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Background: The pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF) is heterogeneous and incompletely understood. This study evaluated the presence of a ventricular conduction delay (VCD) phenotype in HFpEF through QRS duration and vectorcardiographic QRS area, and their relation to adverse outcomes. Methods: This study included consecutive ambulatory HFpEF patients. Baseline QRS duration was obtained from an electrocardiogram (ECG). QRS area was derived from vectorcardiographic analyses of the ECG. QRS duration and area were assessed and analysed as categorical (43.1 µVs) and continuous variables to determine the relation to the composite outcome of HF hospitalisation and all-cause mortality. Results: 349 HFpEF patients were included of whom 70 % had a QRS duration 43.1 µVs. Only 4 % had a QRS area ≥69µVs, indicating delayed lateral wall activation. After a median of 3 years follow-up, 30 % of the patients had an adverse outcome. Longer QRS duration but not larger QRS area was associated with more adverse outcomes on both categorical and continuous scales (HR per 5 ms increase = 1.06, P = 0.033). This prognostic association was mainly present in males. Conclusion: HFpEF patients have a low prevalence of a VCD phenotype(9 % QRS duration ≥120 ms;4 % a QRS area ≥69 µVs). However, QRS duration >100 ms was present in 30 % and was an independent predictor for adverse outcomes. Future efforts are needed to understand the mechanisms underlying the association of QRS duration and adverse outcomes, and to determine its clinical implications.

Uranium trioxide, UO3, has a T-shaped structure with bent uranyl, UO22+, coordinated by an equatorial oxo, O2-. The structure of cation UO3+ is similar but with an equatorial oxyl, O•-. Neutral and cationic uranium trioxide coordinated by nitrates were characterized by collision induced dissociation (CID), infrared multiple-photon dissociation (IRMPD) spectroscopy, and density functional theory. CID of uranyl nitrate, [UO2(NO3)3]- (complex A1), eliminates NO2 to produce nitrate-coordinated UO3+, [UO2(O•)(NO3)2]- (B1), which ejects NO3 to yield UO3 in [UO2(O)(NO3)]- (C1). Finally, C1 associates with H2O to afford uranyl hydroxide in [UO2(OH)2(NO3)]- (D1). IRMPD of B1, C1, and D1 confirms uranyl equatorially coordinated by nitrate(s) along with the following ligands: (B1) radical oxyl O•-; (C1) oxo O2-; and (D1) two hydroxyls, OH-. As the nitrates are bidentate, the equatorial coordination is six in A1, five in B1, four in D1, and three in C1. Ligand congestion in low-coordinate C1 suggests orbital-directed bonding. Hydrolysis of the equatorial oxo in C1 epitomizes the inverse trans influence in UO3, which is uranyl with inert axial oxos and a reactive equatorial oxo. The uranyl ν3 IR frequencies indicate the following donor ordering: O2-[best donor] ≫ O•-> OH-> NO3-.

One challenge in the quest to map the intrinsic reactivity of model actinide species has been the controlled synthesis of organo-actinide ions in the gas phase. We report here evidence that a series of gas-phase, σ-bonded [U–R]+ species (where R = CH3, C2H3, C2H5, C3H7, or C5H6) can be generated for subsequent study of ion-molecule chemistry by using preparative tandem mass spectrometry (PTMSn) via ion-molecule reactions between [UH]+ and a series of nitriles. Density functional theory calculations support the hypothesis that the [U–R]+ ions are created in a pathway that involves intramolecular hydride attack and the elimination of neutral HCN. Subsequent reactivity experiments revealed that the [UCH3]+ readily undergoes hydrolysis, yielding cationic uranium hydroxide ([UOH]+) and methane (CH4). Other possible reaction pathways, such as the spontaneous rearrangement to [HUCH2]+, are shown by theoretical calculations to have energy barriers, strengthening the evidence for the formation of a σ-bonded [U–CH3]+ complex in the gas-phase. [ABSTRACT FROM AUTHOR]

