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To evaluate cardiac findings in newborn twins from the general population and investigate if newborn twins may require systematic evaluation of cardiac parameters.Prospective cohort study of newborns with cardiac evaluation performed during the first month of life. Cardiac findings were compared 1:3 with matched singletons.We included 412 newborn twins (16% monochorionic; 50% boys) and 1236 singletons. Comparing cardiac findings showed twins had an increased prevalence of non-severe structural heart disease (most common: ventricular septal defects in both groups), thinner left ventricular posterior wall in diastole (LVPWd; 1.82 vs. 1.87 mm, p = 0.02), smaller diameter of the left atrium (10.6 vs. 11.1 mm, p = 0.04), higher heart rate (148 vs. 144 bpm, p = 0.04), more left-shifted QRS axis (106 vs. 111°, p 0.001), and lower maximum R-wave amplitude in V1 (927 vs. 1015 μV, p = 0.02) compared to singletons. After multifactorial adjustment for potential confounders, the effect of twinning on cardiac parameters persisted only for LVPWd (p 0.05).Despite contemporary surveillance, we found an increased prevalence of non-severe structural heart disease in a population-based cohort of newborn twins. However, the effect of twinning on cardiac parameters was modest and generally did not persist after correction for likely confounding factors.

During the first month of life, the relation between right and left ventricular function is markedly altered. We aimed at describing the electrocardiographic transition from fetal to neonatal circulation by investigating changes in R- and S-wave amplitudes in V1 and V6 during the first 4 weeks of life. This study is part of the prospective, population-based Copenhagen Baby Heart Study offering cardiac evaluation to newborns within 28 days from birth. ECGs were obtained and analyzed using a computerized algorithm. A total of 14,577 newborns (52% boys), median age of 11.0 days, were included. All had normal echocardiograms. Within 28 days from birth, the amplitudes in V1 decreased: R-V1 (1262 µV day0; 947 µV day28, p 0.05), but R-V1, R-V6, and S-V6 positively correlated with newborn weight (p

Background: The QRS axis represents the sum and orientation of the ventricular depolarization. Accurate interpretation of abnormalities in the QRS axis may facilitate early diagnosis of heart disease in newborns. We aimed at describing the evolution of the QRS axis during the first 4 weeks of life and provide reference values from healthy newborns. Methods: The Copenhagen Baby Heart Study is a prospective general population study that offered cardiac evaluation during the first month of life to all newborns delivered in the Copenhagen area. Results: Electrocardiograms from 12,317 newborns (52% boys; mean age 12 days) with normal echocardiograms were included. The median QRS axis was 119° at the ages 0–7 days and shifted leftward to 102° at the ages 22–28 days (p < 0.001). We found that girls had a significantly less pronounced right-shifted axis than boys (p < 0.001) and that increasing gestational age (GA) was associated with a more pronounced right-shifted axis (p < 0.05). Infant size did not affect the axis (p > 0.05). Only 0.5% had an axis within the interval 0 to −90° and 1.1% in the interval +240 to +30°. Conclusions: The QRS axis showed a gradual leftward-shift during the first 4 weeks of life and was affected by sex and GA but unaffected by infant size. Less than 1% of the newborns had a QRS axis between 0 and −90°. This study represents updated reference values, which may facilitate the clinical handling of newborns.

Background Ventricular septal defect (VSD) is one of the most common congenital heart defects. Some VSDs close spontaneously while persistence of the VSD may result in heart failure and, at long term, irreversible pulmonary hypertension. Consequently, identification of factors associated with spontaneous closure are important to ensure relevant clinical follow up of those at risk of a persistent VSD. Purpose We aimed to assess the rate of spontaneous closure in a population-based cohort of newborns with VSD and to identify significant predictors for spontaneous closure. Methods The study is part of a large-scale population-based study, focusing on cardiac structure and function, including newborns born from 1st April 2016 to 31st October 2018. Newborns with a VSDs at baseline were followed with echocardiography at 3, 6 and 12 months (+30 days) of age. Cox proportional hazard model was used to determine significant predictors of spontaneous closure Results Based on echocardiographies of 25.750 newborn, 850 newborns (3.3%) with a VSD were identified. The majority of newborns with VSDs were born at term (88.7%) and the mean age at inclusion was 11.7±8.1 days. VSDs were more frequent in females (57.1%, p Conclusion In a population study including more than 25,000 newborns we found that the vast majority, i.e. almost 9/10 of all VSDs, closed spontaneously during the first year of life, ultimately resulting in a prevalence of VSD in one-year old children of 0.5%. The identified factors associated with spontaneous closure – anatomical location, size and presence of multiple VSDs are of use for future management of VSDs in newborns. Funding Acknowledgement Type of funding source: Other. Main funding source(s): The Danish Heart Foundation

