Incidence and predictors of heart failure with reduced and preserved ejection fraction after ST-elevation myocardial infarction in the contemporary era of early percutaneous coronary intervention.

AIMS: The development and incidence of de-novo heart failure after ST-elevation myocardial infarction (STEMI) in the contemporary era of rapid reperfusion are largely unknown. We aimed to establish the incidence of post-STEMI heart failure, stratified by left ventricular ejection fraction (LVEF) and to find predictors for its occurrence. Furthermore, we investigated the course of left ventricular systolic and diastolic function after STEMI. METHODS AND RESULTS: A total of 1172 all-comer STEMI patients from the CardioLines Biobank were included. Patients were predominantly male (74.5%) and 64 ± 12 years of age. During a median follow-up of 3.7 years (2.0, 5.5) we found a total incidence of post-STEMI heart failure of 10.9%, of which 52.1% heart failure with reduced ejection fraction (HFrEF), 29.4% heart failure with mildly reduced ejection fraction and 18.5% heart failure with preserved ejection fraction (HFpEF). Independent predictors for the development of HFrEF were male sex (ß = 0.97, p = 0.009), lung crepitations (ß = 1.09, p = 0.001), potassium level (mmol/L, ß = 0.43, p = 0.012), neutrophil count (109/L, ß = 0.09, p = 0.001) and a reduced LVEF (ß = 1.91, p < 0.001) at baseline. Independent predictors for the development of HFpEF were female sex (ß = 0.99, p = 0.029), pre-existing kidney failure (ß = 1.95, p = 0.003) and greater left atrial volume index (ß = 0.04, p = 0.033) at baseline. Follow-up echocardiography (median follow-up 20 months) showed an improvement in LVEF (p < 0.001), whereas changes in diastolic function parameters showed both improvement and deterioration. CONCLUSION: In the current era of early STEMI reperfusion, still one in 10 patients develops heart failure, with approximately half of the patients with a reduced and half with a mildly reduced or normal LVEF. Predictors for the development of HFrEF were different from HFpEF.

Fetuin-A and its genetic association with cardiometabolic disease.

Fetuin-A acts as both an inhibitor of calcification and insulin signaling. Previous studies reported conflicting results on the association between fetuin-A and cardiometabolic diseases. We aim to provide further insights into the association between genetically predicted levels of fetuin-A and cardiometabolic diseases using a Mendelian randomization strategy. Genetic variants associated with fetuin-A and their effect sizes were obtained from previous genetic studies. A series of two-sample Mendelian randomization analyses in 412,444 unrelated individuals from the UK Biobank did not show evidence for an association of genetically predicted fetuin-A with any stroke, ischemic stroke, or myocardial infarction. We do find that increased levels of genetically predicted fetuin-A are associated with increased risk of type 2 diabetes (OR = 1.21, 95%CI 1.13-1.30, P = < 0.01). Furthermore, genetically predicted fetuin-A increases the risk of coronary artery disease in individuals with type 2 diabetes, but we did not find evidence for an association between genetically predicted fetuin-A and coronary artery disease in those without type 2 diabetes (P for interaction = 0.03). One SD increase in genetically predicted fetuin-A decreases risk of myocardial infarction in women, but we do not find evidence for an association between genetically predicted fetuin-A and myocardial infarction in men (P for interaction = < 0.01). Genetically predicted fetuin-A is associated with type 2 diabetes. Furthermore, type 2 diabetes status modifies the association of genetically predicted fetuin-A with coronary artery disease, indicating that fetuin-A increases risk in individuals with type 2 diabetes. Finally, higher genetically predicted fetuin-A reduces the risk of myocardial infarction in women, but we do not find evidence for an association between genetically predicted fetuin-A and myocardial infarction in men.

Augmented intelligence facilitates concept mapping across different electronic health records.