Introduction: Left bundle branch area pacing (LBBAP) comprises pacing at the left ventricular septum (LVSP) or left bundle branch (LBBP). The aim of the present study was to investigate the differences in ventricular electrical heterogeneity between LVSP, LBBP, right ventricular pacing (RVP) and intrinsic conduction with different dyssynchrony measures using the ECG, vectorcardiograpy, ECG belt, and Ultrahigh frequency (UHF‐)ECG. Methods: Thirty‐seven patients with a pacemaker indication for bradycardia or cardiac resynchronization therapy underwent LBBAP implantation. ECG, vectorcardiogram, ECG belt and UHF‐ECG signals were recorded during RVP, LVSP and LBBP, and intrinsic activation. QRS duration (QRSd) was measured from the ECG, QRS area was calculated from the vectorcardiogram, LV activation time (LVAT) and standard deviation of activation time (SDAT) from ECG belt and electrical dyssynchrony (e‐DYS16) from UHF‐ECG. Results: Both LVSP and LBBP significantly reduced ventricular electrical heterogeneity as compared to underlying LBBB and RV pacing in terms of QRS area (p <.001), SDAT (p <.001), LVAT (p <.001) and e‐DYS16 (p <.001). QRSd was only reduced as compared to RV pacing(p <.001). QRS area was similar during LBBP and normal intrinsic conduction, e‐DYS16 was similar during LVSP and normal intrinsic conduction, whereas SDAT was similar for LVSP, LBBP and normal intrinsic conduction. For all these variables there was no significant difference between LVSP and LBBP. Conclusion: Both LVSP and LBBP resulted in a more synchronous LV activation than LBBB and RVP. Especially LBBP resulted in levels of LV synchrony comparable to normal intrinsic conduction. [ABSTRACT FROM AUTHOR]

Identifying electrical dyssynchrony is crucial for cardiac pacing and cardiac resynchronization therapy (CRT). The ultra-high-frequency electrocardiography (UHF-ECG) technique allows instantaneous dyssynchrony analyses with real-time visualization. This review explores the physiological background of higher frequencies in ventricular conduction and the translational evolution of UHF-ECG in cardiac pacing and CRT. Although high-frequency components were studied half a century ago, their exploration in the dyssynchrony context is rare. UHF-ECG records ECG signals from eight precordial leads over multiple beats in time. After initial conceptual studies, the implementation of an instant visualization of ventricular activation led to clinical implementation with minimal patient burden. UHF-ECG aids patient selection in biventricular CRT and evaluates ventricular activation during various forms of conduction system pacing (CSP). UHF-ECG ventricular electrical dyssynchrony has been associated with clinical outcomes in a large retrospective CRT cohort and has been used to study the electrophysiological differences between CSP methods, including His bundle pacing, left bundle branch (area) pacing, left ventricular septal pacing and conventional biventricular pacing. UHF-ECG can potentially be used to determine a tailored resynchronization approach (CRT through biventricular pacing or CSP) based on the electrical substrate (true LBBB vs. non-specified intraventricular conduction delay with more distal left ventricular conduction disease), for the optimization of CRT and holds promise beyond CRT for the risk stratification of ventricular arrhythmias.

Vectorcardiographic QRS area is a promising tool for patient selection and implantation guidance in cardiac resynchronization therapy (CRT). Research has mainly focused on the role of QRS area in patient selection for CRT. Recently, QRS area has been proposed as a tool to guide left ventricular lead placement in CRT. Theoretically, vector-based electrical information of ventricular fusion pacing, calculated from the basic 12-lead ECG, can give real-time insight into the extent of resynchronization at any LV lead position, as well as any selected electrode on the LV lead. The objective of this review is to provide an overview of the background of vectorcardiographic QRS area and its potential in optimizing LV lead location in order to optimize the benefits of CRT.

The following gas-phase uranyl/12-crown-4 (12C4) complexes were synthesized by electrospray ionization: [UO2(12C4)2]2+ and [UO2(12C4)2(OH)]+. Collision-induced dissociation (CID) of the dication resulted in [UO2(12C4-H)]+ (12C4-H is a 12C4 that has lost one H), which spontaneously adds water to yield [UO2(12C4-H)(H2O)]+. The latter has the same composition as complex [UO2(12C4)(OH)]+ produced by CID of [UO2(12C4)2(OH)]+ but exhibits different reactivity with water. The postulated structures as isomeric [UO2(12C4-H)(H2O)]+ and [UO2(12C4)(OH)]+ were confirmed by comparison of infrared multiphoton dissociation (IRMPD) spectra with computed spectra. The structure of [UO2(12C4-H)]+ corresponds to cleavage of a C-O bond in the 12C4 ring, with formation of a discrete U-Oeq bond and equatorial coordination by three intact ether moieties. Comparison of IRMPD and computed IR spectra furthermore enabled assignment of the structures of the other complexes. Theoretical studies of the chemical bonding features of the complexes provide an understanding of their stabilities and reactivities. The results reveal bonding and structures of the uranyl/12C4 complexes and demonstrate the synthesis and identification of two different isomers of gas-phase uranyl coordination complexes.

