Scenarios of Delayed First Births and Associated Cohort Fertility Levels.

Fertility rates among individuals in their 20s have fallen sharply across Europe over the past 50 years. The implications of delayed first births for fertility levels in modern family regimes remain little understood. Using microsimulation models of childbearing and partnership for the 1970-1979 birth cohorts in Italy, Great Britain, Sweden, and Norway, we implement fictive scenarios that reduce the risk of having a first child before age 30 and examine fertility recovery mechanisms for aggregate fertility indicators (the proportion of women with at least one, two, three, or four children; cohort completed fertility rate). Exposure to a first birth increases systematically in the ages following the simulated reduction in first-birth risks, leading to a structural recovery in childbearing that varies across countries according to their fertility and partnership regimes. Full recovery requires an increase in late first-birth risks, with greater increases in countries where late family formation is uncommon and average family sizes are larger: in scenarios where early fertility declines substantially (a linear decline from 50% at age 15 to 0% at age 30), first-birth risks above age 30 would have to increase by 54% in Great Britain, 40% in Norway and Sweden, and 20% in Italy to keep completed fertility constant.

Coronary Angiography in Patients With Left Ventricular Hypertrabeculation/Noncompaction.

BACKGROUND: Left ventricular hypertrabeculation/noncompaction (LVHT) is a cardiac abnormality of unknown pathogenesis, frequently associated with neuromuscular disorders. The relevance of coronary artery disease (CAD) in LVHT is largely unknown. This study aimed to assess the role of CAD as a prognostic marker in LVHT. METHODS: Data from patients with LVHT were collected from an echocardiographic laboratory. The hospital information system was retrospectively screened for coronary angiography. The association of CAD with clinical, echocardiographic, and neurologic baseline parameters was assessed. End points were all-cause death and heart transplantation. RESULTS: A total of 154 patients (mean [SD] age, 57 [13.7] years; 31% female) who had undergone coronary angiography between 1995 and 2020 were included in the study. Coronary angiography disclosed CAD in 53 of 154 patients. Patients with CAD were older (mean [SD] age of, 64.2 [12.9] years vs 52.7 [12.4] years; P < .001); more frequently had angina pectoris (P = .05), diabetes (P = .002), and hypertension (P = .03); and more frequently had 3 or more electrocardiographic abnormalities (P = .04) than patients without CAD. During a median (IQR) follow-up period of 6.48 (2.44-11.20) years, 39% of patients reached an end point (death, n = 56; heart transplantation, n = 4). Mortality was 4.5% per year, and the rate of death or heart transplantation did not differ between patients with and without CAD (P = .26). Patients with 3-vessel disease had a worse prognosis than patients with 1- or 2-vessel disease (P = .046). CONCLUSION: In patients with LVHT, CAD does not appear to be associated with an increased rate of death or heart transplantation.

NT-pro-BNP in patients with left ventricular hypertrabeculation/non-compaction.

AIMS: Left ventricular hypertrabeculation/non-compaction (LVHT) is a cardiac abnormality of unknown pathogenesis and frequently associated with neuromuscular disorders. The N-terminal fragment of the pro brain natriuretic peptide (NT-pro-BNP) is a prognostic marker in heart failure whose relevance in LVHT patients is largely unknown. The aim of the study was to assess the role of NT-pro-BNP levels as prognostic markers in LVHT. METHODS AND RESULTS: Data of LVHT patients were collected in a database from one echocardiographic laboratory since 1996. The hospital information system was screened for measurements of NT-pro-BNP levels, and their association with clinical and echocardiographic baseline parameters was retrospectively assessed. During follow-up, the endpoints were death and heart transplantation. In 113 patients (median age 57 years, 24% women), data about NT-pro-BNP measurements were found, ranging from 8 to 121 152 (median 2029) ng/L. High NT-pro-BNP levels were associated with heart failure, valvular abnormalities, diabetes mellitus, hypertension, angina pectoris, number of LVHT-affected segments, end-diastolic diameter, and systolic dysfunction. During a follow-up of 73 (±64; 0-237) months, 35% of the patients reached an endpoint. High NT-pro-BNP levels were associated with the occurrence of an endpoint (P < 0.001). By multivariate analysis, predictors for endpoints were increased age (P = 0.0025), atrial fibrillation (P = 0.0023), natural logarithm of NT-pro-BNP levels (P = 0.0073), diabetes mellitus (P = 0.014), and thromboembolic events before diagnosis (P = 0.0347). CONCLUSIONS: Also in LVHT patients, high NT-pro-BNP levels are indicators for death and heart transplantation.