Background Primary cardiac tumours in children are rare, with an estimated prevalence of 0.014% in foetuses, whereas in the paediatric population, a 100-fold difference in autopsy prevalence has been reported (0.0017% to 0.28%). In neonates, rhabdomyoma is the most common primary cardiac tumour, followed by teratoma and fibroma, all of which are benign. Cardiac rhabdomyomas are associated to tuberous sclerosis in >50% of cases. The prevalence of cardiac tumours in neonates has not previously been assessed in a large population-based cohort. Purpose To determine the prevalence of congenital cardiac tumours by systematic echocardiography in a large, population-based, cohort of neonates. Methods Systematic transthoracic echocardiography (TTE), including standard sub-xiphoid, apical, left parasternal, and suprasternal views, was performed in neonates included in a population study. Cardiac tumours were defined as solid, echogenic masses, and description included location, size, and numbers (one/multiple). Information regarding subsequent diagnosis of tuberous sclerosis was collected from review of medical charts. Results A total of 25,537 neonates (age 12±9 days, 51.6% male) were enrolled in the study and underwent TTE. Cardiac tumours were detected in 7 neonates (4 males), corresponding to a prevalence of 0.3 [0.1; 0.6] per 1,000 live-births. Characteristics including sex, gestational age at birth, birth length and weight, APGAR 5-score, age and weight at TTE, and maternal age and pre-pregnancy BMI, did not significantly differ between the neonates with (n=7) and without (n=25,530) cardiac tumours (all p>0.05). In 6 out of 7 neonates, the cardiac tumours were located in the ventricles (86%), with multiple tumours seen in five (83%) (Fig. 1A+B), and with size ranging from 2.0x1.9mm to 10.0x5.1mm. In the seventh neonate, two cardiac tumours were detected in close proximity to the aortic and pulmonary valves in the ascending aortic and main pulmonary artery wall (Fig. 1C), with sizes 5.1x4.7mm and 3.7x3.2mm, respectively. All seven neonates had otherwise structurally normal hearts and no flow obstruction. Three neonates with multiple cardiac tumours in the ventricles were subsequently diagnosed with tuberous sclerosis. Conclusions Systematic TTE in a population-based cohort revealed a prevalence of congenital cardiac tumours of 0.3 per 1,000 live-births. The majority of the tumours were located in the ventricles and most often multiple cardiac tumours were encountered. Detection of congenital cardiac tumours in the ventricles was associated with tuberous sclerosis in half the cases. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Danish Heart Association, Danish Children's Heart Foundation

Aims Evaluation of the neonatal QT interval is important to diagnose arrhythmia syndromes and evaluate side effects of drugs. We aimed at describing the natural history of the QT interval duration during the first 4 weeks of life and to provide reference values from a large general population sample. Methods and results The Copenhagen Baby Heart Study is a prospective general population study that offered cardiac evaluation of newborns. Eight-lead electrocardiograms were obtained and analysed with a computerized algorithm with manual validation. We included 14 164 newborns (52% boys), aged 0–28 days, with normal echocardiograms. The median values (ms, 2–98%ile) for the corrected intervals QTc (Bazett), QTc (Hodges), QTc (Fridericia), and QTc (Framingham) were 419 (373–474), 419 (373–472), 364 (320–414), and 363 (327–405). During the 4 weeks, we observed a small decrease of QTcFramingham, and an increase of QTcHodges (both P 0.05). Applying published QT interval cut-off values resulted in 5–25% of the newborns having QT prolongation. Uncorrected QT intervals decreased linearly with increasing heart rate (HR). Sex and infant size did not affect the QT interval and the gestational age (GA) only showed an effect when comparing the extreme low- vs. high GA groups (≤34 vs. ≥42 weeks, P = 0.021). Conclusion During the 4 weeks QTcFramingham and QTcHodges showed minor changes, whereas QTcBazett and QTcFridericia were stable. The QT interval was unaffected by sex and infant size and GA only showed an effect in very premature newborns. Reference values for HR-specific uncorrected QT intervals may facilitate a more accurate diagnosis of newborns with abnormal QT intervals.