In uranyl coordination complexes, UO2(L)n2+, uranium in the formally dipositive [O=U=O]2+ moiety is coordinated by n neutral organic electron donor ligands, L. The extent of ligand electron donation, which results in partial reduction of uranyl and weakening of the U=O bonds, is revealed by the magnitude of the red-shift of the uranyl asymmetric stretch frequency, ν3. This phenomenon appears in gas-phase complexes in which uranyl is coordinated by electron donor ligands: the ν3 red-shift increases as the number of ligands and their proton affinity (PA) increases. Because PA is a measure of the enthalpy change associated with a proton-ligand interaction, which is much stronger and of a different nature than metal ion-ligand bonding, it is not necessarily expected that ligand PAs should reliably predict uranyl-ligand bonding and the resulting ν3 red-shift. Here, ν3 was measured for uranyl coordinated by ligands with a relatively broad range of PAs, revealing a surprisingly good correlation between PA and ν3 frequency From computed ν3 frequencies for bare UO2 cations and neutrals, it is inferred that the effective charge of uranyl in UO2(L)n2+ complexes can be reduced to near zero upon ligation by sufficiently strong charge-donor ligands. The basis for the correlation between ν3 and ligand PAs, as well as limitations and deviations from it, are considered. It is demonstrated that the correlation evidently extends to a ligand that exhibits polydentate metal ion coordination.

In uranyl coordination complexes, UO2(L)n2+, uranium in the formally dipositive [O=U=O]2+ moiety is coordinated by n neutral organic electron donor ligands, L. The extent of ligand electron donation, which results in partial reduction of uranyl and weakening of the U=O bonds, is revealed by the magnitude of the red-shift of the uranyl asymmetric stretch frequency, ν3. This phenomenon appears in gas-phase complexes in which uranyl is coordinated by electron donor ligands: the ν3 red-shift increases as the number of ligands and their proton affinity (PA) increases. Because PA is a measure of the enthalpy change associated with a proton-ligand interaction, which is much stronger and of a different nature than metal ion-ligand bonding, it is not necessarily expected that ligand PAs should reliably predict uranyl-ligand bonding and the resulting ν3 red-shift. Here, ν3 was measured for uranyl coordinated by ligands with a relatively broad range of PAs, revealing a surprisingly good correlation between PA and ν3 frequency From computed ν3 frequencies for bare UO2 cations and neutrals, it is inferred that the effective charge of uranyl in UO2(L)n2+ complexes can be reduced to near zero upon ligation by sufficiently strong charge-donor ligands. The basis for the correlation between ν3 and ligand PAs, as well as limitations and deviations from it, are considered. It is demonstrated that the correlation evidently extends to a ligand that exhibits polydentate metal ion coordination.

Recent efforts to activate the strong uranium-oxygen bonds in the dioxo uranyl cation have been limited to single oxo-group activation through either uranyl reduction and functionalization in solution, or by collision induced dissociation (CID) in the gas-phase, using mass spectrometry (MS). Here, we report and investigate the surprising double activation of uranyl by an organic ligand, 3,4,3-LI(CAM), leading to the formation of a formal U6+ chelate in the gas-phase. The cleavage of both uranyl oxo bonds was experimentally evidenced by CID, using deuterium and 18O isotopic substitutions, and by infrared multiple photon dissociation (IRMPD) spectroscopy. Density functional theory (DFT) computations predict that the overall reaction requires only 132 kJ/mol, with the first oxygen activation entailing about 107 kJ/mol. Combined with analysis of similar, but unreactive ligands, these results shed light on the chelation-driven mechanism of uranyl oxo bond cleavage, demonstrating its dependence on the presence of ligand hydroxyl protons available for direct interactions with the uranyl oxygens.

