RESUMO
We present the use of CineECG in visualizing abnormal ventricular activation in a case of a complex conduction disorder. CineECG combines the standard 12lead surface ECG with a 3D anatomical model of the heart. It projects the location and direction of the average ventricular activation and recovery on the heart model over time. In this case, CineECG was able to visualize the different type of fascicular conduction in this progressive conduction block. This novel imaging technique was able to provide additional insight in this complex case, and might be of use in other complex ECG patterns.
Assuntos
Bloqueio Atrioventricular , Eletrocardiografia , Humanos , Eletrocardiografia/métodos , Coração , Ventrículos do Coração , Frequência CardíacaRESUMO
A case of a complex advanced two level AV junctional conduction block is described with electrocardiographic features consistent with the combination of incompletely concealed Wenckebach in the left anterior fascicle of the left bundle branch, and most probably in the right bundle branch and with Mobitz type II in the left posterior fascicle of the left bundle branch, resulting in intermittent trifascicular block.
Assuntos
Bloqueio Atrioventricular , Bloqueio de Ramo , Bloqueio Atrioventricular/diagnóstico , Bradicardia/diagnóstico , Fascículo Atrioventricular , Bloqueio de Ramo/diagnóstico , Eletrocardiografia , Sistema de Condução Cardíaco , HumanosRESUMO
BACKGROUND: The presence of reperfusion ventricular arrhythmias (VA) has been shown to correlate with larger infarct size (IS). However it is unclear whether the initial area at risk (AAR), also a determining factor for IS, is responsible for this correlation. We hypothesized that IS would be significantly larger in the presence of VA, while AAR would not differ. METHODS: 68 STEMI patients from the MAST study with 24-hour, continuous, 12lead Holter monitoring initiated prior to primary percutaneous coronary intervention (PCI) resulting in TIMI 3 flow post PCI were included. VA bursts were identified against subject-specific background VA rates using a previously validated statistical outlier method. IS, and infarct endocardial surface area (ESA) were obtained using CMR at mean 4.9â¯days after admission. Holter and CMR results were determined in core laboratories blinded to all other data. RESULTS: VA bursts were present in 69% (45/65) of patients. No significant differences were found for demographic characteristics, comorbidities, infarct location, number of diseased coronary vessels, or duration of ischemia between groups with and without VA burst. IS was significantly smaller in the group without VA bursts (median 9.3% vs 17.0%; pâ¯=â¯0.025). Infarct ESA did not significantly differ between the population with and without VA burst; median 24.3% vs 20.0%; pâ¯=â¯0.15. CONCLUSION: VA bursts are a marker for larger IS independent of AAR, assessed by surrogate markers. These findings support the hypothesis that VA bursts are a marker of reperfusion damage occurring downstream at myocellular level.
Assuntos
Arritmias Cardíacas/fisiopatologia , Eletrocardiografia/tendências , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Idoso , Arritmias Cardíacas/diagnóstico por imagem , Bases de Dados Factuais/tendências , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial/métodos , Eletrocardiografia Ambulatorial/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/diagnóstico por imagem , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagemRESUMO
AIMS: The survival rate of sudden out-of-hospital cardiac arrests (OHCAs) increases by early notification of Emergency Medical Systems (EMS) and early application of basic life support (BLS) techniques and defibrillation. A Text Message (TM) alert system for trained volunteers in the community was implemented in the Netherlands to reduce response times. The aim of this study was to assess if this system improves survival after OHCA. METHODS AND RESULTS: From April 2012 to April 2014 data on all 1546 emergency calls for OHCA in the Dutch province of Limburg were collected according to the Utstein template. On site resuscitation attempts for presumed cardiac arrest were made in 833 cases, of which the TM-alert system was activated in 422 cases. Two cardiopulmonary resuscitation (CPR) scenarios were compared: 1. TM-alert system was activated but no responders attended (n=131), and 2. TM-alert system was activated with attendance of ≥1 responder(s) (n=291). Survival to hospital discharge was 16.0% in scenario 1 and 27.1% in scenario 2 corresponding with OR=1.95 (95% CI 1.15-3.33; P=.014). After adjustment for potential confounders the odds ratio increased (OR=2.82; 95% CI 1.52-5.24; P=.001). Of the 100 survivors, 92% were discharged from the hospital to their home with no or limited neurological sequelae. CONCLUSION: The TM-alert system is effective in increasing survival to hospital discharge in OHCA victims and the degree of disability or dependence after survival is low.
Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Envio de Mensagens de Texto , Voluntários , Idoso , Cardioversão Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Prospectivos , Qualidade de Vida , Sistema de Registros , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: We hypothesized that ventricular arrhythmia (VA) bursts during reperfusion phase are a marker of larger infarct size despite optimal epicardial and microvascular perfusion. METHODS: 126 STEMI patients were studied with 24h continuous, 12-lead Holter monitoring. Myocardial blush grade (MBG) was determined and VA bursts were identified against subject-specific background VA rates in core laboratories. Delayed-enhancement cardiovascular magnetic resonance imaging was used to determine infarct size. RESULTS: In the group with MBG 3 no significant differences were found for baseline characteristics between burst versus no burst (102 vs. 24). In those with optimal epicardial and microvascular reperfusion (TIMI 3, stable ST-recovery, and MBG 3), VA burst was associated with larger infarct size (N=102/126; median 11.0 vs. 5.1%; p=0.004). CONCLUSION: In the event of MBG 3, VA bursts were associated with significantly larger infarct size even if optimal epicardial and microvascular reperfusion was present.
Assuntos
Diagnóstico por Computador/métodos , Eletrocardiografia/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica , Prognóstico , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Sensibilidade e Especificidade , Resultado do Tratamento , Complexos Ventriculares Prematuros/prevenção & controleRESUMO
BACKGROUND: In contrast to LBBB patients less is known about patients with RBBB+LAFB regarding LV contractile abnormalities and the potential role of CRT. This study investigated whether patients with RBBB+LAFB morphology have echocardiographic mechanical strain abnormalities between the inferior and anterior LV walls, similar to abnormalities between septal and lateral walls in LBBB. METHODS AND RESULTS: Ten healthy volunteers with no-BBB, 28 LBBB and 28 RBBB+LAFB heart failure patients were included in this retrospective study. Two-dimensional regional-strains were obtained by speckle-tracking. Scar was assessed by CMR. Response on echo was defined as normal, classical, borderline or other pattern. The number of classical patterns in LBBB was significantly higher than in RBBB+LAFB and no-BBB groups (p<0.001 for both). Contrary, the RBBB+LAFB group showed a significantly higher number of borderline patterns compared to other groups (LBBB: p=0.042, no-block: p=0.012). In addition, RBBB+LAFB patients had more scar than LBBB patients (9.9% vs 3.4%, p=0.041), and the average amount of scar in each wall was also higher in RBBB+LAFB (<5% in LBBB and <16% in RBBB+LAFB). CONCLUSIONS: Patients with RBBB+LAFB on ECG and clinical HF demonstrate echocardiographic wall motion abnormalities between inferior and anterior LV walls, similar to abnormalities found between septal and lateral LV walls in patients with LBBB and HF. Fewer patients with RBBB+LAFB showed a classical pattern of opposing wall motion compared to LBBB. Factors that might alter strain patterns in RBBB+LAFB, including the detailed presence or absence of LV scar and coexisting block of the central fascicle, should be assessed in future studies.
Assuntos
Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico por imagem , Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Volume SistólicoRESUMO
An important treatment for patients with heart failure is cardiac resynchronization therapy (CRT). Even though only 20% of women were included in clinical trials for CRT, a benefit has been shown in recent studies for subgroups of women compared to their male counterparts. Given this low inclusion rate of women in clinical studies, professional society guideline-based CRT recommendations, such as those by the American College of Cardiology Foundation (ACCF)/American Heart Association (AHA)/Heart Rhythm Society (HRS), may not truly represent the best treatment for women, especially since most of the reports that showed this greater benefit in women were published after the latest guidelines. Despite having research and multiple publications regarding sex-specific heart failure outcomes and response to CRT, the ACCF/AHA/HRS guidelines have not yet been updated to account for the recent information regarding the differences in benefit for women and men with similar patient characteristics. This review discusses the physiology behind CRT, sex-specific characteristics of heart failure, and cardiac electrophysiology and summarizes the current sex-specific literature to encourage consideration of CRT guidelines for women and men separately.
Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/normas , Terapia de Ressincronização Cardíaca/normas , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Insuficiência Cardíaca/terapia , Desenho de Equipamento , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Fatores Sexuais , Resultado do TratamentoRESUMO
BACKGROUND: Heart failure (HF) is expected to be highly prevalent in nursing home residents, but precise figures are scarce. The aim of this study was to determine the prevalence of HF in nursing home residents and to get insight in the clinical characteristics of residents with HF. METHODS: The study followed a multi-centre cross-sectional design. Nursing home residents (n = 501) in the southern part of the Netherlands aged over 65 years and receiving long-term somatic or psychogeriatric care were included in the study. The diagnosis of HF and related characteristics were based on data collected from actual clinical examinations (including history, physical examination, ECG, cardiac markers and echocardiography), patient records and questionnaires. A panel of two cardiologists and a geriatrician ultimately judged the data to diagnose HF. RESULTS: The overall prevalence of HF in nursing home residents was 33 %, of which 52 % had HF with preserved ejection fraction. The symptoms dyspnoea and oedema and a cardiac history were more common in residents with HF. Diabetes mellitus, chronic obstructive pulmonary disease (COPD) were also more prevalent in those with HF. Residents with HF had a higher score on the Mini Mental State Examination. 54 % of those with HF where not known before, and in 31 % with a history of HF, this diagnosis was not confirmed by the expert panel. CONCLUSION: This study shows that HF is highly prevalent in nursing home residents with many unknown or falsely diagnosed with HF. Equal number of HF patients had reduced and preserved left-ventricular ejection fraction. TRIAL REGISTRATION: The Netherlands National Trial Register NTR2663 (27-12-2010).
Assuntos
Insuficiência Cardíaca , Idoso , Estudos Transversais , Técnicas de Diagnóstico Cardiovascular , Feminino , Avaliação Geriátrica/métodos , Necessidades e Demandas de Serviços de Saúde , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Prontuários Médicos/estatística & dados numéricos , Países Baixos/epidemiologia , Casas de Saúde/estatística & dados numéricos , Exame Físico , Prevalência , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Early reperfusion of ischemic myocytes is essential for optimal salvage in acute myocardial infarction. VA (ventricular arrhythmia) bursts after recanalization of the culprit vessel have been found to be related to larger infarct size (IS), using SPECT. OBJECTIVE: The hypothesis was tested that this finding could be confirmed in an independent cohort using a more accurate technique, i.e. delayed-enhancement cardiovascular magnetic resonance imaging (DE-CMR). METHODS: All 196 patients from the PREPARE and MAST studies who had 24-hour, continuous, 12-lead Holter, started before primary percutaneous coronary intervention resulting in brisk TIMI (thrombolysis in myocardial infarction) 3 flow and stable ST-recovery were included. VA bursts were identified against subject-specific background VA rates using a previously published statistical outlier method. IS was assessed using DE-CMR. Angiography, Holter and DE-CMR results were assessed in core laboratories, blinded to all other data. RESULTS: VA bursts were present in 154/196 (79%) of patients. Baseline characteristics between the groups with and without bursts were similar. VA burst was associated with significantly larger infarct size in the population as a whole (median 11.3% vs 5.3%; p=0.001) and also when divided in non-anterior (median 9.9% vs 4.9%; p=0.003) and anterior myocardial infarction (median 21.4% vs 12.0%; p=0.48), the latter not reaching statistical significance due to the small subset of patients. CONCLUSION: Beyond the classical markers of "optimal" reperfusion such as TIMI 3 flow and stable ST-segment recovery, VA bursts occurring during the reperfusion phase are an early electrobiomarker of larger IS. CLINICAL TRIAL REGISTRATION: PREPARE: ISRCTN71104460 http://www.controlled-trials.com/ISRCTN71104460.
Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio , Reperfusão Miocárdica/efeitos adversos , Taquicardia Ventricular , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/métodos , Angiografia Coronária/métodos , Eletrocardiografia/métodos , Eletrocardiografia Ambulatorial/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Avaliação de Resultados em Cuidados de Saúde , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Fatores de TempoRESUMO
BACKGROUND: New-onset left bundle branch block (LBBB) is a known complication during Transcatheter Aortic Valve Replacement (TAVR). This study evaluated the influence of pre-TAVR cardiac conditions on left ventricular functions in patients with new persistent LBBB post-TAVR. METHODS: Only 11 patients qualified for this study because of the strict inclusion criteria. Pre-TAVR electrocardiograms were evaluated for Selvester QRS infarct score and QRS duration, and left ventricular end-systolic volume (LVESV) was used as outcome variable. RESULTS: There was a trend towards a positive correlation between QRS score and LVESV of r=0.59 (p=0.058), while there was no relationship between QRS duration and LVESV (r=-0.18 [p=0.59]). CONCLUSION: This study showed that patients with new LBBB and higher pre-TAVR QRS infarct score may have worse post-TAVR left ventricular function, however, pre-TAVR QRS duration has no such predictive value. Because of the small sample size these results should be interpreted with caution and assessed in a larger study population.
Assuntos
Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/etiologia , Eletrocardiografia/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Diagnóstico por Computador/métodos , Ecocardiografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Volume Sistólico , Resultado do TratamentoRESUMO
INTRODUCTION: Several studies have investigated the ability of the twelve-lead electrocardiogram (ECG) to reliably distinguish Takotsubo cardiomyopathy (TC) from an acute anterior ST-segment elevation myocardial infarction (STEMI). In these studies, only ECG changes were required - ST-segment deviation and/or T-wave inversion - in TC whereas in acute anterior STEMI, ECGs had to meet STEMI criteria. In the majority of these studies, patients of both genders were used even though TC predominantly occurs in women. The aim of this study is to see whether TC can be distinguished from acute anterior STEMI in a predominantly female study population where all patients meet STEMI-criteria. METHODS: Retrospective analysis of the ST-segment changes was done on the triage ECGs of 37 patients with TC (34 female) and was compared to the triage ECGs of 103 female patients with acute anterior STEMI. The latter group was divided into the following subgroups: 46 patients with proximal, 47 with mid and 10 with distal LAD occlusion. Three ST-segment based ECG features were investigated: (1) Existing criterion for differentiating anterior STEMI from TC: ST-segment depression >0.5mm in lead aVR+ST-segment elevation ≤1mm in lead V1, (2) frontal plane ST-vector and (3) mean amplitude of ST-segment deviation in each lead. RESULTS: The existing ECG criterion was less accurate (76%) than in the original study (95%), with a large difference in sensitivity (26% vs. 91%). Only a frontal plane ST-vector of 60° could significantly distinguish TC from all acute anterior STEMI subgroups (p<0.01) with an overall diagnostic accuracy of 81%. The mean amplitude in inferior leads II and aVF was significantly higher for patients with TC compared to all patients with acute anterior STEMI (p<0.01 and p<0.05 respectively) and the mean amplitude in the precordial leads V1 and V2 was significantly lower compared to proximal and mid LAD occlusion (p<0.01). CONCLUSIONS: Given the consequences of missing the diagnosis of an acute anterior STEMI the diagnostic accuracy of the ECG criteria investigated in this retrospective study were insufficient to reliably distinguish patients with TC from patients with an acute anterior STEMI. To definitely exclude the diagnosis of an acute anterior STEMI coronary angiography, which remains the gold standard, will need to be performed.
Assuntos
Algoritmos , Diagnóstico por Computador/métodos , Eletrocardiografia/métodos , Infarto do Miocárdio/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Triagem/métodos , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: Recent research has established that a tall R-wave in V1 indicates lateral wall involvement in non-anterior wall myocardial infarction (MI). The objective of this study was to assess the value of the admission electrocardiogram (ECG) to predict R-waves and consequently lateral wall damage in the late phase of non-anterior MI. METHODS: ECGs of 69 patients were analyzed. ST-segment changes in representative leads for lateral wall infarction such as V1, V2, V6 and I were correlated with the extent of QRS-wave changes in V1 and V6. RESULTS: ST-segment elevation in V6 showed correlations with R/S ratio in V1 (r=0.802, B=0.440, P=<0.001) and with the depth of Q-waves in V6 (r=0.671, B=0.441, P=0.007). This correlation was higher in a small subgroup where the left circumflex branch (Cx) was the culprit vessel (r=0.888, B=1.469 and P=0.018). ST-segment depression in lead I correlated with the height of R and the surface of R in V1 (height times width of R) (r=0.542, B=-0.150, P=0.005 and r=0.538, B=-0.153, P=0.005 respectively), especially in the subgroup without proximal occlusions of RCA (r=0.711 and r=0.699). ST-segment depression in lead I also predicted Q-waves in V6 (r=0.538, B=0.114, P=0.006). ST-segment changes in V2 showed no significant correlation with either R- or Q-wave measurements. CONCLUSIONS: ST-segment elevation in V6 in the acute phase of non-anterior MI predicts lateral involvement as expressed by the R/S ratio in V1 in the post reperfusion phase. A subgroup with Cx occlusion showed especially strong correlations, although the size of the group was small. In lead I ST-segment depression is correlated to height and surface of R in V1 and Q-waves in V6.