Background Maternal preeclampsia (PE) has been associated with an increased risk of a variety of congenital heart defects in the infant. Whether PE also confers an increased risk of subtle structural and functional cardiac deficits is unknown. Purpose We investigated whether left ventricular dimensions and systolic function differed among infants of mothers with PE, compared to infants born after uncomplicated pregnancies. Method Systematic transthoracic echocardiography (TTE) was performed in neonates included in a population-based study in the period 2016–2018 (n=25,000). TTE was preferably performed within 14 days of birth. Left ventricular (LV) posterior wall end-diastolic thickness (LVPWd), interventricular septum end-diastole thickness (IVSd), LV internal diameter in end-diastole and end-systole (LVIDd and LVIDs), LV ejection fraction (LVEF) and fractional shortening (FS) were assessed. Information on maternal PE (ICD-10 codes DO140–142 and DO159) was retrieved from an obstetric database. Using linear regression in a sample of echocardiograms, we compared the LV structure and function adjusted for maternal age; gestational age; sex; weight and length. Results In total, 447 infants were exposed to PE, and 7,178 were born to uncomplicated pregnancies (Table). In infants of PE mothers, we found significantly larger LVPWd and IVSd (0.18 mm, 95% CI [0.14; 0.22], p LV measures in PE and non-PE infants Parameter Infants of PE mothers, Infants of non-PE mothers, p-value Estimate* [95% CI] p-value mean [± SD] (n=447) mean [± SD] (n=7,178) Left Ventricular Posterior Wall in end-Diastole, LVPWd (mm) 2.20 [±0.58] 2.07 [±0.40] Conclusion In the largest population-based group of neonates to date, we showed that infants born to PE mothers compared to infants of non-PE mothers had significantly thicker left ventricular myocardium, and reduced left ventricular volumes. However, PE was not associated with altered systolic function. Our results might reflect an adaption of the fetal heart to the increased resistance in the placental arteries in PE mothers, and a secondary increased left ventricular afterload. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Lundbeck Found.

Introduction The prevalence of interatrial communications (IACs) (patent foramen ovale (PFO) or atrial septal defect (ASD)) in newborns has previously been reported to be between 24% and 92%. However, previous studies were generally small, and no universal classification of IACs exists. We proposed a new echocardiographic diagnostic algorithm developed in collaboration with a group of international experts to classify IACs into subtypes based on echocardiographic findings on transthoracic echocardiographic (TTE) images of the atrial septum in unselected newborns. Purpose To describe the distribution of the six newly defined subtypes of IACs in newborns based on the new diagnostic algorithm. Method Echocardiograms of newborns (age 0–30 days) consecutively included in a large, prospective population study (n=25,000) were analyzed using the new algorithm. The algorithm classifies IACs into three subtypes of PFO and three subtypes of ASD based on subxiphoid TTE findings considering the normal fetal development. The images were examined for colour Doppler signal possibly crossing the atrial septum, with or without acceleration, and with or without a visible communication on 2D. Furthermore, the size and morphology (channel-like structure or open hole) of a possible IAC as well as the number of communications were evaluated in determining the subtype of IAC according to the algorithm. The three subtypes of PFO were determined as follows: PFO1 were only detectable using colour Doppler; PFO2 had a channel-like structure visible on 2D; and PFO3 had a diameter of ≤3.4 mm and no channel-like structure. The three subtypes of ASD were determined as follows: ASD1 had a diameter of >3.4 mm; ASD2 was located in the inferior 1/3 part of the septum; and ASD3 had more than one IAC. Preliminary results As of 3 February 2019, 9,028 echocardiograms have been analyzed. A total of 2,026 (22.4%) were excluded due to poor image quality of the atrial septum. Of the 7,002 included echocardiograms, an IAC was detected on the TTE images in 85.9% of the newborns (median age 12 days [IQR 8; 15], 47.9% females). According to the algorithm, 78.7% of the newborns were classified as having a PFO (35.0% had a PFO1; 21.8% had a PFO2; and 21.9% had a PFO3) whereas 7.2% were classified as having an ASD (3.5% had an ASD1; 0.2% has an ASD2; and 3.5% had an ASD3) (see Figure 1). Figure 1. Distribution of subtypes Conclusion An IAC was present in the vast majority of newborns aged 0–30 days. The most frequent PFO subtype was PFO1, which was only detectable by colour Doppler and was 1.6 times more frequent than the two other PFO subtypes, which had equal frequencies. The most uncommon ASD subtype was ASD2 which was located in the lower 1/3 part of the atrial septum and was 17.5 times less frequent than the ASD1 and ASD3 subtypes, which had equal frequencies. (Figure 1: PFO: Patent foramen ovale, ASD: Atrial septal defect, IAC: Interatrial communication) Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