The synthesis, reactivity, structures, and bonding in gas-phase binary and complex oxide anion molecules of protactinium and uranium have been studied by experiment and theory. The oxalate ions, AnVO2(C2O4)-, where An = Pa or U, are essentially actinyl ions, AnVO2+, coordinated by an oxalate dianion. Both react with water to yield the pentavalent hydroxides, AnVO(OH)2(C2O4)-. The chemistry of Pa and U becomes divergent for reactions that result in oxidation: whereas PaVI is inaccessible, UVI is very stable. The UVO2(C2O4)- complex exhibits a remarkable spontaneous exothermic replacement of the oxalate ligand by O2 to yield UO4- and two CO2 molecules. The structure of the uranium tetroxide anion is computed to correspond to distorted uranyl, UVIO22+, coordinated in the equatorial plane by two equivalent O atoms each having formal charges of -1.5 and U-O bond orders intermediate between single and double. The unreactive nature of PaVO2(C2O4)- toward O2 is a manifestation of the resistance toward oxidation of PaV, and clearly reveals the disparate chemistries of Pa and U. The uranium tetroxide anion, UO4-, reacts with water to yield UO5H2-. Infrared spectra obtained for UO5H2- confirm the computed lowest-energy structure, UO3(OH)2-.

Background: Manually derived electrocardiographic (ECG) parameters were not associated with mortality in mechanically ventilated COVID‐19 patients in earlier studies, while increased high‐sensitivity cardiac troponin‐T (hs‐cTnT) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) were. To provide evidence for vectorcardiography (VCG) measures as potential cardiac monitoring tool, we investigated VCG trajectories during critical illness. Methods: All mechanically ventilated COVID‐19 patients were included in the Maastricht Intensive Care Covid Cohort between March 2020 and October 2021. Serum hs‐cTnT and NT‐proBNP concentrations were measured daily. Conversion of daily 12‐lead ECGs to VCGs by a MATLAB‐based script provided QRS area, T area, maximal QRS amplitude, and QRS duration. Linear mixed‐effect models investigated trajectories in serum and VCG markers over time between non‐survivors and survivors, adjusted for confounders. Results: In 322 patients, 5461 hs‐cTnT, 5435 NT‐proBNP concentrations and 3280 ECGs and VCGs were analyzed. Non‐survivors had higher hs‐cTnT concentrations at intubation and both hs‐cTnT and NT‐proBNP significantly increased compared with survivors. In non‐survivors, the following VCG parameters decreased more when compared to survivors: QRS area (−0.27 (95% CI) (−0.37 to −0.16, p <.01) μVs per day), T area (−0.39 (−0.62 to −0.16, p <.01) μVs per day), and maximal QRS amplitude (−0.01 (−0.01 to −0.01, p <.01) mV per day). QRS duration did not differ. Conclusion: VCG‐derived QRS area and T area decreased in non‐survivors compared with survivors, suggesting that an increase in myocardial damage and tissue loss play a role in the course of critical illness and may drive mortality. These VCG markers may be used to monitor critically ill patients. [ABSTRACT FROM AUTHOR]

Background Interatrial block (IAB) has been associated with supraventricular arrhythmias and stroke, and even with sudden cardiac death in the general population. Whether IAB is associated with life‐threatening arrhythmias (LTA) and sudden cardiac death in dilated cardiomyopathy (DCM) remains unknown. This study aimed to determine the association between IAB and LTA in ambulant patients with DCM. Methods and Results A derivation cohort (Maastricht Dilated Cardiomyopathy Registry; N=469) and an external validation cohort (Utrecht Cardiomyopathy Cohort; N=321) were used for this study. The presence of IAB (P‐wave duration>120 milliseconds) or atrial fibrillation (AF) was determined using digital calipers by physicians blinded to the study data. In the derivation cohort, IAB and AF were present in 291 (62%) and 70 (15%) patients with DCM, respectively. LTA (defined as sudden cardiac death, justified shock from implantable cardioverter‐defibrillator or anti‐tachypacing, or hemodynamic unstable ventricular fibrillation/tachycardia) occurred in 49 patients (3 with no IAB, 35 with IAB, and 11 patients with AF, respectively; median follow‐up, 4.4 years [2.1; 7.4]). The LTA‐free survival distribution significantly differed between IAB or AF versus no IAB (both P

Understanding of the nature and extent of chemical bonding in uranyl coordination complexes is crucial for the design of new ligands for nuclear waste separation, uranium extraction from seawater, and other applications. We report here the synthesis, infrared spectroscopic characterization, and quantum chemical studies of a molecular uranyl-di-15-crown-5 complex. The structure and bonding of this unique complex featuring a distinctive 6-fold coplanar coordination staggered sandwich structure and an unusual non-perpendicular orientation of the uranyl moiety are evaluated using density functional theory and chemical bonding analyses. The results provide fundamental understanding of the coordination interaction of uranyl with oxygen-donor ligands.

