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2.
Artigo em Inglês | MEDLINE | ID: mdl-31350150

RESUMO

OBJECTIVE: To investigate the prognostic impact of red blood cell (RBC) transfusion on the outcome after transfemoral transcatheter aortic valve replacement (TAVR). DESIGN: Nationwide, retrospective multicenter study. SETTING: Five University Hospitals. PARTICIPANTS: The nationwide FinnValve registry included data from 2,130 patients who underwent TAVR for aortic stenosis from 2008 to 2017. After excluding patients who underwent TAVR through nontransfemoral accesses, 1,818 patients were selected for this analysis. INTERVENTION: TAVR with or without coronary revascularization. MEASUREMENTS AND MAIN RESULTS: RBCs were transfused in 293 patients (16.1%). Time-trend analysis showed that the rates of RBC transfusion decreased significantly from 27.5% in 2012 to 10.0% in 2017 (p < 0.0001). Among 281 propensity score matched pairs, RBC transfusion was associated with higher 30-day mortality (7.1% v 0%, p < 0.0001), late mortality (at 5-year, 59.1% v 43.3%, p = 0.008), as well as increased risk of acute kidney injury (17.0% v 4.4%, p < 0.0001), renal replacement therapy (3.6% v 0.4, p < 0.0001) and prolonged hospital stay (mean, 8.5 v 4.7 days, p < 0.0001) compared with patients who did not receive blood transfusion. In the overall series, the risk of adverse events increased significantly with the increasing amount of transfused RBC units and when operation for excessive bleeding was necessary. Consistently with these findings, postoperative hemoglobin drop and nadir level were associated with higher early and late mortality. CONCLUSIONS: Patients who received blood transfusion after TAVR had an increased risk of early and late adverse events. These adverse effects were particularly evident with increasing amount of RBC transfusion and operations for excessive bleeding.

3.
J Am Heart Assoc ; 8(15): e010881, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31311438

RESUMO

Background Clinical characteristics and outcomes of takotsubo syndrome (TTS) patients with malignancy have not been fully elucidated. This study sought to explore differences in clinical characteristics and to investigate short- and long-term outcomes in TTS patients with or without malignancy. Methods and Results TTS patients were enrolled from the International Takotsubo Registry. The TTS cohort was divided into patients with and without malignancy to investigate differences in clinical characteristics and to assess short- and long-term mortality. A subanalysis was performed comparing long-term mortality between a subset of TTS patients with or without malignancy and acute coronary syndrome (ACS) patients with or without malignancy. Malignancy was observed in 16.6% of 1604 TTS patients. Patients with malignancy were older and more likely to have physical triggers, but less likely to have emotional triggers compared with those without malignancy. Long-term mortality was higher in patients with malignancy (P<0.001), while short-term outcome was comparable (P=0.17). In a subanalysis, long-term mortality was comparable between TTS patients with malignancies and ACS patients with malignancies (P=0.13). Malignancy emerged as an independent predictor of long-term mortality. Conclusions A substantial number of TTS patients show an association with malignancy. History of malignancy might increase the risk for TTS, and therefore, appropriate screening for malignancy should be considered in these patients. Clinical Trial Registration URL: http://www.clinicaltrial.gov. Unique identifier: NCT01947621.

