Subjects -> MEDICAL SCIENCES (Total: 8196 journals)
    - ANAESTHESIOLOGY (105 journals)
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    - MEDICAL SCIENCES (2241 journals)
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    - SURGERY (388 journals)

MEDICAL SCIENCES (2241 journals)            First | 1 2 3 4 5 6 7 8 | Last

Showing 601 - 800 of 3562 Journals sorted alphabetically
Extreme Physiology & Medicine     Open Access   (Followers: 1)
F&S Reports     Open Access  
F&S Science : Official journal of the American Society for Reproductive Medicine     Open Access  
Facial Plastic Surgery & Aesthetic Medicine     Full-text available via subscription   (Followers: 7)
Facta Universitatis, Series : Medicine and Biology     Open Access  
Family Medicine and Community Health     Open Access   (Followers: 8)
Family Practice     Hybrid Journal   (Followers: 17)
Family Practice & Palliative Care     Open Access   (Followers: 5)
Family Practice Management     Full-text available via subscription   (Followers: 4)
Faridpur Medical College Journal     Open Access  
FEM : Revista de la Fundación Educación Médica     Open Access  
Finlay : Revista de Enfermedades no Transmisibles     Open Access  
Fisioterapia     Full-text available via subscription   (Followers: 2)
Fisioterapia & Saúde Funcional     Open Access  
Flugmedizin · Tropenmedizin · Reisemedizin - FTR     Hybrid Journal  
FMC - Formación Médica Continuada en Atención Primaria     Full-text available via subscription  
Folia Medica     Open Access  
Folia Medica Indonesiana     Open Access  
Folia Morphologica     Full-text available via subscription  
Folia Phoniatrica et Logopaedica     Full-text available via subscription   (Followers: 1)
Fontanus     Open Access   (Followers: 1)
Food Hydrocolloids for Health     Open Access  
Foodborne Pathogens and Disease     Hybrid Journal   (Followers: 11)
Foot & Ankle Specialist     Hybrid Journal   (Followers: 4)
Foot and Ankle Clinics     Full-text available via subscription   (Followers: 12)
Foot and Ankle Online Journal     Full-text available via subscription   (Followers: 6)
Forensic Science International : Mind and Law     Open Access   (Followers: 4)
Forum Medycyny Rodzinnej     Hybrid Journal  
Forum Zaburzeń Metabolicznych     Hybrid Journal  
Frontières     Full-text available via subscription   (Followers: 3)
Frontiers in Digital Health     Open Access   (Followers: 4)
Frontiers in Medical Technology     Open Access  
Frontiers in Medicine     Open Access   (Followers: 2)
Frontiers in Network Physiology     Open Access   (Followers: 2)
Frontiers in Neuroprosthetics     Open Access   (Followers: 6)
Frontiers in Synaptic Neuroscience     Open Access   (Followers: 2)
Frontiers in Tropical Diseases     Open Access  
Frontiers of Medical and Biological Engineering     Hybrid Journal  
Frontiers of Medicine     Hybrid Journal   (Followers: 2)
Fuss & Sprunggelenk     Hybrid Journal  
Future Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Future Prescriber     Hybrid Journal  
Future Science OA     Open Access  
Gaceta Médica Boliviana     Open Access  
Gaceta Médica Espirituana     Open Access  
Galen Medical Journal     Open Access  
Galician Medical Journal     Open Access   (Followers: 1)
Galle Medical Journal     Open Access  
Gefäßmedizin Scan     Hybrid Journal  
Gender and the Genome     Open Access   (Followers: 1)
Gene Expression     Full-text available via subscription   (Followers: 1)
General Reanimatology     Open Access  
Genes     Open Access   (Followers: 2)
Genome Instability & Disease     Hybrid Journal  
Geoforum     Hybrid Journal   (Followers: 25)
Gestão e Desenvolvimento     Open Access  
Ghana Medical Journal     Open Access   (Followers: 1)
GigaScience     Open Access   (Followers: 4)
Gimbernat : Revista d’Història de la Medicina i de les Ciències de la Salut     Open Access  
Glia     Hybrid Journal   (Followers: 5)
Global Advances in Health and Medicine     Open Access  
Global Bioethics     Open Access   (Followers: 5)
Global Health : Science and Practice     Open Access   (Followers: 7)
Global Health Journal     Open Access   (Followers: 2)
Global Journal of Integrated Chinese Medicine and Western Medicine     Open Access  
Global Journal of Cancer Therapy     Open Access  
Global Journal of Fertility and Research     Open Access  
Global Journal of Health Science     Open Access   (Followers: 5)
Global Journal of Infectious Diseases and Clinical Research     Open Access   (Followers: 1)
Global Journal of Medical and Clinical Case Reports     Open Access  
Global Journal of Obesity, Diabetes and Metabolic Syndrome     Open Access   (Followers: 2)
Global Journal of Perioperative Medicine     Open Access  
Global Journal of Rare Diseases     Open Access  
Global Medical & Health Communication     Open Access   (Followers: 1)
Global Reproductive Health     Open Access  
Grande Medical Journal     Open Access  
Growth Factors     Hybrid Journal   (Followers: 2)
GSTF Journal of Advances in Medical Research     Open Access  
Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi     Open Access  
Hamdan Medical Journal     Open Access  
Hämostaseologie     Hybrid Journal   (Followers: 4)
Hämostaseologie     Open Access  
Hand     Hybrid Journal   (Followers: 4)
Hand Clinics     Full-text available via subscription   (Followers: 6)
Hand Therapy     Hybrid Journal   (Followers: 11)
Hard Tissue     Open Access  
Head & Face Medicine     Open Access   (Followers: 1)
Head and Neck Cancer Research     Open Access  
Head and Neck Tumors     Open Access  
Health Information : Jurnal Penelitian     Open Access  
Health Matrix : The Journal of Law-Medicine     Open Access  
Health Notions     Open Access  
Health Science Journal of Indonesia     Open Access  
Health Science Reports     Open Access   (Followers: 1)
Health Sciences and Disease     Open Access   (Followers: 1)
Health Sciences Review     Open Access  
Health Security     Hybrid Journal   (Followers: 1)
Healthcare Technology Letters     Open Access  
Hearing, Balance and Communication     Hybrid Journal   (Followers: 6)
Hearts     Open Access   (Followers: 1)
HEC Forum     Hybrid Journal   (Followers: 1)
Heighpubs Otolaryngology and Rhinology     Open Access  
Heilberufe     Hybrid Journal  
HeilberufeSCIENCE     Hybrid Journal  
Heilpflanzen     Hybrid Journal   (Followers: 8)
Helicobacter     Hybrid Journal  
HemaSphere     Open Access   (Followers: 2)
Hemoglobin     Hybrid Journal  
Hepatology, Medicine and Policy     Open Access  
HERALD of North-Western State Medical University named after I.I. Mechnikov     Open Access  
Herald of the Russian Academy of Sciences     Full-text available via subscription  
Herzschrittmachertherapie + Elektrophysiologie     Hybrid Journal  
Highland Medical Research Journal     Full-text available via subscription  
Hipertensión y Riesgo Vascular     Full-text available via subscription  
HIV Australia     Full-text available via subscription   (Followers: 3)
Homeopathy     Hybrid Journal   (Followers: 1)
Homoeopathic Links     Hybrid Journal  
Hong Kong Physiotherapy Journal     Open Access   (Followers: 14)
Horizonte Medico     Open Access  
Hormones : International Journal of Endocrinology and Metabolism     Hybrid Journal  
Hospital a Domicilio     Open Access  
Hospital Practices and Research     Open Access  
Hospital Topics     Hybrid Journal   (Followers: 1)
Hua Hin Sook Jai Klai Kangwon Journal     Open Access  
Huisarts en wetenschap     Hybrid Journal   (Followers: 4)
Human & Veterinary Medicine - International Journal of the Bioflux Society     Open Access   (Followers: 4)
Human Factors in Healthcare     Open Access   (Followers: 2)
Human Fertility     Hybrid Journal   (Followers: 4)
Humanidades Médicas     Open Access  
I.P. Pavlov Russian Medical Biological Herald     Open Access  
Iatreia     Open Access  
Ibnosina Journal of Medicine and Biomedical Sciences     Open Access  
IDCases     Open Access  
IEEE Journal of Biomedical and Health Informatics     Hybrid Journal   (Followers: 14)
IEEE Journal of Electromagnetics, RF and Microwaves in Medicine and Biology     Hybrid Journal  
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 5)
IEEE Open Journal of Engineering in Medicine and Biology     Open Access   (Followers: 1)
IEEE Transactions on Medical Robotics and Bionics     Hybrid Journal   (Followers: 3)
IEEE/ACM Transactions on Computational Biology and Bioinformatics     Hybrid Journal   (Followers: 18)
IJID Regions     Open Access   (Followers: 1)
IJS Global Health     Open Access  
IJU Case Reports     Open Access  
iLiver     Open Access   (Followers: 6)
Im OP     Hybrid Journal  
Image Analysis & Stereology     Open Access   (Followers: 1)
IMAGING     Full-text available via subscription   (Followers: 1)
Imaging in Medicine     Open Access  
Imaging Journal of Clinical and Medical Sciences     Open Access   (Followers: 1)
Imam Journal of Applied Sciences     Open Access  
Indian Journal of Ayurveda and lntegrative Medicine Klue     Open Access   (Followers: 4)
Indian Journal of Burns     Open Access   (Followers: 2)
Indian Journal of Clinical Medicine     Open Access  
Indian Journal of Community and Family Medicine     Open Access   (Followers: 3)
Indian Journal of Community Medicine     Open Access   (Followers: 1)
Indian Journal of Health Sciences and Biomedical Research KLEU     Open Access   (Followers: 2)
Indian Journal of Medical Microbiology     Open Access   (Followers: 1)
Indian Journal of Medical Research     Open Access   (Followers: 3)
Indian Journal of Medical Sciences     Open Access   (Followers: 2)
Indian Journal of Medical Specialities     Hybrid Journal  
Indian Journal of Otology     Open Access   (Followers: 1)
Indian Journal of Public Health     Open Access   (Followers: 1)
Indian Journal of Transplantation     Open Access  
Indian Spine Journal     Open Access  
Indo-Pacific Journal of Phenomenology     Open Access   (Followers: 1)
Indonesia Journal of Biomedical Science     Open Access   (Followers: 1)
Indonesian Biomedical Journal     Open Access  
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Indonesian Journal of Medicine     Open Access  
Indonesian Journal of Tropical and Infectious Disease     Open Access  
Infant Observation: International Journal of Infant Observation and Its Applications     Hybrid Journal   (Followers: 1)
Inflammation     Hybrid Journal   (Followers: 3)
Inflammation Research     Hybrid Journal   (Followers: 4)
Info Diabetologie     Full-text available via subscription   (Followers: 1)
Infodir : Revista de Información científica para la Dirección en Salud     Open Access  
Informatics in Medicine Unlocked     Open Access  
Injury Prevention     Hybrid Journal   (Followers: 6)
InnovAiT     Hybrid Journal   (Followers: 1)
Innovare Journal of Health Science     Open Access  
Innovare Journal of Medical Science     Open Access  
Innovation in Aging     Open Access   (Followers: 1)
Inside Precision Medicine     Full-text available via subscription   (Followers: 6)
Insights in Biology and Medicine     Open Access  
Integrative and Complementary Therapies     Full-text available via subscription   (Followers: 6)
Integrative Medicine Insights     Open Access   (Followers: 1)
Integrative Medicine International     Open Access   (Followers: 1)
Integrative Medicine Research     Open Access   (Followers: 3)
Intellectual Disability Australasia     Full-text available via subscription   (Followers: 12)
Intelligence-Based Medicine     Open Access  
Intelligent Medicine     Open Access   (Followers: 1)
intensiv     Hybrid Journal   (Followers: 1)
interactive Journal of Medical Research     Open Access  
Interdisciplinary Perspectives on Infectious Diseases     Open Access   (Followers: 1)
Interdisciplinary Sciences : Computational Life Sciences     Hybrid Journal   (Followers: 2)
Internal Medicine     Open Access   (Followers: 1)
International Biomechanics     Open Access   (Followers: 1)
International Health     Hybrid Journal   (Followers: 5)
International Health Trends and Perspectives     Open Access  
International Journal for Numerical Methods in Biomedical Engineering     Hybrid Journal   (Followers: 2)
International Journal for Vitamin and Nutrition Research     Hybrid Journal   (Followers: 10)
International Journal of Academic Medicine     Open Access   (Followers: 1)