Background There is a paucity of published data presenting reference values for ventricular function in newborns. Purpose This study was conducted to establish echocardiographic normal data and z-scores for ventricular functional parameters in newborns assessed by Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE). Methods We included healthy, term newborns from a prospective, population-based study of newborns, who had a comprehensive, systematic echocardiographic (TTE) examination performed within 14 days of birth. Only newborns without any signs of structural or functional cardiac abnormalities were included. Measurements were obtained according to guidelines. Body surface area (BSA) was calculated using the Haycock formula. Z-score models according to birthweight and BSA at time of TTE were developed for TDI and STE parameters. Results Four hundred newborns (53% male) with gestational age of (median (IQR)) 40.3 (39.4, 41.1) weeks were included. Age, weight, and BSA at TTE were (mean±SD) 11±3 days, 3.7±0.5 kg, and 0.23±0.02m2, resp. Ejection fraction was 67±4%. TDI and STE measurements of ventricular function are presented as mean±SD (Table). Global longitudinal strain was calculated as the average of all left ventricular segmental strain values from apical 4-, 2-, and 3-chamber views. Results for selected parameters according to BSA are illustrated (Figure). TDI and STE of ventricular function Parameter View and modality Value Unit Mitral annulus septal wall e' Apical 4-chamber Tissue Doppler 5.7±0.8 cm/s Mitral annulus septal wall a' Apical 4-chamber Tissue Doppler 5.9±1.0 cm/s Mitral annulus septal wall s' Apical 4-chamber Tissue Doppler 4.6±0.6 cm/s Mitral annulus lateral wall e' Apical 4-chamber Tissue Doppler 6.9±1.0 cm/s Mitral annulus lateral wall a' Apical 4-chamber Tissue Doppler 6.0±1.1 cm/s Mitral annulus lateral wall s' Apical 4-chamber Tissue Doppler 4.8±0.6 cm/s Left ventricular longitudinal strain, 4-chamber Apical 4-chamber 2D 19±2 % Left ventricular longitudinal strain, 2-chamber Apical 2-chamber 2D 20±2 % Left ventricular longitudinal strain, 3-chamber Apical 3-chamber 2D 19±2 % Left ventricular global strain 19±2 % Right ventricular longitudinal strain, free wall Apical 4-chamber 2D 23±4 % Percentile charts Conclusion Normal data for TDI and STE assessment of ventricular function in 400 healthy, term newborns ispresented. An online z-score calculator will be available. Normal data is necessary for the evaluation of pathological changes, and these results contribute substantially to a field where available data is limited. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

