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1.
Artigo em Inglês | MEDLINE | ID: mdl-35682443

RESUMO

A community-based opportunistic screening program was implemented to (i) improve atrial fibrillation (AF) awareness and detection and (ii) assess the performance of the Microlife WatchBP Home A for detecting AF when used in community screening. Screening sessions were conducted among people aged ≥ 65 years with no history of AF at public events across Tasmania, Australia. Participants with positive screening results were referred to their general medical practitioner for assessment. The device's performance was assessed using the positive predictive value. A total of 1704 eligible participants were screened at 79 sessions. Of these people, 50 (2.9%) had a positive screening result. The device correctly identified AF in 22 (46.8%) participants with positive results. Among those with subsequently confirmed AF, 6 (27.3%) had a history of AF but were not aware of the diagnosis, and 16 (72.7%) were identified to have previously undiagnosed AF, with an overall prevalence of 0.9% (95% CI, 0.58 to 1.52). Oral anticoagulation therapy was initiated in 12 (87.5%) eligible participants. The positive predictive value of the device was 46.8% (95% CI, 33.3 to 60.7). Given the relatively low performance of the device, its application in community-based opportunistic screening programs for AF is unlikely to be cost-effective.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Diagnóstico Precoce , Eletrocardiografia , Humanos , Programas de Rastreamento/métodos , Valor Preditivo dos Testes
3.
Int J Cardiol ; 362: 93-96, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35643214

RESUMO

In-vitro evidence suggests hydroxychloroquine could be a potential immunomodulator for the inflammatory carditis of acute rheumatic fever (ARF). Hydroxychloroquine used as an anti-inflammatory agent has a low side effect profile but its use in the Covid-19 pandemic raised concerns about QTc interval prolongation and cardiac arrhythmias. The prolongation of QTc in ARF appears benign but has not been widely studied. We aim to report QTc intervals in a contemporary ARF population and consider implications for hydroxychloroquine use in ARF. The study cohort was 197 children <15 years of age with a clinical diagnosis of ARF. The QTc mean (SD) was 445 msec (28), range 370-545 msec. Eighteen percent of the cohort had a QTc > 99th percentile for normal by age and 8 patients (4%) had a QTc over 500 msec. There was no difference of QTc by age or gender. Inter-observer repeatability for QTc (n = 33) was 35 msec. The QTc is often prolonged in the early phase of ARF, meaning that QT prolonging medications should be used with caution in this setting. Serial ECG monitoring of the QT interval is recommended if hydroxycholoroquine is used in ARF.


Assuntos
COVID-19 , Síndrome do QT Longo , Febre Reumática , COVID-19/tratamento farmacológico , Criança , Eletrocardiografia , Humanos , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/epidemiologia , Pandemias , Febre Reumática/diagnóstico , Febre Reumática/tratamento farmacológico
4.
Sci Total Environ ; 839: 156235, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-35644403

RESUMO

BACKGROUND: Solar and geomagnetic activity (GA) have been linked to increased cardiovascular (CVD) events. We hypothesize that heart rate variability (HRV) may be the biological mechanism between increased CVD risk and intense geomagnetic disturbances (GMD). METHODS: To evaluate the impact of GA and intense GMD on HRV in 809 elderly men [age mean 74.5 (SD = 6.8)] enrolled in the Normative Aging Study (Greater Boston Area), we performed repeated-measures using mixed-effects regression models. We evaluated two HRV outcomes: the square root of the mean squared differences of successive normal-to-normal intervals (r-MSSD) and the standard deviation of normal-to-normal heartbeat intervals (SDNN) in milliseconds (ms). We also compared the associations between Kp and HRV in patients with and without comorbidities such as diabetes and coronary heart diseases (CHD). We used data on global planetary K-Index (Kp) from middle latitudes as a GA and GMD (>75th Kp) parameters from the National Oceanic and Atmospheric Agency's Space Weather Prediction Center. RESULTS: We found a near immediate effect of continuous and higher Kp on reduced HRV for exposures up to 24 h prior to electrocardiogram recording. A 75th percentile increase in 15-hour Kp prior the examination was associated with a -14.7 ms change in r-MSSD (95 CI: -23.1, -6.3, p-value = 0.0007) and a -8.2 ms change in SDNN (95 CI: -13.9, -2.5, p-value = 0.006). The associations remained similar after adjusting the models for air pollutants over the exposure window prior to the event. In periods of intense GMD, the associations were stronger in patients with CHD and non-diabetes. CONCLUSIONS: This is the first study to demonstrate the potential adverse effects of geomagnetic activity on reduced heart rate variability in a large epidemiologic cohort over an extended period, which may have important clinical implications among different populations.