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Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2673-3846
Published by MDPI Homepage  [84 journals]
  • Hearts, Vol. 3, Pages 45-53: A Review of the Wide Range of Indications and
           Uses of Implantable Loop Recorders: A Review of the Literature

    • Authors: Chun Shing Kwok, Daniel Darlington, Joseph Mayer, Gaurav Panchal, Vincent Walker, Donah Zachariah, Thanh Phan, Christian D. Mallen, Diane Barker, Ashish Patwala
      First page: 45
      Abstract: Implantable loop recorders (ILR) are devices that are implanted subcutaneously on the chest, which enables the continuous monitoring of arrhythmias for up to three years. These devices have an important role in helping to make a diagnosis and supporting decisions about the best patient management. There are currently three companies that produce ILRs. The Reveal DX and XT device is produced by Medtronic. The Confirm device is produced by Abbott. The Biomonitor III device is produced by Biotronik. The established indications for ILR include the management of transient loss of consciousness and the diagnosis of undocumented palpitations; however, they are also used for less established applications, including atrial fibrillation (AF) monitoring and risk stratification in patients with previous myocardial infarction or inherited cardiomyopathies. There is also diverse literature exploring the use of these devices in other populations, including patients with conditions such as congenital heart disease, amyloidosis, stroke, obstructive sleep apnea, renal transplant and patients who undergo procedures such as AF ablation and coronary artery bypass graft. In this review, we describe how the use of ILR has been applied in different settings, including patients with cardiac and non-cardiac conditions as well as post-cardiac procedures. We then discuss the potential issues related to using ILR in these other indications.
      Citation: Hearts
      PubDate: 2022-04-05
      DOI: 10.3390/hearts3020007
      Issue No: Vol. 3, No. 2 (2022)
  • Hearts, Vol. 3, Pages 54-65: Can Weight Loss Improve the Cardiovascular
           Outcomes of Patients with Obesity and Obstructive Sleep Apnea'

    • Authors: Ayyad Alruwaily, Heshma Alruwaili, John Garvey, Carel W. le Roux
      First page: 54
      Abstract: Cardiovascular events are the primary cause of mortality in patients with obstructive sleep apnea and obesity. The rising prevalence of obstructive sleep apnea in recent decades has been linked to increasing rates of obesity. Obstructive sleep apnea has also been linked with many different cardiovascular diseases including coronary artery disease, stroke, heart failure, hypertension, and atrial fibrillation. Obesity is an increasing health concern globally, in part because obesity complications such as hypertension, diabetes, and obstructive sleep apnea increase the risk of cardiovascular diseases. More than 10% weight loss may be required to prevent or reverse obesity complications. Treatment approaches to obesity include nutritional therapy, exercise therapy, pharmacotherapy, and surgical therapies. This review intends to identify the effects of weight loss on cardiovascular outcomes in patients with obesity and obstructive sleep apnea. Despite the strong association between cardiovascular diseases and obstructive sleep apnea, randomized trials have failed to demonstrate that treatment of obstructive sleep apnea reduces cardiovascular events, even in patients with established cardiovascular diseases. Weight loss in patients with obstructive sleep apnea improves HbA1c, systolic blood pressure, HDL cholesterol, and triglycerides, but thus far no changes in cardiovascular events have been shown. The combination of weight loss with continuous positive airway pressure (CPAP) appears more beneficial than either treatment in isolation. Large well-controlled trials in patients with obstructive sleep apnea to assess the effects of different weight reduction programs on cardiovascular disease are still needed.
      Citation: Hearts
      PubDate: 2022-05-24
      DOI: 10.3390/hearts3020008
      Issue No: Vol. 3, No. 2 (2022)
  • Hearts, Vol. 3, Pages 1-5: The Application of Computer Techniques to ECG

    • Authors: Peter W. Macfarlane
      First page: 1
      Abstract: It is over 120 years since Einthoven introduced the electrocardiogram [...]
      Citation: Hearts
      PubDate: 2022-01-11
      DOI: 10.3390/hearts3010001
      Issue No: Vol. 3, No. 1 (2022)
  • Hearts, Vol. 3, Pages 6-13: An Alternative to Transvenous Lead Extraction
           in Selected Patients with CIED Infections—A Retrospective Outcome

    • Authors: Jennifer Llewellyn, Goutham Meda, Daniel Garner, David J. Wright, Archana Rao
      First page: 6
      Abstract: Cardiac implantable electronic device (CIED) implants are rising in an older, more co-morbid population. The prevalence of CIED infection ranges from 1–4%. Whilst complete extraction of all transvenous hardware is recommended for infected, eroded, or pre-eroding CIEDs, this approach is not without risk and may be unacceptable to some patients. Long-term data on a more conservative strategy is lacking. We report on our experience of conservative management with pocket revision as a primary strategy in carefully selected patients. Method: A retrospective review of all CIED revision procedures was undertaken at a large tertiary center, over a 7-year period, with a mean follow-up timeframe of 39 months. Results: A total of 86 patients underwent 96 revision procedures; 7 patients required further revisions and 13 went on to undergo CIED extraction by the end of the follow-up period. The overall rate of mortality at 12 months was 8.1%, increasing to 24.4% at the end of the follow-up period. Conclusion: Our data provide important outcome information on an alternative strategy to lead extraction in carefully selected patients where the risk of extraction is perceived to be unacceptable. The absence of systemic infection appears to predict better outcomes than previously reported, and over two-thirds of patients remained complication-free at 12 months.
      Citation: Hearts
      PubDate: 2022-01-20
      DOI: 10.3390/hearts3010002
      Issue No: Vol. 3, No. 1 (2022)
  • Hearts, Vol. 3, Pages 14-18: Why Does the NOTION Trial Show Poorer than
           Expected Outcomes in the Surgical Arm'

    • Authors: Stefano Urso, Rafael Sadaba, Eliú Nogales, Francisco Portela
      First page: 14
      Abstract: The NOTION trial compares transcatheter aortic valve implantation versus surgical aortic valve replacement in low-risk patients. Looking carefully at the outcomes of this trial, there is no doubt that the transcatheter aortic valve implantation results were outstanding. The same thing cannot be said for the results of the surgery. We tried to understand the reason for that.
      Citation: Hearts
      PubDate: 2022-01-26
      DOI: 10.3390/hearts3010003
      Issue No: Vol. 3, No. 1 (2022)
  • Hearts, Vol. 3, Pages 19: Acknowledgment to Reviewers of Hearts in 2021

    • Authors: Hearts Editorial Office Hearts Editorial Office
      First page: 19
      Abstract: Rigorous peer-reviews are the basis of high-quality academic publishing [...]
      Citation: Hearts
      PubDate: 2022-01-29
      DOI: 10.3390/hearts3010004
      Issue No: Vol. 3, No. 1 (2022)
  • Hearts, Vol. 3, Pages 20-37: A Review on Atrial Fibrillation (Computer
           Simulation and Clinical Perspectives)

    • Authors: Muhammad Adib Uz Zaman, Dongping Du
      First page: 20
      Abstract: Atrial fibrillation (AF), a heart condition, has been a well-researched topic for the past few decades. This multidisciplinary field of study deals with signal processing, finite element analysis, mathematical modeling, optimization, and clinical procedure. This article is focused on a comprehensive review of journal articles published in the field of AF. Topics from the age-old fundamental concepts to specialized modern techniques involved in today’s AF research are discussed. It was found that a lot of research articles have already been published in modeling and simulation of AF. In comparison to that, the diagnosis and post-operative procedures for AF patients have not yet been totally understood or explored by the researchers. The simulation and modeling of AF have been investigated by many researchers in this field. Cellular model, tissue model, and geometric model among others have been used to simulate AF. Due to a very complex nature, the causes of AF have not been fully perceived to date, but the simulated results are validated with real-life patient data. Many algorithms have been proposed to detect the source of AF in human atria. There are many ablation strategies for AF patients, but the search for more efficient ablation strategies is still going on. AF management for patients with different stages of AF has been discussed in the literature as well but is somehow limited mostly to the patients with persistent AF. The authors hope that this study helps to find existing research gaps in the analysis and the diagnosis of AF.
      Citation: Hearts
      PubDate: 2022-02-14
      DOI: 10.3390/hearts3010005
      Issue No: Vol. 3, No. 1 (2022)
  • Hearts, Vol. 3, Pages 38-44: Outcomes of Acute Coronary Syndrome in
           Hospitalized Patients with Celiac Disease, a United States Nationwide