Background Pronounced trabeculation of the left ventricular myocardium, or non-compaction, may be accompanied by systolic dysfunction in ventricular non-compaction cardiomyopathy (LVNC). It is unclear whether non-compaction represents a fetal development defect or may develop later in life. Previous studies have estimated the prevalence of non-compaction to 0.01–0.31% in adults referred for echocardiography. The prevalences in unselected populations of adults or children are unknown. Purpose To determine the prevalence of non-compaction of the left ventricle in a large population-based cohort of newborns and to assess the relation to left ventricular systolic function. Methods Transthoracic echocardiography was performed according to a standardized protocol in all newborns included in a regional population-based cohort study in 2016–2018. For the present study, the extent of trabeculations were assessed by one of three primary reviewers in apical long-axis views (4-chamber, 5-chamber, and sinus coronarius views), parasternal short (SAX), and long axis (PLAX) views. Based on the presence of pronounced trabeculations, deep intertrabecular recesses and/or an impression of a ratio of >1 of non-compact:compact myocardium (NC:C), the exam was regarded as either possible or not possible non-compaction: In examinations classified as possible non-compaction, an expert reviewer would determine if diagnostic criteria were fulfilled. A ratio of NC:C myocardium ≥2 was considered as non-compaction in accordance with previously suggested criteria. Results As of January 11, 2019, 6,880 neonate echocardiograms (median age 10 days [IQR 5,14], 48.8% females) had been analyzed. In total, 127 (1.8%) were considered as possible non-compaction. Six newborns (median age 14 days [IQR 8,18], 33.3% females) had a ratio of NC:C myocardium ≥2 corresponding to a prevalence of non-compaction of 8.7 per 10,000 newborns (95% CI 0.04–0.19%) (Figure). One of six neonates had a ratio of NC:C myocardium≥2 in more than one segment. Median fractional shortening (FS %), left ventricular end-diastolic (LVIDd) and end-systolic diameter (LVIDs) were 29.5% (IQR 27.0, 31.0), 1.9 cm (IQR 1.8, 2.1) and 1.3 cm (IQR 1.3, 1.5) respectively in the six newborns with non-compaction. The corresponding mean z-scores (standard deviations away from the age-matched reference mean) according to The Boston Children's Hospital z-score Calculator were FS: r=−3.0 (IQR r=−3.8, r=−2.5), LVIDd: r=−1.3 (IQR r=−2.7, r=−0.2), LVIDs: 0.2 (IQR r=−0.1, 1.6). 10-days-old boy with LVNC (FS 22%) Conclusion Echocardiography of an unselected population-based cohort of 6,880 newborns revealed a prevalence of non-compaction of 8.7 per 10,000 newborns. The prevalence is in accordance with previously described prevalences in adults referred for echocardiography and corroborate the view that non-compaction may be a fetal developmental defect. Non-compaction was not associated with left ventricular dilatation but with systolic dysfunction. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

Background The right ventricle (RV) serves as the dominant ventricle in utero. The transition from fetal to post-natal circulation at birth involves marked structural and functional cardiac changes including a large increase in pulmonary blood flow and closure of fetal shunts. Little is known about how the transitional circulation influences RV structure and function in healthy neonates during the first weeks of life. The purpose of this study was to systematically assess RV remodeling in a large, unselected cohort of healthy neonates. Methods Transthoracic echocardiograms of unselected neonates Results A total of 3,412 echocardiograms were assessed, of which 414 were excluded due to age ≥26 days (n=159), presence of cardiac abnormality (n=179), or suboptimal parasternal views (n=76). Thus, a total of 2,998 (48% male) were included for analysis. Age, weight, and length at examination were (mean±SD) 11.1±7.5 days, 3.6±0.6 kg, and 52±2.6 cm, respectively. BSA-corrected mean (95% CI) end-diastolic outflow tract diameter and end-diastolic anterior wall thickness according to age are presented (Figure). There was a small age-related reduction in end-diastolic RV outflow tract diameter (r2=0.018, p Figure 1. Mean (95% CI) BSA-corrected end-diastolic RV anterior wall thickness and end-diastolic RV outflow tract diameter. P-value for correlation. Conclusion RV remodeling during the first 25 days of life in unselected neonates included a small decrease in RV outflow tract diameter and a 35% decrease in anterior wall thickness.

