk, the occurrence of adverse events, comorbidities, co-medications, and the availability of the respective drugs.
Triple antithrombotic therapy. In at least 6–8% of patients undergoing PCI, long-term oral anticoagulation is indicated and should be continued. NOACs are preferred over VKAs in terms of safety when patients are eligible. DAT with a NOAC at the recommended dose for stroke prevention and SAPT (preferably clopidogrel, chosen in more than 90% of cases in available trials) is recommended as the default strategy up to 12 months after a short period up to 1 week of TAT (with NOAC and DAPT). TAT may be prolonged up to 1 month when the ischaemic risk outweighs the bleeding risk.
Rural and indigenous populations are disproportionately affected by cardiovascular disease,1,2 with a higher prevalence of cardiovascular risk factors than urban populations, as well as harsher environmental conditions, reduced access to services, and greater difficulty in attracting and retaining health professionals.3,4 Patients therefore wait longer and travel larger distances to access diagnostic services, or they forgo treatment.
We compared waiting and reporting times and patient travel distances for exercise stress testing and 24-hour Holter monitoring over 12-month periods before (retrospective analysis) and after (prospective analysis) implementation of a telemedicine program (Tele-Cardiac Investigations) in two rural and remote regions in Australia with a referral population of 44,400 and a geographic area of 696,650 km2.
The telemedicine program enabled cardiology specialists at a metropolitan location (Royal Brisbane and Women’s Hospital [RBWH]) to work with local staff to conduct exercise stress tests and Holter monitoring remotely at 11 facilities (see the Supplementary Appendix, available at NEJM.org). For exercise stress testing, a live video feed of the electrocardiographic monitor at the rural facility allowed the telemedicine team to view patient data in real time. Local staff performed the exercise stress test with guidance from the telemedicine team, or, alternatively, the exercise stress test system was remotely controlled by the telemedicine team. The test results were immediately reported by the telemedicine team with the use of remote access software. For Holter monitoring, rural staff applied the device with guidance from the telemedicine team. The telemedicine team then remotely accessed the initialization software to program and start the recording. After the recording was complete, the telemedicine team remotely transferred the data to analysis software at RBWH for reporting.Table 1.Effect of Implementation of Telemedicine for Cardiac Testing.
Implementation of the telemedicine program was associated with a 42% increase in the number of tests performed over 12 months (516 in the 12 months before implementation vs. 734 in the 12 months after), with an even greater proportional increase in the number of patients from indigenous populations undergoing testing (63 before implementation vs. 127 after implementation) (Table 1). There were substantial reductions in waiting times to have tests conducted (17.71 fewer days [44.6% reduction]) and to have results reported (35.82 fewer days [99.2% reduction]), resulting in a significant reduction in the total time from referral to reporting (56.66 fewer days [71.1% reduction]; P<0.001). Round-trip travel was reduced by 502 km per patient, on average, for patients requiring Holter monitoring, with telemedicine allowing 91.3% of patients to receive testing without having to travel away from their local health facilities.
Adam C. Scott, Ph.D. Alice McDonald, G.Dip.Cardiac. Tiffany Roberts, B.E.S.S. Curtis Martin, B.E.S.S. Timothy Manns, B.E.S.S. Meghan Webster, B.E.S.S. Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia firstname.lastname@example.org
David Walker, M.B., B.S. Longreach Hospital, Longreach, QLD, Australia
Alan Sandford, M.B., B.S. Mount Isa Hospital, Mount Isa, QLD, Australia
Paul Scuffham, Ph.D. Griffith University, Brisbane, QLD, Australia
John J. Atherton, Ph.D., M.B., B.S. Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
Nobuyuki Kagiyama, Marco Piccirilli, Naveena Yanamala, Sirish Shrestha, Peter D. Farjo, Grace Casaclang-Verzosa, Wadea M. Tarhuni, Negin Nezarat, Matthew J. Budoff, Jagat Narula and Partho P. Sengupta
Journal of the American College of Cardiology Volume 76, Issue 8, August 2020 DOI: 10.1016/j.jacc.2020.06.061
Background Left ventricular (LV) diastolic dysfunction is recognized as playing a major role in the pathophysiology of heart failure; however, clinical tools for identifying diastolic dysfunction before echocardiography remain imprecise.