INTRODUCTION: With the advent of artificial intelligence, the secondary use of routinely collected medical data from electronic healthcare records (EHR) has become increasingly popular. However, different EHR systems typically use different names for the same medical concepts. This obviously hampers scalable model development and subsequent clinical implementation for decision support. Therefore, converting original parameter names to a so-called ontology, a standardized set of predefined concepts, is necessary but time-consuming and labor-intensive. We therefore propose an augmented intelligence approach to facilitate ontology alignment by predicting correct concepts based on parameter names from raw electronic health record data exports. METHODS: We used the manually mapped parameter names from the multicenter "Dutch ICU data warehouse against COVID-19" sourced from three types of EHR systems to train machine learning models for concept mapping. Data from 29 intensive care units on 38,824 parameters mapped to 1,679 relevant and unique concepts and 38,069 parameters labeled as irrelevant were used for model development and validation. We used the Natural Language Toolkit (NLTK) to preprocess the parameter names based on WordNet cognitive synonyms transformed by term-frequency inverse document frequency (TF-IDF), yielding numeric features. We then trained linear classifiers using stochastic gradient descent for multi-class prediction. Finally, we fine-tuned these predictions using information on distributions of the data associated with each parameter name through similarity score and skewness comparisons. RESULTS: The initial model, trained using data from one hospital organization for each of three EHR systems, scored an overall top 1 precision of 0.744, recall of 0.771, and F1-score of 0.737 on a total of 58,804 parameters. Leave-one-hospital-out analysis returned an average top 1 recall of 0.680 for relevant parameters, which increased to 0.905 for the top 5 predictions. When reducing the training dataset to only include relevant parameters, top 1 recall was 0.811 and top 5 recall was 0.914 for relevant parameters. Performance improvement based on similarity score or skewness comparisons affected at most 5.23% of numeric parameters. CONCLUSION: Augmented intelligence is a promising method to improve concept mapping of parameter names from raw electronic health record data exports. We propose a robust method for mapping data across various domains, facilitating the integration of diverse data sources. However, recall is not perfect, and therefore manual validation of mapping remains essential.

Reactions to peanut at first introduction in infancy are associated with age ≥8 months and severity of eczema.

BACKGROUND: Previous studies have shown the efficacy of the early introduction of peanut to prevent peanut allergy. Due to the exclusion of infants with sensitization to peanut, it remains unclear what the optimal timing of introduction is. METHODS: The PeanutNL study was performed in 6 pediatric allergology centers in the Netherlands. Infants referred for the clinical early introduction of peanut to prevent peanut allergy underwent skin prick tests for peanut and an oral peanut challenge at a median age of 6 months. RESULTS: One hundred sixty two of 707 infants (23%) who had never eaten peanut before were sensitized to peanut, of which 80 (49%) had wheals of >4 mm. Sixty seven of 707 infants (9.5%) had a positive oral challenge to peanut at first introduction. Multivariate analysis revealed that age (p < .001) and SCORAD eczema severity scores (p = .001) were significant risk factors. Introduction of peanut at ≥8 months in infants with moderate and severe eczema resulted in an increased risk (odds ratio 5.24 (p = .013) and 3.61 (p = .019), respectively) of having reactions to peanut as compared to introduction before 8 months. A family history of peanut allergy and previous reactions to egg were not identified as independent risk factors. CONCLUSION: These results suggest that peanut should be introduced before the age of 8 months to reduce the risk of reactions at first exposure in infants with moderate and severe eczema. Furthermore, since children with severe eczema have the highest risk of reactions, the clinical introduction of peanut should be considered, at the latest at the age of 7 months.

Generalizable calibrated machine learning models for real-time atrial fibrillation risk prediction in ICU patients.