Introduction The prevalence of any interatrial communication (IAC) (patent foramen ovale (PFO) or atrial septal defect (ASD)) in newborns has previously been reported to be between 24% and 92%. However, previous studies were relatively small, and no universal classification of IACs exists. We proposed a new echocardiographic diagnostic algorithm developed in collaboration with a group of international experts to classify IACs based on echocardiographic findings on subxiphoid transthoracic echocardiographic (TTE) images of the atrial septum in unselected newborns. Purpose To determine the prevalence of IACs (PFO and ASD) in newborns based on the new diagnostic algorithm. Method Echocardiograms of newborns (age 0–30 days) consecutively included in a large, prospective population study (n=25,000) were analyzed using the new algorithm. The algorithm classifies IACs into PFO and ASD based on transthoracic echocardiographic (TTE) findings including size and number of the communication(s) as well as the morphology and structure of the atrial septum, taking the normal fetal development into consideration. An IAC was classified as a PFO when either there was only one communication located in the upper 2/3 of the atrial septum with a visible communication having a diameter of ≤3.4 mm or a channel-like structure; or there was no visible communication on 2D but acceleration of colour Doppler flow crossing the septum was documented. An IAC was classified as an ASD if the diameter of a visible communication was >3.4 mm, or the communication was located in the lower 1/3 part of the atrial septum, or more than one communication was present. No visible communication on 2D and no flow acceleration despite possible colour Doppler flow crossing the atrial septum was classified as an absence of IAC. Preliminary results As of 3 February 2019, 9,028 echocardiograms have been analyzed. A total of 2,026 (22.4%) were excluded due to poor image quality of the atrial septum. Of the 7,002 included echocardiograms, an IAC was detected on the TTE images in 85.9% of the newborns (median age 12 days [IQR 8; 15], 47.9% females). According to the algorithm 78.7% of the newborns were classified as having a PFO (see Table 1) whereas 7.2% were classified as having an ASD. Table 1. Prevalence of interatrial communications in newborns aged 0–30 days Type of interatrial communication: Prevalence (n=7,002): Patent foramen ovale 78.7% Atrial septal defect 7.2% No interatrial communication 14.1% Conclusion An IAC was present in the vast majority of newborns aged 0–30 days. PFOs were 11 times more frequent than ASDs. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

The Copenhagen Baby Heart Study (CBHS) is a population-based cohort study of neonates (N = 25,000), including echocardiography. Echocardiography in neonates is mainly focused on congenital heart disease (CHD), whereas general aspects of cardiac dimensions and function in neonates without CHD remain to be further addressed.This study was conducted to assess the reliability of neonatal echocardiography and validity of echocardiographic methods used in the CBHS.Reliability and agreement were tested for two-dimensional (2D), M-mode, spectral Doppler, and tissue velocity echocardiography for the following. (1) Measurements: seven sonographers independently performed two measurement rounds: (a) measurement of the same 50 echocardiograms (n = 350 echocardiograms measured) and (b) repeated measurement of 25 of the 50 echocardiograms (n = 175 echocardiograms measured). (2) Acquisition: four sonographers independently performed two rounds of echocardiographic acquisition and subsequent measurement of the same 22 neonates (n = 176 acquisitions and measures). Intra- and interobserver variabilities were assessed by determinations of coefficient of variation (CV), intraclass correlation coefficient (ICC), Bland-Altman plot, and 95% limits of agreement.(1) Measurements: we found intra- and interobserver ICC ≥ 0.67 for 2D parameters, except for left ventricular (LV) wall thicknesses and LV diameter (interobserver); ICC ≥ 0.84 for tricuspid annular plane systolic excursion (TAPSE); ICC ≥ 0.93 for pulsed-wave Doppler (PW); ICC ≥ 0.84 for continuous-wave Doppler; and ICC ≥ 0.87 for tissue velocity parameters. We found CV15% for all parameters except LV wall thicknesses. (2) Acquisition: we found intra- and interobserver ICC ≥ 0.69 for 2D parameters, except for LV wall thicknesses, aortic valve annulus (interobserver), and LV end-systolic diameter (interobserver); ICC = 0.45-0.49 for TAPSE; ICC = 0.48-0.64 for PW; and ICC ≥ 0.70 for continuous wave. We found CV15% for all parameters.Reliability of echocardiographic measurements and acquisition of cardiac dimensions and function were good for most parameters but lower for TAPSE (acquisition) and PW Doppler (acquisition) and poor for LV wall thicknesses. In general, echocardiography of cardiac dimensions and function in the neonate is reliable.

