Search

Christian Madelaire,1,2 Thomas Gerds,3,4 Lars Køber,5 Finn Gustafsson,5 Charlotte Andersson,1,6 Søren Lund Kristensen,5 Jawad Haider Butt,1 Deewa Zahir Anjum,1 Ann Banke,2 Emil Loldrup Fosbøl,5 Gunnar Gislason,1,4 Christian Torp-Pedersen,7 Morten Schou1 1Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark; 2Department of Cardiology, Odense University Hospital, Odense, Denmark; 3Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; 4The Danish Heart Foundation, Copenhagen, Denmark; 5Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 6Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University, Boston, MA, USA; 7Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, DenmarkCorrespondence: Christian Madelaire, Email Christian.madelaire@rsyd.dkBackground: Heart failure (HF) is associated with increased risk of death and a hospitalization, but for patients initiating guideline directed medical therapy, it is unknown how high these risks are compared to the general population – and how this may vary depending on age and comorbidity.Methods: In this retrospective cohort study, we identified patients diagnosed with HF in the period 2011– 2017, surviving the initial 120 days after diagnosis. Patients who were on angiotensin converting enzyme inhibitor (ACEi)/ angiotensin receptor blocker (ARB) and beta-blocker were included and matched to 5 non-HF individuals from the background population each based on age and sex. We assessed the 5-year risk of all-cause death, HF and non-HF hospitalization according to sex and age and baseline comorbidity.Results: We included 35,367 patients with HF and 176,835 matched non-HF individuals. Patients with HF had a five-year excess risk (absolute risk difference) of death of 13% (31% [for HF] – 18% [for non-HF]), of HF hospitalization of 17% and of non-HF hospitalization of 24%. Excess risk of death increased with increasing age, whereas the relative risk decreased - for women in their twenties, the excess risk was 7%, risk ratio 7.2, while the excess risk was 18%, risk ratio 1.5 for women in their eighties. Having HF as a 60-year old man was associated with a five-year risk of death similar to a 75-year old man without HF. Further, HF was associated with an excess risk of non-HF hospitalization, ranging from 8% for patients > 85 years to 30% for patients < 30 years.Conclusion: Regardless of age, sex and comorbidity, HF was associated with excess risk of mortality and non-HF hospitalizations, but the relative risk ratio diminishes sharply with advancing age, which may influence allocation of resources for medical care across populations.Keywords: heart failure, excess risk, mortality, hospitalization

Christian Madelaire,1 Finn Gustafsson,2,3 Lars Køber,2 Christian Torp-Pedersen,4,5 Charlotte Andersson,1,6 Søren Lund Kristensen,2 Gunnar Gislason,1,7 Morten Schou1 1Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; 2Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 3Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 4Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark; 5Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; 6Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston, MA, USA; 7Danish Heart Foundation, Copenhagen, DenmarkCorrespondence: Christian MadelaireDepartment of Cardiology, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, Opgang 6, 3rd floor, Copenhagen, DenmarkTel +45 20 92 86 45Email cras0185@regionh.dkBackground: In Danish administrative registers, ejection fraction (EF) is not recorded, which is a considerable limitation for correct subclassification of patients with heart failure (HF). We hypothesized that a diagnosis of HF combined with the recorded prescription of both renin-angiotensin system (RAS) inhibitors and beta- blockers (RASi+BB) within 120 days could identify patients with HF and reduced ejection fraction (EF ≤ 40%) (HFrEF).Methods: On two sites, we identified all patients with a first-time registration of HF as primary hospital discharge diagnosis (ICD-10: I50) between June 1, 2016, and May 31, 2018 in inpatient or outpatient settings. Patients were included if they survived the initial 120 days after discharge. Reviewing patient records, we identified patients with HFrEF, based on EF ≤ 40% and reported HF symptoms. We registered the use of RASi+BB at 120 days and calculated sensitivity, specificity and predictive values.Results: A total of 704 consecutive patients with a primary diagnosis of HF were included, of whom 541 (77%) fulfilled the HFrEF criteria. Patients with HFrEF confirmed from patient records were younger (median age 73 compared to 79 years) and less frequently women (31% compared to 56%) compared to non-HFrEF patients. At baseline, 24 (4%) of HFrEF patients were treated with RASi+BB compared to 22 (14%) of non-HFrEF patients. At 120 days, 460 (85%) of HFrEF patients received RASi+BB as compared to 25 (15%) of non-HFrEF patients. This resulted in a positive predictive value of 95%, sensitivity of 85% and specificity of 85%.Conclusion: In Denmark, the ICD-10 HF diagnosis combined with recorded RASi+BB treatment by 120 days after discharge has high positive predictive value and can accurately be used to identify patients with HFrEF.Keywords: heart failure, reduced ejection fraction, register data, validation

