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Article ; Online: Advances in cardiac resynchronization and implantable cardioverter/defibrillator therapy: Medtronic Cobalt and Crome.

Gierula, John / Paton, Maria F / Witte, Klaus K

2021 Volume 17, Issue 4, Page(s) 609–618

Abstract: Cardiovascular implantable electronic devices have revolutionized the management of heart failure with reduced ejection fraction. New device generations tend to be launched every few years, with incremental improvements in performance and safety and with ...

Abstract	Cardiovascular implantable electronic devices have revolutionized the management of heart failure with reduced ejection fraction. New device generations tend to be launched every few years, with incremental improvements in performance and safety and with an expectation that these will improve patient management and outcomes while remaining cost-effective. As a result, today's cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator devices are quite different from the pioneering but often bulky devices of the late 20th century. This review discusses new and improved features developed to target specific needs in managing heart failure patients, some of which are especially pertinent to the current worldwide healthcare situation, with focus on the latest generation of CRTs with defibrillator (CRT-Ds) and implantable cardioverter defibrillators from Medtronic.
MeSH term(s)	Cardiac Resynchronization Therapy ; Cardiac Resynchronization Therapy Devices ; Cobalt ; Defibrillators, Implantable ; Heart Failure/therapy ; Humans ; Treatment Outcome
Chemical Substances	Cobalt (3G0H8C9362)
Language	English
Publishing date	2021-02-26
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2274267-0
ISSN	1744-8298 ; 1479-6678
ISSN (online)	1744-8298
ISSN	1479-6678
DOI	10.2217/fca-2020-0117
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Zs.A 6836: Show issues

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Article ; Online: Heart failure and right ventricular pacing - how to avoid the need for cardiac resynchronization therapy.

Paton, Maria F / Witte, Klaus K

Expert review of medical devices

2018 Volume 16, Issue 1, Page(s) 35–43

Abstract: Introduction: Heart failure (HF) is a common finding in patients with pacemakers implanted for bradycardia, with cross-sectional and longitudinal studies contributing to the growing consensus that right ventricular pacing can cause adverse cardiac ... ...

Abstract	Introduction: Heart failure (HF) is a common finding in patients with pacemakers implanted for bradycardia, with cross-sectional and longitudinal studies contributing to the growing consensus that right ventricular pacing can cause adverse cardiac remodeling and left ventricular systolic dysfunction increasing the risk of hospitalization and death. An unselected approach using cardiac resynchronization therapy from the time of first implant in patients with heart block has produced equivocal results. Contemporary research has therefore begun to focus on the stratification of patients' risk of pacemaker-associated impairment to permit focused, personalized management. Areas covered: The present review will describe the incidence and relevance of HF in the pacemaker population and discuss current management options for such patients. Expert commentary: At present there are few contemporary data to guide the identification of patients with and at risk of pacemaker-associated cardiac remodeling and dysfunction. Emphasis must be placed on precise and personalized treatment approaches which currently remain under-investigated due to a number of challenges, for example, small sample sizes, limited clarity on programmed settings, and short follow-up periods.
MeSH term(s)	Cardiac Pacing, Artificial ; Cardiac Resynchronization Therapy ; Heart Failure/therapy ; Heart Ventricles/physiopathology ; Humans ; Treatment Outcome ; Ventricular Dysfunction, Left/physiopathology ; Ventricular Dysfunction, Left/prevention & control ; Ventricular Dysfunction, Left/therapy
Language	English
Publishing date	2018-12-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2250857-0
ISSN	1745-2422 ; 1743-4440
ISSN (online)	1745-2422
ISSN	1743-4440
DOI	10.1080/17434440.2019.1552133
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Zs.A 6424: Show issues

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Article: The athlete's heart: insights from echocardiography.

Flanagan, Harry / Cooper, Robert / George, Keith P / Augustine, Daniel X / Malhotra, Aneil / Paton, Maria F / Robinson, Shaun / Oxborough, David

Echo research and practice

2023 Volume 10, Issue 1, Page(s) 15

Abstract: The manifestations of the athlete's heart can create diagnostic challenges during an echocardiographic assessment. The classifications of the morphological and functional changes induced by sport participation are often beyond 'normal limits' making it ... ...

