Assessment of the sublingual microcirculation with the GlycoCheck system: Reproducibility and examination conditions.

BACKGROUND: The glycocalyx is an extracellular layer lining the lumen of the vascular endothelium, protecting the endothelium from shear stress and atherosclerosis and contributes to coagulation, immune response and microvascular perfusion. The GlycoCheck system estimates glycocalyx' thickness in vessels under the tongue from perfused boundary region (PBR) and microvascular perfusion (red blood cell (RBC) filling) via a camera and dedicated software. OBJECTIVES: Evaluating reproducibility and influence of examination conditions on measurements with the GlycoCheck system. METHODS: Open, randomised, controlled study including 42 healthy smokers investigating day-to-day, side-of-tongue, inter-investigator variance, intraclass-correlation (ICC) and influence of examination conditions at intervals from 0-180 minutes on PBR and RBC filling. RESULTS: Mean (SD) age was 24.9 (6.1) years, 52% were male. There was no significant intra- or inter-investigator variation for PBR or RBC filling nor for PBR for side-of-tongue. A small day-to-day variance was found for PBR (0.012µm, p = 0.007) and RBC filling (0.003%, p = 0.005) and side-of-tongue, RBC filling (0.025%, p = 0.009). ICC was modest but highly improved by increasing measurements. Small significant influence of cigarette smoking (from 40-180 minutes), high calorie meal intake and coffee consumption was found. The latter two peaking immediately and tapering off but remained significant up to 180 minutes, highest PBR changes for the three being 0.042µm (p<0.05), 0.183µm (p<0.001) and 0.160µm (p<0.05) respectively. CONCLUSIONS: Measurements with the GlycoCheck system have a moderate reproducibility, but highly increases with multiple measurements and a small day-to-day variability. Smoking, meal and coffee intake had effects up to 180 minutes, abstinence is recommended at least 180 minutes before GlycoCheck measurements. Future studies should standardise conditions during measurements.

Comparative evaluation of Plateletworks, Multiplate analyzer and Platelet function analyzer-200 in cardiology patients.

The objective of this study was to comparatively evaluate three commercial whole-blood platelet function analyzer systems: Platelet Function Analyzer-200 (PFA; Siemens Canada, Mississauga, Ontario, Canada), Multiplate analyzer (MP; Roche Diagnostics International Ltd., Rotkreuz, Switzerland), and Plateletworks Combo-25 kit (PLW; Helena Laboratories, Beaumont, TX, USA). Venipuncture was performed on 160 patients who visited a department of cardiology. Pairwise agreement among the three platelet function assays was assessed using Cohen's kappa coefficient and percent agreement within the reference limit. Kappa values with the same agonists were poor between PFA-collagen (COL; agonist)/adenosine diphosphate (ADP) and MP-ADP (-0.147), PFA-COL/ADP and PLW-ADP (0.089), MP-ADP and PLW-ADP (0.039), PFA-COL/ADP and MP-COL (-0.039), and between PFA-COL/ADP and PLW-COL (-0.067). Nonetheless, kappa values for the same assay principle with a different agonist were slightly higher between PFA-COL/ADP and PFA-COL/EPI (0.352), MP-ADP and MP-COL (0.235), and between PLW-ADP and PLW-COL (0.247). The range of percent agreement values was 38.7% to 73.8%. Therefore, various measurements of platelet function by more than one method were needed to obtain a reliable interpretation of platelet function considering low kappa coefficient and modest percent agreement rates among 3 different platelet function tests.

Magnetic particle imaging for radiation-free, sensitive and high-contrast vascular imaging and cell tracking.

Magnetic particle imaging (MPI) is an emerging ionizing radiation-free biomedical tracer imaging technique that directly images the intense magnetization of superparamagnetic iron oxide nanoparticles (SPIOs). MPI offers ideal image contrast because MPI shows zero signal from background tissues. Moreover, there is zero attenuation of the signal with depth in tissue, allowing for imaging deep inside the body quantitatively at any location. Recent work has demonstrated the potential of MPI for robust, sensitive vascular imaging and cell tracking with high contrast and dose-limited sensitivity comparable to nuclear medicine. To foster future applications in MPI, this new biomedical imaging field is welcoming researchers with expertise in imaging physics, magnetic nanoparticle synthesis and functionalization, nanoscale physics, and small animal imaging applications.