Objectives This study sought to develop machine-learning models that quantitatively estimate myocardial relaxation using clinical and electrocardiography (ECG) variables as a first step in the detection of LV diastolic dysfunction.
Methods A multicenter prospective study was conducted at 4 institutions in North America enrolling a total of 1,202 subjects. Patients from 3 institutions (n = 814) formed an internal cohort and were randomly divided into training and internal test sets (80:20). Machine-learning models were developed using signal-processed ECG, traditional ECG, and clinical features and were tested using the test set. Data from the fourth institution was reserved as an external test set (n = 388) to evaluate the model generalizability.
Results Despite diversity in subjects, the machine-learning model predicted the quantitative values of the LV relaxation velocities (e’) measured by echocardiography in both internal and external test sets (mean absolute error: 1.46 and 1.93 cm/s; adjusted R2 = 0.57 and 0.46, respectively). Analysis of the area under the receiver operating characteristic curve (AUC) revealed that the estimated eʹ discriminated the guideline-recommended thresholds for abnormal myocardial relaxation and diastolic and systolic dysfunction (LV ejection fraction) the internal (area under the curve [AUC]: 0.83, 0.76, and 0.75) and external test sets (0.84, 0.80, and 0.81), respectively. Moreover, the estimated eʹ allowed prediction of LV diastolic dysfunction based on multiple age- and sex-adjusted reference limits (AUC: 0.88 and 0.94 in the internal and external sets, respectively).
Conclusions A quantitative prediction of myocardial relaxation can be performed using easily obtained clinical and ECG features. This cost-effective strategy may be a valuable first clinical step for assessing the presence of LV dysfunction and may potentially aid in the early diagnosis and management of heart failure patients.
It is hard to believe that 4 years have flown by since we launched Cardio-Jenic Pty Ltd,in August 2016. Cardio-Jenicwas created to fill the void in innovation in diagnostic cardiology. Since our launch and informed by our motto “innovation…not iteration in cardiology”, we have searched the world to find innovative solutions that are underpinned by three key questions: is it truly innovative?; does it actually solve a problem?; does it provide more clinical data than current solutions?
It’s been quite the ride and we’ve built the business logically and methodically with a view to long-term sustainability, and year 4 showed a 228% grow with sales into every Australian state and New Zealand, which suggests we’re doing the right things for our customers.
Applying our key questions, we noted that most clinical cardiology departments have clunky, piecemeal solutions; Holter’s from one company, resting ECGs from another and often stress from a different supplier, Ambulatory BP Monitor’s from another source, all with different software that don’t interface with each other. Surely efficiencies in hospitals and clinics should be all about seamless integration, safe and fast workflows as well as user-optimised solutions. To address these requirements, we partnered with German company custo med GmbH to introduce a single source cardiopulmonary diagnostic software solution the”custo diagnostic clinical” that allows for flawless daily work, modularity and flexibity. Imagine getting your service, hardware, and software from only one single source while having access to the vast expertise of Cardio-Jenicand custo med.
The custo diagnostic platform is supported by sexy devices such as the custo watch with AF diagnostics for Holters, and the lightweight custo cardio 300, a versatile, portable Bluetooth 12-channel resting/stress ECG with superior 32 kHz sampling rate. Cardio-Jenicinvested in research to support PhD candidate, Dr Kam Wong from Westmead Applied Research Centre, who demonstrated the advanced potential of the custo cardio 300 Bluetooth ECG in the community. His poster presentation will feature at the 2020 CSANZ meeting.
We imagined a low-cost, simple community screening solution enabling detection of cardiac dysfunction, and partnered with HeartSciences from Texas to launch MyoVista® Wavelet ECG (wavECGTM) a new resting 12-lead ECG utilising continuous wavelet transform (CWT) based signal processing. MyoVista wavECG technology is designed to improve the sensitivity of an ECG in detecting ischemic and structural heart disease at an early stage.