Gas-phase organoactinyl complexes possessing discrete An-C bonds (An = U, Np, Pu) were synthesized in a quadrupole ion trap by endothermic decarboxylation of [AnO2(O2C-R)3]- anion complexes in which a formally AnO22+ actinyl core is coordinated by three carboxylate ligands, with R = CH3 (methyl), CH3CC (1-propynyl), C6H5 (phenyl), C6F5 (pentafluorophenyl). Decarboxylation and competing ligand loss were studied computationally by density functional theory complementing experiment. Although decarboxylation was computed to be the energetically most favorable process in all cases, reduction from An(VI) to An(V) via neutral ligand loss was often prevalent, particularly for An = Np, Pu, presumably resulting from barriers associated with decarboxylation. Comparative hydrolysis rates of the An-C bonds were experimentally determined, and the chemical properties of these bonds were analyzed by the quantum theory of atoms in molecules. The measured hydrolysis rates differed by up to 3 orders of magnitude: the fastest was for [(CH3CC)UO2(O2C-CCCH3)2]- and the slowest for [(C6F5)PuO2(O2C-C6F5)2]-. There is a general correlation between hydrolysis exothermicity and hydrolysis rate. Prototypical hydrolysis reaction pathways computed for R = CH3 (An = U, Np) reveal a mechanism in which an outer-sphere water becomes inner-sphere concomitant with transfer of an H atom to yield an OH ligand and CH4, with a net energy release of 170 kJ mol-1 and a transition state barrier of 45 kJ mol-1 for An = U. Infrared multiphoton dissociation spectra of selected complexes were acquired to confirm the predicted structures by agreement between the computed and observed vibrational frequencies. The experiment and theory results provide an evaluation of the comparative propensities for formation of the organoactinyls as a function of actinide and carboxylate and an assessment of the nature and stability toward hydrolysis of the primarily ionic An-C bonds.

Despite recent developments, heart failure (HF) remains to be a great burden to the individual patient, entailing major morbidity and mortality. Moreover, HF is a great burden to overall healthcare, mainly because of frequent hospitalizations. Timely diagnosis of HF deterioration and implementation of appropriate therapy may prevent hospitalization and eventually improve a patient’s prognosis; however, depending on the patient’s presentation, the signs and symptoms of HF often offer too little therapeutic window to prevent hospitalizations. Cardiovascular implantable electronic devices (CIEDs) can provide real-time physiologic parameters and remote monitoring of these parameters can potentially help to identify patients at high risk. However, routine implementation of remote monitoring of CIEDs has still not been widely used in daily patient care. This review gives a detailed description of available metrics for remote HF monitoring, the studies that provide evidence of their efficacy, ways to implement them in clinical HF practice, as well as lessons learned on where to go on from where we currently are.

Background Cardiac resynchronisation therapy (CRT) requires intensive, complex and multidisciplinary care to maximize the clinical benefit. In current practice this is typically a task for highly specialised physicians. We report on a novel multidisciplinary, standardised CRT care pathway (CRT-CPW). Experienced clinicians developed a CPW with simple and broadly applicable aids based on clinical evidence and identified shortcomings in the current CRT care. The resulting CPW was implemented at the Maastricht University Medical Center, aiming at a transfer from heterogeneous physician-led care to standardized nurse-led care.Methods Two CRT patient cohorts were compared in this analysis. The benchmarked usual care cohort (2012–2014, 122 patients) was compared with the CRT-CPW cohort (2015–2017, 115 patients). The primary outcomes were process-related: number of physician consultations, nurse consultations, length of stay (LOS) at implantation and total hospitalisation days during 1-year follow-up, and referral-to-treatment time. Clinical outcomes were assessed to adress non-inferiority of quality of care.Results Patients in the CRT-CPW cohort consulted nurses and technicians significantly more often than patients in the usual care cohort (2.4±1.5 vs 1.7±2.0, p