Remote Cardiac Rehabilitation With Wearable Devices.

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients' busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as cost-effectiveness and insurance coverage still persist.

Anatomical cardiac and electrocardiographic axes correlate in both upright and supine positions: an upright/supine CT study.

The correlation between the anatomical cardiac and electrocardiographic axes has been discussed for several years. Using upright computed tomography, this study aimed to reveal the relationship between the anatomical cardiac and electrocardiographic axes in both the supine and upright positions. Upright CT and standard supine CT were performed for healthy volunteers, following electrocardiography in both upright and supine position. On CT images, the coordinates of apex, the center of aortic valve (AV) and mitral valve (MV) were recorded, and the vectors and angles were calculated. Subcutaneous and visceral fat volume were semi-automatically calculated in a workstation. From a total 190 volunteers, 41 males were performed electrocardiography and included for this study. The QRS and anatomical axes (AV-apex and MV-apex axis) were significantly correlated in both supine and upright positions, while the angle of the AV-apex to Z axis was the most correlated (supine: r = - 0.54, p = 0.0002, upright: r = - 0.47, p = 0.0020). The anatomical axis moved in the dorsal and caudal directions from the supine to upright position. Multiple regression analysis revealed that the anatomical axis from the AV-apex to the Z-axis was determined according to age, body height, subcutaneous and visceral fat volumes.

Dynamic aortic changes during the cardiac cycle in patients with aortic valve disease analyzed by computed tomography combined with PhyZiodynamics software.

BACKGROUND: Endovascular therapy for the ascending aorta is expected in the future, but the dynamic changes in the ascending aorta are unclear. PURPOSE: The purpose of the present study was to evaluate dynamic changes in the aortic cross-sectional area and examine related determinants. METHODS: The subjects included 75 patients (aortic regurgitation [AR] in 18 patients, aortic stenosis [AS] in 46 patients, and 11 controls) who underwent dynamic computed tomography (CT) prior to cardiac treatment. According to the centerline method, the cross-sectional areas of the ascending and descending aortas at the same level were analyzed. The rate of change from the minimum value to the maximum value in one heartbeat and peak rate of change in cross-sectional area (peak area change) were measured. RESULTS: The rates of change of the ascending and descending aortas were 4.4% and 6.4% (P < 0.05) and the peak area change was 0.3 mm2/msec vs. 0.2 mm2/msec (P < 0.05), respectively. In both the ascending and descending aortas, the rate of change and the peak area change were significantly greater in the AR group than in the AS and control groups. Results of the multiple regression analysis showed that greater stroke volumes (SVs) were associated with greater change in the ascending aorta and a faster momentary expansion rate. Furthermore, it was observed that the momentary expansion rate declined with age. CONCLUSION: The ascending aortic diameter changes significantly in one heartbeat and differs depending on AR, age, and SV. TRIAL REGISTRATION NUMBER: 17 - 006. DATE OF REGISTRATION: May 29, 2017 Retrospectively registered.

Two-Year Results of a Multicenter Prospective Observational Study of the Zenith Spiral-Z Limb Deployed in the External Iliac Artery During Endovascular Aneurysm Repair.

BACKGROUND: Limited data is available on the use of a polyester graft limb with a helical stent configuration deployed in the external iliac artery (EIA) during endovascular aneurysm repair (EVAR), so we prospectively analyzed the efficacy of the Zenith Spiral-Z limb deployed in the EIA.Methods and Results:Patients undergoing EVAR using a Zenith stent-graft and Spiral-Z limb deployed in the EIA were prospectively registered in 24 Japanese institutions from June 2017 to November 2017. In total, 65 patients (74 limbs) (mean age: 77.1±8.0 years, 87.7% men, mean abdominal aortic aneurysm (AAA) diameter: 51.9±7.2 mm, mean iliac artery aneurysm (IAA) diameter: 38.3±10.0 mm) were registered and followed up. The most common reason for deployment in the EIA was a common IAA (43 limbs, 58.1%), and 8 limbs (10.8%) had a bare nitinol stent placed at the Spiral-Z limb. A total of 61 patients (70 limbs) completed a 24-month follow-up. There were 2 Spiral-Z limb stenoses and 1 occlusion, leading to a primary patency of 95.5% and a secondary patency of 100%, at 24 months. Buttock claudication occurred in 24.3% of the limbs treated at 1 month but decreased to 4.3% at 24 months. CONCLUSIONS: Our multicenter prospective study showed that Spiral-Z limb deployed in the EIA was associated with satisfactory results and seems to be a durable option, even in the era of iliac branch devices.