Usefulness of Neuromuscular Co-morbidity, Left Bundle Branch Block, and Atrial Fibrillation to Predict the Long-Term Prognosis of Left Ventricular Hypertrabeculation/Noncompaction.

The prognosis of patients with left ventricular hypertrabeculation/noncompaction (LVHT) is assessed controversially. LVHT is associated with other cardiac abnormalities and with neuromuscular disorders (NMD). Aim of the study was to assess cardiac and neurological findings as predictors of mortality rate in adult LVHT-patients. Included were patients with LVHT diagnosed between 1995 and 2019 in 1 echocardiographic laboratory. Patients underwent a baseline cardiologic examination and were invited for a neurological investigation. In January 2020, their survival status was assessed. End points were death or heart transplantation. LVHT was diagnosed by echocardiography in 310 patients (93 female, aged 53 ± 18 years) with a prevalence of 0.4%/year. A neurologic investigation was performed in 205 patients (67%). A specific NMD was found in 33 (16%), NMD of unknown etiology in 123 (60%) and the neurological investigation was normal in 49 (24%) patients. During follow-up of 84 ± 71 months, 59 patients received electronic devices, 105 patients died, and 6 underwent heart transplantation. The mortality was 4.7%/year, the rate of heart transplantation/death 5%/year. By multivariate analysis, the following parameters were identified to elevate the risk of mortality/heart transplantation: increased age (p = 0.005), inpatient (p = 0.001), presence of a specific NMD (p = 0.0312) or NMD of unknown etiology (p = 0.0365), atrial fibrillation (p = 0.0000), ventricular premature complexes (p = 0.0053), exertional dyspnea (p = 0.0023), left bundle branch block (p = 0.0201), and LVHT of the posterior wall (p = 0.0158). In conclusion, LVHT patients should be systematically investigated neurologically since neurological co-morbidity has a prognostic impact.

Some Questions to Our Chinese Colleagues Pioneering Research Into Coronavirus Disease 2019 (COVID-19).

A pandemic has developed, so physicians worldwide are particularly interested in the experiences of their Chinese Colleagues which are frequently cited. To assess the long-term pulmonary, cardiac, neurologic, and psychiatric consequences after COVID-19, the outcome of patients included in the early publications and the association with baseline findings is of particular interest. Thus, we review the methods of early Coronavirus disease 2019 (COVID-19) publications. Reports published before March 19th 2020, comprising >40 patients were included, considering especially cardiologic aspects. It remains unclear whether patients were described several times, or they were different patients. Only patients with confirmed COVID-19 were described, and no differences in findings of patients with initially suspected and later confirmed, or excluded infection. It remains unclear in how many cases information was missing, since missing values were not reported. Medication before hospital admission, level of education and occupation, household size and composition, weight or body mass index are lacking. No details about electrocardiographic findings are given. Patients still in follow-up, constituting the major part of observations, were excluded. The data should be re-analyzed. A comparison between confirmed and excluded cases could be carried out. By now, in November 2020, the reported patients will most probably have recovered. Thus, it would be possible to differentiate prognostic indicators more precisely. Laboratory tests and electrocardiograms could be analyzed in more detail to shed light on the spectrum of this disease and to solve some of the unanswered questions related with COVID-19.

Contribution of the Rise in Cohabiting Parenthood to Family Instability: Cohort Change in Italy, Great Britain, and Scandinavia.