    • Authors: Kamesh Gupta, Khalid Sawalha, Shayal Pundlik, Mohammad Abozenah, Khadija Naseem, Mohammad Al-Akchar, Ahmad Khan
      First page: 38
      Abstract: Background: Cardiovascular disease remains the leading cause of death in the United States. Coronary artery disease alone accounted for approximately 13% of deaths in the US in 2016. Some studies have suggested an increased prevalence of coronary artery disease (CAD) in chronic inflammatory conditions, such as celiac disease (CD). Chronic subclinical systemic inflammation, decreased absorption of cardio-protective nutrients and drugs have all been postulated as the driving mechanisms for this increased risk of CAD. Methods: We reviewed a Nationwide Inpatient Sample from 2007 to 2017, using Acute Coronary syndrome as a principal diagnosis with CD as the secondary diagnosis, utilizing validated ICD-9-CM and ICD-10 codes. We examined the annual trends in the number of cases and hospitalization charges yearly and used survey regression to calculate adjusted odds ratios (aOR) for hospital mortality and other outcomes. Results: We identified a total of 8,036,307 ACS hospitalizations from 2007 to 2017, of which 5917 (0.07%) had a diagnosis for CD. The proportion of patients with CD in ACS hospitalizations increased from 0.015% in 2007 to 0.076% in 2017. These patients were significantly older (70.3 vs. 67.4 years, p < 0.02), more likely female (51.9% vs. 39.5%, p < 0.01), and more likely to be white (93.8% vs. 76.6%; p < 0.01) than ACS patients without CD. After adjusting for age, gender, race, Charlson Comorbidity index and hospital level characteristics, ACS hospitalizations for CD patients had a lower odds ratio for hospital mortality (aOR = 0.39; 95% CI = 0.23–0.67; p < 0.01). Additionally, length of stay in this patient population was shorter (4.53 vs. 4.84 days, p < 0.01) but the mean hospitalization charges were higher (USD 64,058 vs. USD 60,223, p < 0.01). Conclusion: We found that the number of ACS-related admissions in CD patients has risen more than five-fold between 2007 and 2017. However, the odds of in-hospital mortality in these patients is not higher than patients without CD. The results of our study demonstrate that although the systemic inflammation related to CD is associated with an increasing prevalence of ACS hospitalizations, on the contrary, the mortality rate is significantly higher in patients without celiac disease.
      Citation: Hearts
      PubDate: 2022-03-01
      DOI: 10.3390/hearts3010006
      Issue No: Vol. 3, No. 1 (2022)
  • Hearts, Vol. 2, Pages 433-448: Automated ECG Interpretation—A Brief
           History from High Expectations to Deepest Networks

    • Authors: Peter W. Macfarlane, Julie Kennedy
      First page: 433
      Abstract: This article traces the development of automated electrocardiography from its beginnings in Washington, DC around 1960 through to its current widespread application worldwide. Changes in the methodology of recording ECGs in analogue form using sizeable equipment through to digital recording, even in wearables, are included. Methods of analysis are considered from single lead to three leads to twelve leads. Some of the influential figures are mentioned while work undertaken locally is used to outline the progress of the technique mirrored in other centres. Applications of artificial intelligence are also considered so that the reader can find out how the field has been constantly evolving over the past 50 years.
      Citation: Hearts
      PubDate: 2021-09-23
      DOI: 10.3390/hearts2040034
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 449-458: Electrocardiographic Predictors of
           Mortality: Data from a Primary Care Tele-Electrocardiography Cohort of
           Brazilian Patients

    • Authors: Gabriela M. M. Paixão, Emilly M. Lima, Paulo R. Gomes, Derick M. Oliveira, Manoel H. Ribeiro, Jamil S. Nascimento, Antonio H. Ribeiro, Peter W. Macfarlane, Antonio L. P. Ribeiro
      First page: 449
      Abstract: Computerized electrocardiography (ECG) has been widely used and allows linkage to electronic medical records. The present study describes the development and clinical applications of an electronic cohort derived from a digital ECG database obtained by the Telehealth Network of Minas Gerais, Brazil, for the period 2010–2017, linked to the mortality data from the national information system, the Clinical Outcomes in Digital Electrocardiography (CODE) dataset. From 2,470,424 ECGs, 1,773,689 patients were identified. A total of 1,666,778 (94%) underwent a valid ECG recording for the period 2010 to 2017, with 1,558,421 patients over 16 years old; 40.2% were men, with a mean age of 51.7 [SD 17.6] years. During a mean follow-up of 3.7 years, the mortality rate was 3.3%. ECG abnormalities assessed were: atrial fibrillation (AF), right bundle branch block (RBBB), left bundle branch block (LBBB), atrioventricular block (AVB), and ventricular pre-excitation. Most ECG abnormalities (AF: Hazard ratio [HR] 2.10; 95% CI 2.03–2.17; RBBB: HR 1.32; 95%CI 1.27–1.36; LBBB: HR 1.69; 95% CI 1.62–1.76; first degree AVB: Relative survival [RS]: 0.76; 95% CI0.71–0.81; 2:1 AVB: RS 0.21 95% CI0.09–0.52; and RS 0.36; third degree AVB: 95% CI 0.26–0.49) were predictors of overall mortality, except for ventricular pre-excitation (HR 1.41; 95% CI 0.56–3.57) and Mobitz I AVB (RS 0.65; 95% CI 0.34–1.24). In conclusion, a large ECG database established by a telehealth network can be a useful tool for facilitating new advances in the fields of digital electrocardiography, clinical cardiology and cardiovascular epidemiology.
      Citation: Hearts
      PubDate: 2021-09-29
      DOI: 10.3390/hearts2040035
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 459-471: Computer Assisted Patient Monitoring:
           Associated Patient, Clinical and ECG Characteristics and Strategy to
           Minimize False Alarms

    • Authors: Michele M. Pelter, David Mortara, Fabio Badilini
      First page: 459
      Abstract: This chapter is a review of studies that have examined false arrhythmia alarms during in-hospital electrocardiographic (ECG) monitoring in the intensive care unit. In addition, we describe an annotation effort being conducted at the UCSF School of Nursing, Center for Physiologic Research designed to improve algorithms for lethal arrhythmias (i.e., asystole, ventricular fibrillation, and ventricular tachycardia). Background: Alarm fatigue is a serious patient safety hazard among hospitalized patients. Data from the past five years, showed that alarm fatigue was responsible for over 650 deaths, which is likely lower than the actual number due to under-reporting. Arrhythmia alarms are a common source of false alarms and 90% are false. While clinical scientists have implemented a number of interventions to reduce these types of alarms (e.g., customized alarm settings; daily skin electrode changes; disposable vs. non-disposable lead wires; and education), only minor improvements have been made. This is likely as these interventions do not address the primary problem of false arrhythmia alarms, namely deficient and outdated arrhythmia algorithms. In this chapter we will describe a number of ECG features associated with false arrhythmia alarms. In addition, we briefly discuss an annotation effort our group has undertaken to improve lethal arrhythmia algorithms.
      Citation: Hearts
      PubDate: 2021-10-01
      DOI: 10.3390/hearts2040036
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 472-494: Applications of Machine Learning in
           Ambulatory ECG

    • Authors: Joel Xue, Long Yu
      First page: 472
      Abstract: The ambulatory ECG (AECG) is an important diagnostic tool for many heart electrophysiology-related cases. AECG covers a wide spectrum of devices and applications. At the core of these devices and applications are the algorithms responsible for signal conditioning, ECG beat detection and classification, and event detections. Over the years, there has been huge progress for algorithm development and implementation thanks to great efforts by researchers, engineers, and physicians, alongside the rapid development of electronics and signal processing, especially machine learning (ML). The current efforts and progress in machine learning fields are unprecedented, and many of these ML algorithms have also been successfully applied to AECG applications. This review covers some key AECG applications of ML algorithms. However, instead of doing a general review of ML algorithms, we are focusing on the central tasks of AECG and discussing what ML can bring to solve the key challenges AECG is facing. The center tasks of AECG signal processing listed in the review include signal preprocessing, beat detection and classification, event detection, and event prediction. Each AECG device/system might have different portions and forms of those signal components depending on its application and the target, but these are the topics most relevant and of greatest concern to the people working in this area.
      Citation: Hearts
      PubDate: 2021-10-13
      DOI: 10.3390/hearts2040037
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 495-504: Unexplained Syncope: The Importance of the
           Electrophysiology Study

    • Authors: Ioannis Doundoulakis, Stergios Soulaidopoulos, Petros Arsenos, Polychronis Dilaveris, Dimitris Tsiachris, Christos-Konstantinos Antoniou, Skevos Sideris, Athanasios Kordalis, Ageliki Laina, Sotirios Kallinikidis, Panagiotis Xydis, Stefanos Archontakis, Konstantinos Tsioufis, Konstantinos A. Gatzoulis
      First page: 495
      Abstract: Syncope of cardiac origin may be associated with an increased risk of sudden cardiac death if not treated in a timely and appropriate manner. The diagnostic approach of syncope imposes a significant economic burden on society. The investigation and elucidation of the pathogenetic mechanism of syncope are of great clinical importance, as both prognosis and appropriate therapeutic approaches depend on these factors. The responsible mechanism of presyncope or syncope can only be revealed through the patient history, baseline clinical examination and electrocardiogram. The percentage of patients who are diagnosed with these tests alone exceeds 50%. In patients with a history of organic or acquired heart disease or/and the presence of abnormal findings on the electrocardiogram, a further diagnostic electrophysiology inclusive approach should be followed to exclude life threatening arrhythmiological mechanism. However, if the patient does not suffer from underlying heart disease and does not show abnormal electrocardiographic findings in the electrocardiogram, then the probability in the electrophysiology study to find a responsible cause is small but not absent. The role of a two-step electrophysiology study inclusive risk stratification approach for the effective management of the former is thoroughly discussed in this review.
      Citation: Hearts
      PubDate: 2021-10-25
      DOI: 10.3390/hearts2040038
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 505-513: ECG Interpretation: Clinical Relevance,
           Challenges, and Advances

    • Authors: Nikita Rafie, Anthony H. Kashou, Peter A. Noseworthy
      First page: 505
      Abstract: Since its inception, the electrocardiogram (ECG) has been an essential tool in medicine. The ECG is more than a mere tracing of cardiac electrical activity; it can detect and diagnose various pathologies including arrhythmias, pericardial and myocardial disease, electrolyte disturbances, and pulmonary disease. The ECG is a simple, non-invasive, rapid, and cost-effective diagnostic tool in medicine; however, its clinical utility relies on the accuracy of its interpretation. Computer ECG analysis has become so widespread and relied upon that ECG literacy among clinicians is waning. With recent technological advances, the application of artificial intelligence-augmented ECG (AI-ECG) algorithms has demonstrated the potential to risk stratify, diagnose, and even interpret ECGs—all of which can have a tremendous impact on patient care and clinical workflow. In this review, we examine (i) the utility and importance of the ECG in clinical practice, (ii) the accuracy and limitations of current ECG interpretation methods, (iii) existing challenges in ECG education, and (iv) the potential use of AI-ECG algorithms for comprehensive ECG interpretation.
      Citation: Hearts
      PubDate: 2021-11-02
      DOI: 10.3390/hearts2040039
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 514-542: Body Surface Potential Mapping:
           Contemporary Applications and Future Perspectives

    • Authors: Jake Bergquist, Lindsay Rupp, Brian Zenger, James Brundage, Anna Busatto, Rob S. MacLeod
      First page: 514
      Abstract: Body surface potential mapping (BSPM) is a noninvasive modality to assess cardiac bioelectric activity with a rich history of practical applications for both research and clinical investigation. BSPM provides comprehensive acquisition of bioelectric signals across the entire thorax, allowing for more complex and extensive analysis than the standard electrocardiogram (ECG). Despite its advantages, BSPM is not a common clinical tool. BSPM does, however, serve as a valuable research tool and as an input for other modes of analysis such as electrocardiographic imaging and, more recently, machine learning and artificial intelligence. In this report, we examine contemporary uses of BSPM, and provide an assessment of its future prospects in both clinical and research environments. We assess the state of the art of BSPM implementations and explore modern applications of advanced modeling and statistical analysis of BSPM data. We predict that BSPM will continue to be a valuable research tool, and will find clinical utility at the intersection of computational modeling approaches and artificial intelligence.
      Citation: Hearts
      PubDate: 2021-11-05
      DOI: 10.3390/hearts2040040
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 543-550: Safety and Cost Implications of Same-Day
           Discharge Following Elective Percutaneous Closure of Patent Foramen Ovale
           and Atrial Septal Defects in Australia