Assuntos
Algoritmos , Diagnóstico por Computador/métodos , Eletrocardiografia/métodos , Infarto do Miocárdio/diagnóstico , Disfunção Ventricular Direita/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Disfunção Ventricular Direita/etiologiaRESUMO
BACKGROUND: Metabolomics, defined as the comprehensive identification and quantification of low-molecular-weight metabolites to be found in a biological sample, has been put forward as a potential tool for classifying individuals according to their risk of coronary heart disease (CHD). Here, we investigated whether a single-point blood measurement of the metabolome is associated with and predictive for the risk of CHD. METHODS AND RESULTS: We obtained proton nuclear magnetic resonance spectra in 79 cases who developed CHD during follow-up (median 8.1 years) and in 565 randomly selected individuals. In these spectra, 100 signals representing 36 metabolites were identified. Applying least absolute shrinkage and selection operator regression, we defined a weighted metabolite score consisting of 13 proton nuclear magnetic resonance signals that optimally predicted CHD. This metabolite score, including signals representing a lipid fraction, glucose, valine, ornithine, glutamate, creatinine, glycoproteins, citrate, and 1.5-anhydrosorbitol, was associated with the incidence of CHD independent of traditional risk factors (TRFs) (hazard ratio 1.50, 95% CI 1.12-2.01). Predictive performance of this metabolite score on its own was moderate (C-index 0.75, 95% CI 0.70-0.80), but after adding age and sex, the C-index was only modestly lower than that of TRFs (C-index 0.81, 95% CI 0.77-0.85 and C-index 0.82, 95% CI 0.78-0.87, respectively). The metabolite score was also associated with prevalent CHD independent of TRFs (odds ratio 1.59, 95% CI 1.19-2.13). CONCLUSION: A metabolite score derived from a single-point metabolome measurement is associated with CHD, and metabolomics may be a promising tool for refining and improving the prediction of CHD.
Assuntos
Doença das Coronárias/sangue , Doença das Coronárias/epidemiologia , Lipídeos/sangue , Espectroscopia de Ressonância Magnética/métodos , Metabolômica/métodos , Adulto , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: The education of patients with heart failure (HF) is an essential part of disease management. The perspectives of an increasing number of patients and a shortage of professionals force healthcare to explore new strategies in supporting patients to be better informed and more active. METHODS: Three hundred and eighty-two patients with HF (age 71±SD 11.2 years) were randomly assigned to either a telemonitoring or a usual care group. Patients received four postal questionnaires to assess their levels of self-reported knowledge, self-care, self-efficacy and adherence. Generalized estimating equations analysis was performed to assess the effects of telemonitoring during the 1-year follow-up. Corrections for baseline were performed if needed. RESULTS: Baseline differences between groups were found for self-care (p=0.001) and self-efficacy (p=0.024). Knowledge of patients in the telemonitoring group significantly improved with 0.9 point on a 15-points scale (p<0.001). Their self-care abilities improved with 1.5 point on a 10-item scale whereas no changes were found in patients receiving usual care (p<0.001). Self-efficacy of patients in the intervention group improved significantly after 6 months yet was not significantly different after 3 months and 1 year. For patients in the intervention group adherence improved for daily weighing (p<0.001) during the whole follow-up and for fluid intake (p=0.019) after 3 months and after 12 months (p=0.086). Adherence for activity recommendations improved (p=0.023) after 3 months and importance of medication adherence increased after 6 (p=0.012) and 12 months (p=0.037). No effects were found regarding appointments, diet, smoking and use of alcohol. CONCLUSIONS: Tailored telemonitoring was found to educate patients with HF and to improve their self-care abilities and sense of self-efficacy.