Frequency of Cardiac Rhythm Abnormalities in a Half Million Adults

Khurshid, Shaan; Choi, Seung Hoan; Weng, Lu‐Chen; Wang, Elizabeth; Trinquart, Ludovic; Benjamin, Emelia J.; Ellinor, Patrick T.; Lubitz, Steven A.

doi:10.1161/circep.118.006273

Cited by 198 publications

(155 citation statements)

References 29 publications

(39 reference statements)

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“…Abnormal neurosonology examination can represent AF as simple extra-systolic beats and consequently the specificity of this examination as a predictor of AF appears low. However, AF appears to account for a substantial proportion of rhythm abnormalities [47]. Even if the cardiac arrhythmia detected by neurosonology examinations is finally diagnosed as paroxysmal supraventricular tachycardia (PSVT) in ECG studies, this is also clinically relevant information, as PSVT patients have higher prevalence rate of AF [48].…”

Section: Discussionmentioning

confidence: 99%

Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

Liantinioti

Palaiodimou

Tympas

et al. 2019

JCM

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Background: Occult paroxysmal atrial fibrillation (PAF) is a common and potential treatable cause of cryptogenic stroke (CS). We sought to prospectively identify independent predictors of atrial fibrillation (AF) detection in patients with CS and sinus rhythm on baseline electrocardiogram (ECG), without prior AF history. We had hypothesized that cardiac arrhythmia detection during neurosonology examinations (Carotid Duplex (CDU) and Transcranial Doppler (TCD)) may be associated with higher likelihood of AF detection. Methods: Consecutive CS patients were prospectively evaluated over a six-year period. Demographics, clinical and imaging characteristics of cerebral ischemia were documented. The presence of arrhythmia during spectral waveform analysis of CDU/TCD was recorded. Left atrial enlargement was documented during echocardiography using standard definitions. The outcome event of interest included PAF detection on outpatient 24-h Holter ECG recordings. Statistical analyses were performed using univariate and multivariate logistic regression models. Results: A total of 373 patients with CS were evaluated (mean age 60 ± 11 years, 67% men, median NIHSS-score 4 points). The rate of PAF detection of any duration on Holter ECG recordings was 11% (95% CI 8%–14%). The following three variables were independently associated with the likelihood of AF detection on 24-h Holter-ECG recordings in both multivariate analyses adjusting for potential confounders: age (OR per 10-year increase: 1.68; 95% CI: 1.19–2.37; p = 0.003), moderate or severe left atrial enlargement (OR: 4.81; 95% CI: 1.77–13.03; p = 0.002) and arrhythmia detection during neurosonology evaluations (OR: 3.09; 95% CI: 1.47–6.48; p = 0.003). Conclusion: Our findings underline the potential utility of neurosonology in improving the detection rate of PAF in patients with CS.

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Section: Discussionmentioning

confidence: 99%

Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

Liantinioti

Palaiodimou

Tympas

et al. 2019

JCM

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“…Coronary and peripheral artery diseases (CAD and PAD) remain the major causes of morbidity and mortality in Western countries, despite current medical and surgical options [ 1 ]. Therapeutic angiogenesis aims at restoring the blood supply in ischemic tissues by delivering factors that control vascular growth and is an attractive strategy to improve treatment of these disabling and often fatal conditions.…”

Section: Introductionmentioning

confidence: 99%

PDGF-BB regulates splitting angiogenesis in skeletal muscle by limiting VEGF-induced endothelial proliferation