Cardio-Jenichas also supported research using MyoVista®wavECG at Baker Heart & Diabetes Institute, showcased at the American College of Cardiology and the European Society of Cardiology that demonstrated “Using Machine Learning algorithms, sensitivity of ewECG is suitable for application as a screening test for Stage B Heart Failure in apparent Stage A Heart Failure. Our data suggest ewECG could reduce the number of echocardiograms performed as part of a HF population screening program by 18‐25%.”
We are also supporting research at Curtin and Monash Universities, and we are excited to be launching a new trial with MyoVista®wavECG at the Royal Brisbane Women’s Hospital in the Cardiac Investigations Unit.
We are grateful for the support of Prof. Tom Marwick in referring Cardio-Jenicto a true innovator in echocardiography, John Freeland. In 2019 we launched the browser/cloud-based PACS cPAC from Freeland Systems providing anywhere/anytime echo image review, intelligent structured reporting, and archiving solutions.
Cardio-Jenicalso introduced into Australia the cuffless SOMNOtouch™ NIBP from another German innovation company SOMNOmedics GmbH. Many clinicians in Australia are enjoying the advantages of the additional diagnostics provided by the SOMNOtouch™ NIBP, Holter data, ESH validated 24-hour beat-to-beat blood pressure measurements, SpO2 and positional data.
Coronary heart disease remains the leading underlying cause of death in Australia and cardiology has only just started embracing the potential of AI, which is why Cardio-Jenic continues the international search for diagnostics solutions, including ongoing discussions with innovation companies in the USA, Ireland, Poland and Malaysia. We are also partnering with Australian development and commercialisation companies to seek new platforms to improve healthcare outcomes for regional and remote communities.
Cardio-Jeniccontinues to invest in research, and aside from those projects already mentioned, we provided matching seed funding in collaboration with Sydney University for research at Westmead. It was also a highlight to be invited to be a co-investigator on a significant NH&MRC grant application. Should this grant be approved the impact on improving cardiology excellence will leave a generational legacy.
Further highlights included our Manager Director, Carolyn Jensen, being named a finalist in the 2020 Telstra Business Women’s Awards.
Cardio-Jenicalso retains an awareness of its commitment to our community, and have made philanthropic donations to Baker Heart & Diabetes Institute, TRACTION for Young People, a charity providing unique solutions for youth at risk, and Ipswich Grammar School for investment in STEM.
Of course, year 5 will be challenging in different ways as we find ourselves facing a unique, pandemic influenced economy with significant travels restrictions both in Australia and internationally. Cardio-Jenicwas already ahead of the curve by having implemented IT solutions to service our customers remotely, and we have now launched our virtual solutions to be able to demo and trial our products anywhere throughout Australia. The way of doing business must adapt in this COVID world, and we are grateful for the grant support of the Queensland government to ensure our COVID-safe plan allows us to provide ongoing service for our regional and remote customers.
We have achieved so much in our first 4 years, and we remain grateful for the support and advice from our international partners, as well as from key-opinion-leaders including Prof. Marwick, Prof. Clara Chow, Assoc. Prof. Sudhir Wahi, Assoc. Prof. Gerald Kaye, and Adjunct Prof. Adam Scott. Your wisdom is most appreciated.
Finally, we would like to thank our customers who have joined Cardio-Jenicin providing solutions for better health outcomes for their patients, through innovation… not iteration in cardiology. Here’s to the next 4 years together…
MyoVista® AI-based ECG Device detects Left Ventricle Dysfunction
SOUTHLAKE, TEXAS – July 28, 2020– HeartSciences, a medical device company focused on advancing the field of electrocardiology through innovation, announced it has been awarded a New Product Innovation Award – Europe by Frost & Sullivan, a leader in global research and consulting solutions.
HeartSciences MyoVista® Wavelet ECG (wavECG™) Cardiac Testing Device uses artificial intelligence to detect left ventricular (LV) relaxation abnormalities related to LV diastolic dysfunction (LVDD), an early indicator of most forms of heart disease. Specifically, the MyoVista wavECG Device provides information relating to the echo measurement e’ which has previously not been possible using an ECG.