In this study, we investigate through microsimulation the link between cohabiting parenthood and family instability. We identify mechanisms through which increases in cohabiting parenthood may contribute to overall increases in separation among parents, linking micro-level processes to macro-level outcomes. Analyses are based on representative surveys in Italy, Great Britain, and Scandinavia (represented by Norway and Sweden), with full histories of women's unions and births. We first generate parameters for the risk of first and higher-order birth and union events by woman's birth cohort and country. The estimated parameters are used to generate country- and cohort-specific populations of women with stochastically predicted family life courses. We use the hypothetical populations to decompose changes in the percentage of mothers who separate/divorce across maternal birth cohorts (1940s to 1950s, 1950s to 1960s, 1960s to 1970s), identifying how much of the change can be attributed to shifts in union status at first birth and how much is due to change in separation rates for each union type. We find that when cohabiting births were uncommon, increases in parents' separation were driven primarily by increases in divorce among married parents. When cohabiting parenthood became more visible, it also became a larger component, but continued increases in parents' divorce also contributed to increasing parental separation. When cohabiting births became quite common, the higher separation rates of cohabiting parents began to play a greater role than married parents' divorce. When most couples had their first birth in cohabitation, those having children in marriage were increasingly selected from the most stable relationships, and their decreasing divorce rates offset the fact that increasing proportions of children were born in somewhat less stable cohabiting unions.

Union instability as an engine of fertility? A microsimulation model for France.

Opportunities for conceiving and bearing children are fewer when unions are not formed or are dissolved during the childbearing years. At the same time, union instability produces a pool of persons who may enter new partnerships and have additional children in stepfamilies. The balance between these two opposing forces and their implications for fertility may depend on the timing of union formation and parenthood. In this article, we estimate models of childbearing, union formation, and union dissolution for female respondents to the 1999 French Etude de l'Histoire Familiale. Model parameters are applied in microsimulations of completed family size. We find that a population of women whose first unions dissolve during the childbearing years will end up with smaller families, on average, than a population in which all unions remain intact. Because new partnerships encourage higher parity progressions, repartnering minimizes the fertility gap between populations with and those without union dissolution. Differences between the two populations are much smaller when family formation is postponed-that is, when union formation and dissolution or first birth occurs after age 30, or when couples delay childbearing after union formation.

The Impact of Policies Influencing the Demography of Age-Structured Populations: Lessons from Academies of Sciences.

In this paper, we assess the role of policies aimed at regulating the number and age structure of elections on the size and age structure of five European Academies of Sciences. We show the recent pace of ageing and the degree of variation in policies across them and discuss the implications of different policies on the size and age structure of academies. We also illustrate the potential effect of different election regimes (fixed vs. linked) and age structures of election (younger vs. older) by contrasting the steady-state dynamics of different projections of Full Members in each academy into 2070 and measuring the size and age-compositional effect of changing a given policy relative to a status quo policy scenario. Our findings suggest that academies with linked intake (i.e., where the size of the academy below a certain age is fixed and the number of elections is set to the number of members becoming that age) may be a more efficient approach to curb growth without suffering any ageing trade-offs relative to the faster growth of academies electing a fixed number of members per year. We further discuss the implications of our results in the context of stable populations open to migration.

Neuromuscular and cardiac comorbidity determines survival in 140 patients with left ventricular hypertrabeculation/noncompaction.