Abstract	The manifestations of the athlete's heart can create diagnostic challenges during an echocardiographic assessment. The classifications of the morphological and functional changes induced by sport participation are often beyond 'normal limits' making it imperative to identify any overlap between pathology and normal physiology. The phenotype of the athlete's heart is not exclusive to one chamber or function. Therefore, in this narrative review, we consider the effects of sporting discipline and training volume on the holistic athlete's heart, as well as demographic factors including ethnicity, body size, sex, and age.
Language	English
Publishing date	2023-10-18
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2777997-X
ISSN	2055-0464
ISSN	2055-0464
DOI	10.1186/s44156-023-00027-8
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Article ; Online: Diabetes mellitus does not alter mortality or hospitalisation risk in patients with newly diagnosed heart failure with preserved ejection fraction: Time to rethink pathophysiological models of disease progression.

Gierula, John / Straw, Sam / Cole, Charlotte A / Lowry, Judith E / Paton, Maria F / McGinlay, Melanie / Witte, Klaus K / Grant, Peter J / Wheatcroft, Stephen B / Drozd, Michael / Slater, Thomas A / Cubbon, Richard M / Kearney, Mark T

Diabetes & vascular disease research

2024 Volume 21, Issue 2, Page(s) 14791641231224241

Abstract: Introduction: Type 2 diabetes is a common and adverse prognostic co-morbidity for patients with heart failure with reduced ejection fraction (HFrEF). The effect of diabetes on long-term outcomes for heart failure with preserved ejection fraction (HFpEF) ...

Abstract	Introduction: Type 2 diabetes is a common and adverse prognostic co-morbidity for patients with heart failure with reduced ejection fraction (HFrEF). The effect of diabetes on long-term outcomes for heart failure with preserved ejection fraction (HFpEF) is less established. Methods: Prospective cohort study of patients referred to a regional HF clinic with newly diagnosed with HFrEF and HFpEF according to the 2016 European Society of Cardiology guidelines. The association between diabetes, all-cause mortality and hospitalisation was quantified using Kaplan-Meier or Cox regression analysis. Results: Between 1st May 2012 and 1st May 2013, of 960 unselected consecutive patients referred with suspected HF, 464 and 314 patients met the criteria for HFpEF and HFrEF respectively. Within HFpEF and HFrEF groups, patients with diabetes were more frequently male and in both groups patients with diabetes were more likely to be treated with β-adrenoceptor antagonists and angiotensin converting enzyme inhibitors. After adjustment for age, sex, medical therapy and co-morbidities, diabetes was associated with increased mortality in individuals with HFrEF (HR 1.46 95% CI: 1.05-2.02; Conclusion: In unselected patients with newly diagnosed HF, diabetes is not an adverse prognostic marker in patients with HFpEF, but is in HFrEF.
MeSH term(s)	Humans ; Male ; Heart Failure ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/diagnosis ; Prospective Studies ; Stroke Volume/physiology ; Disease Progression ; Prognosis ; Hospitalization
Language	English
Publishing date	2024-04-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2250793-0
ISSN	1752-8984 ; 1479-1641
ISSN (online)	1752-8984
ISSN	1479-1641
DOI	10.1177/14791641231224241
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Article: Atrial secondary mitral regurgitation: prevalence, characteristics, management, and long-term outcomes.

Straw, Sam / Gupta, Ankit / Johnson, Kerryanne / Cole, Charlotte A / Kneizeh, Kinan / Gierula, John / Kearney, Mark T / Malkin, Christopher J / Paton, Maria F / Witte, Klaus K / Schlosshan, Dominik

Echo research and practice

2023 Volume 10, Issue 1, Page(s) 4

Abstract: Background: The prevalence, clinical characteristics, management and long-term outcomes of patients with atrial secondary mitral regurgitation (ASMR) are not well described.: Methods: We performed a retrospective, observational study of consecutive ... ...

Abstract	Background: The prevalence, clinical characteristics, management and long-term outcomes of patients with atrial secondary mitral regurgitation (ASMR) are not well described. Methods: We performed a retrospective, observational study of consecutive patients with grade III/IV MR determined by transthoracic echocardiography. The aetiology of MR was grouped as being either primary (due to degenerative mitral valve disease), ventricular SMR (VSMR: due to left ventricular dilatation/dysfunction), ASMR (due to LA dilatation), or other. Results: A total of 388 individuals were identified who had grade III/IV MR; of whom 37 (9.5%) had ASMR, 113 (29.1%) had VSMR, 193 had primary MR (49.7%), and 45 (11.6%) were classified as having other causes. Compared to MR of other subtypes, patients with ASMR were on average older (median age 82 [74-87] years, p < 0.001), were more likely to be female (67.6%, p = 0.004) and usually had atrial fibrillation (83.8%, p = 0.001). All-cause mortality was highest in patients with ASMR (p < 0.001), but similar to that in patients with VSMR once adjusted for age and sex (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.52-1.25). Hospitalisation for worsening heart failure was more commonly observed in those with ASMR or VSMR (p < 0.001) although was similar between these groups when age and sex were accounted for (HR 0.74, 95% CI 0.34-1.58). For patients with ASMR, the only variables associated with outcomes were age and co-morbidities. Conclusions: ASMR is a prevalent and distinct disease process associated with a poor prognosis, with much of this related to older age and co-morbidities.
Language	English
Publishing date	2023-03-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2777997-X
ISSN	2055-0464
ISSN	2055-0464
DOI	10.1186/s44156-023-00015-y
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Article ; Online: Left bundle branch pacing better preserves ventricular mechanical synchrony than right ventricular pacing: a two-centre study.