LV diastolic function is impaired by all of the common heart disease processes that affect LV function. Thus, detecting impaired relaxation through the use of 12-lead ECG testing is a potential game-changer for front-line heart disease testing.
“We are pleased that HeartSciences’ MyoVista wavECG Technology has been recognized by Frost & Sullivan,” said Mark Hilz, President and CEO. “Through technology leadership HeartSciences is demonstrating new possibilities in the capability of an ECG to effectively detect a wider range of heart disease conditions. We believe our first indication for LV relaxation abnormalities will be the first of many.”
Frost & Sullivan analysts follow a 10-step process to evaluate Award candidates and assess their fit with select best practice criteria. The reputation and integrity of the Awards are based on close adherence to this process. The firm’s 360-degree research methodology represents the analytical rigor of its research process, offering a 360-degree-view of industry challenges, trends, and issues by integrating all 7 of Frost & Sullivan’s research methodologies into an evaluation platform for benchmarking industry players and for identifying those performing at best-in-class levels.
HeartSciences’ sits at the forefront of innovation and technological development focused on advancing the field of electrocardiology to provide early heart disease detection. Its first product, the MyoVista® Wavelet ECG (wavECG™) Cardiac Testing Device, is a resting 12-lead electrocardiograph that uses AI and continuous wavelet transform (CWT) signal processing to provide cardiac information associated with left ventricular diastolic disfunction (LVDD), a condition which has not been possible to detect previously using electrocardiology. LVDD is associated with almost all forms and co-morbidities of heart disease including hypertension, diabetes, valvular disease, ischemia, and reduced systolic function.
The MyoVista Device additionally provides all the information and capabilities of a full-featured conventional resting 12-lead ECG within the same test and follows the same clinical AHA/IEC lead placement protocol.
HeartSciences is a privately held U.S. corporation based in Southlake, Texas.
The MyoVista Device is not currently FDA cleared and is not available in the United States.
About Frost & Sullivan
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Researchers of the Universities of Stuttgart and Adelaide in cooperation with medical research centers in Australia developed a special microoptical tool with a thickness of only 125 microns. This enables endoscopic examimations within blood vessels whose diameter is smaller than 0.5 mm and helps detecting plaques or thrombs to reduce the danger of a stroke or a heart attack.
Endoscopy allows to examine the body with tubular instruments. Examples include colonoscopy of the intestines or gastroscopy of the stomach. However, such endoscopes are often still as thick as a finger. They are not suited to enter small blood vessels. Glass fiber technology is a promising technique to inspect to such fine veins, because the fibers are just 125 µm in diameter.
The main technological issue is the extremely small optics on the tip of the fiber: it should look sideways to deflect a laser beam from inside the fiber to the inside vessel wall, detect its shape and depth composition, and send its reflection back into the fiber. This way a doctor can get an image from inside the body.
The examination uses a technology called optical coherence tomography (OCT), which one might know from eye and retina examinations. It uses a laser beam whose spectrum of colors is relatively broad that penetrates the tissue. The analysis of the reflected light allows for exact depth mapping of the tissue, similarly to ultrasound, but with much higher spatial resolution.
Dr. Simon Thiele from the group of Prof. Alois Herkommer at the Institute of Technical Optics at University of Stuttgart teamed up with 3D printing experts of the group of Prof. Harald Giessen in Stuttgart and developed together with fiber OCT experts Dr. Jiawen Li and Prof. Robert McLaughlin from University of Adelaide the smallest endoscope of the world, with an outer diameter including the sheath of less than 0.5 mm. Together with colleagues from Royal Adelaide Hospital, SAHMRI Institute in Adelaide and Monash Cardiovascular Research Center in Melbourne, they used the 3D printed microoptical OCT endoscope to examine the inside of blood vessels of mice and humans. The doctors obtained highly accurate 3-dimensional images of the veins, which were later compared with histological stained images.