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Insuficiência Cardíaca , Autocuidado/métodos , Autoeficácia , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Enfermagem Cardiovascular/métodos , Feminino , Insuficiência Cardíaca/enfermagem , Insuficiência Cardíaca/psicologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Arrhythmogenic right-ventricular cardiomyopathy (ARVC) can lead to RV dilatation. We hypothesized that electrocardiographic characteristics including QRS amplitudes in the extremity- and precordial leads, the S amplitude in lead V1 , and extent of T-wave negativity over the precordial leads are related to RV dilatation in this condition. METHODS: In 42 ARVC patients and 42 controls, we correlated total QRS amplitude in the extremity leads (∑QRSext ), precordial leads (∑QRSprec ) and in all leads (∑QRStot : summation of ∑QRSext and ∑QRSprec ), S amplitude in lead V1 and the extent of T-wave inversion in the precordial leads (V1 vs. beyond V1 ) with RV end diastolic diameter (RVEDD) by echocardiography. RESULTS: In the ARVC group, the mean age was 46 ± 14 years, 31 patients were male, 28 had an implantable cardioverter defibrillator (ICD), and 7 had a LV ejection fraction (EF) < 55%. The control group was age- and gender matched to the ARVC cohort. In contrast to controls, the ∑QRSext (regression coefficient (RC), -0.29; P = 0.020), ∑QRSprec (RC, -0.20; P = 0.015), and ∑QRStot (RC, -0.14; P = 0.009) were lower with RV dilatation in ARVC. S amplitude in lead V1 was not related to RV diameter (RC, -0.98; P = 0.088). Precordial T-wave inversion beyond lead V1 (V2 -V6 ) was associated with a larger RV diameter (RC, 8.58; P = 0.012). CONCLUSIONS: Summed QRS amplitudes in the extremity and precordial leads, and T-wave inversion beyond lead V1 are associated with RV dilatation in patients with ARVC.
Assuntos
Arritmias Cardíacas/complicações , Arritmias Cardíacas/fisiopatologia , Displasia Arritmogênica Ventricular Direita/complicações , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Sistema de Condução Cardíaco/anormalidades , Hipertrofia Ventricular Direita/complicações , Hipertrofia Ventricular Direita/fisiopatologia , Síndrome de Brugada , Doença do Sistema de Condução Cardíaco , Estudos de Coortes , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Although high-sensitivity cardiac troponin (hs-cTn) substantially improves the early detection of myocardial injury, it lacks specificity for acute myocardial infarction (MI). In suspected non-ST-elevation MI, invasive coronary angiography (ICA) remains necessary to distinguish between acute MI and noncoronary myocardial disease (eg, myocarditis), unnecessarily subjecting the latter to ICA and associated complications. This trial investigates whether implementing cardiovascular magnetic resonance (CMR) or computed tomography angiography (CTA) early in the diagnostic process may help to differentiate between coronary and noncoronary myocardial disease, thereby preventing unnecessary ICA. STUDY DESIGN: In this prospective, single-center, randomized controlled clinical trial, 321 consecutive patients with acute chest pain, elevated hs-cTnT, and nondiagnostic electrocardiogram are randomized to 1 of 3 strategies: (1) CMR, or (2) CTA early in the diagnostic process, or (3) routine clinical management. In the 2 investigational arms of the study, results of CMR or CTA will guide further clinical management. It is expected that noncoronary myocardial disease is detected more frequently after early noninvasive imaging as compared with routine clinical management, and unnecessary ICA will be prevented. The primary end point is the total number of patients undergoing ICA during initial admission. Secondary end points are 30-day and 1-year clinical outcome (major adverse cardiac events and major procedure-related complications), time to final diagnosis, quality of life, and cost-effectiveness. CONCLUSION: The CARMENTA trial investigates whether implementing CTA or CMR early in the diagnostic process in suspected non-ST-elevation MI based on elevated hs-cTnT can prevent unnecessary ICA as compared with routine clinical management, with no detrimental effect on clinical outcome.