Insertion of miniaturized cardiac monitors outside the catheter operating room: experience and practical advice.

Minor surgical procedures are increasingly being performed as outpatient procedures in settings outside hospital operating rooms (ORs). In electrophysiology, the recent miniaturization of insertable cardiac monitors (ICMs) has enabled the routine insertion of the device as a minimally invasive procedure without the need of a catheter OR. However, a shift to office-based environments for minor surgical procedures is associated with some concerns, particularly with respect to patient- and procedure-related safety in the new setting. In the present document, the authors provide practical advice on facilities, practices, and adaptations necessary when performing ICM insertions in office settings, based on available recommendations as well as their own experience with the use of the novel Reveal LINQ ICM. The main differences from in-hospital implant settings are simplified requirements of room, equipment, and insertion procedures, while ensuring and maintaining an adequate, sterile environment. Patient selection is important: certain groups of patients are recommended to be treated in the catheter OR (e.g. those at increased risk for bleeding or very frail elderly individuals). Insertion in alternative positions, as is sometimes performed for cosmetic reasons, should be referred to dedicated hospitals. Quality assurance and internal quality control are critical in the new procedural landscape, and it is important not to trivialize minor surgical procedures. Operators' sharing of experiences and lessons learned, e.g. in the form of registries, should be encouraged.

Opportunistic screening of atrial fibrillation by automatic blood pressure measurement in the community.

OBJECTIVE: Timely detection of atrial fibrillation (AF) may effectively prevent cardiovascular consequences. However, traditional diagnostic tools are either poorly reliable (pulse palpation) or not readily accessible (ECG) in general practice. We tested whether an automatic oscillometric blood pressure (BP) monitor embedded with an algorithm for AF detection might be effective for opportunistic screening of asymptomatic AF in the community. SETTING: A community-based screening campaign in an unselected population to verify the feasibility of AF screening with a Microlife WatchBP Office BP monitor with a patented AFIB algorithm. When possible AF was detected (≥2 of 3 BP measurements reporting AF), a doctor immediately performed a single-lead ECG in order to confirm or exclude the presence of the arrhythmia. The main demographic and clinical data were also collected. PARTICIPANTS: 220 consecutive participants from an unselected sample of individuals in a small Italian community. PRIMARY AND SECONDARY OUTCOME MEASURES: Number of patients detected with AF and diagnosed risk factors for AF. RESULTS: In 12 of 220 participants, the device detected possible AF during the BP measurement: in 4 of them (1.8%), the arrhythmia was confirmed by the ECG. Patients with AF were more likely to be older (77.0±1.2 vs 57.2±15.2 years, p=0.010), obese (50.0 vs 14.4%, p=0.048) and to suffer from a cardiovascular disease (50.0 vs 10.6%, p=0.014) than patients without AF. Participants with a positive BP AF reading and non-AF arrhythmias (n=8) did not differ in their general characteristics from participants with a negative BP AF reading and were younger than patients with AF (mean age 56.4±14.8, p=0.027; 5 of 8 participants aged <65 years). CONCLUSIONS: Opportunistic screening of AF by BP measurement is feasible to diagnose this arrhythmia in unaware participants, particularly in those older than 65 years, who are the target patient group recommended by current AF screening guidelines.

Clinical utility of multi-detector cardiac computed tomography in structural heart interventions.

In recent years, there have been major advances in structural interventional cardiology, which have revolutionized the practice of cardiology. Appropriate selection and follow-up of patients undergoing these structural heart interventions is vital. Multi-detector computed tomography (MDCT) has emerged as a key imaging modality in the peri-procedural assessment of patients undergoing multiple structural cardiac interventions. The purpose of this review is to provide an evidence-based clinical update on the roles of MDCT in both established and evolving structural heart interventions, including transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve implantation (TMVI). The utility of MDCT in the peri-procedural assessment of patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation, cardiac resynchronization therapy (CRT) and left atrial appendage (LAA) closure will also be reviewed.