BACKGROUND: The prognosis of patients with left ventricular hypertrabeculation/noncompaction (LVHT) is controversial. We assessed cardiologic and neurologic predictors for mortality in LVHT patients and how many received implantable cardioverters/defibrillators(ICD) or cardiac resynchronization devices (CRT). METHODS AND RESULTS: Included were patients with LVHT diagnosed echocardiographically between June 1995 and May 2009. All patients underwent a baseline cardiologic examination, and were invited for a neurological investigation. During June 2009, the patients were contacted by telephone and their records were screened if they had received ICD or CRT. In 140 patients (29% females, mean age 53 ± 16, range 14-94 years) LVHT was diagnosed. The neurologic investigation, carried out in 76%, disclosed a neuromuscular disorder of definite (n = 22) or unknown (n = 68) etiology or was normal (n = 16). During a follow-up of 4.5 years the mortality was 5.7%/year. Causes of death were heart failure(n = 11), pneumonia (n = 6), sudden cardiac death (n = 3), malignancy (n = 3), pulmonary embolism(n = 2), sepsis (n = 2), stroke (n = 2), hepatic failure (n = 1) or unknown (n = 6). Sixteen patients received devices (ICD n = 4, CRT n = 3, ICD plus CRT n = 9). Predictors for mortality were increased age (p = 0.0307), neuromuscular disorder of definite or unknown etiology (p = 0.0063), exertional dyspnea (p =0.0018), edema (p = 0.0000), heart failure (p = 0.0002), ventricular ectopic beats (p = 0.0119), atrial fibrillation (p = 0.0000), low voltage (p = 0.0139), presence of one or more ECG abnormalities (p = 0.0420), left ventricular fractional shortening <25% (p = 0.0046), extension of LVHT (p = 0.0063) and LVHT affecting the lateral wall (p = 0.0110). CONCLUSION: Mortality in LVHT is high and due to cardiac and neuromuscular comorbidity, why monitoring and therapy, including device therapy, should be improved.

In- and outpatients with noncompaction: differences in cardiac and neuromuscular co-morbidity.

BACKGROUND AND METHODS: The prognosis of patients with left ventricular hypertrabeculation/noncompaction (LVHT) is controversial. LVHT is associated with neuromuscular disorders (NMD) and diagnosed echocardiographically in in- as well as outpatients. We compared cardiologic and neurologic findings and mortality in LVHT-patients according to their diagnosis established as in- or outpatients. RESULTS: Among 113 patients (33 females, mean-age 53 years), 91 were investigated neurologically. Fifty-nine inpatients were older (55 versus 50 years, p<0.05), more frequently referred because of heart failure (73 versus 37%, p<0.001), had more often diabetes (24 versus 7%, p<0.05), heart failure (81 versus 57%, p<0.01), a lower left-ventricular fractional-shortening (21 versus 26%, p<0.05) and more extensive LVHT (1.7 versus 1.5 affected walls, p<0.05). Fifty-four outpatients were referred more often because of chest-pain (33 versus 12%, p<0.01), myopathy (13 versus 2%, p<0.05), were more often neurologically normal (20 versus 7%, p<0.05) or had a specific NMD (28 versus 12%, p<0.05). During a mean follow-up of 3.8 years, mortality was 5.8%/year. Inpatients had a higher mortality (12.1 versus 2.1%/year, p=0.0002) and a shorter time between LVHT-diagnosis and death (1.7 versus 4.6 years, p=0.0197) than outpatients. CONCLUSIONS: Outpatients with LVHT have a better prognosis than inpatients. Inpatients with LVHT should be closely monitored.

Atrial fibrillation in left ventricular noncompaction with and without neuromuscular disorders is associated with a poor prognosis.

AIMS: The study in patients with left ventricular hypertrabeculation/noncompaction (LVHT) aimed to compare patients with and without atrial fibrillation (AF) regarding prevalence of neuromuscular disorders (NMD), cardiac symptoms, electrocardiographic (ECG) findings, left ventricular function, location and extension of LVHT and mortality. METHODS AND RESULTS: LVHT was diagnosed in 102 patients (30 female, age 53+/-16 years) between June 1995 and November 2006. A specific NMD was diagnosed in 21, a NMD of unknown etiology in 47, the neurologic investigation was normal in 14, and 20 patients refused. The 15 patients with AF were older (65 versus 51 years, p<0.01), suffered more often from exertional dyspnoea (100 versus 62%, p<0.01), diabetes mellitus (33 versus 12%, p<0.05) and heart failure (100 versus 57%, p<0.01) than patients without AF. The prevalence of NMD was slightly higher in patients with than without AF (87 versus 82%, p=NS). AF patients had more frequent ECG abnormalities (2.3 versus 1.4, p<0.01), valvular abnormalities (93 versus 48%, p<0.01), lateral wall LVHT (87 versus 37%, p<0.01), more extensive LVHT (2.1 versus 1.5 ventricular parts, p<0.05), a worse left ventricular fractional shortening (14 versus 25%, p<0.01) and higher mortality during 3.8 years. CONCLUSION: LVHT-patients with AF deserve special care because they have a worse prognosis than LVHT-patients without AF.