Assuntos
Poluentes Atmosféricos , Doença das Coronárias , Idoso , Envelhecimento/fisiologia , Eletrocardiografia , Frequência Cardíaca , Humanos , Masculino
5.
Sensors (Basel) ; 22(11)2022 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-35684656

RESUMO

This work presents an overview of the main strategies that have been proposed for non-invasive monitoring of heart rate (HR) in extramural and home settings. We discuss three categories of sensing according to what physiological effect is used to measure the pulsatile activity of the heart, and we focus on an illustrative sensing modality for each of them. Therefore, electrocardiography, photoplethysmography, and mechanocardiography are presented as illustrative modalities to sense electrical activity, mechanical activity, and the peripheral effect of heart activity. In this paper, we describe the physical principles underlying the three categories and the characteristics of the different types of sensors that belong to each class, and we touch upon the most used software strategies that are currently adopted to effectively and reliably extract HR. In addition, we investigate the strengths and weaknesses of each category linked to the different applications in order to provide the reader with guidelines for selecting the most suitable solution according to the requirements and constraints of the application.


Assuntos
Eletrocardiografia , Fotopletismografia , Frequência Cardíaca/fisiologia , Monitorização Fisiológica
6.
Sensors (Basel) ; 22(11)2022 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-35684692

RESUMO

Vibration monitoring provides a good-quality source of information about the health condition of machines, and it is often based on the use of accelerometers. This article focuses on the use of accelerometer sensors in fabricating a low-cost system for monitoring vibrations in agricultural machines, such as rotary tedders. The aim of the study is to provide useful data on equipment health for improving the durability of such machinery. The electronic prototype, based on the low-cost AVR microcontroller ATmega128 with 10-bit ADC performing a 12-bit measurement, is able to acquire data from an accelerometer weighing up to 10 g. Three sensors were exposed to low accelerations with the use of an exciter, and their static characteristics were presented. Standard experimental tests were used to evaluate the constructed machine monitoring system. The self-contained prototype system was calibrated in a laboratory test rig, and sinusoidal and multisinusoidal excitations were used. Measurements in time and frequency domains were carried out. The amplitude characteristic of the preformed system differed by no more than 15% within a frequency range of 10 Hz-10 kHz, compared to the AVM4000 commercial product. Finally, the system was experimentally tested to measure acceleration at three characteristic points in a rotational tedder, i.e., the solid grease gearbox, the drive shaft bearing and the main frame. The RMS amplitude values of the shaft vibrations on the bearing in relation to the change in the drive shaft speed of two tedders of the same type were evaluated and compared. Additionally, the parameters of kurtosis and crest factor were compared to ascertain the bearing condition.


Assuntos
Aceleração , Vibração , Eletrocardiografia , Modalidades de Fisioterapia
7.
Sensors (Basel) ; 22(11)2022 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-35684694

RESUMO

Arrhythmia detection algorithms based on deep learning are attracting considerable interest due to their vital role in the diagnosis of cardiac abnormalities. Despite this interest, deep feature representation for ECG is still challenging and intriguing due to the inter-patient variability of the ECG's morphological characteristics. The aim of this study was to learn a balanced deep feature representation that incorporates both the short-term and long-term morphological characteristics of ECG beats. For efficient feature extraction, we designed a temporal transition module that uses convolutional layers with different kernel sizes to capture a wide range of morphological patterns. Imbalanced data are a key issue in developing an efficient and generalized model for arrhythmia detection as they cause over-fitting to minority class samples (abnormal beats) of primary interest. To mitigate the imbalanced data issue, we proposed a novel, cost-sensitive loss function that ensures a balanced deep representation of class samples by assigning effective weights to each class. The cost-sensitive loss function dynamically alters class weights for every batch based on class distribution and model performance. The proposed method acquired an overall accuracy of 99.81% for intra-patient classification and 96.36% for the inter-patient classification of heartbeats. The experimental results reveal that the proposed approach learned a balanced representation of ECG beats by mitigating the issue of imbalanced data and achieved an improved classification performance as compared to other studies.