Mao, Yankai / Duchenne, Jürgen / Yang, Yuan / Garweg, Christophe / Yang, Ying / Sheng, Xia / Zhang, Jiefang / Ye, Yang / Wang, Min / Paton, Maria F / Puvrez, Alexis / Vöros, Gabor / Ma, Mingming / Fu, Guosheng / Voigt, Jens-Uwe

European heart journal. Cardiovascular Imaging

2023 Volume 25, Issue 3, Page(s) 328–336

Abstract: Aims: Left bundle branch pacing (LBBP) has been shown to better maintain electrical synchrony compared with right ventricular pacing (RVP), but little is known about its impact on mechanical synchrony. This study investigates whether LBBP better ... ...

Abstract	Aims: Left bundle branch pacing (LBBP) has been shown to better maintain electrical synchrony compared with right ventricular pacing (RVP), but little is known about its impact on mechanical synchrony. This study investigates whether LBBP better preserves left ventricular (LV) mechanical synchronicity and function compared with RVP. Methods and results: Sixty patients with pacing indication for bradycardia were included: LBBP (n = 31) and RVP (n = 29). Echocardiography was performed before and shortly after pacemaker implantation and at 1-year follow-up. The lateral wall-septal wall (LW-SW) work difference was used as a measure of mechanical dyssynchrony. Septal flash, apical rocking, and septal strain patterns were also assessed. At baseline, LW-SW work difference was small and similar in two groups. SW was markedly decreased, while LW work remained mostly unchanged in RVP, resulting in a larger LW-SW work difference compared with LBBP (1253 ± 687 mmHg·% vs. 439 ± 408 mmHg·%, P < 0.01) at last follow-up. In addition, RVP more often induced septal flash or apical rocking and resulted in more advanced strain patterns compared with LBBP. At 1 year follow-up, LV ejection fraction (EF) and global longitudinal strain (GLS) were more decreased in RVP compared with LBBP (ΔLVEF: -7.4 ± 7.0% vs. 0.3 ± 4.1%; ΔLVGLS: -4.8 ± 4.0% vs. -1.4 ± 2.5%, both P < 0.01). In addition, ΔLW-SW work difference was independently correlated with LV adverse remodelling (r = 0.42, P < 0.01) and LV dysfunction (ΔLVEF: r = -0.61, P < 0.01 and ΔLVGLS: r = -0.38, P = 0.02). Conclusion: LBBP causes less LV mechanical dyssynchrony than RVP as it preserves a more physiologic electrical conduction. As a consequence, LBBP appears to preserve LV function better than RVP.
MeSH term(s)	Humans ; Cardiac Pacing, Artificial/methods ; Electrocardiography ; Heart Ventricles/diagnostic imaging ; Ventricular Septum ; Heart Conduction System ; Ventricular Function, Left/physiology ; Ventricular Remodeling ; Treatment Outcome
Language	English
Publishing date	2023-11-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2638345-7
ISSN	2047-2412 ; 2047-2404
ISSN (online)	2047-2412
ISSN	2047-2404
DOI	10.1093/ehjci/jead296
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Zs.A 5614: Show issues

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Article ; Online: To the Editor-New phones, old problem? Interference with cardiovascular implantable electronic devices by phones containing magnets.

Patterson, Zara / Straw, Sam / Drozd, Michael / Paton, Maria F / Cole, Charlotte / Witte, Klaus K / Gierula, John

Heart rhythm

2021 Volume 18, Issue 6, Page(s) 1041

MeSH term(s)	Defibrillators, Implantable/adverse effects ; Electronics ; Magnets/adverse effects ; Pacemaker, Artificial
Language	English
Publishing date	2021-02-03
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2229357-7
ISSN	1556-3871 ; 1547-5271
ISSN (online)	1556-3871
ISSN	1547-5271
DOI	10.1016/j.hrthm.2021.01.029
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Article ; Online: 4D Flow Cardiac MR in Primary Mitral Regurgitation.