    • Authors: Abhisheik Prashar, Sanjana Shah, Richard Zhang, Kurt Mitchell, Mark Sader
      First page: 543
      Abstract: Background: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defects (ASD) is being more commonly performed due to changes in international guidelines supporting its use. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context. Methods: This was a retrospective, observational study of patients undergoing elective percutaneous PFO or ASD closure at St. George Hospital, Australia between January 2011 and January 2020. Primary outcomes included 30-day major adverse cardiovascular endpoints (MACE) and readmission to hospital within 30 days. Results: Twenty-four patients were included in the primary analysis. Ten (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among the 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were re-admitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post-elective percutaneous structural heart condition closure, SDD yielded a cost saving of AUD 5999 per case. Conclusion: SDD following elective percutaneous closure of ASD and PFO was demonstrated to be a safe and effective strategy for managing patients. With more widespread use, it can lead to significant cost savings for hospitals without compromising patient care.
      Citation: Hearts
      PubDate: 2021-11-09
      DOI: 10.3390/hearts2040041
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 551-560: PAF Physiology in Target Organ
           Systems—A Deep Dive to Understand the PAF Mystery in Pathogenesis of

    • Authors: Nilank Shah, Karan Kumar, Nikeith Shah
      First page: 551
      Abstract: The purpose of this literature review is to gain an overview of the role of platelet-activating factor (PAF) within each of the body systems and how it contributes to normal and pathophysiological states. The review showed that there are multiple functions of PAF that are common to several body systems; however, there is little evidence to explain why PAF has this affect across multiple systems. Interestingly, there seems to be conflicting research as to whether PAF is an overall protective or pathogenic pathway. Within this research, it was found that there are different pathways depending on the specific body system, as well as between body systems. However, one universal function reported in the literature is of PAF as a pro-inflammatory molecule. Overall, this review identified five major functions of PAF: vasoconstriction, increased inflammation, vascular remodeling, increased edema, and endothelial permeability.
      Citation: Hearts
      PubDate: 2021-11-29
      DOI: 10.3390/hearts2040042
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 561-569: Cost-Effectiveness and Safety of Same-Day
           Discharge after Elective Percutaneous Coronary Intervention

    • Authors: Abhisheik Prashar, Kurt Mitchell, Andrew Hopkins, Mark Sader, Ananth M. Prasan
      First page: 561
      Abstract: Objectives: We sought to investigate the rates of same-day discharge (SDD) post elective percutaneous coronary intervention (PCI) at our institution and review its safety by examining clinical outcomes. We also performed an economic analysis evaluating our hospital’s cost data for SDD following PCI. Methods: Patients undergoing elective PCI at St George Hospital, Australia, from January 2017 to December 2019 were evaluated. Primary outcomes included 7-day major adverse cardiovascular endpoints (MACEs) and readmission to hospital within 30 days. Results: Among 502 patients who underwent elective PCI, 421 patients (83.8%) were managed with SDD. There was one case of acute stent thrombosis and one case of coronary wire-induced perforation requiring a pericardial drain that occurred following elective PCI with SDD (0.54%). Unplanned cardiac re-hospitalisation at 30 days following elective PCI was 5.2%. SDD after elective PCI was associated with a healthcare cost saving of AUD 4817 per case. Conclusion: SDD following elective PCI was demonstrated to be a safe and effective strategy that was also associated with significant cost savings. SDD following elective PCI warrants more widespread use as it lowers healthcare costs, has equivalent patient outcomes and improves patient satisfaction.
      Citation: Hearts
      PubDate: 2021-12-08
      DOI: 10.3390/hearts2040043
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 570-574: Bundle Branch Re-Entrant Ventricular
           Tachycardia after Minimal Invasive Cardiac Surgery

    • Authors: Vincent Vandoren, Thomas Phlips, Philippe Timmermans
      First page: 570
      Abstract: Background: Bundle branch re-entrant ventricular tachycardia (BBRVT) is a monomorphic ventricular arrhythmia with wide QRS complexes caused by re-entrant tachycardia between both bundle branches. BBRVT can occur in a variety of cardiac pathologies with His–Purkinje system (HPS) conduction abnormalities such as dilated cardiomyopathy, coronary artery disease, hypertrophic cardiomyopathy, valvular heart disease and even after aortic valve surgery. Case report: A 62-year-old male patient with an ischemic cardiomyopathy and implantable cardioverter defibrillator (ICD) underwent minimal invasive aortic valve replacement (Yil-AVR) and coronary artery bypass graft (CABG). He was remitted a week later because of relapsing sustained ventricular tachycardia (VT). Electrocardiogram showed a wide QRS tachycardia, which was remarkably similar to the patient’s sinus rhythm. Analysis of ICD revealed the presence of BBRVT. Catheter ablation of the right bundle branch (RBB) was performed. He is currently in clinical follow-up and no reoccurrence of VT has been recorded so far. Conclusion: Patients with known cardiomyopathy can develop BBRVT early after cardiac surgery. To our knowledge, this is the first time that BBRVT occurred after Yil-AVR.
      Citation: Hearts
      PubDate: 2021-12-15
      DOI: 10.3390/hearts2040044
      Issue No: Vol. 2, No. 4 (2021)
  • Hearts, Vol. 2, Pages 294-301: Outcomes of Patients Who Have Incidental
           Non-Sustained Ventricular Tachycardia Identified on Cardiac Implantable
           Electronic Device Interrogation

    • Authors: Aditya Narain, Chun Shing Kwok, Caterina Liggett-Wright, Joseph Mayer, Daniel Darlington, Fozia Z. Ahmed, Thanh Phan, Diane Barker
      First page: 294
      Abstract: Background: Non-sustained ventricular tachycardia (NSVT) is an arrhythmia prevalent in both structurally normal and abnormal hearts. Methods: We conducted a single-center retrospective clinical audit of patients followed-up in a device clinic with one or more incidental NSVT episodes recorded on their device between November 2017 and August 2018 and followed up patients for outcomes until January 2019. Results: A total of 83 patients were included in the analysis with one or more episodes of NSVT on device interrogation. Those identified to have NSVT were more likely to be male (74.7%) and there was a mean of 14.2 beats per episode and a mean of 3.7 episodes for each patient. Only 24.7% of patients had electrolytes checked within 4 weeks of episode detection and 18.3% had an echocardiogram post-episode. The majority of patients (73.5%) were followed up again in the pacing clinic but had no changes in medication, or other management implemented. In terms of outcomes, 81.7% of patients had no admission to hospital, mortality, or shock during the follow-up period. Conclusions: Most patients who developed NSVT did not have an extra follow-up, medication review, or investigation. Despite this, outcomes such as admission, shock, or death were uncommon.
      Citation: Hearts
      PubDate: 2021-06-24
      DOI: 10.3390/hearts2030024
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 302-306: BRASH: Case Report and Review of Literature

    • Authors: Sauradeep Sarkar, Nicole Rapista, Amit Rout, Rahul Chaudhary
      First page: 302
      Abstract: BRASH syndrome is characterized by bradycardia, renal failure, AV nodal blockade, shock, and hyperkalemia. The proposed mechanism involves a vicious cycle between AV nodal blockers, hyperkalemia, and renal failure and was first described in 2016. We present a case of a 52-year-old woman who presented with progressively worsening shortness of breath and hypertensive urgency who subsequently developed profound bradycardia and shock that was refractory to resuscitative measures, she was diagnosed with BRASH syndrome. In this article, we explore the predisposing factors and challenges faced during the management of patients with BRASH syndrome.
      Citation: Hearts
      PubDate: 2021-06-27
      DOI: 10.3390/hearts2030025
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 307-330: Non-Coding RNAs in the Cardiac Action
           Potential and Their Impact on Arrhythmogenic Cardiac Diseases

    • Authors: Estefania Lozano-Velasco, Amelia Aranega, Diego Franco
      First page: 307
      Abstract: Cardiac arrhythmias are prevalent among humans across all age ranges, affecting millions of people worldwide. While cardiac arrhythmias vary widely in their clinical presentation, they possess shared complex electrophysiologic properties at cellular level that have not been fully studied. Over the last decade, our current understanding of the functional roles of non-coding RNAs have progressively increased. microRNAs represent the most studied type of small ncRNAs and it has been demonstrated that miRNAs play essential roles in multiple biological contexts, including normal development and diseases. In this review, we provide a comprehensive analysis of the functional contribution of non-coding RNAs, primarily microRNAs, to the normal configuration of the cardiac action potential, as well as their association to distinct types of arrhythmogenic cardiac diseases.
      Citation: Hearts
      PubDate: 2021-06-30
      DOI: 10.3390/hearts2030026
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 331-349: Excitation and Contraction of the Failing
           Human Heart In Situ and Effects of Cardiac Resynchronization Therapy:
           Application of Electrocardiographic Imaging and Speckle Tracking

    • Authors: Christopher M. Andrews, Gautam K. Singh, Yoram Rudy
      First page: 331
      Abstract: Despite the success of cardiac resynchronization therapy (CRT) for treating heart failure (HF), the rate of nonresponders remains 30%. Improvements to CRT require understanding of reverse remodeling and the relationship between electrical and mechanical measures of synchrony. The objective was to utilize electrocardiographic imaging (ECGI, a method for noninvasive cardiac electrophysiology mapping) and speckle tracking echocardiography (STE) to study the physiology of HF and reverse remodeling induced by CRT. We imaged 30 patients (63% male, mean age 63.7 years) longitudinally using ECGI and STE. We quantified CRT-induced remodeling of electromechanical parameters and evaluated a novel index, the electromechanical delay (EMD, the delay from activation to peak contraction). We also measured dyssynchrony using ECGI and STE and compared their effectiveness for predicting response to CRT. EMD values were elevated in HF patients compared to controls. However, the EMD values were dependent on the activation sequence (CRT-paced vs. un-paced), indicating that the EMD is not intrinsic to the local tissue, but is influenced by factors such as opposing wall contractions. After 6 months of CRT, patients had increased contraction in native rhythm compared to baseline pre-CRT (baseline: −8.55%, 6 months: −10.14%, p = 0.008). They also had prolonged repolarization at the location of the LV pacing lead. The pre-CRT delay between mean lateral LV and RV electrical activation time was the best predictor of beneficial reduction in LV end systolic volume by CRT (Spearman’s Rho: −0.722, p < 0.001); it outperformed mechanical indices and 12-lead ECG criteria. HF patients have abnormal EMD. The EMD depends upon the activation sequence and is not predictive of response to CRT. ECGI-measured LV activation delay is an effective index for CRT patient selection. CRT causes persistent improvements in contractile function.
      Citation: Hearts
      PubDate: 2021-07-23
      DOI: 10.3390/hearts2030027
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 350-368: Computer Modeling of the Heart for ECG
           Interpretation—A Review