Aims Patients admitted with chest pain are a diagnostic challenge because the majority does not have coronary artery disease (CAD). Assessment of CAD with coronary computed tomography angiography (CCTA) is safe, cost-effective, and accurate, albeit with a modest specificity. Stress myocardial computed tomography perfusion (CTP) has been shown to increase the specificity when added to CCTA, without lowering the sensitivity. This article describes the design of a randomized controlled trial, CATCH-2, comparing a clinical diagnostic management strategy of CCTA alone against CCTA in combination with CTP. Methods Patients with acute-onset chest pain older than 50 years and with at least one cardiovascular risk factor for CAD are being prospectively enrolled to this study from 6 different clinical sites since October 2013. A total of 600 patients will be included. Patients are randomized 1:1 to clinical management based on CCTA or on CCTA in combination with CTP, determining the need for further testing with invasive coronary angiography including measurement of the fractional flow reserve in vessels with coronary artery lesions. Patients are scanned with a 320-row multidetector computed tomography scanner. Decisions to revascularize the patients are taken by the invasive cardiologist independently of the study allocation. The primary end point is the frequency of revascularization. Secondary end points of clinical outcome are also recorded. Discussion The CATCH-2 will determine whether CCTA in combination with CTP is diagnostically superior to CCTA alone in the management of patients with acute-onset chest pain.

Congenital heart diseases (CHDs) are reported in 0.8% of newborns. Numerous factors influence cardiovascular development and CHD prevalence, and possibly also development of cardiovascular disease later in life. However, known factors explain the probable etiology in only a fraction of patients. Past large-scale population-based studies have made invaluable contributions to the understanding of cardiac disease, but none recruited participants prenatally and focused on the neonatal period. The Copenhagen Baby Heart Study (CBHS) is a population-based study of the prevalence, spectrum, and prognosis of structural and functional cardiac abnormalities. The CBHS will also establish normal values for neonatal cardiac parameters and biomarkers, and study prenatal and early childhood factors potentially affecting later cardiovascular disease risk. The CBHS is an ongoing multicenter, prospective study recruiting from second trimester pregnancy (gestational weeks 18–20) (expected n = 25,000). Information on parents, pregnancy, and delivery are collected. After birth, umbilical cord blood is collected for biochemical analysis, DNA purification, and biobank storage. An echocardiographic examination, electrocardiography, and post-ductal pulse oximetry are performed shortly after birth. Infants diagnosed with significant CHD are referred to a specialist or admitted to hospital, depending on CHD severity. CBHS participants will be followed prospectively as part of specific research projects or regular clinical follow-up for CHD. CBHS design and methodology are described. The CBHS aims to identify new mechanisms underlying cardiovascular disease development and new targets for prevention, early detection, and management of CHD and other cardiac diseases presenting at birth or developing later in life.

Patients admitted with chest pain are a diagnostic challenge because the majority does not have coronary artery disease (CAD). Assessment of CAD with coronary computed tomography angiography (CCTA) is safe, cost-effective, and accurate, albeit with a modest specificity. Stress myocardial computed tomography perfusion (CTP) has been shown to increase the specificity when added to CCTA, without lowering the sensitivity. This article describes the design of a randomized controlled trial, CATCH-2, comparing a clinical diagnostic management strategy of CCTA alone against CCTA in combination with CTP.Patients with acute-onset chest pain older than 50 years and with at least one cardiovascular risk factor for CAD are being prospectively enrolled to this study from 6 different clinical sites since October 2013. A total of 600 patients will be included. Patients are randomized 1:1 to clinical management based on CCTA or on CCTA in combination with CTP, determining the need for further testing with invasive coronary angiography including measurement of the fractional flow reserve in vessels with coronary artery lesions. Patients are scanned with a 320-row multidetector computed tomography scanner. Decisions to revascularize the patients are taken by the invasive cardiologist independently of the study allocation. The primary end point is the frequency of revascularization. Secondary end points of clinical outcome are also recorded.The CATCH-2 will determine whether CCTA in combination with CTP is diagnostically superior to CCTA alone in the management of patients with acute-onset chest pain.