Microwave-based stroke diagnosis making global prehospital thrombolytic treatment possible.

Here, we present two different brain diagnostic devices based on microwave technology and the associated two first proof-of-principle measurements that show that the systems can differentiate hemorrhagic from ischemic stroke in acute stroke patients, as well as differentiate hemorrhagic patients from healthy volunteers. The system was based on microwave scattering measurements with an antenna system worn on the head. Measurement data were analyzed with a machine-learning algorithm that is based on training using data from patients with a known condition. Computer tomography images were used as reference. The detection methodology was evaluated with the leave-one-out validation method combined with a Monte Carlo-based bootstrap step. The clinical motivation for this project is that ischemic stroke patients may receive acute thrombolytic treatment at hospitals, dramatically reducing or abolishing symptoms. A microwave system is suitable for prehospital use, and therefore has the potential to allow significantly earlier diagnosis and treatment than today.

[Possibilities of instrumental methods of diagnosis of unstable atherosclerotic plaques of carotid arteries].

Today there exists a wide variety of laboratory and instrumental methods aimed at diagnosing an unstable carotid aortosclerotic plaque. Assessment of the laboratory indices is not sufficiently effective since it does not allow of revealing the fact of the formation of an unstable plague at early stages and to determine its localization. The instrumental methods employed (ultrasonographic study, magnetic resonance imaging, multiplanar computed tomography, positron emission tomography) were focussed on detecting pathomorphological markers of instability - thickness of the fibrous coating, structural plaques, the presence of erosions, ulcerations, haemorrhages, calcifications, lipid nucleus, activity of the cellular processes inside the plaque. The revealed signs promote early diagnosis of unstable atherosclerotic plaque with the determination of its localization. Nevertheless, they do not provide evidence about the danger of its rupture, whereas the overwhelming majority of acute vascular catastrophes including acute impairments of cerebral circulation is directly associated with arterial thrombosis resulting from rupture of the atherosclerotic plaque. Therefore, search for new methods aimed at prediction of complications of the atherosclerotic plaque which would be employed in routine clinical practice still remain urgently important today. The most promising is the study of the state of the atherosclerotic plaques of carotid arteries for prediction of acute impairment of cerebral circulation.

La tomagrafía computarizada como prueba para diagnosticar enfermedad arterial coronaria con comentarios sobre la aplicación de la teoría de Bayes y la placa vulnerable / Computerized tomography as a coronary artery disease diagnostic test and comments on the Bayes` theory and the vulnerable plaque

Los factores de riesgo en enfermedad arterial coronaria fueron evaluados en historias clínicas y estudios de pruebas de esfuerzos con el protocolo de Duke. Los índices de certeza se definen y utilizan comparándolos con el "el patrón de oro" la arteriografía coronaria. Se establece el valor diagnóstico de la tomagrafía axial computarizada, basándose en los índices de certeza. también se mencionan los estudios intracoronarios para evaluar la placa obstructiva

Risk factors in coronary artery disease were evaluated with the clinical history and the stress test with the Duke protocol. Probability indexes were defined and compared with the gold standard (coronary arteriogram). The diagnostic value of coronary angiotac was established with probability indexes. Intracoronary studies to diagnose vulnerable plaque are also mentioned

Beneficial aspects of real time flow measurements for the management of acute right ventricular heart failure following continuous flow ventricular assist device implantation.

BACKGROUND: Optimal management of acute right heart failure following the implantation of a left ventricular assist device requires a reliable estimation of left ventricular preload and contractility. This is possible by real-time pump blood flow measurements. CLINICAL CASE: We performed implantation of a continuous flow left ventricular assist device in a 66 years old female patient with an end-stage heart failure on the grounds of a dilated cardiomyopathy. Real-time pump blood flow was directly measured by an ultrasonic flow probe placed around the outflow graft. DIAGNOSIS: The progressive decline of real time flow and the loss of pulsatility were associated with an increase of central venous pressure, inotropic therapy and progressive renal failure suggesting the presence of an acute right heart failure. Diagnosis was validated by echocardiography and thermodilution measurements. TREATMENT: Temporary mechanical circulatory support of the right ventricle was successfully performed. Real time flow measurement proved to be a useful tool for the diagnosis and ultimately for the management of right heart failure including the weaning from extracorporeal membrane oxygenation.