Impact of Acute Kidney Injury on Early to Long-Term Outcomes in Patients Who Underwent Surgery for Type A Acute Aortic Dissection.

Acute kidney injury (AKI) is relatively common after cardiothoracic surgery for type A acute aortic dissection (TA-AAD) and increases mortality. We investigated the incidence and risk factors for AKI in patients with TA-AAD and its impact on their outcomes. The records of 375 consecutive patients who underwent surgical treatment for TA-AAD from October 2007 to March 2013 were analyzed retrospectively. We defined AKI using the Kidney Disease Improving Global Outcomes criteria, which are based on serum creatinine concentration or glomerular filtration rate. We used Kaplan-Meier methods and multivariate Cox proportional hazards regression to assess the impact of AKI on both mortality and major adverse cardiovascular and cerebrovascular events. We also examined the association between risk factors and AKI using logistic regression modeling. Postoperative AKI was observed in 165 patients (44.0%). The overall 30-day and mid- to long-term mortality was 1.6% and 8.8%, respectively. Mortality and major adverse cardiovascular and cerebrovascular events correlated significantly with the severity of AKI, and multivariate analysis showed that AKI stage 3 (the most sever stage) was an independent risk factor for mortality (hazard ratio 6.83, 95% confidence interval 2.52 to 18.52) after adjustment for important confounding factors. Extracorporeal circulation time, body mass index, perioperative peak serum C-reactive protein concentration, renal malperfusion, and perioperative sepsis were found to be risk factors for AKI. In conclusion, AKI was common in patients who underwent surgery for type A acute aortic dissection. The severity of AKI strongly influences patient outcomes, so it should be recognized promptly and treated aggressively when possible.

Surgical repair for popliteal venous aneurysm causing severe or recurrent pulmonary thromboembolism: three case reports.

Poplitealvenous aneurysms (PVA) are associated with deep venous thrombosis and recurrentpulmonary thromboembolism (PE). We report three cases of PVA. In all three patients the first sign of PVA was acute PE; in one case, the PE was recurrent. Computed tomography and duplex ultrasonography revealed not only PE but also popliteal venous dilatation with thrombus. Surgical reconstruction was performed in each case after treatment for PE. No postoperative complications occurred, including recurrent PE. Surgical repair of PVA is safe and is a recommended treatment.

Initial experience with proximal ligation for profunda femoris artery aneurysms: report of three cases.

Profunda femoris artery aneurysms (PFAAs) are rare and difficult to diagnose in the early stage. They are often found due to the presence of complicated conditions, such as rapid expansion, rupture, or acute lower limb ischemia. Surgical procedures such as aneurysmectomy and endoaneurysmorrhaphy tend to be technically challenging because of the patient status and the extent of the aneurysm. We experienced three cases of PFAAs that were treated by proximal ligation (PL) without complete control of the distal branches. The exclusion of PFAAs was confirmed by duplex ultrasound or angiography at the end of the operation. There was no mortality in the perioperative period. During a 12-month follow-up, all cases exhibited complete exclusion of aneurysms with marked size reduction. Based on these findings, we propose that PL, with a careful follow-up for PFAA exclusion and distal limb circulation, could be an alternative treatment for complicated PFAAs.

[Successful endovascular repair with chimney graft technique and carotid artery bypass for ruptured aortic arch aneurysm].

An 83-year-old man with a decreasing level of consciousness was carried to the emergency room. Computed tomography (CT) revealed a ruptured aortic arch aneurysm. He was deemed a high risk candidate for conventional surgical repair. The case was treated by a hybrid approach. Endo-exclusion of thoracic aortic aneurysm (TAA) was obtained by implanting stentgrafts from the ascending to descending aorta. The brain circulation was maintained by right to left carotid and to left subcravian artery bypasses combined with" chimney endo-debranching graft" of the innominate artery. This could be a method of choice for the acute patients under similar circumstances.

Preservation of aortic arch branches using chimney and sandwich stent grafts.

PURPOSE: To share our hybrid endovascular experiences using chimney or sandwich stent grafts for acute aortic arch pathologies. METHODS: Hybrid procedures for a distal aortic arch aneurysm and an ascending anastomotic aortic aneurysm rupture were reported. Right to left common carotid and left axillar artery bypasses were located. Covered stents were inserted into the inominate artery, with the flow-proximal end located in the ascending (standard chimney) or the descending aortic stent graft (retrograde sandwich). RESULTS: Both cases had no signs of brain ischemia. Aneurysms are decreasing in size. CONCLUSION: Chimney and sandwich techniques were technically feasible in the complex and acute situations.