BACKGROUND: Atrial Fibrillation (AF) is the most common arrhythmia in the intensive care unit (ICU) and is associated with increased morbidity and mortality. Identification of patients at risk for AF is not routinely performed as AF prediction models are almost solely developed for the general population or for particular ICU populations. However, early AF risk identification could help to take targeted preemptive actions and possibly reduce morbidity and mortality. Predictive models need to be validated across hospitals with different standards of care and convey their predictions in a clinically useful manner. Therefore, we designed AF risk models for ICU patients using uncertainty quantification to provide a risk score and evaluated them on multiple ICU datasets. METHODS: Three CatBoost models, utilizing feature windows comprising data 1.5-13.5, 6-18, or 12-24 hours before AF occurrence, were built using 2-repeat-10-fold cross-validation on AmsterdamUMCdb, the first freely available European ICU database. Furthermore, AF Patients were matched with no-AF patients for training. Transferability was validated using a direct and a recalibration evaluation on two independent external datasets, MIMIC-IV and GUH. The calibration of the predicted probability, used as an AF risk score, was measured using the Expected Calibration Error (ECE) and the presented Expected Signed Calibration Error (ESCE). Additionally, all models were evaluated across time during the ICU stay. RESULTS: The model performance reached Areas Under the Curve (AUCs) of 0.81 at internal validation. Direct external validation showed partial generalizability with AUCs reaching 0.77. However, recalibration resulted in performances matching or exceeding that of the internal validation. All models furthermore showed calibration capabilities demonstrating adequate risk prediction competence. CONCLUSION: Ultimately, recalibrating models reduces the challenge of generalization to unseen datasets. Moreover, utilizing the patient-matching methodology together with the assessment of uncertainty calibration can serve as a step toward the development of clinical AF prediction models.

The Groningen electrocardiographic criteria for left ventricular hypertrophy: a sex-specific analysis.

The sensitivity of electrocardiogram (ECG) criteria to detect left ventricular hypertrophy (LVH) is low, especially in women. We determined sex-specific sensitivities of ECG-LVH criteria, and developed new criteria, using cardiovascular magnetic resonance imaging (CMR). Sensitivities of ECG-LVH criteria were determined in participants of the UK Biobank (N = 3632). LVH was defined when left ventricular mass was > 95% confidence interval (CI) according to age and sex. In a training cohort (75%, N = 2724), sex-specific ECG-LVH criteria were developed by investigating all possible sums of QRS-amplitudes in all 12 leads, and selecting the sum with the highest pseudo-R2 and area under the curve to detect LVH. Performance was assessed in a validation cohort (25%, N = 908), and association with blood pressure change was investigated in an independent cohort. Sensitivities of ECG-LVH criteria were low, especially in women. Newly developed Groningen-LVH criterion for women (QV2 + RI + RV5 + RV6 + SV2 + SV4 + SV5 + SV6) outperformed all ECG-LVH criteria with a sensitivity of 42% (95% CI 35-49%). In men, newly developed criterion ((RI + RV5 + SII + SV2 + SV6) × QRS duration) was equally sensitive as 12-lead sum with a sensitivity of 44% (95% CI 37-51%) and outperformed the other criteria. In an independent cohort, the Groningen-LVH criteria were strongest associated with change in systolic blood pressure. Our proposed CMR sex-specific Groningen-LVH criteria improve the sensitivity to detect LVH, especially in women. Further validation and its association with clinical outcomes is warranted.

Active Tobacco Smoking Impairs Cardiac Systolic Function.

Tobacco smoking is a well-established risk factor for cardiovascular disease, but its direct effect on myocardial structure and function remains unclear. This study investigated the effects of smoking using a nested matched case-control study design. 5,668 participants of the UK Biobank study who underwent cardiovascular magnetic resonance imaging were screened for inclusion. 102 smokers (56 males) with a median age of 56 years were matched to non-smokers based on sex, age, and body surface area. Manual post-processing and feature tracking analyses were performed to determine left ventricular (LV) and right ventricular (RV) structure and function measures. Linear regression analyses were performed to determine the effect of tobacco smoking on imaging measures. Tobacco smoking was associated with increased LV and RV end-systolic volume (4.98 ± 2.08 mL, 5.19 ± 2.62 mL, P = 0.018, 0.049 respectively), reduced LV and RV ejection fraction (ß: -2.21 ± 0.82%, -2.06 ± 0.87%, P = 0.007, 0.019 respectively), and reduced absolute measures of LV peak global longitudinal, radial, and circumferential strain (ß: 0.86 ± 0.30%, -2.52 ± 0.99%, 1.05 ± 0.32%, P = 0.004, 0.011, 0.001 respectively). Effect sizes were larger in daily smokers compared to occasional smokers. In a general Caucasian population without known clinical cardiovascular disease, active tobacco smoking was dose dependently associated with impaired cardiac systolic function.