4.
JAMA Netw Open ; 2(6): e195742, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31199448

RESUMO

Importance: Transcatheter aortic valve replacement (TAVR) has been shown to be a valid alternative to surgical aortic valve replacement (SAVR) in patients at high operative risk with severe aortic stenosis (AS). However, the evidence of the benefits and harms of TAVR in patients at low operative risk is still scarce. Objective: To compare the short-term and midterm outcomes after TAVR and SAVR in low-risk patients with AS. Design, Setting, and Participants: This retrospective comparative effectiveness cohort study used data from the Nationwide Finnish Registry of Transcatheter and Surgical Aortic Valve Replacement for Aortic Valve Stenosis of patients at low operative risk who underwent TAVR or SAVR with a bioprosthesis for severe AS from January 1, 2008, to November 30, 2017. Low operative risk was defined as a Society of Thoracic Surgeons Predicted Risk of Mortality score less than 3% without other comorbidities of clinical relevance. One-to-one propensity score matching was performed to adjust for baseline covariates between the TAVR and SAVR cohorts. Exposures: Primary TAVR or SAVR with a bioprosthesis for AS with or without associated coronary revascularization. Main Outcomes and Measures: The primary outcomes were 30-day and 3-year survival. Results: Overall, 2841 patients (mean [SD] age, 74.0 [6.2] years; 1560 [54.9%] men) fulfilled the inclusion criteria and were included in the analysis; TAVR was performed in 325 patients and SAVR in 2516 patients. Propensity score matching produced 304 pairs with similar baseline characteristics. Third-generation devices were used in 263 patients (86.5%) who underwent TAVR. Among these matched pairs, 30-day mortality was 1.3% after TAVR and 3.6% after SAVR (P = .12). Three-year survival was similar in the study cohorts (TAVR, 85.7%; SAVR, 87.7%; P = .45). Interaction tests found no differences in terms of 3-year survival between the study cohorts in patients younger than vs older than 80 years or in patients who received recent aortic valve prostheses vs those who did not. Conclusions and Relevance: Transcatheter aortic valve replacement using mostly third-generation devices achieved similar short- and mid-term survival compared with SAVR in low-risk patients. Further studies are needed to assess the long-term durability of TAVR prostheses before extending their use to low-risk patients.

5.
Eur Heart J ; 40(26): 2142-2151, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31098611

RESUMO

AIMS: We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS: We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS: Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.

7.
J Am Coll Cardiol ; 72(8): 874-882, 2018 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-30115226

RESUMO

BACKGROUND: Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. OBJECTIVES: This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. METHODS: Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. RESULTS: Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. CONCLUSIONS: Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621).

8.
Sci Rep ; 8(1): 9344, 2018 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-29921933

RESUMO

Cardiac translational and rotational vibrations induced by left ventricular motions are measurable using joint seismocardiography (SCG) and gyrocardiography (GCG) techniques. Multi-dimensional non-invasive monitoring of the heart reveals relative information of cardiac wall motion. A single inertial measurement unit (IMU) allows capturing cardiac vibrations in sufficient details and enables us to perform patient screening for various heart conditions. We envision smartphone mechanocardiography (MCG) for the use of e-health or telemonitoring, which uses a multi-class classifier to detect various types of cardiovascular diseases (CVD) using only smartphone's built-in internal sensors data. Such smartphone App/solution could be used by either a healthcare professional and/or the patient him/herself to take recordings from their heart. We suggest that smartphone could be used to separate heart conditions such as normal sinus rhythm (SR), atrial fibrillation (AFib), coronary artery disease (CAD), and possibly ST-segment elevated myocardial infarction (STEMI) in multiclass settings. An application could run the disease screening and immediately inform the user about the results. Widespread availability of IMUs within smartphones could enable the screening of patients globally in the future, however, we also discuss the possible challenges raised by the utilization of such self-monitoring systems.

9.
Clin Cardiol ; 41(7): 966-971, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29802625

RESUMO

BACKGROUND: Electrical cardioversion (CV) is essential in rhythm management of atrial fibrillation (AF). However, optimal timing of CV remains unknown. HYPOTHESIS: Timing of CV in AF is associated with risk of adverse events. METHODS: We analyzed the effect of AF episode duration on safety and efficacy of electrical CV in a multicenter, multicohort study exploring 4356 CVs in 2530 patients on oral anticoagulation. The composite adverse outcome included unsuccessful CV, acute arrhythmic complications, thromboembolic events, mortality, and AF recurrence within 30-day follow-up. RESULTS: Study groups were stratified according to duration of index AF episode (<24 h, 24-48 h, 48 h-30d, and > 30d), consisting of 1767, 516, 632, and 1441 CVs, respectively. CVs were unsuccessful in 8.5% (<24 h), 5.4% (24-48 h), 11.1% (48 h-30d), and 13.9% (>30d), respectively (P < 0.01). Occurrence of thromboembolic events (0.1%), mortality (0.1%), and asystole >5 seconds (0.7%) within 30-day follow-up was infrequent and comparable in the study groups. AF recurrence within 30 days after initially successful CVs was 29.8% (<24 h), 26.5% (24-48 h), 37.3% (48 h-30d), and 30.3% (>30d), respectively (P < 0.01). Composite adverse outcome occurred in 1669 (38.4%) CVs, and index AF episode >48 hours was an independent predictor for the composite endpoint (OR: 1.49, 95% CI: 1.28-1.74, P < 0.01) in multivariate analysis. CONCLUSIONS: Optimal timing of CV for AF showed a J-shaped curve, with fewest adverse outcomes in patients with CV performed 24 to 48 hours after onset of AF. In patients with rhythm-control strategy, delaying CV >48 hours is associated with increased risk for adverse outcomes.


