Background: Left atrial appendage closure is an established therapy in patients with atrial fibrillation. Although device-related thrombosis (DRT) is relatively rare, it is potentially linked to adverse events. As data on DRT characteristics, outcome, and treatment regimen are scarce, we aimed to assess these questions in a multicenter approach. Methods: One hundred fifty-six patients with the diagnosis of DRT after left atrial appendage closure were included in the multinational EUROC-DRT registry. Baseline characteristics included clinical and echocardiographic data. After inclusion, all patients underwent further clinical and echocardiographic follow-up to assess DRT dynamics, treatment success, and outcome. Results: DRT was detected after a median of 93 days (interquartile range, 54–161 days) with 17.9% being detected >6 months after left atrial appendage closure. Patients with DRT were at high ischemic and bleeding risk (CHA ₂ DS ₂ -VASc 4.5±1.7, HAS-BLED 3.3±1.2) and had nonparoxysmal atrial fibrillation (67.3%), previous stroke (53.8%), and spontaneous echo contrast (50.6%). The initial treatment regimens showed comparable resolution rates (antiplatelet monotherapy: 57.1%, dual antiplatelet therapy: 85.7%, vitamin K antagonists: 80.0%, novel oral anticoagulants: 75.0%, and heparin: 68.6%). After intensification or switch of treatment, complete DRT resolution was achieved in 79.5% of patients. Two-year follow-up revealed a high risk of mortality (20.0%) and ischemic stroke (13.8%) in patients with DRT. Patients with incomplete DRT resolution showed numerically higher stroke rates and increased mortality rates (stroke: 17.6% versus 12.3%, P =0.29; mortality: 31.3% versus 13.1%, P =0.05). Conclusions: A substantial proportion of DRT is detected >6 months after left atrial appendage closure, highlighting the need for imaging follow-up. Patients with DRT appear to be at a high risk for stroke and mortality. While DRT resolution was achieved in most patients, incomplete DRT resolution appeared to identify patients at even higher risk. Optimal DRT diagnostic criteria and treatment regimens are warranted.

Seasonal influenza vaccination is established as important infection prevention measure, especially among highly exposed healthcare workers (HCWs) [1]. Coadministration with the third dose of COVID-19 vaccine could be an efficient strategy protecting HCWs from two major viral respiratory infections [2–4]. To date, the humoral immunogenicity and side-effects of a coadministered third COVID-19 and a seasonal quadrivalent influenza vaccine are still unclear, and the available data is limited in transferability to the general public [5–7]. This preference-based non-randomised controlled study examines the antibody-mediated immunogenicity and vaccine-related side-effects of mRNA-based COVID-19 and seasonal influenza vaccine coadministration in HCWs.

Against the background of the current COVID‐19 infection dynamics with its rapid spread of SARS‐CoV‐2 variants of concern (VOC), the immunity and the vaccine prevention of healthcare workers (HCWs) against SARS‐CoV‐2 continues to be of high importance. This observational cross‐section study assesses factors influencing the level of anti‐SARS‐CoV‐2‐spike IgG after SARS‐CoV‐2 infection or vaccination. One thousand seven hundred and fifty HCWs were recruited meeting the following inclusion criteria: age ≥18 years, PCR‐confirmed SARS‐CoV‐2 infection convalescence and/or at least one dose of COVID‐19 vaccination. anti‐SARS‐CoV‐2‐spike IgG titers were determined by SERION ELISA agile SARS‐CoV‐2 IgG. Mean anti‐SARS‐CoV‐2‐spike IgG levels increased significantly by number of COVID‐19 vaccinations (92.2 BAU/ml for single, 140.9 BAU/ml for twice and 1144.3 BAU/ml for threefold vaccination). Hybrid COVID‐19 immunized respondents (after infection and vaccination) had significantly higher antibody titers compared with convalescent only HCWs. Anti‐SARS‐CoV‐2‐spike IgG titers declined significantly with time after the second vaccination. Smoking and high age were associated with lower titers. Both recovered and vaccinated HCWs presented a predominantly good humoral immune response. Smoking and higher age limited the humoral SARS‐CoV‐2 immunity, adding to the risk of severe infections within this already health impaired collective.

Purpose: Cardiac MRI represents the gold standard to determine myocardial function. However, the current clinical standard protocol, a segmented Cartesian acquisition, is time‐consuming and can lead to compromised image quality in the case of arrhythmia or dyspnea. In this article, a machine learning–based reconstruction of undersampled spiral k‐space data is presented to enable free breathing real‐time cardiac MRI with good image quality and short reconstruction times.Methods: Data were acquired in free breathing with a 2D spiral trajectory corrected by the gradient system transfer function. Undersampled data were reconstructed by a variational network (VN), which was specifically adapted to the non‐Cartesian sampling pattern. The network was trained with data from 11 subjects. Subsequently, the imaging technique was validated in 14 subjects by quantifying the difference to a segmented reference acquisition, an expert reader study, and by comparing derived volumes and functional parameters with values obtained using the current clinical gold standard.Results: The scan time for the entire heart was below 1 min. The VN reconstructed data in about 0.9 s per image, which is considerably shorter than conventional model‐based approaches. The VN furthermore performed better than a U‐Net and not inferior to a low‐rank plus sparse model in terms of achieved image quality. Functional parameters agreed, on average, with reference data.Conclusions: The proposed VN method enables real‐time cardiac imaging with both high spatial and temporal resolution in free breathing and with short reconstruction time.

Summary: Sleep modulates the immune response, and sleep loss can reduce vaccine immunogenicity; vice versa, immune responses impact sleep. We aimed to investigate the influence of mental health and sleep quality on the immunogenicity of COVID‐19 vaccinations and, conversely, of COVID‐19 vaccinations on sleep quality. The prospective CoVacSer study monitored mental health, sleep quality and Anti‐SARS‐CoV‐2‐Spike IgG titres in a cohort of 1082 healthcare workers from 29 September 2021 to 19 December 2022. Questionnaires and blood samples were collected before, 14 days, and 3 months after the third COVID‐19 vaccination, as well as in 154 participants before and 14 days after the fourth COVID‐19 vaccination. Healthcare workers with psychiatric disorders had slightly lower Anti‐SARS‐CoV‐2‐Spike IgG levels before the third COVID‐19 vaccination. However, this effect was mediated by higher median age and body mass index in this subgroup. Antibody titres following the third and fourth COVID‐19 vaccinations (“booster vaccinations”) were not significantly different between subgroups with and without psychiatric disorders. Sleep quality did not affect the humoral immunogenicity of the COVID‐19 vaccinations. Moreover, the COVID‐19 vaccinations did not impact self‐reported sleep quality. Our data suggest that in a working population neither mental health nor sleep quality relevantly impact the immunogenicity of COVID‐19 vaccinations, and that COVID‐19 vaccinations do not cause a sustained deterioration of sleep, suggesting that they are not a precipitating factor for insomnia. The findings from this large‐scale real‐life cohort study will inform clinical practice regarding the recommendation of COVID‐19 booster vaccinations for individuals with mental health and sleep problems.