[Sex differences in left ventricular noncompaction in patients with and without neuromuscular disorders]. / Diferencias de sexo en la ausencia de compactación ventricular izquierda con y sin trastornos neuromusculares.

INTRODUCTION AND OBJECTIVES: Left ventricular hypertrabeculation/noncompaction (LVHT/NC) is more prevalent in men and is frequently associated with neuromuscular disorders (NMDs). The aim of this study was to assess sex differences in a) the location and extent of LVHT/NC; b) left ventricular function; c) cardiac symptoms; d) electrocardiographic findings; e) the prevalence of NMD, and f) mortality. METHODS: Between June 1995 and September 2006, 100 patients (mean age, 53[15] years, range 14-94 years, 29 female) were diagnosed echocardiographically with LVHT/NC. All underwent cardiologic investigation and were invited to undergo a neurologic examination. RESULTS: The neurologic examination showed normal results in 14 patients, 21 were diagnosed with a specific form of NMD, and 44 had an NMD of unknown etiology. The other 21 refused to undergo the examination. Women presented more often with LVHT/NC affecting the anterior wall (10% vs. 0%; P< .05), the inferoposterior wall (28% vs. 10%; P< .05), and the lateral wall (72% vs. 31%; P< .001). In addition, on average 2.0 ventricular regions were affected in woman compared with 1.4 in men (P< .001). In contrast, apical LVHT/NC was slightly more common in men (97% versus 86%; P=.057). No differences were observed in age, symptoms, NMD prevalence, electrocardiographic findings, or mortality. CONCLUSIONS: In adults with LVHT/NC, there were sex differences in the location and extent of the condition. However, these did not affect clinical, neurologic, echocardiographic or electrocardiographic parameters, or prognosis. The higher prevalence of LVHT/NC in males remains unexplained.

Diferencias de sexo en la ausencia de compactación ventricular izquierda con y sin trastornos neuromusculares / Sex differences in left ventricular noncompaction in patients with and without neuromuscular disorders

Introducción y objetivos. La hipertrabeculación/ausencia de compactación ventricular izquierda (HACVI) es más prevalente en los varones y a menudo se asocia con trastornos neuromusculares (TNM). Este estudio se diseñó para valorar las diferencias por sexos de: a) la localización y la extensión de la HACVI; b) la función ventricular izquierda; c) los síntomas cardiacos; d) los hallazgos electrocardiográficos; e) la prevalencia de TNM, y f) la mortalidad. Métodos. Entre junio de 1995 y septiembre de 2006, se diagnosticó HACVI mediante ecocardiograma a 100 pacientes (29 mujeres; media de edad: 53 ± 15 [intervalo: 14-94] años). Todos los pacientes fueron sometidos a una exploración cardiológica e invitados a realizarse un examen neurológico. Resultados. El estudio neurológico fue normal en 14 pacientes, a 21 personas se les diagnosticó un TNM específico, a 44 un TNM de etiología desconocida, y 21 pacientes rehusaron ser sometidos a un estudio neurológico. Las mujeres presentaron con más frecuencia una HACVI que afectaba a la pared anterior (el 10 frente al 0%; p < 0,05), a la posteroinferior (el 28 frente al 10%; p < 0,05) y a la lateral (el 72 frente al 31%; p < 0,001), además de HACVI que afectaba a 2 frente a 1,4 regiones ventriculares (p < 0,001). En contraste, los varones presentaban con una frecuencia ligeramente más elevada HACVI apical (el 97 frente al 86%; p = 0,057). No se detectaron diferencias con respecto a la edad, los síntomas, la prevalencia de TNM, los hallazgos electrocardiográficos ni la mortalidad. Conclusiones. La HACVI en los adultos difiere según el sexo en cuanto a su localización y extensión, pero esto no afecta a los parámetros clínicos, neurológicos, electrocardiográficos o ecocardiográficos, ni tampoco al pronóstico. La prevalencia superior de HACVI en los varones continúa sin ser explicada (AU)