et al. 2018

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VEGF induces normal or aberrant angiogenesis depending on its dose in the microenvironment around each producing cell in vivo. This transition depends on the balance between VEGF-induced endothelial stimulation and PDGF-BB-mediated pericyte recruitment, and co-expression of PDGF-BB normalizes aberrant angiogenesis despite high VEGF doses. We recently found that VEGF over-expression induces angiogenesis in skeletal muscle through an initial circumferential vascular enlargement followed by longitudinal splitting, rather than sprouting. Here we investigated the cellular mechanism by which PDGF-BB co-expression normalizes VEGF-induced aberrant angiogenesis. Monoclonal populations of transduced myoblasts, expressing similarly high levels of VEGF alone or with PDGF-BB, were implanted in mouse skeletal muscles. PDGF-BB co-expression did not promote sprouting and angiogenesis that occurred through vascular enlargement and splitting. However, enlargements were significantly smaller in diameter, due to a significant reduction in endothelial proliferation, and retained pericytes, which were otherwise lost with high VEGF alone. A time-course of histological analyses and repetitive intravital imaging showed that PDGF-BB co-expression anticipated the initiation of vascular enlargement and markedly accelerated the splitting process. Interestingly, quantification during in vivo imaging suggested that a global reduction in shear stress favored the initiation of transluminal pillar formation during VEGF-induced splitting angiogenesis. Quantification of target gene expression showed that VEGF-R2 signaling output was significantly reduced by PDGF-BB co-expression compared to VEGF alone. In conclusion, PDGF-BB co-expression prevents VEGF-induced aberrant angiogenesis by modulating VEGF-R2 signaling and endothelial proliferation, thereby limiting the degree of circumferential enlargement and enabling efficient completion of vascular splitting into normal capillary networks despite high VEGF doses.

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“…Arrhythmias can be classified into two types according to their origin: ventricular and supraventricular arrhythmias (Jenkins et al, 1979). Arrhythmias is an age-related disease (Hatch et al, 2011;Khurshid et al, 2018). For instance, the incidence of paroxysmal supraventricular arrhythmias is 14.8 per 100,000 person-years in adults aged 18 to 24 years, but in persons aged ≥65 years, the rate is increased to 231.9 per 100,000 person-years (Go et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Continuous Blood Pressure Estimation From Electrocardiogram and Photoplethysmogram During Arrhythmias

Liu

Zhou

et al. 2020

Front. Physiol.

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Objective: Continuous blood pressure (BP) provides valuable information for the disease management of patients with arrhythmias. The traditional intra-arterial method is too invasive for routine healthcare settings, whereas cuff-based devices are inferior in reliability and comfortable for long-term BP monitoring during arrhythmias. The study aimed to investigate an indirect method for continuous and cuff-less BP estimation based on electrocardiogram (ECG) and photoplethysmogram (PPG) signals during arrhythmias and to test its reliability for the determination of BP using invasive BP (IBP) as reference. Methods: Thirty-five clinically stable patients (15 with ventricular arrhythmias and 20 with supraventricular arrhythmias) who had undergone radiofrequency ablation were enrolled in this study. Their ECG, PPG, and femoral arterial IBP signals were simultaneously recorded with a multi-parameter monitoring system. Fifteen features that have the potential ability in indicating beat-to-beat BP changes during arrhythmias were extracted from the ECG and PPG signals. Four machine learning algorithms, decision tree regression (DTR), support vector machine regression (SVR), adaptive boosting regression (AdaboostR), and random forest regression (RFR), were then implemented to develop the BP models. Results: The results showed that the mean value ± standard deviation of root mean square error for the estimated systolic BP (SBP), diastolic BP (DBP) with the RFR model against the reference in all patients were 5.87 ± 3.13 and 3.52 ± 1.38 mmHg, respectively, which achieved the best performance among all the models. Furthermore, the mean error ± standard deviation of error between the estimated SBP and DBP with the RFR model against the reference in all patients were −0.04 ± 6.11 and 0.11 ± 3.62 mmHg, respectively, which complied with the Association for the

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Frequency of Cardiac Rhythm Abnormalities in a Half Million Adults

Cited by 198 publications

References 29 publications

Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

PDGF-BB regulates splitting angiogenesis in skeletal muscle by limiting VEGF-induced endothelial proliferation

Continuous Blood Pressure Estimation From Electrocardiogram and Photoplethysmogram During Arrhythmias

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