This work reports on the application of a novel electric field-ionization setup for high-resolution laser spectroscopy measurements on bunched fast atomic beams in a collinear geometry. In combination with multi-step resonant excitation to Rydberg states using pulsed lasers, the field ionization technique demonstrates increased sensitivity for isotope separation and measurement of atomic parameters over previous non-resonant laser ionization methods. The setup was tested at the Collinear Resonance Ionization Spectroscopy experiment at ISOLDE-CERN to perform high-resolution measurements of transitions in the indium atom from the 5s 2 5d 2 D 5 / 2 and 5s 2 5d 2 D 3 / 2 states to 5s 2 n p 2 P and 5s 2 n f 2 F Rydberg states, up to a principal quantum number of n = 72 . The extracted Rydberg level energies were used to re-evaluate the ionization potential of the indium atom to be 46 , 670.107 (4) cm - 1 . The nuclear magnetic dipole and nuclear electric quadrupole hyperfine structure constants and level isotope shifts of the 5s 2 5d 2 D 5 / 2 and 5s 2 5d 2 D 3 / 2 states were determined for 113 , 115 In. The results are compared to calculations using relativistic coupled-cluster theory. A good agreement is found with the ionization potential and isotope shifts, while disagreement of hyperfine structure constants indicates an increased importance of electron correlations in these excited atomic states. With the aim of further increasing the detection sensitivity for measurements on exotic isotopes, a systematic study of the field-ionization arrangement implemented in the work was performed at the same time and an improved design was simulated and is presented. The improved design offers increased background suppression independent of the distance from field ionization to ion detection. [ABSTRACT FROM AUTHOR]

Background and Objective: Rapid saline infusion and exercise has been proposed as methods to unmask cardiovascular disease. However, the normal hemodynamic response to rapid saline infusion has not been compared to exercise nor is it known whether the responses are age-dependent.We assessed the hemodynamic response to rapid saline infusion in healthy participants over a wide age-range and compared it to exercise in the same participants.Methods and Results: Fifty healthy participants (young <40 years, n = 16, middle-aged 40-59 years, n = 15, elderly 60-80 years, n = 19) underwent right heart catheterization at rest, during semisupine ergometer exercise at three exercise levels (25%, 50%, and 75% of peak VO2) and after rapid saline infusion (10 ml/kg at a rate of 150 ml/min). Rapid saline infusion significantly increased pulmonary capillary wedge pressure (PCWP) similarly across all age groups (∆PCWP 6 ± 2; 7 ± 2; 6 ± 4 mmHg for the young, middle-aged and elderly respectively) with no correlation between age and ∆PCWP (r = 0.05; p = 0.74). However, there was a negative correlation between age and ∆stroke volume (SV) as elderly participants had a lower increase in SV following rapid saline infusion (r = 0.44; p = 0.002). On the contrary, exercise-induced significantly larger and age-dependent increases in PCWP (r = 0.58; p < 0.0001). Exercise also caused a larger increase in SV compared with rapid fluid loading (p = 0.0003) CONCLUSION: Unlike exercise, rapid saline infusion caused an age-independent increase in PCWP in healthy adults. Suggesting that age-related impairments beyond passive stiffness have a greater impact on exercise-induced increase in PCWP.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT01974557. [ABSTRACT FROM AUTHOR]

A platform for sensor fusion consisting of a standard smartphone equipped with the specially developed Sensor Fusion app is presented. The platform enables real-time streaming of data over WiFi to a computer where signal processing algorithms, e.g., the Kaiman filter, can be developed and executed in a Matlab framework. The platform is an excellent tool for educational purposes and enables learning activities where methods based on advanced theory can be implemented and evaluated at low cost. The article describes the app and a laboratory exercise developed around these new technological possibilities. The laboratory session is part of a course in sensor fusion, a signal processing continuation course focused on multiple sensor signal applications, where the goal is to give the students hands on experience of the subject. This is done by estimating the orientation of the smartphone, which can be easily visualized and also compared to the built-in filters in the smartphone. The filter can accept any combination of sensor data f r om accelerometers, gyroscopes, and magnetometers to exemplify their importance. This way different tunings and tricks of important methods are easily demonstrated and evaluated on-line. The presented framework facilitates this in a way previously impossible. [ABSTRACT FROM AUTHOR]