    • Authors: Olaf Dössel, Giorgio Luongo, Claudia Nagel, Axel Loewe
      First page: 350
      Abstract: Computer modeling of the electrophysiology of the heart has undergone significant progress. A healthy heart can be modeled starting from the ion channels via the spread of a depolarization wave on a realistic geometry of the human heart up to the potentials on the body surface and the ECG. Research is advancing regarding modeling diseases of the heart. This article reviews progress in calculating and analyzing the corresponding electrocardiogram (ECG) from simulated depolarization and repolarization waves. First, we describe modeling of the P-wave, the QRS complex and the T-wave of a healthy heart. Then, both the modeling and the corresponding ECGs of several important diseases and arrhythmias are delineated: ischemia and infarction, ectopic beats and extrasystoles, ventricular tachycardia, bundle branch blocks, atrial tachycardia, flutter and fibrillation, genetic diseases and channelopathies, imbalance of electrolytes and drug-induced changes. Finally, we outline the potential impact of computer modeling on ECG interpretation. Computer modeling can contribute to a better comprehension of the relation between features in the ECG and the underlying cardiac condition and disease. It can pave the way for a quantitative analysis of the ECG and can support the cardiologist in identifying events or non-invasively localizing diseased areas. Finally, it can deliver very large databases of reliably labeled ECGs as training data for machine learning.
      Citation: Hearts
      PubDate: 2021-07-26
      DOI: 10.3390/hearts2030028
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 369-378: Fractional Flow Reserve Derived from
           Computer Tomography in Asymptomatic Patients with Type 2 Diabetes and
           Albuminuria without Significant Coronary Artery Stenosis—A Surrogate for
           Coronary Microvascular Dysfunction'

    • Authors: Jess Lambrechtsen, Laurits Juhl Heinsen, Johanna Larsson, Gokulan Pararajasingam, Kenneth Egstrup
      First page: 369
      Abstract: Background: Type 2 diabetes mellitus (T2D) patients with albuminuria have coronary microvascular dysfunction (CMD). Fractional flow reserve assessed by coronary computed tomography angiography (FFRct) is dependent on the structure and function of the microcirculation and is likely influenced by CMD. We aimed to evaluate if asymptomatic patients with T2D who had no significant coronary artery stenosis but had been diagnosed with albuminuria had lower value of nadir FFRct compared to asymptomatic patients with T2D and no albuminuria. Methods and results: This was a cross-sectional study which compared the mean nadir FFRct values in coronary arteries in patients with T2D who had no symptoms of angina. The T2D patients were divided into two groups (albuminuria and no albuminuria) with albuminuria being defined as albumin–creatinine-ratio (ACR) ≥30 milligram per gram. The nadir FFRct values were compared between the two groups for left anterior descendent artery (FFRct-LAD), circumflex artery (FFRct-CX), and right coronary artery (FFRct-RCA) by using a two-sample Wilcoxon rank-sum (Mann–Whitney) test. Ninety-eight patients without albuminuria and 26 patients with albuminuria were included. No significant differences in mean values were detected for FFRct-CX 0.86 ± 0.07 and 0.88 ± 0.0, FFRct-RCA 0.88 ± 0.05 and 0.88 ± 0.07, or for FFRct-LAD 0.82 ± 0.07 and 0.82 ± 0.07 in patients with albuminuria and without albuminuria, respectively. Conclusion: In this observational study, we did not find that FFRct was affected by CMD. Therefore, it is not a surrogate for microvascular dysfunction in asymptomatic T2D patients with albuminuria.
      Citation: Hearts
      PubDate: 2021-08-05
      DOI: 10.3390/hearts2030029
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 379-383: Early Graft Failure after Coronary Artery
           Bypass Surgery: A Case of Anastomosis Detachment Due to Fibromuscular

    • Authors: Andrea Lorenzo Vecchi, Roberta Maragliano, Fausto Sessa, Cesare Beghi, Roberto De Ponti, Battistina Castiglioni
      First page: 379
      Abstract: Fibromuscular dysplasia is a non-atherosclerotic, non-inflammatory arteriopathy, considered a rare cause of coronary artery disease. Although familial cases have been described, no specific gene association has been detected so far. When the coronary vessels are involved, the main clinical scenarios are stable angina, acute coronary syndromes, left ventricular dysfunction, and sudden death. Specific clinical and angiographic findings may suggest this as the underlying disease, but certain diagnosis histological. The involvement of the lower and upper limbs is unusual; however, it may have decisive clinical implications for the most appropriate revascularization method and the selection of the arterial graft to be used.
      Citation: Hearts
      PubDate: 2021-08-15
      DOI: 10.3390/hearts2030030
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 384-409: The History and Challenges of SCP-ECG: The

    • Authors: Paul Rubel, Jocelyne Fayn, Peter W. Macfarlane, Danilo Pani, Alois Schlögl, Alpo Värri
      First page: 384
      Abstract: Ever since the first publication of the standard communication protocol for computer-assisted electrocardiography (SCP-ECG), prENV 1064, in 1993, by the European Committee for Standardization (CEN), SCP-ECG has become a leading example in health informatics, enabling open, secure, and well-documented digital data exchange at a low cost, for quick and efficient cardiovascular disease detection and management. Based on the experiences gained, since the 1970s, in computerized electrocardiology, and on the results achieved by the pioneering, international cooperative research on common standards for quantitative electrocardiography (CSE), SCP-ECG was designed, from the beginning, to empower personalized medicine, thanks to serial ECG analysis. The fundamental concept behind SCP-ECG is to convey the necessary information for ECG re-analysis, serial comparison, and interpretation, and to structure the ECG data and metadata in sections that are mostly optional in order to fit all use cases. SCP-ECG is open to the storage of the ECG signal and ECG measurement data, whatever the ECG recording modality or computation method, and can store the over-reading trails and ECG annotations, as well as any computerized or medical interpretation reports. Only the encoding syntax and the semantics of the ECG descriptors and of the diagnosis codes are standardized. We present all of the landmarks in the development and publication of SCP-ECG, from the early 1990s to the 2009 International Organization for Standardization (ISO) SCP-ECG standards, including the latest version published by CEN in 2020, which now encompasses rest and stress ECGs, Holter recordings, and protocol-based trials.
      Citation: Hearts
      PubDate: 2021-08-24
      DOI: 10.3390/hearts2030031
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 410-418: The New ISO/IEC Standard for Automated ECG

    • Authors: Brian Young, Johann-Jakob Schmid
      First page: 410
      Abstract: Updates to industry consensus standards for ECG equipment is a work-in-progress by the ISO/IEC Joint Work Group 22. This work will result in an overhaul of existing industry standards that apply to ECG electromedical equipment and will result in a new single international industry, namely 80601-2-86. The new standard will be entitled “80601, Part 2-86: Particular requirements for the basic safety and essential performance of electrocardiographs, including diagnostic equipment, monitoring equipment, ambulatory equipment, electrodes, cables, and leadwires”. This paper will provide a high-level overview of the work in progress and, in particular, will describe the impact it will have on requirements and testing methods for computerized ECG interpretation algorithms. The conclusion of this work is that manufacturers should continue working with clinical ECG experts to make clinically meaningful improvements to automated ECG interpretation, and the clinical validation of ECG analysis algorithms should be disclosed to guide appropriate clinical use. More cooperation is needed between industry, clinical ECG experts and regulatory agencies to develop new data sets that can be made available for use by industry standards for algorithm performance evaluation.
      Citation: Hearts
      PubDate: 2021-08-27
      DOI: 10.3390/hearts2030032
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 419-432: Current ECG Aspects of Interatrial Block

    • Authors: Antoni Bayés-de-Luna, Miquel Fiol-Sala, Manuel Martínez-Sellés, Adrian Baranchuk
      First page: 419
      Abstract: Interatrial blocks like other types of block may be of first degree or partial second degree, also named transient atrial block or atrial aberrancy, and third degree or advanced. In first degree, partial interatrial block (P-IAB), the electrical impulse is conducted to the left atrium, through the Bachmann’s region, but with delay. The ECG shows a P-wave ≥ 120 ms. In third-degree, advanced interatrial block (A-IAB), the electrical impulse is blocked in the upper part of the interatrial septum (Bachmann region); the breakthrough to LA has to be performed retrogradely from the AV junction zone. This explains the p ± in leads II, III and aVF. In typical cases of A-IAB, the P-wave morphology is biphasic (±) in leads II, III and aVF, because the left atrium is activated retrogradely and, therefore, the last part of the atrial activation falls in the negative hemifield of leads II, III and aVF. Recently, some atypical cases of A-IAB have been described. The presence of A-IAB is a risk factor for atrial fibrillation, stroke, dementia, and premature death.
      Citation: Hearts
      PubDate: 2021-09-08
      DOI: 10.3390/hearts2030033
      Issue No: Vol. 2, No. 3 (2021)
  • Hearts, Vol. 2, Pages 188-201: Technical Modifications for Ductal Stenting
           in Neonates with Duct-Dependent Pulmonary Circulation

    • Authors: Worakan Promphan, Shakeel A. Qureshi
      First page: 188
      Abstract: The ductal stenting (DS) is currently an acceptable palliative treatment in newborns suffering with duct-dependent pulmonary circulation. However, this procedure remains technically a challenge in complex ductal morphology, which may eventually lead to detrimental outcomes. This review is mainly focused on pre-procedural planning, essential instruments and practical approaches for DS, and post-procedural care.
      Citation: Hearts
      PubDate: 2021-03-26
      DOI: 10.3390/hearts2020015
      Issue No: Vol. 2, No. 2 (2021)
  • Hearts, Vol. 2, Pages 202-212: A Historical Perspective of Cardiac
           Implantable Electronic Device Infection: How a Menace Can Drive
           Technological and Clinical Improvement

    • Authors: Giulia Massaro, Igor Diemberger, Matteo Ziacchi, Andrea Angeletti, Giovanni Statuto, Nazzareno Galiè, Mauro Biffi
      First page: 202
      Abstract: In recent decades there has been a relevant increase in the implantation rate of cardiac implantable electronic devices (CIEDs), albeit with relevant geographical inhomogeneities. Despite the positive impact on clinical outcomes, the possibility of major complications is not negligible, particularly with respect to CIED infections. CIED infections significantly affect morbidity and mortality, especially in instances of delayed diagnosis and appropriate treatment. In the present review, we will start to depict the factors underlying the development of CIED infection as well as the difficulties related to its diagnosis and treatment. We will explain the reasons underlying the need to focus on prophylaxis rather than treatment, in view of the poor outcomes despite improvements in lead extraction procedures. This will lead to the consideration of management of this complication in a hub-spoke manner, and to our analysis of the several technological and procedural improvements developed to minimize this complication. These include prolongation of CIED longevity, the development of leadless devices, and integrated prophylactic approaches. We will conclude with a discussion regarding new devices and strategies under development. This complete excursus will provide the reader with a new perspective on how a major complication can drive technological improvements.
      Citation: Hearts
      PubDate: 2021-03-30
      DOI: 10.3390/hearts2020016
      Issue No: Vol. 2, No. 2 (2021)
  • Hearts, Vol. 2, Pages 213-223: Is Greater Than 0.5 MAC Inhalational Agent
           Use Post-Bypass Related to Need for Inotropic and/or Vasoconstrictor