Assuntos
Eletrocardiografia , Redes Neurais de Computação , Algoritmos , Arritmias Cardíacas/diagnóstico , Eletrocardiografia/métodos , Frequência Cardíaca , Humanos
10.
BMC Cardiovasc Disord ; 22(1): 255, 2022 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-35672678

RESUMO

BACKGROUND: Certain cerebrovascular events can induce electrocardiography (ECG) abnormalities and cardiac dysfunction. The most frequent patterns reported are nonspecific ST-T change, inverted or broad T wave, prolongation of QT interval as well as ST-segment depression or elevation. Here we present a case of intracerebral hemorrhage (ICH) with transient J wave-like ST-segment elevation accompanied by myocardial lesion. CASE PRESENTATION: A 58-year-old woman was admitted to our hospital and diagnosed with right basal ganglia region cerebral hemorrhage. The ECG recorded on the second hospital day showed transient J wave-like ST-segment elevation accompanied by increased myocardial troponin I and myocardial enzyme. CONCLUSIONS: The J wave-like ST-segment elevation may be not a specific ECG signs for primary ischemic heart diseases as it also could be found in ICH patients. We believe that the follow-up ECGs can be used in conjunction with repeated myocardial enzyme analysis and echocardiography to differentiate ICH-ralated J wave-like ST-segment elevation from acute myocardial infarction (AMI), thus avoiding unnecessary cardiac catheterization.


Assuntos
Infarto do Miocárdio , Isquemia Miocárdica , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Miocárdio
12.
Anatol J Cardiol ; 26(6): 442-449, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35703480

RESUMO

BACKGROUND: In patients with essential hypertension, fragmented QRS has been asso- ciated with many remodeling components that might lead to adverse cardiovascular effects. This study aimed to evaluate the relationship between fragmented QRS and adverse events and its potential long-term prognostic value. METHODS: The patients with essential hypertension were divided into two groups accord- ing to the presence of fragmented QRS: fragmented QRS (+) and fragmented QRS (-). During long-term follow-up, the relationship of fragmented QRS to coronary artery dis- ease, congestive heart failure, stroke, cardiovascular death, all-cause death, and majoradverse cardiovascular and cerebrovascular events was evaluated. RESULTS: The study group included 542 patients with essential hypertension. Fragmented QRS on ECG was observed in 224 (41.3%) patients. Considering the incidence rates at the end of 5.6 ± 1.3 years' follow-up, the total incidence rate of major adverse cardiovascular and cerebrovascular events (P < .001), coronary artery disease (P < .001), and congestive heart failure (P < .001) were higher in patients with fragmented QRS. No significant dif- ference was observed between the two groups in terms of stroke (P = .734), cardiovas- cular death (P=1), and all-cause death (P=.574). As a result of multiple cox regression analysis, fragmented QRS (P = .005) was identified as an independent predictor for major adverse cardiovascular and cerebrovascular events development. CONCLUSION: In patients with hypertension, the presence of fragmented QRS was found as an independent predictor for major adverse cardiovascular and cerebrovascular events development.


Assuntos
Doença da Artéria Coronariana , Insuficiência Cardíaca , Doença da Artéria Coronariana/complicações , Eletrocardiografia , Hipertensão Essencial/complicações , Insuficiência Cardíaca/complicações , Humanos , Prognóstico
14.
J Am Heart Assoc ; 11(12): e024045, 2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-35699164