Introduction and objectives. Left ventricular hypertrabeculation/noncompaction (LVHT/NC) is more prevalent in men and is frequently associated with neuromuscular disorders (NMDs). The aim of this study was to assess sex differences in a) the location and extent of LVHT/NC; b) left ventricular function; c) cardiac symptoms; d) electrocardiographic findings; e) the prevalence of NMD, and f) mortality. Methods. Between June 1995 and September 2006, 100 patients (mean age, 53[15] years, range 14­-94 years, 29 female) were diagnosed echocardiographically with LVHT/NC. All underwent cardiologic investigation and were invited to undergo a neurologic examination. Results. The neurologic examination showed normal results in 14 patients, 21 were diagnosed with a specific form of NMD, and 44 had an NMD of unknown etiology. The other 21 refused to undergo the examination. Women presented more often with LVHT/NC affecting the anterior wall (10% vs. 0%; P<.05), the inferoposterior wall (28% vs. 10%; P<.05), and the lateral wall (72% vs. 31%; P<.001). In addition, on average 2.0 ventricular regions were affected in woman compared with 1.4 in men (P<.001). In contrast, apical LVHT/NC was slightly more common in men (97% versus 86%; P=.057). No differences were observed in age, symptoms, NMD prevalence, electrocardiographic findings, or mortality. Conclusions. In adults with LVHT/NC, there were sex differences in the location and extent of the condition. However, these did not affect clinical, neurologic, echocardiographic or electrocardiographic parameters, or prognosis. The higher prevalence of LVHT/NC in males remains unexplained (AU)

Cerebrovascular events in left ventricular hypertrabeculation/noncompaction with and without myopathy.

UNLABELLED: Little is known about frequency, morphology, and causes of stroke in patients with left-ventricular hypertrabeculation/noncompaction (LVHT). Aim of this study was to find out how many LVHT-patients suffer from stroke, which abnormalities are found on cerebral imaging, and if stroke LVHT-patients differ from non-stroke LVHT-patients with regard to cardiac and neuromuscular abnormalities. METHOD AND MATERIALS: Records of all included patients were reviewed for stroke diagnosed upon history, clinical examination, or cerebral CT/MRI (CCT, cMRI). RESULTS: Among 104 LVHT-patients included, stroke was diagnosed in 16 (15%). Of these two had a transitory ischemic attack and one a prolonged ischemic deficit. Among 36 patients undergoing a CCT (n=32), cMRI (n=9), or both (n=5) territorial stroke was found in 7, lacunar stroke in 2, and intracerebral bleeding in 1. Other imaging findings were atrophy (n=7), microangiopathy (n=4), leucencephalopathy (n=3), basal-ganglia-calcification (n=2), or non-specific hypodensities (n=2). Imaging studies without vascular lesions were found in 2 patients. At least one classical risk factor for stroke was found in 15 patients. Stroke-patients did not differ from non-stroke-patients regarding cardiac or neuromuscular findings. CONCLUSIONS: If systematically looked for, stroke is a frequent feature of LVHT. A causal relation between LVHT and stroke, however, is rather the exception than the rule.

Cardiologic and neuromuscular co-morbidity influences mortality of patients with left ventricular hypertrabeculation/noncompaction: comparison with the Austrian general population.

