Assessment of the systolic rise time by photoplethysmography in peripheral arterial diseases: a comparative study with ultrasound Doppler.

Aims: Peripheral arterial disease (PAD) is a major public health burden requiring more intensive population screening. Ankle brachial index (ABI) using arm and ankle cuffs is considered as the reference method for the detection of PAD. Although it requires a rigorous methodology by trained operators, it remains time-consuming and more technically difficult in patients with diabetes due to mediacalcosis. Techniques based on the study of hemodynamic, such as the systolic rise time (SRT), appear promising but need to be validated. We retrospectively compared the reliability and accuracy of SRT using a photoplethysmography (PPG) technique to the SRT measured by ultrasound doppler (UD) in PAD patients diagnosed with the ABI (137 patients, 200 lower limbs). Methods and results: There was a significant correlation between SRT measured with UD (SRTud) compared with that with PPG (SRTppg, r = 0.25; P = 0.001). Best correlation was found in patients without diabetes (r = 0.40; P = 0.001). Bland and Altman analysis showed a good agreement between the SRTud and SRTppg. In contrast, there was no significant correlation between UD and PPG in diabetes patients. Furthermore, patients with diabetes exhibited a significant increase of SRTppg (P = 0.02) compared with patients without diabates but not with the SRTud (P = 0.18). The SRTppg was significantly linked to the arterial velocity waveforms, the type of arterial lesion but not vascular surgery revascularization technique. Conclusion: This monocentric pilot study shows that SRT measured with the PPG signal reliably correlates with SRT recorded with UD. The PPG is an easy to use technique in the hand of non-expert with a potential interest for general screening of PAD, especially in diabetes patients, due to its ease to use.

Computed tomography for the detection of free-floating thrombi in the right heart in acute pulmonary embolism.

OBJECTIVES: The aim of this study was to assess the prevalence of free-floating thrombi in the right heart (FFT) and the accuracy of computed tomography (CT) for their detection in pulmonary embolism (PE). METHODS: We studied 340 consecutive patients presenting with PE. All patients underwent CT and echocardiography. RESULTS: The prevalence of FFT was 3.5% in the global population of PE and 22% in high-risk PE. Dyspnoea, cardiogenic shock, cardiac arrest and tachycardia were more frequently found in patients with FFT (p = 0.04, p < 0.0001, p = 0.0003 and p = 0.01, respectively). Sensitivity and specificity of CT for the detection of FFT were 100% (95% confidence interval: 74%-100%) and 97% (95%-99%), whereas positive and negative predictive values were 57% (34%-78%) and 100% (99%-100%). Among patients with FFT, right ventricular dilation was always detected by CT, whereas no right ventricular dilation was found among patients with a false diagnosis of FFT performed by CT (p < 0.0001). CONCLUSION: Prevalence of FFT is 3.5% and differs according to the clinical presentation. Detection of FFT by CT is feasible and should lead to echocardiography being promptly performed for the confirmation of FFT.

Management of atrial fibrillation in heart failure in the elderly.

In elderly patients, atrial fibrillation prevalence exceeds 10% and is commonly associated with heart failure rendering their management even more challenging. Therapies to be considered for heart failure related atrial fibrillation include appropriate treatment of underlying disease, prevention of thromboembolism, rate or rhythm control. The debate regarding rate versus rhythm control in the management of this group of patients has yet to be resolved. For old patients, the management requires an individual approach, which largely depends on comorbid conditions, underlying cardiac disease, and patient and physician preferences. Use of antiarrhythmic drug therapy for maintenance of sinus rhythm carries concerns of risk and limited efficacy. Catheter ablation for rhythm control is feasible for some patients, but further studies are needed to define the risks and benefits especially in older patients. Atrioventricular nodal ablation associated with pacing therapy is an effective non-pharmacological therapy in selected patients with medically refractory permanent high heart rate atrial fibrillation and heart failure. Several studies are ongoing and will provide more insight into the management of such patients.