A novel in vivo technique for observations of choke vessels in a rat skin flap model.

BACKGROUND: Choke vessels are reduced-caliber vessels that link adjacent vascular territories throughout the body. The behavior of choke vessels determines flap survival. Therefore, it is important to develop a reliable technique with which to study these vessels. The purpose of this report is to document a novel in vivo technique for the study of choke anastomotic vessels in a rat skin flap model. METHODS: This study was divided into two parts. In part I, 30 adult Sprague-Dawley rats underwent whole-body lead oxide/gelatin injection and the skin was removed for radiography to analyze the skin vasculature. In part II, a dorsal skin flap was elevated in 12 rats, and a skinfold chamber was installed to observe the choke vessels between the iliolumbar artery perforator and the posterior intercostal artery perforator for 8 days. Evans blue dye was injected through the lateral tail vein. Blood flow velocity was calculated. RESULTS: In part I, three distinct patterns of dorsal cutaneous vasculature were found. A three-territory, 3.5×10-cm flap can be elevated on the dorsum of the rat. In part II, an increase in diameter of the choke arteries and the choke veins was observed, particularly in the fine venules. Blood flow velocity across the arterial segment of the choke zone was found to be 2.5 mm/second. CONCLUSIONS: The observation chamber technique for in vivo study of the choke anastomotic region of the rat dorsal skin flap model is a promising novel method for studying skin microcirculation. The time sequence of microvascular events in the choke anastomotic zone of this rat model was documented.

Identificación no invasiva de ateroesclerosis subclínica en individuos con psoriasis / Non-invasive identification of subclinical atheroesclerosis

Antecedentes. La psoriasis es una enfermedad inflamatoria crónica multisistémica que implica un riesgo cardiovascular aumentado, incluidos enfermedad coronaria, infarto de miocardio y muerte de causa cardiovascular, sobre todo en pacientes jóvenes y con psoriasis más graves. Esto se debe a una aterogénesis precoz y en ocasiones subclínica, que podría ser identificada de manera no invasiva mediante estudios vasculares de vasos periféricos. Objetivos. a) identificar la presencia de ateroesclerosis subclínica en pacientes con psoriasis; b) establecer su valor predictivo independientemente de otros factores de riesgo cardiovascular. Diseño. Estudio de cohorte, prospectivo, controlado. Métodos. Se incluyeron 175 pacientes consecutivos, un grupo con psoriasis (GP, n:35) y un grupo control (GC, n:140), a quienes se les efectuó estudios de identificación de placas de ateroesclerosis y de elasticidad arterial en vasos carotídeos extracraneales y femorales. Resultados. El score de Framingham en los pacientes de ambos grupos fue bajo (7 ± 2,3% vs. 5,7 ± 1,8%; GP vs. GC respectivamente; p = .003), mientras que el score de riesgo vascular determinado según la alteración de parámetros de ateroesclerosis subclínica evaluados fue mayor en el GP (2,9 ± 1,2 vs. 2,2 ± 0.08; p = .002). La rigidez de la pared arterial se halló significativamente incrementada en el GP (EIM 0,7 ± 0,2 vs. 0,63 ± 0,1 mm, p< 0.001), donde se observó una prevalencia mayor de placas ateroescleróticas (94% vs. 62,5%, p = .001) la mayoría de alta vulnerabilidad. Conclusiones. El uso de técnicas no invasivas que faciliten la detección precoz de pacientes psoriásicos con enfermedad subclínica de la pared arterial, permitiría evaluar correctamente el riesgo, que puede ser subestimado si sólo se realizan estudios clínicos de los factores de riesgoconvencionales.