OBJECTIVE: Left ventricular hypertrabeculation/noncompaction (LVHT) is characterized by prominent trabeculations and intertrabecular recesses. LVHT patients suffer from heart failure, arrhythmias, chest pain and neuromuscular disorders (NMD). Data about long-term prognosis of LVHT are controversial. The aim of the study was to compare the mortality of LVHT patients with that of the Austrian general population and to assess which clinical and echocardiographic parameters influence mortality, and if mortality differs between patients with and without NMD. METHODS AND RESULTS: In 86 patients LVHT was diagnosed echocardiographically between June 1995 and December 2004 (21 women, mean age 52 +/- 14, range 14 - 94 years). A specific NMD was diagnosed in 21, a NMD of unknown aetiology in 33, the neurologic investigation was normal in 13 and 19 patients refused examination. During a mean follow-up of 51 months (range 3 - 106 months) the mortality rate was 5.3%/year. Compared with the lifetable from the Austrian general population and considering the sex, the standardized mortality ratio (SMR) of LVHT patients was 5.584 (95% CI 3.562-8.754, p = 0.000). The SMR was high in LVHT patients with NMD of unknown aetiology, who refused the neurologic investigation, with heart failure, diabetes mellitus, syncope, ventricular ectopic beats, pathologic Q waves, left anterior hemiblock, atrial fibrillation and low-voltage ECG. Patients with more extensive LVHT had a high SMR. CONCLUSIONS: Mortality in LVHT patients is higher than in the general population and cardiac and neurologic morbidity is the presumed cause for the increased mortality.

Association of electrocardiographic abnormalities with cardiac findings and neuromuscular disorders in left ventricular hypertrabeculation/non-compaction.

INTRODUCTION AND OBJECTIVES: Left ventricular hypertrabeculation/non-compaction (LVHT) is a cardiac abnormality characterized by prominent trabeculations and intertrabecular recesses, and frequently associated with neuromuscular disorders (NMD). The aim of the study was to assess the prevalence of electrocardiographic (ECG) abnormalities in LVHT and its association with clinical symptoms, left ventricular size, wall thickness, systolic function, location and extension of LVHT and presence or absence of NMD. METHODS AND RESULTS: In 86 patients LVHT was diagnosed echocardiographically between June 1995 and December 2004 (21 female, 65 male, age: 14-94 years, mean age: 52 +/- 14 years). All patients underwent a baseline cardiologic investigation and were invited for a neurologic investigation. A specific NMD was diagnosed in 21 (metabolic myopathy, n = 14; Leber's hereditary optic neuropathy, n = 3; myotonic dystrophy, n = 2; Becker muscular dystrophy, n = 1; Duchenne muscular dystrophy, n = 1), a NMD of unknown etiology in 32, the neurologic investigation was normal in 13, and 20 patients refused. Only 9 patients (10%) had normal ECGs. Frequent ECG abnormalities were tall QRS complexes (43%); ST/T-wave abnormalities (37%) and left bundle branch block (20%). ECG abnormalities were related with symptoms of heart failure and echocardiographic findings of systolic dysfunction and valvular abnormalities. Only atrial fibrillation (9%) was related to extension of LVHT. ECG abnormalities did not differ between patients with and without NMD. CONCLUSION: ECG abnormalities are frequent in LVHT. A normal ECG, however, does not exclude LVHT. No ECG pattern is typical for LVHT. ECG abnormalities occur independently of presence or absence of NMD, and thus all patients with LVHT should be referred to the neurologist.

Cardiologic and neurologic findings in left ventricular hypertrabeculation/noncompaction relating to echocardiographic indication.