Journal of magnetic resonance imaging : JMRI

2024

Abstract: Background: Four-dimensional-flow cardiac MR (4DF-MR) offers advantages in primary mitral regurgitation. The relationship between 4DF-MR-derived mitral regurgitant volume (MR-Rvol) and the post-operative left ventricular (LV) reverse remodeling has not ... ...

Abstract	Background: Four-dimensional-flow cardiac MR (4DF-MR) offers advantages in primary mitral regurgitation. The relationship between 4DF-MR-derived mitral regurgitant volume (MR-Rvol) and the post-operative left ventricular (LV) reverse remodeling has not yet been established. Purpose: To ascertain if the 4DF-MR-derived MR-Rvol correlates with the LV reverse remodeling in primary mitral regurgitation. Study type: Prospective, single-center, two arm, interventional vs. nonintervention observational study. Population: Forty-four patients (male N = 30; median age 68 [59-75]) with at least moderate primary mitral regurgitation; either awaiting mitral valve surgery (repair [MVr], replacement [MVR]) or undergoing "watchful waiting" (WW). Field strength/sequence: 5 T/Balanced steady-state free precession (bSSFP) sequence/Phase contrast imaging/Multishot echo-planar imaging pulse sequence (five shots). Assessment: Patients underwent transthoracic echocardiography (TTE), phase-contrast MR (PMRI), 4DF-MR and 6-minute walk test (6MWT) at baseline, and a follow-up PMRI and 6MWT at 6 months. MR-Rvol was quantified by PMRI, 4DF-MR, and TTE by one observer. The pre-operative MR-Rvol was correlated with the post-operative decrease in the LV end-diastolic volume index (LVEDVi). Statistical tests: Included Student t-test/Mann-Whitney test/Fisher's exact test, Bland-Altman plots, linear regression analysis and receiver operating characteristic curves. Statistical significance was defined as P < 0.05. Results: While Bland-Altman plots demonstrated similar bias between all the modalities, the limits of agreement were narrower between 4DF-MR and PMRI (bias 15; limits of agreement -36 mL to 65 mL), than between 4DF-MR and TTE (bias -8; limits of agreement -106 mL to 90 mL) and PMRI and TTE (bias -23; limits of agreement -105 mL to 59 mL). Linear regression analysis demonstrated a significant association between the MR-Rvol and the post-operative decrease in the LVEDVi, when the MR-Rvol was quantified by PMRI and 4DF-MR, but not by TTE (P = 0.73). 4DF-MR demonstrated the best diagnostic performance for reduction in the post-operative LVEDVi with the largest area under the curve (4DF-MR 0.83; vs. PMRI 0.78; and TTE 0.51; P = 0.89). Data conclusion: This study demonstrates the potential clinical utility of 4DF-MR in the assessment of primary mitral regurgitation. Evidence level: 2 TECHNICAL EFFICACY: Stage 5.
Language	English
Publishing date	2024-02-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1146614-5
ISSN	1522-2586 ; 1053-1807
ISSN (online)	1522-2586
ISSN	1053-1807
DOI	10.1002/jmri.29284
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Zs.A 3648: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Projected longevities of cardiac implantable defibrillators: a retrospective analysis over the period 2007-17 and the impact of technological factors in determining longevity.

Paton, Maria F / Landolina, Maurizio / Billuart, Jean-Renaud / Field, Duncan / Sibley, Jonathan / Witte, Klaus

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

2019 Volume 22, Issue 1, Page(s) 149–155

Abstract: Aims: Implanters of cardiac implantable electronic devices cannot easily choose devices by longevity as usually current models only have projected longevity data since those with known performance are obsolete. This study examines how projected device ... ...