Demands for care are met not only by professional care services but as well by family members and friends, especially by partners and children. These personal resources are not equally available to everyone. Moreover, there may be differences in preferences when choosing between alternative care arrangements. In particular, the often intimate situations arising in nursing care will lead many to prefer close relatives or friends over professional care services. We consider preference orderings between potentially supporting persons or professional care services. The orderings were obtained by asking respondents to name the most preferred groups of persons they would ask for support in a hypothetical case of being in the need of care. This question is part of the standard panel questionnaire program of the Socio-Economic Panel Study (SOEP) and is thus regularly posed. Similar questions to state preferences among a given set of potential alternatives can be found in many social surveys. The analysis of such data requires suitable methods that take their special features into account. We present a method to visualize partial rankings. The method is then used to present rankings over partial preferences, where the set of alternatives depends on the availability of networks of relatives, partners and friends. The method visualizes rank data using the skeleton of polytopes, by which the complexity of given preferences can faithfully be represented . Using the method for responses to the question about nursing care clearly demonstrates a shortcoming of this type of questions in general survey questionnaires. Pflegebedürfnisse werden zum erheblichen Teil durch professionelle Dienste befriedigt. Ein wichtiger Eckpfeiler in der pflegerischen Versorgung stellen darüber hinausfamiliäre Beziehungen wie Partner und Kinder, sowie Freundes- und Nachbarschaftsnetzwerke dar. Diese Ressourcen stehen aber nicht allen Personen gleichermaßen zur Verfügung, sondern sind in der Bevölkerung ungleich verteilt. Wir beschäftigen uns mit der Reihenfolge von genannten Unterstützungspersonen, bei der Befragte Personengruppen – überwiegend aus dem Kreis informeller Beziehungen – im Hinblick auf die Versorgung im Rahmen einer hypothetischen Pflegebedürftigkeit nennen sollten. Es handelt sich um eine Frage, die u.a. den Befragten des Sozio-ökonomischen Panels regelmäßig gestellt wird. Die Besonderheit der Situation einer pflegerischen Bedürftigkeit aufgrund der Notlage und der Intimität des Ereignisses setzt eher vertrauensvolle Personen als Ansprechpartner voraus. Inhaltlich können somit durch diese Personenangaben Hinweise auf die Ausgestaltung individuell differenzierter Teilnetzwerke gefunden werden. Ähnliche Fragen nach Präferenzen finden sich aber auch in vielen anderen Bereichen der Sozialstatistik, in denen Befragte gebeten werden, ihre Präferenzen für bestimmte Alternativen zu äußern. Die besonderen Eigenschaften solcher Daten erfordern geeignete Methoden, die den Besonderheiten der erzeugten Daten Rechnung tragen. Die vorliegende Arbeit soll einen Beitrag zur Darstellung und Analyse solcher Rangdaten leisten. Dabei werden zwei Ziele verfolgt: Einerseits wird ein Verfahren zur Visualisierung von Rangdaten dargestellt, das bislang in der sozialwissenschaftlichen Forschung wenig Beachtung gefunden hat und hier im konkreten Fall für die Darstellung von Teilnetzwerken angewendet wird. Es handelt sich um die Darstellung von Rangdaten mit Hilfe von Polytopen, durch die sich die Komplexität in den Präferenzäußerungen explorativ grafisch veranschaulichen lässt. Andererseits soll anhand dieses Verfahrens die inhaltliche und methodische Problematik einer Fragebogenkonstruktion diskutiert werden, in der Personen gebeten werden, Aussagen über hypothetische Zustände oder Meinungen zu leisten, um ihren Präferenzen Ausdruck zu verleihen.

Demands for care are met not only by professional care services but as well by family members and friends, especially by partners and children. These personal resources are not equally available to everyone. Moreover, there may be differences in preferences when choosing between alternative care arrangements. In particular, the often intimate situations arising in nursing care will lead many to prefer close relatives or friends over professional care services. We consider preference orderings between potentially supporting persons or professional care services. The orderings were obtained by asking respondents to name the most preferred groups of persons they would ask for support in a hypothetical case of being in the need of care. This question is part of the standard panel questionnaire program of the Socio-Economic Panel Study (SOEP) and is thus regularly posed. Similar questions to state preferences among a given set of potential alternatives can be found in many social surveys. The analysis of such data requires suitable methods that take their special features into account. We present a method to visualize partial rankings. The method is then used to present rankings over partial preferences, where the set of alternatives depends on the availability of networks of relatives, partners and friends. The method visualizes rank data using the skeleton of polytopes, by which the complexity of given preferences can faithfully be represented. Using the method for responses to the question about nursing care clearly demonstrates a shortcoming of this type of questions in general survey questionnaires.