Background. Psoriasis is a chronic multisystem inflammatory disease that involves an increasedcardiovascular risk as heart disease, myocardial infarction and cardiovascular death, especially inyounger patients and severe psoriasis. This is due to early atherogenesis, and sometimes to a subclinicalcourse, which could be identified by non invasive vascular studies of peripheral vessels.Objectives. a) Identify the presence of subclinical atherosclerosis in patients with psoriasis; b)Determine its predictive value independently of other cardiovascular risk factors.Design. Cohort, prospective, controlled trial. Methods. 175 consecutive patients were included, a Psoriatic Group (PG, n:35) and a Control Group(CG, n:140) where identified, and submited to studies for identification of atherosclerotic plaquesand arterial elasticity in extracranial carotids and femoral vessels.Results. The Framingham scores in patients of both groups was low (7 ± 2.3% vs. 5.7 ± 1.8%;GP vs. GC respectively, p = .003) while the vascular risk score, determined by the alteration ofsubclinical atherosclerosis parameters, was higher in the GP (2.9 ± 1.2 vs. 2.2 ± 0.08, p = .002).The arterial wall stiffness was found significantly increased in the GP (EIM 0.7 ± 0.2 vs 0.63 ± 0.1mm, p< 0.001), where a higher prevalence of atherosclerotic plaques (94% vs. 62.5%, p = .001),mostly of high vulnerability, was also observed.Conclusions. The use of non invasive techniques that facilitate early detection of psoriaticindividuals with subclinical arterial wall disease, would allow a proper assessment of risk whichmay be underestimates by only clinical assessment of conventional risk factors.

Assessment of clopidogrel non-response by the PFA-100 system using the new test cartridge INNOVANCE PFA P2Y.

Until now, the PFA-100 system has been considered unsuitable for monitoring clopidogrel efficacy. The authors evaluated platelet function in peripheral arterial occlusive disease (PAOD) patients using a new PFA-100(R) test cartridge (product name: INNOVANCE PFA P2Y*) specifically designed for this purpose. Twenty-two stable PAOD patients on antithrombotic therapy with clopidogrel alone (n = 22) and 18 patients undergoing a peripheral catheter intervention, preliminarily treated with 100 mg/day of aspirin followed by co-administration of clopidogrel (loading dose 300 mg, maintenance dose 75 mg/day), were enrolled in this study. Defining non-responsiveness to clopidogrel as an aggregation response within the reference range (90% central interval), four (18.2%) non-responders using light transmittance aggregometry (LTA) induced by 5 microM adenosine diphosphate (ADP) and six (27.3%) non-responders using LTA induced by 2 microM ADP (LateAggr >72.1% and >42.9%, respectively) were identified. INNOVANCE PFA P2Y* determined six (27.3%) non-responders (CT < 87 s). Agreement between the two aggregometry assays and INNOVANCE PFA P2Y* on the definition of clopidogrel response and non-response exceeded 70%. Only three patients were uniformly identified as clopidogrel non-responders by all three assays. When clopidogrel was co-administered with aspirin, two (11.1%) non-responders to clopidogrel were detected with INNOVANCE PFA P2Y*, whereas ADP-induced LTA found all patients to be responsive. INNOVANCE PFA P2Y* appears to be suitable for monitoring the effect of clopidogrel on platelet function. Its sensitivity in detecting responsiveness or non-responsiveness to clopidogrel is comparable to ADP-induced LTA. Additional prospective studies are needed to clarify the clinical relevance of the test results and classification obtained with INNOVANCE PFA P2Y*.

Avaliação de desempenho em um medidor eletromagnético de baixo custo desenvolvido para aplicações em simulação cardiovascular / Performance evaluation on low cost electromagnetic flow meter for cardiovascular simulation system application