Assuntos
Fibrilação Atrial/terapia , Cardioversão Elétrica/métodos , Tromboembolia/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/mortalidade , Eletrocardiografia , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
10.
Int J Cardiol ; 263: 29-31, 2018 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-29681408

RESUMO

BACKGROUND: The MANTA system is a novel vascular closure device (VCD) and its safety and efficacy were compared to the ProGlide VCD in patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). METHODS: This is a retrospective study including 222 patients who underwent transfemoral TAVI at three Finnish University Hospitals. The MANTA VCD was used in 107 patients and their outcome was compared with that of 115 patients in whom the arterial access was closed with the ProGlide VCD. RESULTS: VARC-2 VCD failure occurred less frequently in the MANTA cohort (3.7% vs. 7.8%, p = 0.378), but the difference did not reach statistical significance. When adjusted for the introducer outer diameter, the MANTA cohort had similar rates of VARC-2 major vascular complications (9.3% vs. 12.2%, adjusted: p = 0.456), VARC-2 life-threatening/disabling bleeding (9.3% vs. 6.1%, adjusted: p = 0.296) and need of invasive treatment of bleeding (4.7% vs. 7.0%, adjusted: p = 0.416) compared to the ProGlide cohort. Additional VCDs were more frequently needed in the ProGlide cohort (58.3% vs. 1.9%, p < 0.0001). CONCLUSIONS: In patients undergoing transfemoral TAVI, the MANTA VCD showed a similar risk of VARC-2 vascular and bleeding complications compared to the ProGlide VCD, but it reduced significantly the need of additional VCDs for completion of hemostasis.

12.
Europace ; 20(4): 565-568, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29016758

RESUMO

Aims: Non-vitamin K antagonist oral anticoagulants (NOAC) have been shown to be safe and effective alternatives to warfarin for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF). The aim of this study was to investigate the complications and the use of NOACs in AF patients undergoing elective cardioversion. Methods and results: This nationwide multicentre study included consecutive elective cardioversions in AF patients treated with NOACs between October 2011 and May 2016. Data on patient characteristics, antithrombotic treatment and acute (<30 days) complications were collected. One thousand twenty-one patients (mean age 64 years, 70% men) underwent 1291 elective cardioversions, of which 680 (52.7%) cardioversions were performed in patients using dabigatran, 431 (33.4%) rivaroxaban, and 159 (12.3%) apixaban. Mean CHA2DS2-VASc score was 1.8 (±1.5). A total of 3 thromboembolic events occurred after the cardioversion (0.2%): 1 patient receiving dabigatran experienced an ischaemic stroke on Day 2 and 1 rivaroxaban treated patient on Day 4. One patient receiving dabigatran experienced a transient ischaemic attack on Day 11. All 3 patients had used recommended doses of the NOAC. A total of 6 (0.5%) clinically relevant, but not serious bleeding events occurred. Only short duration of AF was associated with lower rate of AF recurrence. Conclusion: Thrombotic and bleeding complications related to NOACs were uncommon (<0.5%) in real life AF patients undergoing elective cardioversion.

13.
IEEE J Biomed Health Inform ; 22(1): 108-118, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28391210

RESUMO

We present a smartphone-only solution for the detection of atrial fibrillation (AFib), which utilizes the built-in accelerometer and gyroscope sensors [inertial measurement unit, (IMU)] in the detection. Depending on the patient's situation, it is possible to use the developed smartphone application either regularly or occasionally for making a measurement of the subject. The smartphone is placed on the chest of the patient who is adviced to lay down and perform a noninvasive recording, while no external sensors are needed. After that, the application determines whether the patient suffers from AFib or not. The presented method has high potential to detect paroxysmal ("silent") AFib from large masses. In this paper, we present the preprocessing, feature extraction, feature analysis, and classification results of the envisioned AFib detection system based on clinical data acquired with a standard mobile phone equipped with Google Android OS. Test data was gathered from 16 AFib patients (validated against ECG), as well as a control group of 23 healthy individuals with no diagnosed heart diseases. We obtained an accuracy of 97.4% in AFib versus healthy classification (a sensitivity of 93.8% and a specificity of 100%). Due to the wide availability of smart devices/sensors with embedded IMU, the proposed methods could potentially also scale to other domains such as embedded body-sensor networks.