Sex differences in leukocyte profile in ST-elevation myocardial infarction patients.

BACKGROUND: Whether sex differences exist in the inflammatory response after ST-elevation myocardial infarction (STEMI) remains to be elucidated. We studied leukocyte profiles and their prognostic value in men and women presenting with STEMI. METHODS: From a total of 552 consecutive STEMI patients, blood samples were collected at hospital admission. Linear regression was used to assess the relationship between leukocyte profiles and enzymatic infarct size. Cox regression was used to assess the association between leukocyte profiles and one-year mortality. RESULTS: Women presented with higher lymphocyte counts (2.3·109 cells/L (IQR 1.6-3.1) vs. 1.8·109 cells/L (IQR 1.4-2.5), p = 3.00 ∙ 10-4) and percentages (21.1% (IQR 14.4-28.1) vs. 17.1% (IQR 12.3-24.3), p = 0.004). Lymphocyte to monocyte ratio (LMR) was also higher in women (3.25 (IQR 2.56-4.5) vs. 2.68 (IQR 2.08-3.59), p = 7.28 ∙ 10-7). Higher LMR was associated with lower peak CK-MB (ß = -0.27 (95% CI: -0.50, -0.03), p = 0.026), lower peak troponin T (ß = -0.45 (95% CI: -0.77, -0.13), p = 0.006) and lower one-year mortality risk (HR 0.35 (95% CI: 0.13, 0.96), p = 0.042). CONCLUSION: At admission for STEMI, women present with higher lymphocyte count and LMR. Higher LMR is associated with smaller infarct size and decreased one-year mortality risk and could be used as a biomarker to predict outcome.

TcMEP threshold change is superior to A-train detection when predicting facial nerve outcome in CPA tumour surgery.

OBJECT: Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facial nerve outcome during surgery. Recent research has shown TcMEP threshold increase and the occurrence of A-trains on the EMG to have great potential in doing so. This study compares these two methods and correlates them to House-Brackmann (HB) scores post-op in patients with tumours in the cerebellopontine angle. METHOD: Forty-three patients (one was operated twice) with large CPA tumours treated surgically in the Radboud University Medical Center between 2015 and 2019 were included in this study. During surgery, TcMEP threshold increases and A-train activity were measured. Because our treatment paradigm aims at facial nerve preservation (accepting residual tumour), TcMEP threshold increase of over 20 mA or occurrence of A-trains were considered as warning signs and used as a guide for terminating surgery. HB scores were measured post-op, at 6 weeks, 6 months and 1 year after surgery. Spearman's correlation was calculated between the IOM-values and the HB scores for a homogeneous subgroup of 30 patients with vestibular schwannoma (VS) without neurofibromatosis type II (NF-II) and all patients collectively. RESULTS: TcMEP threshold was successfully measured in 39 (90.7%) procedures. In the homogeneous VS non-NFII group, we found a statistically significant moderate-to-strong correlation between TcMEP threshold increase and House Brackmann score immediately post-op, at 6 weeks, 6 months and 1 year after surgery (Spearman's rho of 0.79 (p < 0.001), 0.74 (p < 0.001), 0.64 (p < 0.001) and 0.58 (p = 0.002), respectively). For A-trains, no correlation was found. Similar results were found when including all patients with CPA tumours. A threshold increase of < 20 mA was a predictor of good facial nerve outcome. CONCLUSION: These results show that TcMEP threshold increases are strongly correlated to post-operative HB scores, while A-trains are not. This suggests TcMEP threshold increases can be a valuable predictor for facial nerve outcome in patients with large tumours when facial nerve preservation is prioritized over total resection. In this study, we found no use for A-trains to prevent facial nerve deficits.