RESUMO

Background Improved prediction of atrial fibrillation (AF) may allow for earlier interventions for stroke prevention, as well as mortality and morbidity from other AF-related complications. We developed a clinically feasible and accurate AF prediction model using electronic health records and computerized ECG interpretation. Methods and Results A total of 671 318 patients were screened from 3 tertiary hospitals. After careful exclusion of cases with missing values and a prior AF diagnosis, AF prediction models were developed from the derivation cohort of 25 584 patients without AF at baseline. In the internal/external validation cohort of 117 523 patients, the model using 6 clinical features and 5 ECG diagnoses showed the highest performance for 3-year new-onset AF prediction (C-statistic, 0.796 [95% CI, 0.785-0.806]). A more simplified model using age, sex, and 5 ECG diagnoses (atrioventricular block, fusion beats, marked sinus arrhythmia, supraventricular premature complex, and wide QRS complex) had comparable predictive power (C-statistic, 0.777 [95% CI, 0.766-0.788]). The simplified model showed a similar or better predictive performance than the previous models. In the subgroup analysis, the models performed relatively better in patients without risk factors. Specifically, the predictive power was lower in patients with heart failure or decreased renal function. Conclusions Although the 3-year AF prediction model using both clinical and ECG variables showed the highest performance, the simplified model using age, sex, and 5 ECG diagnoses also had a comparable prediction power with broad applicability for incident AF.


Assuntos
Fibrilação Atrial , Eletrocardiografia , Registros Eletrônicos de Saúde , Humanos , Incidência , Medição de Risco/métodos , Fatores de Risco
18.
BMJ Open ; 12(6): e059156, 2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-35728895

RESUMO

OBJECTIVES: Atrial fibrillation (AF) screening may increase early detection and reduce complications of AF. European, Australian and World Heart Federation guidelines recommend opportunistic screening, despite a current lack of clear evidence supporting a net benefit for systematic screening. Where screening is implemented, the most appropriate approaches are unknown. We explored the views of European stakeholders about opportunities and challenges of implementing four AF screening scenarios. DESIGN: Telephone-based semi-structured interviews with results reported using Consolidated criteria for Reporting Qualitative research guidelines. Data were thematically analysed using the framework approach. SETTING: AF screening stakeholders in 11 European countries. PARTICIPANTS: Healthcare professionals and regulators (n=24) potentially involved in AF screening implementation. INTERVENTION: Four AF screening scenarios: single time point opportunistic, opportunistic prolonged, systematic single time point/prolonged and patient-led screening. PRIMARY OUTCOME MEASURES: Stakeholder views about the challenges and feasibility of implementing the screening scenarios in the respective national/regional healthcare system. RESULTS: Three themes developed. (1) Current screening approaches: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity. (2) Feasibility of screening: single time point opportunistic screening in primary care using single-lead ECG devices was considered the most feasible. Software algorithms may aid identification of suitable patients and telehealth services have potential to support diagnosis. (3) Implementation requirements: sufficient evidence of benefit is required. National screening processes are required due to different payment mechanisms and health service regulations. Concerns about data security, and inclusivity for those without primary care access or personal devices must be addressed. CONCLUSIONS: There is an overall awareness of AF screening. Opportunistic screening appears the most feasible across Europe. Challenges are health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit and a tailored approach adapted to national realities.


Assuntos
Fibrilação Atrial , Fibrilação Atrial/diagnóstico , Austrália , Eletrocardiografia , Humanos , Programas de Rastreamento/métodos , Pesquisa Qualitativa
19.
J Med Case Rep ; 16(1): 258, 2022 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-35729641

RESUMO

BACKGROUND: Systemic sclerosis is a multisystemic character autoimmune disease. It is characterized by vascular dysfunction and progressive fibrosis affecting mainly the skin but also different internal organs. All heart structures are commonly affected, including the pericardium, myocardium, and conduction system. However, tachycardia-bradycardia syndrome is not common in the literature as a cardiac complication of systemic sclerosis. Case presentation We report a case of tachycardia-bradycardia syndrome in a 46-year-old Moroccan woman followed for systemic sclerosis with cutaneous, vascular, and articular manifestations. The diagnosis was based mainly on patient-reported symptoms and electrocardiogram data. A permanent pacemaker was implanted, allowing the introduction of beta-blockers with good outcomes. CONCLUSIONS: This case aims to show that even minor electrocardiogram abnormalities should be monitored in this group of patients, preferably by 24-hour ambulatory electrocardiogram because they could be a good indicator of the activity and progression of cardiac fibrosis.


Assuntos
Bradicardia , Escleroderma Sistêmico , Bradicardia/diagnóstico , Bradicardia/etiologia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/diagnóstico , Taquicardia/etiologia
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