Abstract	Aims: Implanters of cardiac implantable electronic devices cannot easily choose devices by longevity as usually current models only have projected longevity data since those with known performance are obsolete. This study examines how projected device longevities are derived, the influencing factors, and their roles in guiding model choice. Methods and results: Ninety-eight implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) models released in Europe in 2007-17 were analysed for reported battery capacities, projected longevities for standardized settings stipulated by the French Haute Autorité de Santé (HAS) and manufacturer-chosen settings. Battery capacities and HAS projected longevities increased during the study period. Based on current drain estimation, therapy functions consumed only a small portion (2-7%) of the battery energy for single- and dual-chamber ICDs, but up to 50% (from biventricular pacing) for CRT-Ds. Large differences exist between manufacturers and models both in terms of battery capacity and energy consumption. Conclusion: Battery capacity is not the sole driver of longevity for electronic implantable cardiac devices and, particularly for ICDs, the core function consume a large part of the battery energy even in the absence of therapy. Providing standardized current drain consumption in addition to battery capacity may provide more meaningful longevity information among implantable electronic cardiac devices.
MeSH term(s)	Cardiac Resynchronization Therapy ; Cardiac Resynchronization Therapy Devices ; Defibrillators, Implantable ; Device Removal ; Electric Countershock ; Equipment Design ; Equipment Failure ; Europe ; Heart Failure/diagnosis ; Heart Failure/therapy ; Humans ; Longevity ; Retrospective Studies ; Time Factors
Language	English
Publishing date	2019-08-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1449879-0
ISSN	1532-2092 ; 1099-5129
ISSN (online)	1532-2092
ISSN	1099-5129
DOI	10.1093/europace/euz222
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Article ; Online: Guideline-directed medical therapy is similarly effective in heart failure with mildly reduced ejection fraction.

Straw, Sam / Cole, Charlotte A / McGinlay, Melanie / Drozd, Michael / Slater, Thomas A / Lowry, Judith E / Paton, Maria F / Levelt, Eylem / Cubbon, Richard M / Kearney, Mark T / Witte, Klaus K / Gierula, John

Clinical research in cardiology : official journal of the German Cardiac Society

2022 Volume 112, Issue 1, Page(s) 111–122

Abstract: Aims: Current guidelines recommend that disease-modifying pharmacological therapies may be considered for patients who have heart failure with mildly reduced ejection fraction (HFmrEF). We aimed to describe the characteristics, outcomes, provision of ... ...

Abstract	Aims: Current guidelines recommend that disease-modifying pharmacological therapies may be considered for patients who have heart failure with mildly reduced ejection fraction (HFmrEF). We aimed to describe the characteristics, outcomes, provision of pharmacological therapies and dose-related associations with mortality risk in HFmrEF. Methods and results: We explored data from two prospective observational studies, which permitted the examination of the effects of pharmacological therapies across a broad spectrum of left ventricular ejection fraction (LVEF). The combined dataset consisted of 2388 unique patients, with a mean age of 73.7 ± 13.2 years of whom 1525 (63.9%) were male. LVEF ranged from 5 to 71% (mean 37.2 ± 12.8%) and 1504 (63.0%) were categorised as having reduced ejection fraction (HFrEF), 421 (17.6%) as HFmrEF and 463 (19.4%) as preserved ejection fraction (HFpEF). Patients with HFmrEF more closely resembled HFrEF than HFpEF. Adjusted all-cause mortality risk was lower in HFmrEF (hazard ratio [HR] 0.86 (95% confidence interval [CI] 0.74-0.99); p = 0.040) and in HFpEF (HR 0.61 (95% CI 0.52-0.71); p < 0.001) compared to HFrEF. Adjusted all-cause mortality risk was lower in patients with HFrEF and HFmrEF who received the highest doses of beta-blockers or renin-angiotensin inhibitors. These associations were not evident in HFpEF. Once adjusted for relevant confounders, each mg equivalent of bisoprolol (HR 0.95 [95% CI 0.91-1.00]; p = 0.047) and ramipril (HR 0.95 [95%CI 0.90-1.00]; p = 0.044) was associated with incremental reductions in mortality risk in patients with HFmrEF. Conclusions: Pharmacological therapies were associated with lower mortality risk in HFmrEF, supporting guideline recommendations which extend the indications of these agents to all patients with LVEF < 50%. HFmrEF more closely resembles HFrEF in terms of clinical characteristics and outcomes. Pharmacological therapies are associated with lower mortality risk in HFmrEF and HFrEF, but not in HFpEF.
MeSH term(s)	Humans ; Male ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Heart Failure ; Stroke Volume ; Ventricular Function, Left ; Prognosis ; Ventricular Dysfunction, Left
Language	English
Publishing date	2022-07-04
Publishing country	Germany
Document type	Observational Study ; Journal Article
ZDB-ID	2213295-8
ISSN	1861-0692 ; 1861-0684
ISSN (online)	1861-0692
ISSN	1861-0684
DOI	10.1007/s00392-022-02053-8
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