Assuntos
Acelerometria/instrumentação , Acelerometria/métodos , Fibrilação Atrial/diagnóstico , Processamento de Sinais Assistido por Computador , Smartphone , Algoritmos , Fibrilação Atrial/fisiopatologia , Balistocardiografia , Estudos de Casos e Controles , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Aprendizado de Máquina Supervisionado , Tórax/fisiologia
14.
BMC Geriatr ; 17(1): 218, 2017 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-28915862

RESUMO

BACKGROUND: Atrial fibrillation (AF) is often asymptomatic and undiagnosed until an ischaemic stroke occurs. An irregular pulse is a key manifestation of AF. We assessed whether pulse self-palpation is feasible in screening of AF. METHODS: Altogether 205 residents of Lieto municipality aged ≥75 years were randomized in 2012 to receive brief education on pulse palpation focusing on evaluating rhythm regularity. Self-detected pulse irregularity and new AF diagnoses were recorded, and the subjects' quality of life and use of health care services were assessed during a three-year follow-up. RESULTS: The subjects' median age was 78.2 [3.8] years, and 89 (43.4%) were men. Overall, 139 (68%) subjects had initial good motivation/capability for regular palpation. At four months, 112 (80.6%) subjects with good and 26 (39.4%) with inadequate motivation/capability palpated their pulse daily. At 12 months, 120 (58.5%) and at 36 months, 69 (33.7%) subjects palpated their pulse at least weekly. During the intervention, 67 (32.7%) subjects reported pulse irregularity. New AF was found in 10 (4.9%) subjects, 7 (70%) of whom had reported pulse irregularity. Pulse irregularity independently predicted new AF, but only one (0.5%) subject with new AF sought undelayed medical attention due to pulse irregularity. Quality of life and number of outpatient clinic visits remained unchanged during follow-up. CONCLUSION: Pulse palpation can be learned also by the elderly, but it is challenging to form a continuing habit. The low persistence of pulse self-palpation limits its value in the screening of AF, and strategies to promote persistence and research on alternative screening methods are needed. TRIAL REGISTRATION: http://www.ClinicalTrials.gov identifier: NCT01721005. The trial was registered retrospectively on October 26, 2012.


Assuntos
Fibrilação Atrial/diagnóstico , Frequência Cardíaca , Palpação/métodos , Autoexame/métodos , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Estudos de Viabilidade , Feminino , Finlândia , Seguimentos , Humanos , Masculino , Educação de Pacientes como Assunto , Autocuidado
15.
Scand J Prim Health Care ; 35(3): 293-298, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28784027

RESUMO

PURPOSE: Atrial fibrillation (AF) may first present as an ischemic stroke. Pulse palpation is a potential screening method for asymptomatic AF. We aimed to assess the reliability of pulse palpation by the elderly in detecting AF. MATERIALS AND METHODS: After brief information and training session conducted by a nurse, 173 subjects aged ≥75 years were instructed to palpate their pulse regularly for a month. After this, their ability to distinguish sinus rhythm (SR), SR with premature ventricular contractions (PVC) and AF by pulse palpation was assessed using an anatomic human arm model programmable with various rhythms. A control group of 57 healthcare professionals received the same information but not the training. Subjects unable to find the pulse were excluded (25 (14.5%) of the elderly and none in the healthcare group). RESULTS: The median age of the elderly subjects was 78.4 [3.9] years and 98 (56.6%) were women. There were no differences between the elderly and healthcare groups in detecting SR (97.3% vs. 96.5%) or SR with PVCs (74.3% vs. 71.4%), but the elderly subjects identified slow (81.8% vs. 56.1%) and fast AF (91.9% vs. 80.7%) significantly better than the healthcare group. The ability to recognize SR with PVCs by the elderly was independently predicted by previous pulse palpation experience, secondary or higher level of education and one-point increase in MMSE score, while identifying the other rhythms had no predictors. CONCLUSIONS: The elderly can learn to reliably distinguish a normal rhythm after education. Pulse self-palpation may be a useful low-cost method to screen for asymptomatic AF.


