Premature Ventricular Complexes: Assessing Burden Density in a Large National Cohort to Better Define Optimal ECG Monitoring Duration

BACKGROUND

Premature ventricular contractions (PVCs) burden is a risk factor for heart failure and cardiovascular death in patients with structural heart disease. Long-term ECG monitoring can have a significant impact on PVC burden evaluation by further defining PVC distribution patterns.

OBJECTIVE

This study aimed to ascertain the optimal duration of ECG monitoring to characterize PVC burden and understand clinical characteristics associated with frequent PVCs and NSVT in a large US cohort.

METHODS

Commercial data (iRhythm's Zio patch) from June 2011 to April 2022 were analyzed. Inclusion criteria were age >18 years, PVC burden ≥5%, and wear period ≥13 days. PVC burden cutoffs were determined based on AHA/ACC/HRS guidelines for very frequent PVCs (10,000-20,000 over 24 hours). Patients were categorized by PVC densities : Low (<10%), Moderate (10% to <20%) and High (≥20%). Mean measured error was assessed at baseline and daily until wear period's end for overall PVC Burden and different PVC densities.

RESULTS

Analysis of 106,705 patch monitors revealed a study population with mean age of 70.6±14.6 years; 33.6% female. PVC burden was higher in males and those >65 years of age. PVC burden mean error decreased from 2.9% at 24 hours to 1.3% at 7 days, and 0.7% at 10 days. Number of VT episodes per patient increased with increasing PVC burden (p<0.0001).

CONCLUSION

Extending ambulatory monitoring beyond 24 hours to 7 days or more, improves accuracy of assessing PVC burden. VT frequency and duration vary based on initial PVC density, highlighting the need for prolonged cardiac monitoring.

Insights on stock structure of round sardinella Sardinella aurita off north-west Africa based on otolith shape analysis

This study examines the geographic variability in otolith shape of round sardinella Sardinella aurita as a tool for stock discrimination. Fish were analysed from six sampling locations from Senegal to the Mediterranean coast of Morocco. A combination of otolith shape indices and elliptic Fourier descriptors was investigated by multivariate statistical procedures. Within the studied area, three distinct groups were identified with an overall correct classification of 78%. Group A: Nador (Alboran Sea), group B: Casablanca (northern Morocco) and group C: Senegalese-Mauritanian. The results of this study confirm the absence of an Atlantic Ocean-Mediterranean Sea transition for this species, the Gibraltar Strait acting as an efficient barrier for S. aurita population separation. Off north-west Africa, fish from northern Morocco form a single group which is clearly isolated from Senegalese-Mauritanian waters, confirming the existence of a distinct stock in this area. Among group C, some discontinuity exists and suggests the existence of a sedentary fraction of S. aurita in northern Mauritania (Arguin Bank). The results are discussed in relation to oceanographic features and physical barriers to dispersal and fish management strategy in the study area.

Effects of chemical stress and food limitation on the energy reserves and growth of turbot, Scophthalmus maximus

The objective of the present study is to examine the growth and energetic performance of juvenile turbot after exposure to contaminated sediment and during the subsequent recovery period with or without food limitation. We designed a two-step experiment by first exposing juvenile turbot to harbour sediment for 26 days and then transferring them to clean sea water with different frequencies of feeding for 35 days. Without food limitation, fish previously exposed to contaminated sediment compensated for weight, length and lipid reserve losses; we did not record any differences in size, Fulton's K condition index and triacylglycerol/sterol (TAG/ST) ratio after the 35-day depuration period compared to the reference fish. This result could be related to the compensatory growth mechanism observed in a wide range of fish species following a period of growth depression. With food limitation during the 35-day depuration period, recovery growth was not sufficient to restore length and weight values similar to the reference fish. Moreover, turbot previously exposed to contaminated sediment and subsequently fed twice or once a week exhibited extremely low TAG/ST ratios, but the reference fish submitted to the same restrictive feeding conditions did not. This study indicates that juvenile fish affected by chemical pollution can improve their biological performance if pollution events are followed by a period of abundant food. However, if pollution events occur during periods of food scarcity, e.g. in winter, storage of energy reserves will be compromised.