Técnicas cirúrgicas, próteses e dispositivos implantáveis utilizados pela cardiologia estão em constante desenvolvimento. Alguns institutos de pesquisas e universidades desenvolvem simuladores hidrodinâmicos com capacidade de reproduzir os níveis de pressão e vazão do sistema cardiovascular humano, com pistões, válvulas, câmaras de complacência, dispositivos para ajustes e medição de pressão e vazão. Este artigo apresenta o desenvolvimento e a avaliação de um fluxômetro eletromagnético (FE). O custo elevado de um fluxômetro por ultrassom (FUS) pode inviabilizar algumas pesquisas com simuladores; desta forma, uma alternativa com menor custo é apresentada neste trabalho. Baseado na indução eletromagnética para medição de vazão em um fluido iônico, o FE desenvolvido mostrou ser uma solução de baixo custo. O transdutor foi montado em um tubo de plástico com diâmetro interno de 9,5 mm, excitado por um campo magnético de 0,35 T, possui 4 eletrodos que, ligados a um circuito eletrônico, fornecem tensão elétrica proporcional à velocidade do fluido. A equação da tensão induzida, técnicas para calibração, ensaios e resultados são apresentados. Para a realização dos ensaios, foram utilizados um simulador cardiovascular e um FUS como referência. Os dados foram obtidos por hardware e software da National Instruments. Dentre os resultados, destaca-se o baixo desvio padrão de 0,043 L/min do FE para uma vazão de 3,56 L/min. O maior erro porcentual relativo foi de 1,49 ± 1,25%. Em um dos gráficos de vazão do FE observou-se um comportamento não monotônico, confirmado por uma análise da resposta em freqüência, observando-se maior amplitude na segunda, terceira e quarta harmônicas. Os resultados indicaram que o FE pode substituir o FUS em aplicações com simuladores hidrodinâmicos.

Implantable devices, prosthesis and their associated surgical techniques in cardiology are constantly under development. Many research groups have been using hydrodynamic simulators as a tool to assist the development in cardiovascular area, capable to mimic pressure and flow found in human cardiovascular system. They are made with plastic tubes, compliances chambers, valves, moving diaphragms and clamps for pressure and flow adjustments. The high cost of ultrasonic flow meters (UF) may difficult, for some research groups, the development of their own mock systems. This paper presents a simple and low cost electromagnetic flow meter (EF) useful for those cardiovascular simulation systems. EF measures flow of ionic fluids based on electromagnetic induction. A special transducer was assembled directly on a plastic tube with 9.5 mm of inner diameter. The transducer has 4 electrodes and, when excited by a magnetic field of 0.35 tesla, detects electric tension that is proportional to the fluid velocity. In this paper, induced electric potential equation, calibration techniques, performance tests and results are presented. A cardiovascular simulation system was used as test setup with an UF (Transonic Systems Inc.) as comparative flow meter. The signals were acquired by a PCI-6036E card and processed with LabView® 7.1 (National Instruments). The results from EF showed a standard deviation (SD) of 0.043 L/min for a flow of 3.56 L/min. The largest relative error was of 1.49 ± 1.25%. In one flow signal from the EF, the non monotonic behavior suggests a rich harmonic signal, which was confirmed by an analysis in the frequency domain. In vitro performance tests indicated that our EF can substitute the commercial available UF for hydrodynamic simulator application.

Continuous cardiac index monitoring: A prospective observational study of agreement between a pulmonary artery catheter and a calibrated minimally invasive technique.

INTRODUCTION: Continuous cardiac index (CCI) monitoring can provide information to assist in hemodynamic support. However, pulmonary artery catheters (PAC) pose logistic challenges in acute care settings. We hypothesized that CCI measured with a calibrated minimally invasive technique (LiDCO/PulseCO, UK) would have good agreement with the PAC. METHODS: We performed a prospective observational study in post-operative cardiac surgery patients. All patients had a PAC with CCI monitoring capability. We connected the LiDCO apparatus to a radial artery line and performed a one-time calibration with a lithium dilution indicator. In order to test the least invasive method possible, we used a peripheral intravenous (IV) line for indicator delivery rather than the conventional central line technique. We recorded paired PAC/LiDCO-PulseCO CCI measurements every minute for 3h. We blinded investigators and clinicians to minimally invasive data with an opaque shield over the monitor. We assessed agreement with Bland-Altman analysis. RESULTS: We obtained 1485 paired measurements in 8 subjects. The mean CI was 2.9L/min/m(2). By Bland-Altman plot, PAC and LiDCO measurements showed minimal bias (-0.01), but the 95% limits of agreement (+/-2SD) of+/-1.3L/min/m(2) were relatively wide with respect to the mean. CONCLUSIONS: This calibrated minimally invasive (i.e. radial arterial line and peripheral IV) technique demonstrated low bias compared with CCI measured by PAC. However, the relatively wide confidence limits indicate that differences in the two measurements could still be clinically significant.