Assuntos
Fibrilação Atrial/diagnóstico , Autoavaliação Diagnóstica , Palpação/métodos , Pulso Arterial , Autocuidado , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
16.
Thromb Res ; 156: 163-167, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28662483

RESUMO

BACKGROUND: Elective cardioversion (ECV) for atrial fibrillation (AF) is associated with a relatively low risk of thromboembolic complications. However, the optimal intensity of anticoagulation for ECV is unknown. We sought to assess the risk of thromboembolism in low (INR 2.0-2.4) vs. high (INR≥2.5) therapeutic range in a large retrospective cohort study. METHODS: This multi-centre "real world" study included 1424 ECVs in 1021 patients. The primary outcome was a stroke or a transient ischaemic attack (TIA) or a systemic embolus during the 30-day follow-up after ECV. RESULTS: Altogether 4 (0.3%) strokes, 2 (0.1%) TIAs and 2 (0.1%) bleeds were detected during the 30-day follow-up after ECV. No systemic emboli were detected. There were 2 deaths (0.1%), one associated with a stroke. Median time to stroke/TIA was 4 (IQR 9.5) days and the median CHA2DS2-VASc-score was 2 (IQR 1.25) among patients with thromboembolic events. Mean INR at ECV was 2.7 (SD 0.54) in the study cohort. Patients with INR 2.0-2.4 at ECV had more thromboembolic events compared with patients with INR≥2.5 (5/529 (0.9%) vs. 1/895 (0.1%), p=0.03). Comprehensive postprocedural INR data was available for 733 (71.8%) patients and 1007 cardioversions. At least one subtherapeutic (<2.0) INR value was detected within 21days after 230 (22.8%) ECVs and this drop in INR level was associated with a higher risk for thromboembolic events compared with continuous therapeutic post-cardioversion anticoagulation (1.7% vs 0.3%, p=0.03). CONCLUSIONS: Our results suggest that the intensity of periprocedural anticoagulation is associated with the risk of thromboembolic events after ECV.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Cardioversão Elétrica/efeitos adversos , Tromboembolia/etiologia , Idoso , Fibrilação Atrial/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tromboembolia/patologia , Resultado do Tratamento
17.
BMC Cardiovasc Disord ; 17(1): 33, 2017 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-28100174

RESUMO

BACKGROUND: Elective cardioversion (ECV) of atrial fibrillation (AF) is a standard procedure to restore sinus rhythm. However, predictors for ineffective ECV (failure of ECV or recurrence of AF within 30 days) are unknown. METHODS: We investigated 1998 ECVs performed for AF lasting >48 h in 1,342 patients in a retrospective multi-center study. Follow-up data were collected from 30 days after ECV. RESULTS: Median number of cardioversions was one per patient with a range of 1-10. Altogether 303/1998 (15.2%) ECVs failed. Long (>5 years) AF history and over 30 days duration of the index AF episode were independent predictors for ECV failure and low (<60/min) ventricular rate of AF predicted success of ECV. In patients with successful ECVs an early recurrence of AF was detected in 549 (32.4%) cases. Female gender, high (>60/min) ventricular rate, renal failure and antiarrhythmic agents at discharge were the independent predictors for recurrence. In total ECV was ineffective in 852 (42.6%) cases. Female gender (OR 1.44, CI95% 1.15-1.80, p < 0.01), young (<65 years) age (OR 1.31, CI95% 1.07-1.62, p = 0.01), ventricular rate >60/min (OR 1.92, CI95% 1.08-3.41, p = 0.03), antiarrhythmic medication at discharge (OR 1.48, CI95% 1.14-1.93, p < 0.01) and low (<60/ml/min) estimated glomerular filtration rate (OR 1.59, CI95% 1.08-2.33, p = 0.02) were predictors of ineffective ECV. CONCLUSIONS: Female gender, use of antiarrhythmic drug therapy and renal failure predicted both recurrence of AF and the composite end point. For the first time in a large real-life study several clinical predictors for clinically ineffective ECV were identified.