A combined measurement of metal bioaccumulation and condition indices in juvenile European flounder, Platichthys flesus, from European estuaries

Condition indices and metal bioaccumulation of early life stages of juvenile flounder (5-10 cm) were determined in three anthropogenic estuaries (the Scheldt, Seine and Loire) and compared to a reference site (the Canche). Significant correlations were found between metal concentrations in sediment and (i) fish liver for Cd, Cu, Ni, Pb, V and Zn and (ii) fish gills for Cd and Mn. Metal accumulation in juvenile flounder from the three anthropogenic estuaries coincided with significantly lower Fulton's K indices (from 0.99 ± 0.03 to 1.06 ± 0.01 mg mm(-3)) compared to those from the Canche estuary (from 1.02 ± 0.01 to 1.13 ± 0.01 mg mm(-3)). This discrepancy in fish condition index increased with fish size and therefore, strongly depends on the time juvenile spend in estuary. Muscle lipid contents and Triacylglycerol to Sterol ratios were significantly lower in fish collected in the Scheldt (lipid content: 21.3 ± 3.6%), Seine (17.9 ± 19.8%) and Loire (19.5 ± 2.4%) estuaries compared to those originating from the Canche (38.3 ± 4.6%). This study highlights that combined measures of both fish metal contents and condition indices gives a relevant assessment of juvenile fish health growing in anthropogenic estuaries.

A multibiomarker approach in juvenile turbot, Scophthalmus maximus, exposed to contaminated sediments

Juvenile turbot were exposed in laboratory conditions to a mixture of chemical contaminants associated with harbour and estuarine sediments for seven and 21 days. Several molecular biomarkers of exposure were then measured in fish liver: two biotransformation parameters [ethoxyresorufin-O-deethylase (EROD) and phase II glutathione S-transferase (GST) activities] and an antioxidant enzyme activity [catalase (CAT)]. Modifications at the histological level were analysed by the measurement of the number and size of melanomacrophage centres (MMCs) and disturbances to the immune function by the measurement of cytokine transforming growth factor-beta (TGF-β) and development of the thymus. The responses of these molecular and immunological biomarkers were correlated with metal and PAH concentrations measured in sediments and with the physiological performance of turbot analysed in a previous study on the same fish (growth rates, condition factor K, RNA:DNA ratio and lipid index). While no difference was found in thymus analysis, some molecular and immunological responses were observed in fish exposed to contaminated sediments. Weak relationships between molecular biomarkers' responses and PAH concentrations were recorded, while their responses were significantly correlated with some metals. MMC and aggregates were weakly related to chemical contaminants whereas some significant correlations were found between TGF-b1 responses and some metal concentrations. However, molecular and immunological biomarkers were weakly related to fish physiological damages since low responses were observed in the condition which led to the lowest growth and condition indices. These data suggest the complexity of cause-effect relationships between exposure to pollutants, metabolisms and health damages. Precautions should be considered in the use of molecular and immunological biomarkers alone in biomonitoring programs. Their complementary use with physiological biomarkers, such as fish growth and condition indices, could improve their utilisation.

Responses of juvenile sea bass, Dicentrarchus labrax, exposed to acute concentrations of crude oil, as assessed by molecular and physiological biomarkers

In the present study, juvenile sea bass were exposed for 48 and 96 h to an Arabian light crude oil and their responses were assessed at the molecular and physiological levels. The aim of the study was therefore to assess (i) the short term effects of crude oil exposure by the measurement of several molecular biomarkers, (ii) the consequences of this short term exposure on fish health by using growth and condition indices measured after a decontamination period of 28 and 26 d in seawater. Hydrocarbon petroleum concentrations was monitored during the 96 h experiments and an increase of PAH concentrations were found in fish following both exposure times. An 7-ethoxyresorufin-O-deethylase (EROD) induction was observed after 48 h of exposure, while a significant decrease in the sea bass specific growth rate in length and for the RNA:DNA ratio was observed 28 d after that exposure ceased. The EROD induction doubled after the 96 h exposure, and a significant increase in GST activities was observed. A significant decrease in the specific growth rates, the otolith recent growth, the RNA:DNA ratio and the Fulton's K condition index were then observed in sea bass 26 d after the 96 h exposure to mechanically dispersed crude oil compared to the control. The present study shows that growth and condition indices can prove useful in assessing fish health status following an oil spill. Their complementary analysis with sensitive molecular biomarkers as EROD could improve the determination of oil spill impact on fish populations.