    • Authors: Tara A. Lenk, Carlos E. Guerra-Londono, Thomas E. Graul, Marc A. Murinson, Prabhdeep K. Hehar, George Divine, Raj K. Modak
      First page: 213
      Abstract: Background and Aims: We hypothesized that maintaining a patient on moderate–high doses of potent inhalational agent for greater than 30 min during the post-bypass period would be an independent predictor of initiation and usage of either inotropic and/or vasopressor infusions. Setting and Design: This study is a retrospective design and approved by the institutional review board. The setting was a single-center, academic tertiary care hospital in Detroit, Michigan. Materials and Methods: Three-hundred, ninety-seven elective cardiac surgery patients were identified for chart review. Electronic medical records were reviewed to collect demographics and perioperative data. Statistics used include a propensity score regression adjusted analysis utilizing logistic regression models and a multivariable model. Results: A propensity score regression adjusted analysis was performed and then applied in both univariate and multivariate logistic regression models with a p value of <0.05 reaching statistical significance. Fifty-six percent of the participants had an exposure of greater than 30 min of a minimum alveolar concentration of isoflurane greater than 0.5 (ETISO ≥ 0.5MAC, 30 min) in the post-bypass period. After adjusting for propensity score, this was found to be a significant predictor of inotrope and/or vasoconstrictor use post-bypass (OR 2.49, 95% CI 1.15–5.38, p = 0.021). In the multivariate model, pulmonary hypertension (OR 5.9; 95% CI 1.33–26.28; p = 0.02), Euroscore II (2.73; 95% CI 1.35–5.5; p = 0.005), and cardiopulmonary bypass hours (OR 1.86; 95% CI 1.02–3.4; p = 0.042) emerged as significant. Conclusions: This study showed that an ETISO ≥ 0.5MAC, 30 min exposure during the immediate post-bypass period during elective cardiac surgery was an independent predictor of a patient being started on inotrope or vasoconstrictor infusions. Further research should consider a prospective design and examine depth of anesthesia during the post-bypass period.
      Citation: Hearts
      PubDate: 2021-04-13
      DOI: 10.3390/hearts2020017
      Issue No: Vol. 2, No. 2 (2021)
  • Hearts, Vol. 2, Pages 224-233: Palliative Balloon Pulmonary Valvotomy in
           Tetralogy of Fallot: Is There a Role in 2021'

    • Authors: Supratim Sen, Bharat Dalvi
      First page: 224
      Abstract: The current treatment practice for Tetralogy of Fallot (TOF) is to undertake complete surgical repair between 6–9 months of age with excellent immediate and long-term results. In patients with increased cyanosis or frequent cyanotic spells, younger age of complete repair as early as 3 months is usually acceptable. Although neonatal TOF repair is reported with good immediate survival from a few centres, post-operative morbidity is significant, and the hospital stay is prolonged. Hence, in neonates and small term and preterm infants with severe cyanosis, palliative procedures such as modified Blalock-Taussig (BT) shunt, ductal stenting, right ventricular outflow tract (RVOT) stenting and balloon pulmonary valvotomy (BPV) have been reported. With the development of low-profile stents, an increasing clinician experience and more predictable outcome with both duct and RVOT stenting, these procedures have gained popularity as the preferred palliations for TOF at most centres. We reviewed the literature to analyse whether BPV for TOF palliation, a technique first reported three decades ago, still has a role in the present era of paediatric cardiac care. In this review, we have concluded that BPV has very specific indications in patients with TOF, with predominantly valvar pulmonary stenosis, and may be a preferred option over other palliative strategies in hypoxemic preterm or low-birth weight infants.
      Citation: Hearts
      PubDate: 2021-04-20
      DOI: 10.3390/hearts2020018
      Issue No: Vol. 2, No. 2 (2021)
  • Hearts, Vol. 2, Pages 234-250: Cardiac Sarcoidosis: Pathophysiology,
           Diagnosis, and Management

    • Authors: Issa Pour-Ghaz, Sharif Kayali, Iman Abutineh, Jay Patel, Sherif Roman, Mannu Nayyar, Neeraja Yedlapati
      First page: 234
      Abstract: Sarcoidosis is a chronic multi-system disorder with an unknown etiology that can affect the cardiac tissue, resulting in Cardiac Sarcoidosis (CS). The majority of these CS cases are clinically silent, and when there are symptoms, the symptoms are vague and can have a lot in common with other common cardiac diseases. These symptoms can range from arrhythmias to heart failure. If CS goes undetected, it can lead to detrimental outcomes for patients. Diagnosis depends on timely utilization of imaging modalities and non-invasive testing, while in some cases, it does necessitate biopsy. Early diagnosis and treatment with immunosuppressive agents are crucial, and it is essential that follow-up testing be performed to ensure resolution and remission. This manuscript provides an in-depth review of CS and the current literature regarding CS diagnosis and treatment.
      Citation: Hearts
      PubDate: 2021-05-03
      DOI: 10.3390/hearts2020019
      Issue No: Vol. 2, No. 2 (2021)
  • Hearts, Vol. 2, Pages 251-269: Novel PITX2 Homeodomain-Contained Mutations
           from ATRIAL Fibrillation Patients Deteriorate Calcium Homeostasis

    • Authors: Adela Herraiz-Martínez, Carmen Tarifa, Estefanía Lozano-Velasco, Verónica Jiménez-Sábado, Sergi Casabella, Francisco Hernández-Torres, Houria Daimi, Eduardo Vázquez Ruiz de Castroviejo, Eva Delpón, Ricardo Caballero, Amelia Aránega, Diego Franco, Leif Hove-Madsen
      First page: 251
      Abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the human population, with an estimated incidence of 1–2% in young adults but increasing to more than 10% in 80+ years patients. Pituitary Homeobox 2, Paired Like Homeodomain 2 (PITX2c) loss-of-function in mice revealed that this homeodomain (HD)-containing transcription factor plays a pivotal role in atrial electrophysiology and calcium homeostasis and point to PITX2 as a candidate gene for AF. To address this issue, we recruited 31 AF patients for genetic analyses of both the known risk alleles and PITX2c open reading frame (ORF) re-sequencing. We found two-point mutations in the homedomain of PITX2 and three other variants in the 5’untranslated region. A 65 years old male patient without 4q25 risk variants but with recurrent AF displayed two distinct HD-mutations, NM_000325.5:c.309G>C (Gln103His) and NM_000325.5:c.370G>A (Glu124Lys), which both resulted in a change within a highly conserved amino acid position. To address the functional impact of the PITX2 HD mutations, we generated plasmid constructs with mutated version of each nucleotide variant (MD4 and MD5, respectively) as well as a dominant negative control construct in which the PITX2 HD was lacking (DN). Functional analyses demonstrated PITX2c MD4 and PITX2c MD5 decreased Nppa-luciferase transactivation by 50% and 40%, respectively, similar to the PITX2c DN (50%), while Shox2 promoter repression was also impaired. Co-transactivation with other cardiac-enriched co-factors, such as Gata4 and Nkx2.5, was similarly impaired, further supporting the pivotal role of these mutations for correct PITX2c function. Furthermore, when expressed in HL1 cardiomyocyte cultures, the PITX2 mutants impaired endogenous expression of calcium regulatory proteins and induced alterations in sarcoplasmic reticulum (SR) calcium accumulation. This favored alternating and irregular calcium transient amplitudes, causing deterioration of the beat-to-beat stability upon elevation of the stimulation frequency. Overall this data demonstrate that these novel PITX2c HD-mutations might be causative of atrial fibrillation in the carrier.
      Citation: Hearts
      PubDate: 2021-05-05
      DOI: 10.3390/hearts2020020
      Issue No: Vol. 2, No. 2 (2021)
  • Hearts, Vol. 2, Pages 270-277: For the Evaluation of Pacific Island
           Athletes, an ECG and Echocardiography Are Highly Recommended

    • Authors: Jean-Claude Chatard
      First page: 270
      Abstract: Physical exercise increases the relative risk of sudden cardiac death (SCD) in athletes when compared to a non-sporting population. Pre-participation evaluation (PPE) of athletes is thus of major importance. For Pacific Island athletes, medical guidelines recommend an echocardiography to complement a PPE including personal and family history, a physical examination and a resting twelve-lead electrocardiogram (ECG). Indeed, silent rheumatoid heart diseases found in up to 7.6% of adolescents give rise to severe valve lesions, which are the main causes of SCD in Pacific Island athletes. This short review examines the incidence rate of SCD in Pacific Island athletes and indicates how a questionnaire, physical examination, ECG and echocardiography can prevent it.
      Citation: Hearts
      PubDate: 2021-05-14
      DOI: 10.3390/hearts2020021
      Issue No: Vol. 2, No. 2 (2021)
  • Hearts, Vol. 2, Pages 278-287: Right Ventricular Outflow Tract Stenting as
           Palliation of Critical Tetralogy of Fallot: Techniques and Results

    • Authors: Alessandra Pizzuto, Magdalena Cuman, Nadia Assanta, Eliana Franchi, Chiara Marrone, Vitali Pak, Giuseppe Santoro
      First page: 278
      Abstract: Background. Despite current trends toward early primary repair, the surgical systemic-to-pulmonary shunt is still considered the first-choice palliation in patients with critical tetralogy of Fallot (TOF) and duct-dependent pulmonary circulation unsuitable for primary repair. However, stenting of the right ventricular outflow tract (RVOT) is nowadays emerging as an effective alternative to surgical palliation in selected patients. Methods and results. RVOT stenting is usually performed from a venous route, either femoral or, in selected cases, the right internal jugular vein. Less frequently, mostly in pulmonary infundibular/valvar atresia, this procedure can be performed using a hybrid surgical/interventional approach by surgical exposure of the RVOT, puncture of the atretic valve, and stent deployment under direct vision. The size and type of the most appropriate stent may be chosen, based on ultrasound measurements of the RVOT, to cover the right ventricular infundibulum completely and, at the same time, sparing the pulmonary valve, unless significant pulmonary valve annulus hypoplasia and/or supra-valvular stenosis is a significant component of the obstruction. In the large series so far published, early mortality of RVOT stenting is less than 2%, comparing favourably with either Blalock-Thomas-Taussig shunt or early primary repair. In addition, morbidity and clinical sequelae of this approach do not significantly differ from surgical palliation, even if RVOT stenting shows lesser durability and a higher rate of trans-catheter re-interventions over a mid-term follow-up. Finally, similar but more balanced pulmonary artery growth than surgical palliation following RVOT stenting is reported over a mid-term follow-up. Conclusions. RVOT stenting is a technically feasible, well-tolerated, and effective palliation in critical TOF. This approach is cost-effective with respect to surgical palliation either in high-risk neonates or whenever a short-term pulmonary blood flow source is anticipated due to the early surgical repair. It effectively increases pulmonary blood flow, improves arterial saturation, and promotes balanced pulmonary artery growth over a mid-term follow-up.
      Citation: Hearts
      PubDate: 2021-05-20
      DOI: 10.3390/hearts2020022
      Issue No: Vol. 2, No. 2 (2021)
  • Hearts, Vol. 2, Pages 288-293: Hidden under the Surface: A Rare Cause of
           Repeated Syncope in a Patient with Recent Pacemaker Implantation