Assessment of right ventricular (RV) function is crucial since RV failure with a reduced cardiac output is associated with compromised outcome in cardiac surgery. Echocardiographic evaluation of RV function is commonly used, and a reduction in tricuspid annular plane systolic excursion (TAPSE) and tricuspid annulus tissue Doppler imaging (S') have been observed independently of clinical signs of RV failure. This has led to uncertainty of these variables' ability to reflect RV function in cardiac surgery [1]. The objective of this study was to describe changes in transoesophageal echocardiographic (TEE) measurements of TAPSE and S' during coronary artery bypass graft (CABG) surgery with detailed haemodynamic monitoring using pulmonary artery catheter (PAC) assessment of RV output in patients undergoing uncomplicated CABG without RV impairment. We prospectively studied 30 patients with concomitant PAC and TEE measurements at four time-points, namely after: anaesthesia induction, sternotomy, cardiopulmonary bypass (CPB) and upon arrival in the intensive care unit (ICU). TAPSE and S' were significantly reduced by 43% (p<.0001) and 22% (p =.006), respectively after CPB without any change in stroke volume (SV). RV ejection fraction (RVEF), RV fractional area change (RVFAC) and global longitudinal strain (RV-GLS) remained unchanged. SV measured with 3D echocardiography correlated with PAC measured SV (r =.66[95% CI.50;.78], p<.0001), but 3D showed a minor, but statistically significant underestimation of SV (8.5 ml (95% CI: 2.7 ml; 14 ml, p =.004). TAPSE and S' were both reduced after CPB despite maintained cardiac output. RVFAC, RVEF and RV-GLS remained stable, however, these measures were unable to detect minor changes in SV. 3D-echocardiography showed a strong correlation with SV measured by thermodilution, but with a consistent underestimation of approximately 10%. Our results suggest that 3D echocardiography is better at tracking RV output than other echocardiographic modalities, however, the clinician should be aware that 3D echocardiography underestimates SV compared to thermodilution. [ABSTRACT FROM AUTHOR]

Critical care following cardiac surgery is a complex task including both cardiac and pulmonary management strategies because optimal postoperative care is essential for outcome [1]. The effect of such interventions on right ventricular (RV) function has not been sufficiently explored. The aim of this study was to investigate what effect ICU interventions have on RV function. Thirty patients were studied in the ICU following coronary artery bypass graft surgery. Transoesophageal echocardiography (TEE) and a pulmonary artery catheter (PAC) were used to assess hemodynamic variables and echocardiographic measures of RV function. TEE evaluation included RV fractional area change, 3D RV ejection fraction, 3D RV stroke volume and RV global longitudinal strain (RV-GLS). Interventions were done separately and included: Trendelenburg position, PEEP 0, 5 and 10 cm H2O, increased oxygen fraction (100%), and AAI, DDD and VVI pacing. Trendelenburg increased global echocardiographic measures of RV function as well as CO 0.44L*min-1 [95%CI: 0.21;0.67] due to an increased stroke volume (SV). Increasing PEEP from 0 to 10 reduced SV and consequently CO by 0.41L*min-1. Pulmonary vascular resistance (PVR) was not significantly changed by different PEEP levels. AAI or DDD pacing at a heart rate 15 beats above baseline increased CO 0.35L*min-1 [95%CI 0.07;0.63]. In contrast VVI pacing decreased CO by 24% (1.2L*min-1 [95%CI 0.9;1.6]). VVI reduced all RV echocardiographic variables. Applying 100% O2 did not affect PVR or haemodynamic state but RV-GLS was significantly improved -4.4% [95%CI: -6.9; -1.9]. In patients with normal RV function undergoing CABG several routine interventions in the ICU affects RV function significantly, in particular PEEP and VVI pacing which induces clinically important reductions in SV. [ABSTRACT FROM AUTHOR]