Propedêutica cardiológica para avaliação dacardiopatia chagásica na atenção primária / Cardiologic investigation for the evaluation of Chagas' heart disease inthe primary health assistance

Objetivos: Controlando-se a transmissão da doença de Chagas, faz-se necessário investir na prevenção dos agravos de sua cardiopatia crônica. Procurou-se comparar a propedêutica cardiológica acessível na Atenção Primária, com exames mais complexos, na avaliação dos cardiopatas chagásicos. Métodos: Foram analisados os prontuários de 515 pacientes acompanhados no ambulatório do Grupo de Estudos em Doença de Chagas (GEDoCh) - HC / UNICAMP, Campinas,SP, sendo selecionados 52 com registro completo dos exames básicos - avaliação clínica, ECG convencional (ECG) e RX detórax (RX), e ao menos um dos exames complementares: teste de esforço (TE), ecocardiograma (ECO) e eletrocardiografia dinâmica (Holter). Excluíram-se os prontuários com dados incompletos ou de portadores de outras cardiopatias, incluindos edoença arterial coronariana e doença reumática, hipertensão arterial e alcoolismo. Comparamos-se os resultados desses dois tipos de investigação. Resultados: A avaliação clínica, associada ao ECG e RX,mostrou significância quando confrontada com aptidão cardiorrespiratória(ACR) e classe funcional (CF) obtidas no TE(p=0,0062; p=0,0409). Os cardiopatas mais graves apresentaram comprometimento maior da ACR e CF mais baixa, comparando-se aos menos graves. Os demais exames complexos não mostraram associação significativa com a propedêutica cardiológica disponível em nível de Atenção Primária.Conclusão: A propedêutica cardiológica básica permite classificar a cardiopatia chagásica em formas leve ou grave. Entretanto, apenas dois parâmetros obtidos no TE (ACR e CF) mostraram correlação significativa com o exame clínico. De qualquer modo, a propedêutica cardiológica básica é relevantena consideração do nível em que devem ser assistidos os portadores crônicos dessa afecção.(AU)

Objective: The next step after the control of Chagas’ diseasetransmission is the investment in the prevention of the chagasic cardiopathy damage. This study intended to comparethe basic cardiologic investigation with the complex cardiologic investigation in Chagas’ heart disease.Methods: The study evaluated 52 medical records among515 of the chagasic patients from the Ambulatory of the Chagas’Disease Study Group (State University of Campinas, SP). These patients showed complete registration of Clinical Evaluation, ECG, Chest Radiography, and, at least one of the morecomplex exams: Ergometric Test, Echocardiography Evaluation,and Holter. It was excluded those with incomplete data, other cardiac diseases, arterial hypertension, and alcoholism.The results obtained from the two kinds of cardiologic evaluationwere compared. Results: The clinical evaluation plus the ECG and chestradiography showed statistical significance compared withthe cardio - respiratory aptitude (CRA) and the functional class (FC) obtained from the Ergometric Test (p = 0.0062; p= 0.0409). The patients classified in the severe stages of the Chagas’ heart disease presented lesser levels of CRA and FC compared with those in the benign stages. The other complexexams didn’t show significant association with the availableexams usually found in the Primary Health Units. Objective: The next step after the control of Chagas’ diseasetransmission is the investment in the prevention of the chagasic cardiopathy damage. This study intended to comparethe basic cardiologic investigation with the complex cardiologic investigation in Chagas’ heart disease. Methods: The study evaluated 52 medical records among 515 of the chagasic patients from the Ambulatory of the Chagas’Disease Study Group.(AU)

Early detection of health changes in older adults.

We have placed a network of sensors in a residential home for the elderly who are aging in place. Restlessness data is displayed as graph of event counts detected by sensors over some time interval, typically a day. This data is related to the actual activities as recorded by the resident. We show two cases of elderly individuals. In both cases the individuals underwent surgery. The restlessness indicators showed changes in patterns that were related to those events. Analyzing the data even at this level we gain increased confidence that technology will be a welcome addition as the population ages and require increasing care.