Retrospective Analysis of Non-Surgical Treatment of Acute Cholecystitis.

Background: Worldwide, acute cholecystitis is a common disease. The current standard of treatment is according to the Tokyo Guidelines established in 2018. Conservative management with various combinations of analgesics, anti-inflammatory drugs, and percutaneous drainage are sometimes used to avoid or delay surgery, especially in frail patients, but little is known about the efficacy and safety of these strategies. Therefore, we evaluated the effect of antibiotic agents, with or without gallbladder drainage, or symptomatic treatment alone in patients with acute cholecystitis who were considered unfit for acute surgery. Patients and Methods: All patients whose initial treatment for cholecystitis was conservative who were admitted between 2014 and 2016 were included in this study. Patients were divided into three groups: those treated with antibiotic agents, those who received antibiotic agents in combination with percutaneous gallbladder drainage and those whose treatment was only symptomatic. Demographic characteristics, comorbidities, Tokyo Severity Classification, length of stay, re-admission rates, secondary treatment (delayed drainage or surgery), and complication rates were retrieved from their medical records. Results: Initially 33 were treated with conservative methods in this period. Fifteen patients were treated initially with antibiotic agents, 12 patients with antibiotic agents in combination with percutaneous drainage, and 6 patients received symptomatic treatment only. One patient had mild cholecystitis (Tokyo Severity Classification grade I) and the other 32 patients had moderate to severe (grade II or III) cholecystitis. Eventually, 25 patients (76%) underwent cholecystectomy, 2 of whom (8%) were emergency operations because of disease progression. Twelve patients (36%) were re-admitted, of whom the majority (83%) was re-admitted before cholecystectomy. Conclusion: Treatment of cholecystitis with antibiotic agents, drainage, or analgesic agents is feasible. However, it should be regarded as a bridge to surgery rather than a definitive solution because of frequent recurrence. Occasionally, an emergency operation could not be avoided as a result of disease progression under conservative treatment.

Effect of Systolic Blood Pressure on Left Ventricular Structure and Function: A Mendelian Randomization Study.

We aimed to estimate the effects of a lifelong exposure to high systolic blood pressure (SBP) on left ventricular (LV) structure and function using Mendelian randomization. A total of 5596 participants of the UK Biobank were included for whom cardiovascular magnetic resonance imaging and genetic data were available. Major exclusion criteria included nonwhite ethnicity, major cardiovascular disease, and body mass index >30 or <18.5 kg/m2. A genetic risk score to estimate genetically predicted SBP (gSBP) was constructed based on 107 previously established genetic variants. Manual cardiovascular magnetic resonance imaging postprocessing analyses were performed in 300 individuals at the extremes of gSBP (150 highest and lowest). Multivariable linear regression analyses of imaging biomarkers were performed using gSBP as continuous independent variable. All analyses except myocardial strain were validated using previously derived imaging parameters in 2530 subjects. The mean (SD) age of the study population was 62 (7) years, and 52% of subjects were female. Corrected for age, sex, and body surface area, each 10 mm Hg increase in gSBP was significantly (P<0.0056) associated with 4.01 g (SE, 1.28; P=0.002) increase in LV mass and with 2.80% (SE, 0.97; P=0.004) increase in LV global radial strain. In the validation cohort, after correction for age, sex, and body surface area, each 10 mm Hg increase in gSBP was associated with 5.27 g (SE, 1.50; P<0.001) increase in LV mass. Our study provides a novel line of evidence for a causal relationship between SBP and increased LV mass and with increased LV global radial strain.

The effect of follow-up after a negative double-blinded placebo-controlled cow's milk challenge on successful reintroduction.