BACKGROUND: Copeptin, a stable fragment of the vasopressin prohormone, has been shown to be a significant biomarker for morbidity and mortality in heart failure. The aims of this study were to evaluate the influence of plasma sodium on the prognostic significance of copeptin concentrations in heart failure outpatients and to determine whether increased copeptin concentrations predict future development of hyponatremia. METHODS AND RESULTS: A total of 340 heart failure patients with left ventricular systolic dysfunction were followed for 55 months (median) in a Danish heart failure clinic. A baseline measurement of plasma copeptin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and sodium was performed, and the sodium concentrations were recorded during 3 months after the baseline visit in the heart failure clinic. Patients were divided into 3 groups according to copeptin tertiles. In multivariate Cox proportional hazard models adjusted for confounders, including plasma sodium, loop diuretic dose, and NT-proBNP, copeptin was a significant predictor of hospitalization or death (hazard ratio 1.4, 95% confidence interval 1.1-1.9; P < .019) but did not predict mortality independently from NT-proBNP. Additionally, copeptin concentrations did not predict future development of hyponatremia. CONCLUSIONS: Plasma copeptin levels predict mortality in outpatients with chronic heart failure independently from clinical variables, plasma sodium, and loop diuretic doses. Furthermore, copeptin predicts the combined end point of hospitalization or death independently from NT-proBNP. [ABSTRACT FROM AUTHOR]

The article offers information about the MATRIS (Markerless Realtime Tracking for Augmented Reality Image Synthesis) Project. It is a three-year project that started in February 2004 as part of European Union's (EU) 6th Framework program aimed to develop a realtime system for measuring camera movement by using image analysis to track natural features in a scene and data from inertial sensors. Discussion about the main components of the MATRIS system structure is also included.

Patients with type 2 diabetes are at increased risk of developing cardiovascular disease. Also, individuals with cardiovascular disease have a poorer prognosis if they are diagnosed with type 2 diabetes. The coexistence of these two disorders increases the risk for morbidity and mortality from large- and small-vessel disease. The importance of dysfunctional glucose metabolism is apparent even at the earliest stages of vascular disease, with insulin resistance contributing to or arising from endothelial dysfunction. In the clinical setting, antihypertensive treatment. Produces proportionally greater benefits in patients with type 2 diabetes than in non-diabetic individuals, and treatments that lower blood glucose reduce the risk of cardiovascular complications. As more becomes known about the inter-relationship of glycometabolic control and cardiovascular disease, the aetiology, pathology and treatment of the two diseases are becoming increasingly entwined. The present review summarizes the importance of type 2 diabetes in cardiovascular disease and discusses some of the therapeutic implications that arise from newly emerging data. [Copyright &y& Elsevier]

We report on laser cooling of a large fraction of positronium (Ps) in free flight by strongly saturating the 1^{3}S-2^{3}P transition with a broadband, long-pulsed 243 nm alexandrite laser. The ground state Ps cloud is produced in a magnetic and electric field-free environment. We observe two different laser-induced effects. The first effect is an increase in the number of atoms in the ground state after the time Ps has spent in the long-lived 2^{3}P states. The second effect is one-dimensional Doppler cooling of Ps, reducing the cloud's temperature from 380(20) to 170(20) K. We demonstrate a 58(9)% increase in the fraction of Ps atoms with v&#95;{1D}<3.7×10^{4}  ms^{-1}.

We have measured the 3d→2p transition x rays of kaonic ^{3}He and ^{4}He atoms using superconducting transition-edge-sensor microcalorimeters with an energy resolution better than 6 eV (FWHM). We determined the energies to be 6224.5±0.4(stat)±0.2(syst)  eV and 6463.7±0.3(stat)±0.1(syst)  eV, and widths to be 2.5±1.0(stat)±0.4(syst)  eV and 1.0±0.6(stat)±0.3(stat)  eV, for kaonic ^{3}He and ^{4}He, respectively. These values are nearly 10 times more precise than in previous measurements. Our results exclude the large strong-interaction shifts and widths that are suggested by a coupled-channel approach and agree with calculations based on optical-potential models.

Isotope shifts of ^{223-226,228}Ra^{19}F were measured for different vibrational levels in the electronic transition A^{2}Π&#95;{1/2}←X^{2}Σ^{+}. The observed isotope shifts demonstrate the particularly high sensitivity of radium monofluoride to nuclear size effects, offering a stringent test of models describing the electronic density within the radium nucleus. Ab initio quantum chemical calculations are in excellent agreement with experimental observations. These results highlight some of the unique opportunities that short-lived molecules could offer in nuclear structure and in fundamental symmetry studies.