Assuntos
Angiografia Coronária/métodos , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
We examined the incremental cost-effectiveness of telemonitoring (TM) versus usual care (UC) in patients with congestive heart failure (CHF). In one university and two general hospitals, 382 patients were randomised to usual care or telemonitoring and followed for 1 year. Hospital-related and home costs were estimated, based on resource use multiplied by the appropriate unit prices. Effectiveness was expressed as QALYs gained. Information was gathered, using 3 monthly costs diaries and questionnaires. The mean age of the patients was 71 years (range 32-93), 59% were male and 64% lived with a partner. Health related quality of life improved by 0.07 points for the usual care and 0.1 points for the telemonitoring group, but the difference between groups was not significant. There were no significant differences in annual costs per patient between groups. At a threshold of 50,000 the probability of telemonitoring being cost-effective was 48%. The cost effectiveness analysis showed a high level of decision uncertainty, probably caused by the divergence between the participating institutions. It is therefore premature to draw an unambiguous conclusion regarding cost-effectiveness for the whole group.
Assuntos
Custos de Cuidados de Saúde , Insuficiência Cardíaca/terapia , Telemedicina/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Insuficiência Cardíaca/economia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Anos de Vida Ajustados por Qualidade de Vida , Telemedicina/métodos , Reino UnidoRESUMO
The 12 lead surface electrocardiogram (ECG) is an indispensable tool to identify acute coronary syndromes and the patient at high risk. Acute coronary syndromes are classified according to the presence or absence of ST elevation (ST Elevation Myocardial Infarction or Acute Coronary Syndrome, STEMI or STEACS and Non ST Elevation Myocardial Infarction). NonSTEMI or nonSTEACS is approached by less invasive and frequently delayed treatment strategies. Because also nonSTEACS comprises severe and/or extensive coronary artery disease undertreatment may occur of these patient categories. Therefore better identification of those patients is needed. In the current guidelines the ischemic ECG changes are incompletely described. Improved description and understanding of the ECG in ACS will lead to better recognition of the patient at risk by emergency physicians and cardiologists.
Assuntos
Síndrome Coronariana Aguda/diagnóstico , Eletrocardiografia/normas , Infarto do Miocárdio/diagnóstico , Guias de Prática Clínica como Assunto , Humanos , Medição de Risco/normasRESUMO
BACKGROUND: The myocardial area at risk (MaR) has been estimated in patients with acute myocardial infarction (AMI) by using ST segment based ECG methods. However, as the process from ischemia to infarction progresses, the ST segment deviation is typically replaced by QRS abnormalities, causing a falsely low estimation of the total MaR if determined by using ST segment based methods. A previous study showed the value of the consideration of the abnormalities in the QRS complex, in addition to those in the ST segment estimating the total MaR for patients with anterior AMI. The purpose of this study was to investigate the same method for patients with inferior AMI. METHODS: Thirty-two patients with acute inferior ST elevation myocardial infarction received (99m)Tc-Sestamibi before percutaneous coronary intervention. SPECT was performed within 2 hours after treatment and was used as a gold standard for the estimation of the total MaR. The ECG recorded at admission in the hospital was used for the ECG estimates of the total MaR. This included a ST segment estimation of the ischemic component of the total MaR (Aldrich score) and an estimation of the infarcted component of the total MaR in the acute phase of AMI by QRS abnormalities (Selvester score). These scores were added for the combined ECG score. RESULTS: The ischemic component of the total MaR estimated by the Aldrich score alone no statistically significant correlation with SPECT (r=0.17, p=0.36). The infarcted component of the total MaR estimated by the Selvester score showed a significant correlation with SPECT (r=0.55, p=0.001). When the Aldrich and Selvester scores were combined, the correlation with SPECT improved (r=0.58, p<0.001). Both the Aldrich and Selvester score alone underestimated the mean MaR measured by SPECT (respectively p=0.007 and p<0.0001). There was no statistically significant difference between the mean MaR estimated by the sum of Aldrich and Selvester and the MaR measured by SPECT (p=0.636). CONCLUSION: The estimation of the total MaR was more accurate by taking both ST deviation and QRS abnormalities in account than by using either method alone. A new ECG method to determine the total MaR during acute coronary occlusion should consider both its ischemic and infarcted components.