Cow's milk allergy is a common food allergy in children with an incidence of 1-3%. The gold standard to diagnose cow's milk allergy is a double-blinded placebo-controlled food challenge (DBPCFC). Previous studies show that reintroduction of cow's milk is unsuccessful in 10-12% of patients. The aim of this retrospective study is to evaluate the effect of follow-up on the reintroduction of cow's milk. We analyzed the data of patients with a negative DBPCFC for cow's milk between 2014 and 2016 in three different departments. Questionnaires were used to compare the three ways of follow-up (no follow-up, follow-up in person or by telephone). Of the 336 children with a negative DBPCFC for cow's milk, 128 questionnaires (41%) were returned. Reintroduction of cow's milk was unsuccessful in 13.3% of the patients. There was no significant difference found between children with (73.8%) or without (26.2%) follow-up, or between follow-up by phone or personally. Whether this finding is caused by small numbers within this retrospective study should be investigated in future prospective studies.Conclusion: Follow-up does not influence the reintroduction success rate of cow's milk after a negative double-blinded placebo-controlled food challenge. What is Known: Diagnosis of cow's milk allergy by double-blinded placebo-controlled food challenge is the gold standard. • After a negative double-blinded placebo-controlled food challenge, reintroduction of cow's milk in the child's diet is unsuccessful in 10-12% of the children. • Recurrence of symptoms, aversion to the examined food, and fear are seen as the main reasons for unsuccessful introduction. What is New: • Reintroduction after a negative double-blinded placebo-controlled food challenge is not influenced by different ways of follow-up.

Agreement of 2D transthoracic echocardiography with cardiovascular magnetic resonance imaging after ST-elevation myocardial infarction.

BACKGROUND: This study was designed to investigate the agreement of 2D transthoracic echocardiography (2D TTE) with cardiovascular magnetic resonance imaging (CMR) in a contemporary population of ST-elevation myocardial infarction (STEMI) patients. METHODS: In this subanalysis of the GIPS-III trial, a randomized controlled trial investigating the administration of metformin in STEMI patients to prevent reperfusion injury, we studied 259 patients who underwent same-day CMR and 2D TTE assessments four months after hospitalization for a first STEMI. Bland-Altman analyses were performed to assess agreement between LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), and LV mass measurements. Sensitivity and specificity of 2D TTE to detect categories of LVEF (≤35%, 35-50%, ≥50%) was determined. Linear regression of absolute differences in measurements between imaging modalities was used to investigate whether patient characteristics impact measurement bias. RESULTS: Pairwise difference (bias) and 95% limits of agreement between CMR and 2D TTE measurements were +84 (37, 147) ml for LVEDV, +39 (6, 85) ml for LVESV, -1.1 ± 13.5% for LVEF, and -75 (-154, -14) g for LV mass. Sensitivity and specificity of 2D TTE to detect subjects with moderately depressed LVEF (35-50%) as measured by CMR were 52% and 88% respectively. We observed a significant effect of enzymatic infarct size on bias between 2D TTE and CMR in measuring LVESV and LVEF (P = 0.029, P = 0.001 respectively), of age and sex on bias between 2D TTE and CMR in measuring LV mass (P = 0.027, P < 0.001) and LVEDV (P = 0.001, P = 0.039), and of heart rate on bias between 2D TTE and CMR in LV volume measurements (P = 0.004, P = 0.016). CONCLUSIONS: Wide limits of agreement, underestimation of LV volumes and overestimation of LV mass was observed when comparing 2D TTE to CMR. Enzymatic infarct size, age, sex, and heart rate are potential sources of bias between imaging modalities.

Author Correction: Causal Pathways from Blood Pressure to Larger QRS Amplitudes: a Mendelian Randomization Study.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Survival After MitraClip Treatment Compared to Surgical and Conservative Treatment for High-Surgical-Risk Patients With Mitral Regurgitation.