BACKGROUND: Left-ventricular hypertrabeculation/noncompaction (LVHT) is characterized by prominent trabeculations and intertrabecular recesses. LVHT is usually diagnosed if a patient is referred for echocardiography. The study assessed if cardiologic and neurologic findings differ relating to indication for echocardiography. METHODS: Included were patients in whom LVHT was diagnosed in one echocardiographic laboratory between June 1995 and December 2005. All patients underwent a cardiologic examination and were invited for a neurological investigation. RESULTS: LVHT was diagnosed in 93/35,181 patients (26 female, 53+/-15 years). Heart failure was the most frequent indication (n=49), followed by chest pain (n=21), syncope (n=8), search for cardiac involvement in myopathy (n=7), stroke or embolism (n=3), arterial hypertension (n=3) and screening of LVHT patients' relatives (n=2). Patients with the indication "heart failure" were older than patients with other indications (59.4+/-13.1 versus 44.9+/-12.9 years, p<0.001), had more often a neuromuscular disorder of unknown etiology (53% versus 32%, p<0.05), exertional dyspnoea (96% versus 32%, p<0.001), edema (25% versus 7%, p<0.05) and advanced heart failure (NYHA III: 41% versus 11%, p<0.01; NYHA IV: 29% versus 9%, p<0.05), suffered less often from arterial hypertension (22% versus 41%, p<0.05), angina pectoris (14% versus 34%, p<0.05) and palpitations or syncope (10% versus 30%, p<0.05). Patients with the indication "heart failure" had less frequent normal ECG than patients with other indications (2% versus 18%, p<0.01), had more frequent > or = 2 ECG abnormalities (57% versus 36%, p<0.05), left bundle branch block (29% versus 9%, p<0.05), a larger left-ventricular enddiastolic diameter (69.9+/-9.7 versus 57.4+/-12.2 mm, p<0.001), a lower left-ventricular fractional shortening (16.9+/-6.1% versus 31.1+/-11.5%, p<0.001) and more often valvular abnormalities (76% versus 30%, p<0.001). Location and extension of LVHT did not differ between indication groups. CONCLUSION: Echocardiographers should be aware of LVHT in any indication for echocardiography.

Prognosis of left ventricular hypertrabeculation/noncompaction is dependent on cardiac and neuromuscular comorbidity.

BACKGROUND AND OBJECTIVES: Left ventricular hypertrabeculation/noncompaction (LVHT) is a cardiac abnormality frequently associated with neuromuscular disorders (NMD). The data about long-term prognosis of patients with LVHT are controversial. Aim of the study in a cohort of LVHT patients was to assess the long-term prognosis regarding mortality, cardiac and neuromuscular comorbidity. METHODS AND RESULTS: In 86 patients LVHT was diagnosed echocardiographically between June 1995 and December 2004 (21 female, mean age 52 +/- 14, range 14-94 years). All patients underwent a baseline cardiologic investigation and were invited for a neurologic investigation. A specific NMD was diagnosed in 21, a NMD of unknown etiology in 33, the neurologic investigation was normal in 13 and 19 patients refused. During a mean follow-up of 51 months (range 3-106 months) the mortality rate was 5.3%/year. Predictors for an increased mortality were increased age (p=0.0134), presence of NMD (p=0.0324), exertional dyspnoea (p=0.0329), edema (p=0.0049), heart failure (p=0.0048), left anterior hemiblock (p=0.0078) and a left ventricular fractional shortening <25% (p=0.0648). CONCLUSION: The mortality of LVHT in adult patients depends on cardiac and neurologic comorbidity. Predictors for mortality are increased age, neuromuscular disorder, heart failure, left ventricular dilatation and systolic dysfunction.

On the age dynamics of learned societies-taking the example of the Austrian Academy of Sciences.

In a hierarchical organisation of stable size the annual intake is strictly determined by the number of deaths and a statutory retirement age (if there is one). In this paper we reconstruct the population of the Austrian Academy of Sciences from 1847 to 2005. For the Austrian Academy of Sciences we observe a shift of its age distribution towards older ages, which on the one hand is due to rising life expectancy, i.e., a rising age at death, as well as to an increased age at entry on the other hand. Therefore the number of new entrants has been fluctuating considerably-especially reflecting several statutory changes-and the length of tenure before reaching the age limit has declined during the second half of the last century.Based on alternative scenarios of the age distribution of incoming members-including a young, an old, the 'current' and a mixed-age model-we then project the population of the Austrian Academy and its ageing forward in time. Our results indicate that the 'optimum policy' would be to elect either young or old aged new members.