The 3D printed microoptics focused to laser beam from the fiber to a fine spot, correcting also for the aberrations in the cylindrical plastic sheath. The OCT system was able to detect plaques as well as cholesterol crystals in human carotid arteries as well as in aortas of obese mice. These causes for vascular deseases could be well detected by the fiber endoscope, which rotated like a spiral inside the blood vessels. Comparisons with stained microscope images of the sliced tissue confirmed the early detection by OCT.
Dr. Simon Thiele, who designed the miniature optics, believes that the new system could add significantly to the already 400 000 performed OCT endoscopic examinations. Millions more could be performed inside blood veins and detect early plaques and cholesterol crystals. He believes that one might be able to dissolve such plaques in the future with a suited laser beam using such a miniature endoscope, which can easily enter such small vessels.
MEDICA-tradefair.com; Source: University of Stuttgart
Half of Covid-19 patients who received a heart scan in hospital showed abnormalities in heart function, according to new research funded by us.
The study, published in the European Heart Journal – Cardiovascular Imaging, found that around one in seven showed severe abnormalities likely to have a major effect on their survival and recovery.
It also showed that one in three patients who received an echocardiography scan had their treatment changed as a result.
The findings suggest that heart scans could prove crucial for identifying patients who may benefit from additional treatments to improve their Covid-19 recovery and prevent potential long-term damage to their heart.
Professor Marc Dweck, British Heart Foundation Senior Lecturer and Consultant Cardiologist at the University of Edinburgh, said:
“Covid-19 is a complex, multisystem disease which can have profound effects on many parts of the body, including the heart. Many doctors have been hesitant to order echocardiograms for patients with Covid-19 because it’s an added procedure which involves close contact with patients. Our work shows that these scans are important – they improved the treatment for a third of patients who received them.”
Doria de Vasconcellos et al, J Am Soc Echocardiogr 2020;33:878-87.
Background: The relationship between long-term obesity and left atrial (LA) structure and function is not entirely understood. We examined the association of cumulative body mass index (cBMI) with LA remodeling using three-dimensional (3D) speckle-tracking echocardiography (STE).
Methods: The Coronary Artery Risk Development in Young Adults (CARDIA) study is a community-based cohort of black and white, men and women, ages 18-30 years at baseline in 1985-86 from four U.S. centers. This study included 2,144 participants who had satisfactory image quality and body mass index measurements during the entire follow-up period. The 3D STE-derived LA parameters were maximum, minimum, and pretrial contraction volumes; total, passive, and active emptying fraction; maximum systolic longitudinal strain; and early and late diastolic longitudinal strain rates. Multivariable linear regression analyses stratified by sex assessed the relationship between cBMI and 3D STE-derived LA parameters, adjusting for demographics and traditional cardiovascular.
Results: Themean age of the cohort was 556 3.6 years; 54.8% were women, and 46.5% were black. There were statistically significant additive sex interactions for the association between cBMI and LA minimum contraction value, maximumsystolic longitudinal strain, and early and late diastolic longitudinal strain rates. In the fully adjusted model, greater cBMI was associated with lower magnitude LA longitudinal deformation (maximum systolic longitudinal strain and early and late diastolic longitudinal strain rates) in men and with higher LA emptying fraction in women. In addition, greater cBMI was associated with higher LA phasic volumes indices in both men and women.
Conclusions: This study showed that while greater cBMI from early adulthood throughout middle age was associated with higher LAvolumes in both genders, differences were found for LA function,with lower longitudinal deformation in men and higher reservoir and active LA function in women.
Cardiomyocytes express a surprisingly large number of potassium channel types. The primary physiological functions of the currents conducted by these channels are to maintain the resting membrane potential and mediate action potential repolarization under basal conditions and in response to changes in the concentrations of intracellular sodium, calcium, and ATP/ADP. Here, we review the diversity and functional roles of cardiac potassium channels under normal conditions and how heritable mutations in the genes encoding these channels can lead to distinct arrhythmias. We briefly review atrial fibrillation and J-wave syndromes. For long and short QT syndromes, we describe their genetic basis, clinical manifestation, risk stratification, traditional and novel therapeutic approaches, as well as insights into disease mechanisms provided by animal and cellular models. Read More…