    • Authors: Leticia Barrios, Dagmara Dilling-Boer, Axel Jacobs, Olivier Ghekiere, Philippe Timmermans
      First page: 288
      Abstract: A 66-year-old woman received a pacemaker implantation because of syncope with documented sinus arrest and junctional bradycardia. Three weeks later the pacemaker analysis revealed episodes of nonsustained ventricular tachycardia. Coronary angiography and invasive coronary assessment showed diffuse moderate stenosis but no significant ischemia. Three months later she experienced a new syncope and the pacemaker analysis showed runs of nonsustained ventricular tachycardia at the time of syncope. The combination of brady- and tachyarrhythmias raised concern for cardiac sarcoidosis. 18F-fluorodeoxyglucose positron emission tomography (PET) scan showed increased FDG uptake in the basal segments compatible with inflammatory disease. Cardiac magnetic resonance imaging showed late gadolinium enhancement in the same region of the PET-avid lesions. Diagnostic electrophysiologic study could induce VT. The diagnosis of cardiac sarcoidosis was made, for which high dose corticosteroids were prescribed and an upgrade to a dual chamber implantable cardioverter defibrillator was performed. Because of the localization of the lesions, an endomyocardial biopsy was not performed. All the lesions regressed completely on PET-scan after treatment with high dose corticosteroids.
      Citation: Hearts
      PubDate: 2021-06-16
      DOI: 10.3390/hearts2020023
      Issue No: Vol. 2, No. 2 (2021)
  • Hearts, Vol. 2, Pages 5-14: Non-Invasive Assessment of Pulmonary

    • Authors: Ines Ponz, Jorge Nuche, Violeta Sanchez Sanchez, Javier Sanchez-Gonzalez, Zorba Blazquez-Bermejo, Pedro Caravaca Perez, Maria Dolores Garcia-Cosio Carmena, Javier S. de Juan Baguda, Adriana Rodríguez Rodríguez Chaverri, Fernando Sarnago Cebada, Fernando Arribas Ynsaurriaga, Borja Ibañez, Juan F. Delgado Jiménez
      First page: 5
      Abstract: Right heart catheterization remains necessary for the diagnosis of pulmonary hypertension and, therefore, for the prognostic evaluation of patients with chronic heart failure. The non-invaSive Assessment of Pulmonary vasculoPathy in Heart failure (SAPPHIRE) study was designed to assess the feasibility and prognostic relevance of a non-invasive evaluation of the pulmonary artery vasculature in patients with heart failure and pulmonary hypertension. Patients will undergo a right heart catheterization, cardiac resonance imaging, and a pulmonary function test in order to identify structural and functional parameters allowing the identification of combined pre- and postcapillary pulmonary hypertension, and correlate these findings with the hemodynamic data.
      Citation: Hearts
      PubDate: 2021-01-05
      DOI: 10.3390/hearts2010002
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 15-35: Cardiac Stimulation in the Third Millennium:
           Where Do We Head from Here'

    • Authors: Mauro Biffi, Alberto Spadotto, Giuseppe Pio Piemontese, Sebastiano Toniolo, Lorenzo Bartoli, Sergio Sorrentino, Alessandro Minguzzi, Giulia Massaro, Claudio Capobianco, Giovanni Statuto
      First page: 15
      Abstract: Over the years, pacemakers have evolved from a life-saving tool to prevent asystole to a device to treat heart rhythm disorders and heart failure, aiming at improving both cardiac function and clinical outcomes. Cardiac stimulation nowadays aims to correct the electrophysiologic roots of mechanical inefficiency in different structural heart diseases. This has led to awareness of the concealed risks of customary cardiac pacing that can inadvertently cause atrioventricular and inter-/intra-ventricular dyssynchrony, and has promoted the development of new pacing modalities and the use of stimulation sites different from the right atrial appendage and the right ventricular apex. The perspective of truly physiologic pacing is the leading concept of the continued research in the past 30 years, which has made cardiac stimulation procedure more sophisticated and challenging. In this article, we analyze the emerging evidence in favor of the available strategies to achieve an individualized physiologic setting in bradycardia pacing.
      Citation: Hearts
      PubDate: 2021-01-06
      DOI: 10.3390/hearts2010003
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 36-44: Heart Rate Variability Relates with
           Competition Performance in Professional Soccer Players

    • Authors: Michele Malagù, Francesco Vitali, Ugo Rizzo, Alessandro Brieda, Ottavio Zucchetti, Filippo Maria Verardi, Gabriele Guardigli, Matteo Bertini
      First page: 36
      Abstract: Background: Heart rate variability (HRV) is widely used in professional soccer players as a tool to assess individual response to training load. Different devices and methods are available for HRV assessment. The relationship between HRV and competitive soccer matches performance is not documented. Methods: We monitored HRV in professional soccer players throughout a game season. Measurements were performed with a portable lightweight device in weekly 5 min sessions from which we obtained the value of the square root of the mean squared differences of successive beat-to-beat intervals (rMSSD). Game parameters of run and velocity were collected. Results: Twenty-seven players were monitored with a total of 121 observations. The rMSSD significantly related with the total distance covered (p = 0.036) and with the distance covered running at >15 km/h (p = 0.039) during soccer games. Conclusions: HRV was associated with competition performance in professional soccer players.
      Citation: Hearts
      PubDate: 2021-01-10
      DOI: 10.3390/hearts2010004
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 45-60: Diagnosis, Prevention, Treatment and
           Surveillance of Anthracycline-Induced Cardiovascular Toxicity in Pediatric
           Cancer Survivors

    • Authors: Valerie Curren, Niti Dham, Christopher Spurney
      First page: 45
      Abstract: Advances in pediatric cancer therapies have dramatically improved the likelihood of survival. As survivors are aging, however, we are now understanding that treatment carries a significant risk of cardiovascular toxicity, which can develop immediately, or even many years after completing therapy. Anthracycline derivates are some of the most commonly used agents in pediatric oncology treatment protocols, which have a dose-dependent correlation with the development of cardiac toxicity. As we learn more about the mechanisms of toxicity, we are developing prevention strategies, including improvements in surveillance, to improve early diagnosis of heart disease. Current survivorship surveillance protocols often include screening echocardiograms to evaluate systolic function by measuring the ejection fraction or fractional shortening. However, these measurements alone are not enough to capture early myocardial changes. The use of additional imaging biomarkers, serum biomarkers, electrocardiograms, as well as cholesterol and blood pressure screening, are key to the early detection of cardiomyopathy and cardiovascular disease. Medical treatment strategies are the same as those used for heart failure from other causes, but earlier recognition and implementation can lead to improved long term outcomes.
      Citation: Hearts
      PubDate: 2021-01-15
      DOI: 10.3390/hearts2010005
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 61-73: Risk Stratification and Management of
           Arterial Hypertension and Cardiovascular Adverse Events Related to Cancer
           Treatments: An Oncology Network from Piedmont and Aosta Valley
           (North-Western Italy) Consensus Document

    • Authors: Giulia Mingrone, Elena Coletti Moia, Erica Delsignore, Gloria Demicheli, Paola Destefanis, Davide Forno, Giovanna Giglio Tos, Alessia Luciano, Giuliano Pinna, Laura Ravera, Antonella Fava, Franco Veglio, Oscar Bertetto, Alberto Milan
      First page: 61
      Abstract: Cancer patients receiving a potentially cardiotoxic oncologic therapy have an increased risk of cardiovascular adverse events (CVAEs), especially in presence of concomitant arterial hypertension (AH). Therefore, cancer patients should be evaluated before, during and after cardiotoxic treatments, to early identify new-onset or worsening AH or CVAEs. An expert panel of oncology networks from Piedmont and Aosta Valley (North-Western Italy) aimed to provide recommendations to support health professionals in selecting the best management strategies for patients, considering the impact on outcome and the risk–benefit ratio of diagnostic/therapeutic tools. We proposed an useful document for evaluating and managing AH related to cancer treatments. Patients should be divided into 4 cardiovascular (CV) risk groups before starting potentially cardiotoxic therapies: patients with low/moderate risk who should be entirely evaluated by oncologists and patients with high/very high risk who should be referred to a cardiologist or arterial hypertension specialist. According to the CV risk class, every patient should be followed up during cancer treatment to monitor any possible CV complications. Adequate control of AH related to antineoplastic treatments is crucial to prevent severe CVAEs. In the presence of high-profile risk or lack of response to anti-hypertensive therapy, the patients should be managed with a cardiovascular-oncology expert center.
      Citation: Hearts
      PubDate: 2021-01-15
      DOI: 10.3390/hearts2010006
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 74-86: Percutaneous Mitral Valve Repair with the
           MitraClip System in the Current Clinical Practice

    • Authors: Sergio Sorrentino, Alessandra Berardini, Giovanni Statuto, Andrea Angeletti, Giulia Massaro, Claudio Capobianco, Giuseppe Pio Piemontese, Alberto Spadotto, Sebastiano Toniolo, Angelo Giuseppe Caponetti, Raffaello Ditaranto, Vanda Parisi, Matteo Minnucci, Valentina Ferrara, Nazzareno Galiè, Elena Biagini
      First page: 74
      Abstract: Severe mitral valve regurgitation (MR) carries a significant burden both in prognosis and quality of life of patients, as well as on healthcare systems, with high rates of hospitalization for heart failure. While mitral valve surgery constitutes the first-line treatment option for primary MR in suitable patients, surgical treatment for secondary severe MR remains controversial, with a substantial lack of evidence on a survival benefit. In recent decades, percutaneous mitral valve repair has emerged as an alternative treatment for patients deemed not suitable for surgery. Among several devices under development or evaluation, the MitraClip system is the most widespread and is supported by the strongest evidence. While the role of MitraClip in patients with chronic primary MR who are not deemed suitable for surgery is well established, with consistent data showing improvement in both prognosis and quality of life, MitraClip treatment in secondary MR is a rapidly evolving field. Two recent randomized clinical trials generated apparently controversial results but actually provided an interesting pathophysiologic frame that could help discerning patients who will benefit from the procedure versus patients who will not. In this review, we will discuss current treatment options for mitral regurgitation, focusing on percutaneous mitral valve repair with the MitraClip system.
      Citation: Hearts
      PubDate: 2021-01-22
      DOI: 10.3390/hearts2010007
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 87-118: Cardiac Development: A Glimpse on Its
           Translational Contributions