Growth and condition indices of juvenile turbot, Scophthalmus maximus, exposed to contaminated sediments: effects of metallic and organic compounds

Since sediments have the potential to form associations with several classes of pollutants, they have been recognized as a possible and significant source of contamination for the benthic environment. Flatfish maintain a close association with sediments for food and cover, and are therefore more likely to be exposed to contaminated sediments, especially in coastal areas (e.g. nursery grounds). The assessment of these potential biological effects involves the use of adapted biomonitoring tools. The main objective of this study was to assess and compare the response of several physiological biomarkers measured on juvenile turbot (Scophthalmus maximus) exposed to contaminated sediments. Sediments were collected from three stations in a harbour in northern France (Boulogne-sur-Mer), in an anthropogenic French estuary (the Seine), and in a reference site (exposed sandy beach of Wimereux). Unexposed lab-reared juvenile turbots were exposed to sediments for 7 and 21 days in laboratory conditions. Sediments were analysed for metals, PAH and PCB contamination. Several fish growth and condition indices were individually analysed in fish according to the chemical contaminant availability in sediment, the metal concentrations in gills and the estimation of PAH metabolites in their bile. Significant decreases in growth rates, morphometric index, RNA:DNA ratio and the lipid storage index, based on the ratio of the quantity of triacylglycerols on sterols (TAG:ST), were observed with increasing level of chemical contamination. This decrease in the fish's physiological status could be related to the significant increase of several metal concentrations in contaminated fish gills and the significant increase of PAH metabolites in bile. In a field situation, such a reduction in growth and energetic status of juvenile fish could dramatically decrease their over-winter survival in contaminated nursery grounds.

Are biochemical biomarker responses related to physiological performance of juvenile sea bass (Dicentrarchus labrax) and turbot (Scophthalmus maximus) caged in a polluted harbour?

Biomarker responses to toxic exposure have been used for decades to indicate stress in aquatic organisms, or the magnitude of environmental pollution. However, little has been done to compare the simultaneous responses of both biochemical and physiological biomarkers. The purpose of this study was twofold. Firstly to analyse the responses of several biochemical biomarkers measured on juvenile sea bass and turbot caged in a northern France harbour at a reference and contaminated stations. Several biotransformation parameters (Ethoxyresorufin-O-deethylase - EROD - and Glutathione S-transferase -GST) and an antioxidant enzyme (Catalase -CAT) were analysed. Secondly, to compare their responses to several growth and condition indices, measured on the same fish. In the contaminated station, EROD and GST activities were found to be significantly higher, and a decrease of CAT activity was observed for both species. For individual sea bass, biochemical biomarkers showed numerous significant correlations with growth and condition indices, such as the Fulton's K condition index, the RNA:DNA ratio and the lipid storage index. On the contrary, there were only a few significant correlations for turbot, suggesting a species-specific response. Our study indicates that the analysis of the simultaneous responses of both biochemical and physiological biomarkers can be useful for monitoring complex exposure and to assess habitat quality.

Heavy metals in four fish species from the French coast of the Eastern English Channel and Southern Bight of the North Sea

Shallow coastal waters act as nurseries for various fish species and have been recognized as essential fish habitat. We studied heavy metal concentrations in four fish species (plaice, dab, flounder and cod) as an indicator of large-scale habitat quality. The study took place along the French coasts between the Eastern English Channel and the Southern Bight of the North Sea. All species show different concentrations of measured metals (e.g., Cd, Cu, Mn and Pb) in liver but not in muscle. The highest concentrations are found for the flounder and the lowest for cod which is consistent with their habitat and diet. Although our results do not highlight levels of appreciable pollution within the study area, inter-site differences are mainly observed in the muscle tissues and are generally in agreement with the known environmental data (e.g., anthropogenic pressure). However, in the Bay of Seine, one of the most contaminated estuaries in Europe, metal concentrations are in the same range or even lower than those found in fish collected from areas distant from any anthropogenic pressures. At one site, the comparisons of the Cd, Cu and Pb concentrations between healthy and diseased dabs have been carried out on the muscle and liver tissues. The results of this preliminary study show a relationship between metal concentrations and the pathological status of the fish. The use of fish health as indicator of habitat quality is discussed.