Assuntos
Fibrilação Atrial/terapia , Cardioversão Elétrica , Frequência Cardíaca , Idoso , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Distribuição de Qui-Quadrado , Feminino , Finlândia , Taxa de Filtração Glomerular , Frequência Cardíaca/efeitos dos fármacos , Humanos , Rim/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Recidiva , Insuficiência Renal/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Falha de Tratamento
18.
IEEE J Biomed Health Inform ; 21(5): 1233-1241, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-27834656

RESUMO

In this paper, a novel method to detect atrial fibrillation (AFib) from a seismocardiogram (SCG) is presented. The proposed method is based on linear classification of the spectral entropy and a heart rate variability index computed from the SCG. The performance of the developed algorithm is demonstrated on data gathered from 13 patients in clinical setting. After motion artifact removal, in total 119 min of AFib data and 126 min of sinus rhythm data were considered for automated AFib detection. No other arrhythmias were considered in this study. The proposed algorithm requires no direct heartbeat peak detection from the SCG data, which makes it tolerant against interpersonal variations in the SCG morphology, and noise. Furthermore, the proposed method relies solely on the SCG and needs no complementary electrocardiography to be functional. For the considered data, the detection method performs well even on relatively low quality SCG signals. Using a majority voting scheme that takes five randomly selected segments from a signal and classifies these segments using the proposed algorithm, we obtained an average true positive rate of [Formula: see text] and an average true negative rate of [Formula: see text] for detecting AFib in leave-one-out cross-validation. This paper facilitates adoption of microelectromechanical sensor based heart monitoring devices for arrhythmia detection.


Assuntos
Fibrilação Atrial/diagnóstico , Cinetocardiografia/métodos , Processamento de Sinais Assistido por Computador , Algoritmos , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino
19.
Conf Proc IEEE Eng Med Biol Soc ; 2016: 2034-2037, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-28268730

RESUMO

The pumping action of the heart is performed by contraction of the myocardium fibers. We present a non-invasive technique named gyrocardiography (GCG) that comprises a sensor of angular motion, gyroscope, configured to obtain three-dimensional angular velocity signals. A tri-axial micro electromechanical (MEMS) gyroscope sensor was attached to the surface of the chest to obtain gyrocardiogram. Color-coded Doppler tissue imaging (DTI) was recorded simultaneously and synchronized with the GCG in an off-line analysis. By placing a region of interest longitudinally around the myocardium in DTI allowed us to investigate whether GCG can provide information indicative of the tissue velocity and relative strain rate of the myocardium. Experimental observations by simultaneously recorded GCG and color DTI suggests that a gyroscope sensor attached to the chest is indeed capable to monitor the myocardial deformation during the cardiac cycle and therefore can provide a gateway to clinically relevant information.


Assuntos
Técnicas de Diagnóstico Cardiovascular , Coração/fisiologia , Contração Miocárdica , Técnicas de Imagem Cardíaca , Ecocardiografia Doppler , Humanos
20.
Conf Proc IEEE Eng Med Biol Soc ; 2016: 4369-4374, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-28269246

RESUMO

In this paper we study the feasibility of seismocardiography (SCG) for the detection of Atrial Fibrillation (AF). In this preclinical study, data acquired from one patient having paroxysmal AF (no other heart diseases) is used to introduce specific changes in SCG signal due to AF. Observed changes and phenomena create a foundation for the development of SCG-based AF detection algorithms. SCG data was recorded from the sternum of an AF patient in dorso-ventral direction while at rest in a supine position using a three-axis high precision MEMS accelerometer simultaneously with a one-lead ECG. In contrast to ECG, the magnitude of beats registered with SCG varies considerably from beat to beat during AF. We show that the magnitude of the beats is not random but is in relation to beat intervals. It is shown that extra indicators for detecting AF become available when SCG data is combined with electrocardiographical (ECG) data; there is a certain behavior in the electromechanical delay characteristic of the AF. It is discussed how all this information can be taken advantage of in the detection of AF. Today electrocardiography (ECG) is the primary method for diagnosing arrhythmias, but there is a growing need for simpler and more convenient method for detecting asymptomatic AF. Given the very small dimensions of modern MEMS accelerometers (2mm×2mm), a reliable MEMS based measurement may provide totally new venues for arrhythmia detection.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia , Acelerometria , Algoritmos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Sistemas Microeletromecânicos
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