    • Authors: Diego Franco, Carlos Garcia-Padilla, Jorge N. Dominguez, Estefania Lozano-Velasco, Amelia Aranega
      First page: 87
      Abstract: Cardiac development is a complex developmental process that is initiated soon after gastrulation, as two sets of precardiac mesodermal precursors are symmetrically located and subsequently fused at the embryonic midline forming the cardiac straight tube. Thereafter, the cardiac straight tube invariably bends to the right, configuring the first sign of morphological left–right asymmetry and soon thereafter the atrial and ventricular chambers are formed, expanded and progressively septated. As a consequence of all these morphogenetic processes, the fetal heart acquired a four-chambered structure having distinct inlet and outlet connections and a specialized conduction system capable of directing the electrical impulse within the fully formed heart. Over the last decades, our understanding of the morphogenetic, cellular, and molecular pathways involved in cardiac development has exponentially grown. Multiples aspects of the initial discoveries during heart formation has served as guiding tools to understand the etiology of cardiac congenital anomalies and adult cardiac pathology, as well as to enlighten novels approaches to heal the damaged heart. In this review we provide an overview of the complex cellular and molecular pathways driving heart morphogenesis and how those discoveries have provided new roads into the genetic, clinical and therapeutic management of the diseased hearts.
      Citation: Hearts
      PubDate: 2021-02-04
      DOI: 10.3390/hearts2010008
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 119-126: Impact of Obstructive Sleep Apnea on
           In-Hospital Outcomes of Patients with Non-ST Elevation Myocardial

    • Authors: Sakiru Oyetunji Isa, Oluwole Adegbala, Olajide Buhari, Mahin Khan, Orimisan Adekolujo, Oyebimpe Adekolujo, Ahmad Munir, Mustafa Hassan
      First page: 119
      Abstract: Background: Obstructive sleep apnea (OSA) is one of the most common breathing disorders. There are uncertainties about its impact on the in-hospital outcomes of patients who suffer acute coronary syndromes. We studied the largest publicly available all-payer inpatient healthcare database in the United States (National Inpatient Sample) to determine the effects of obstructive sleep apnea on the in-hospital outcomes of patients admitted with non-ST elevation myocardial infarction (NSTEMI). Methods: All adult patients (age ≥ 18) admitted primarily for NSTEMI between September 2010 and September 2015 were identified in the National Inpatient Sample. They were then categorized into those with OSA and those without OSA. The main outcome was in-hospital mortality. Propensity scoring and logistic regression models were created to determine the outcomes. Results: There were 1,984,432 patients with NSTEMI (weighted estimates), 123,551 (6.23%) of who had diagnosed OSA while 1,860,881 (93.77%) did not. In-hospital mortality was significantly lower in the OSA group [2.61% vs. 3.53%, adjusted odd ratio (aOR) 0.73 and confidence interval (CI) (0.66–0.81)]. Patients with OSA were also less likely to require coronary artery bypass surgery: 13.85% and 12.77% (p-value 0.0003). The patients with OSA had higher mean hospital costs compared to the patients who did not have OSA: $17,326 vs. $16,984, adjusted mean ratio (aMR) 1.02; CI (1.01–1.02). Conclusion: In-hospital mortality was lower in NSTEMI patients with diagnosed OSA compared to patients without diagnosed OSA. This appears to contrast with the widely recognized adverse effects of OSA on the cardiovascular system.
      Citation: Hearts
      PubDate: 2021-02-07
      DOI: 10.3390/hearts2010009
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 127-138: Durable Continuous-Flow Mechanical
           Circulatory Support: State of the Art

    • Authors: Antonio Loforte, Luca Botta, Silvia Boschi, Gregorio Gliozzi, Giulio Giovanni Cavalli, Carlo Mariani, Sofia Martin Suarez, Davide Pacini
      First page: 127
      Abstract: Implantable mechanical circulatory support (MCS) systems for ventricular assist device (VAD) therapy have emerged as an important strategy due to a shortage of donor organs for heart transplantation. A growing number of patients are receiving permanent assist devices, while fewer are undergoing heart transplantation (Htx). Continuous-flow (CF) pumps, as devices that can be permanently implanted, show promise for the treatment of both young and old patients with heart failure (HF). Further improvement of these devices will decrease adverse events, enable pulse modulation of continuous blood flow, and improve automatic remote monitoring. Ease of use for patients could also be improved. We herein report on the current state of the art regarding implantable CF pumps for use as MCS systems in the treatment of advanced refractory HF.
      Citation: Hearts
      PubDate: 2021-02-12
      DOI: 10.3390/hearts2010010
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 139-148: Extracellular and Intracellular Magnesium
           Deficiency Found in Pregnant Women with Preeclampsia and Gestational
           Diabetes Is Associated with Overexpression of Notch Proteins, Cytokines,
           p53, NF-kB and Proto-Oncogenes: Potential Importance in Growth
           Retardation, Stillbirths, Fetal Mutations and Increased Cardiovascular
           Risks and Stroke with Advancing Age in Pregnant Women

    • Authors: Burton M. Altura, Anthony Carella, Nilank C. Shah, Gatha J. Shah, Lawrence M. Resnick, Sara M. Handwerker, Bella T. Altura
      First page: 139
      Abstract: In 1983, three of us reported in “Science” that umbilical-placental arteries and veins, obtained from normal pregnant women at term delivery, when exposed in vitro to low concentrations of Mg2+ went into vasospasm; the lower the Mg2+, the greater the contractile force developed. These blood vessels also demonstrated amplified contractile force development when challenged with circulating amines and peptides (e.g., norepinephrine, 5-HT, angiotensin II, etc.). We suggested that severe Mg deficiency during pregnancy could in part be responsible for spontaneous abortions, loss of fetuses, stillbirths, and developmental alterations in infants. Using short-term dietary Mg deficient animals, we have noted a great many molecular and biochemical alterations in ventricular, atrial and somatic vascular smooth muscle alterations including DNA methylation and histone changes leading us to speculate that Mg deficiency may represent a genotoxin promoting mutations and causing epigenetic changes. Over the last 35 years, we have new data on severely preeclamptic and gestational diabetic pregnant women that gives credence to our original hypothesis and demonstrates that recently- discovered developmental proteins, originally found 100 years ago in Drosophila fruit flies termed the “Notch pathway”, due to effects on its wings, appears to be important in development of the umbilical-placental blood vessels in pregnant women. Along with the developmental molecule, p53, these Notch proteins clearly alter the behavior of the umbilical-placental vessels. We believe these new findings probably help to explain many of the genetic-toxicity effects seen in women later in life who develop strokes and cardiovascular diseases. Notch alterations could also play an important role in babies born with cardiac defects.
      Citation: Hearts
      PubDate: 2021-03-05
      DOI: 10.3390/hearts2010011
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 149-155: Towards a Better Understanding of
           PTSD/Hypertension Associations: Examining Sociodemographic Aspects

    • Authors: Jeffrey L. Kibler, Mindy Ma
      First page: 149
      Abstract: The present study is an examination of sociodemographic and environmental correlates of hypertension and post-traumatic stress disorder (PTSD), with the goal of better understanding previously identified PTSD and hypertension associations. Data from 5877 adults up to age 54 were analyzed to examine racial and ethnic differences in hypertension, and relationships of socioeconomic status (SES; total family income), employment status, and marital status, and urbanicity (urban, suburban, or rural habitation) with hypertension and PTSD. Next, a total model was tested to determine which sociodemographic and environmental variables, and/or PTSD were significant independent correlates of hypertension. Higher rates of hypertension were evident among African Americans (13.8%), relative to Caucasian (7.7%) or Hispanic (6.7%) participants (p < 0.001). Low SES (family income under USD 19,000) and unemployment were associated with significantly greater likelihood (p < 0.001) of hypertension (9.8% vs. 7.6% for low SES; 14.3% vs. 8.3% for unemployment) and PTSD (16.6% vs. 8.7% for low SES; 21.3% vs. 9.6% for unemployment). Participants who were married versus those separated or divorced were significantly less likely (p < 0.001) to have hypertension (9.0% vs. 11.9%) or PTSD (10.8% vs. 18.3%). Urbanicity was not significantly associated with hypertension or PTSD. Unemployment and PTSD were the only significant independent factors associated with hypertension.
      Citation: Hearts
      PubDate: 2021-03-21
      DOI: 10.3390/hearts2010012
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 156-169: Cardiac Contractility Modulation in
           Patients with Heart Failure with Reduced Left Ventricular Ejection

    • Authors: Francesco Giallauria, Alessandro Parlato, Anna Di Lorenzo, Crescenzo Testa, Antonio D’Onofrio, Gianfranco Sinagra, Mauro Biffi, Carlo Vigorito, Andrew J. S. Coats
      First page: 156
      Abstract: Cardiac contractility modulation is an innovative therapy conceived for the treatment of heart failure. It is a device-based therapy, employing multiple electrodes to deliver relatively high-voltage (~7.5 V) biphasic signals to the endocardium of the right ventricular septum, in order to improve heart failure symptoms, exercise capacity and quality of life. Multiple clinical and mechanistic studies have been conducted to investigate the potential usefulness of this technology and, as of now, they suggest that it could have a place in therapy and meet a relevant medical need for a specific sub-category of underserved heart failure patients with reduced left ventricular ejection fraction. More studies are needed to further investigate its effect on outcomes such as mortality and rate of hospitalizations.
      Citation: Hearts
      PubDate: 2021-03-22
      DOI: 10.3390/hearts2010013
      Issue No: Vol. 2, No. 1 (2021)
  • Hearts, Vol. 2, Pages 170-187: Molecular Basis of Atrial Fibrillation
           Initiation and Maintenance

    • Authors: Kira Beneke, Cristina E. Molina
      First page: 170
      Abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia, largely associated to morbidity and mortality. Over the past decades, research in appearance and progression of this arrhythmia have turned into significant advances in its management. However, the incidence of AF continues to increase with the aging of the population and many important fundamental and translational underlaying mechanisms remain elusive. Here, we review recent advances in molecular and cellular basis for AF initiation, maintenance and progression. We first provide an overview of the basic molecular and electrophysiological mechanisms that lead and characterize AF. Next, we discuss the upstream regulatory factors conducting the underlying mechanisms which drive electrical and structural AF-associated remodeling, including genetic factors (risk variants associated to AF as transcriptional regulators and genetic changes associated to AF), neurohormonal regulation (i.e., cAMP) and oxidative stress imbalance (cGMP and mitochondrial dysfunction). Finally, we discuss the potential therapeutic implications of those findings, the knowledge gaps and consider future approaches to improve clinical management.
      Citation: Hearts
      PubDate: 2021-03-23
      DOI: 10.3390/hearts2010014
      Issue No: Vol. 2, No. 1 (2021)
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Heriot-Watt University
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