BACKGROUND: Survival outcome after MitraClip treatment, compared with surgical or conservative treatment, is not well defined. We examined survival after MitraClip treatment in a large multicenter real-life setting. METHODS AND RESULTS: We retrospectively formed matched high-risk surgically and conservatively treated control cohorts to compare to a high-risk MitraClip cohort. One thousand thirty-six patients were included in 4 Dutch centers, of which 568 were treated with the MitraClip. The observed survival at 5-year follow-up in our MitraClip cohort was low (39.8%) but was comparable to our conservative cohort (40.5%). Observed 5-year survival for our surgical cohort was 76.3%. However, there were significant differences between the baseline characteristics of the 3 studied cohorts, with the MitraClip cohort having the highest comorbidity burden. After adjusting for baseline differences by using Cox regression, the MitraClip and surgical cohorts showed similar survival ratios (hazard ratio, 0.92; 95% confidence interval, 0.67-1.26; P=0.609), whereas both showed a lower mortality hazard when compared with conservative treatment (hazard ratio, 0.61; 95% confidence interval, 0.49-0.77; P<0.001 and hazard ratio, 0.56; 95% confidence interval, 0.42-0.76; P<0.001, respectively). CONCLUSIONS: This matched analysis suggests a lower mortality hazard for MitraClip intervention in a high-risk population with symptomatic mitral regurgitation when compared with conservative management alone.

Left ventricular restoration devices post myocardial infarction.

Even in the era of percutaneous reperfusion therapy, left ventricular (LV) remodeling after myocardial infarction (MI) leading to heart failure remains a major health concern. Contractile dysfunction of the infarcted myocardium results in an increased pressure load, leading to maladaptive reshaping of the LV. Several percutaneous transcatheter procedures have been developed to deliver devices that restore LV shape and function. The purposes of this review are to discuss the spectrum of transcatheter devices that are available or in development for attenuation of adverse LV remodeling and to critically examine the available evidence for improvement of functional status and cardiovascular outcomes.

Causal Pathways from Blood Pressure to Larger Qrs Amplitudes a Mendelian Randomization Study.

Abnormal QRS duration and amplitudes on the electrocardiogram are indicative of cardiac pathology and are associated with adverse outcomes. The causal nature of these associations remains uncertain and could be due to QRS abnormalities being a symptom of cardiac damage rather than a factor on the causal pathway. By performing Mendelian randomization (MR) analyses using summary statistics of genome wide association study consortia with sample sizes between 20,687 and 339,224 individuals, we aimed to determine which cardiovascular risk factors causally lead to changes in QRS duration and amplitude (Sokolow-Lyon, Cornell and 12-leadsum products). Additionally, we aimed to determine whether QRS traits have a causal relationship with mortality and longevity. We performed inverse-variance weighted MR as main analyses and MR-Egger regression and weighted median estimation as sensitivity analyses. We found evidence for a causal relationship between higher blood pressure and larger QRS amplitudes (systolic blood pressure on Cornell: 55SNPs, causal effect estimate per 1 mmHg = 9.77 millimeters·milliseconds (SE = 1.38,P = 1.20 × 10-12) and diastolic blood pressure on Cornell: 57SNPs, causal effect estimate per 1 mmHg = 14.89 millimeters·milliseconds (SE = 1.82,P = 3.08 × 10-16), but not QRS duration. Genetically predicted QRS traits were not associated with longevity, suggesting a more prominent role of acquired factors in explaining the well-known link between QRS abnormalities and outcome.

Strengths and virtues and the development of resilience: A qualitative study in Suriname during a time of economic crisis.

BACKGROUND: Resilience can be described as the capacity to deal with adversity and traumatic events. The current economic situation in Suriname and its social economic consequences may demand a great amount of resilience for people living in Suriname. In this explorative study, we examined the relation between strengths and resilience among the three major ethnic groups in Suriname. METHOD: Semi-structured interviews were conducted with 25 participants. We sought to gather viewpoints from community representatives, health care professionals and academic scholars about the personal resources used by people in Suriname to help them deal with the consequences of the current socio-economic crisis. RESULTS: We identified major five strengths that were associated with resilience: religiousness, hope, harmony, acceptance and perseverance. While these strengths contribute to the development of resilience, they can under certain circumstances have an ambiguous influence. CONCLUSION: Our findings suggest that religiousness is the bedrock strength for the development of resilience in Suriname. We recommend that future positive psychological interventions in non-Western countries integrate positive activities with religious elements into program interventions to achieve a better cultural fit.