Large artery stiffness and pulse wave reflection: results of a population-based study.

OBJECTIVE: To assess the determination of large artery stiffness and pulse wave reflection in a population sample. METHODS: A 1% random population sample aged 25-65 years was selected in nine districts of the Czech Republic for a survey off cardiovascular risk factors (Czech post-MONICA). Of 891 individual screened in the Pilsen centre in the year 2000, arterial properties were studied in 291 (143 males and 148 females) using the Sphygmocor device. Pulse wave velocity (PWV) in the aorta and in the lowe limbs was measured to assess large artery stiffness. Wave reflection was assessed from radial pulse wave analysis; the main estimated parameter was peripheral augmentation index (PAI) defined as P2/P1 = ratio of pulse pressures measures at the peaks of secondary and primary waves. RESULTS: Aortic PWV increased with age (p < 0.001) and was similar in both sexes. Lower extremity PWV increased with age in women, but not in mean, and its mean value was higher in men (p < 0.001). PAI was higher in females in all age groups (p < 0.001) and increased steeply with age in both sexes (p < 0.001). PAI was increased in current smokers (p < 0.001 in both sexes) and in male smokers, the reflected wave returned earlier than in male non-smokers (p < 0.05). Correlation coefficient of PAI with aortic PWV was 0.22 (p < 0.01), and with central augmentation index (CAI), derived from PAI by mathematical transformation, was 0.94 (p < 0.001). Multiple regression analyses, where age, sex, systolic blood pressure (SBP), total cholesterol level, smoking, glucose level and body mass index were included as independent variables, were performed. PAI was better predicted than aortic or lower extremity PWV is these models (41%, 14% and 10% of variance explained, respectively). Age, female sex, smoking, SBP and total cholesterol predicted PAI level whereas age, SBP and glucose level were the main determinants pf aortic PWV. CONCLUSION: Of the studied arterial parameters, PAI showed the closest association with cardiovascular risk factors. The correlation between PAI and aortic PWV was loose, and both parameters had practically different determinants. PAI, which is obtained by direct measurement above radial artery, was practically identical with the mathematically derived CAI in the studied population sample, and therefore, it is a suitable parameter for studying the phenomenon of wave reflection.

Direct intra-aneurysm sac pressure measurement using tip-pressure sensors: in vivo and in vitro evaluation.

OBJECTIVE: Direct intra-aneurysm sac pressure measurement with percutaneous translumbar puncture is a new method for follow-up after endovascular aneurysm repair. The purpose of this study was to evaluate a tip-pressure sensor system for intra-aneurysm pressure measurement in an in vitro aneurysm model and in vivo in patients by studying intraobserver variability. METHODS: We used 0.014-inch guide wire-mounted tip-pressure sensors. For the in vitro aneurysm model, saccular aneurysms filled with thrombus were inserted in a left-heart-driven aneurysm model. Pressure was measured simultaneously with guide wire pressure sensors in the lumen of the model and within the aneurysm thrombus. In vivo, intraobserver variability was evaluated with double percutaneous translumbar puncture of the abdominal aortic aneurysm (AAA) with pressure measurement in 15 patients (14 men, 1 woman; median age, 75 years [63-80 years]; median AAA diameter, 55 mm [47-80 mm]) at a median of 32 months (2-100 months) after endovascular aneurysm repair. Mean pressure index was calculated as the percentage of mean intraaneurysm pressure relative to simultaneous mean systemic pressure. RESULTS: In vitro, the difference in pressure between the tip-sensor measurements and the pressure output of the aneurysm model was 2 mm Hg (1-4 mm Hg) when the output varied between 150/50 and 200/100 mm Hg (n = 90). Mean pressure in the lumen of the model and within the aneurysm thrombus differed by 1 mm Hg (-5-15 mm Hg (n = 10). In vivo, intraobserver variability of mean pressure index (Bland-Altman plot) was 0% (-7%-17%; n = 15%). CONCLUSION: Direct intra-aneurysm sac pressure measurement with tip-pressure sensors mounted on 0.014-inch guide wires is a reliable and reproducible technique for measuring intra-AAA pressure both in vitro and in vivo.