A significant increase in exercise test performance with virtual group motivation: a randomised open-label controlled trial.

AIMS: Exercise stress testing is frequently used for the assessment of coronary artery disease. As the validity of the test result is highly dependent on the patient’s cooperation and motivation, we hypothesised that virtual group motivation would result in a higher exercise capacity and may increase the test’s validity. METHODS: 108 patients at a Swiss teaching hospital with an indication for exercise testing were included in a controlled, open-label trial and randomised 1:1 to treadmill exercise testing whilst either watching a video of a walking group (video group, n = 43), or watching a static image of flowers (image group, n = 43). The video showed a group of five amateur runners, giving the patients the impression of running within the group. As primary outcomes, the performance achieved and the perceived level of comfort during the test were analysed. RESULTS: The video group achieved significantly higher percentages of their age-predicted METs (149 ± 32% vs 135 ± 29%, p = 0.041) and longer exercise durations (11:12 ± 2:54 min vs 08:54 ± 02:39 min, p <0.001). Levels of comfort (8.4 ± 1.4 vs 7.5 ± 1.7 analogue scale, p = 0.011) and closeness to their physical limits (8.9 ± 0.8 vs 8.1 ± 1.5, p = 0.005) were rated significantly higher by patients in the video group. CONCLUSIONS: Patients watching a video of a running group achieved significantly higher maximum exercise levels and longer test durations. This may have implications for the test’s validity. Furthermore, the virtual setting enhanced patient comfort. (This trial was formally registered at clinicaltrials.gov: trial ID NCT03704493.).

Differences of platelet adhesion and thrombus activation on amorphous silicon carbide, magnesium alloy, stainless steel, and cobalt chromium stent surfaces.

BACKGROUND: Coronary stenting is considered to be the gold standard of percutaneous coronary interventions, because stents are able to reduce early and late elastic recoil (negative remodeling) and restenosis in comparison with balloon angioplasty alone. OBJECTIVE: It is known that stent thrombogenicity and neointimal formation are determined by the surface characteristics of the stent platform, electrochemical features of the stent surface, and the degree of degradation after implantation. Metallic stents coated with amorphous silicon carbide and biodegradable stents made of magnesium alloy have been introduced clinically, but there are no data available comparing the biocompatibility of these novel stent materials with conventional stents. METHODS: We demonstrate simple and reproducible in vitro methods assessing the rate of platelet adhesion and thrombus activation for biocompatibility tests of different stent surfaces. RESULTS: We show that amorphous silicon carbide and magnesium alloy stent surfaces markedly lower the rate of platelet adhesion and platelet/fibrin activation when compared with uncoated stainless steel or cobalt chromium alloy surfaces. Semiconductor materials on the stent surface reduce platelet and fibrin activation by increasing the critical electron gap to greater than 0.9 eV resulting in a lower electron transfer out of the stent material. CONCLUSION: Passive stent coatings with specific semiconducting properties such as amorphous silicon carbide or magnesium alloy reduce thrombogenicity and may improve biocompatibility of a stent platform.

[Myocardial Clefts - Incidental Findings in Parainfectious Myocarditis]. / Furchen im Herzen ­ ein Zufallsbefund bei parainfektiöser Myokarditis.

Myocardial Clefts - Incidental Findings in Parainfectious Myocarditis Abstract. We report a 23-year-old woman with parainfectious myocarditis due to gastroenteritis. A transthoracic echocardio-graphy revealed a recess in the left inferobasal ventricle. For further investigation, cardiac magnetic resonance imaging was initiated, which revealed a myocardial cleft, a harmless structural variation of the heart. Cardiac magnetic resonance is a non-invasive imaging technique with a high spatial and temporal resolution that enables a precise depiction of the cardiac anatomy and therefore allows for a differentiation between normal and pathological structural variations of the heart.

When your patient clicks: a loud clicking sound as a key sign to the diagnosis.

A 19-year-old male patient was referred by his general practitioner with a new 'cardiac murmur'. For 1 week, he had been able to provoke a clicking sound, which was in time with his heart beat and originated from his chest. The physical examination and laboratory tests were normal. The sound was initially interpreted as most likely due to a valve condition such as mitral valve prolapse, but a transthoracic echocardiogram was normal. A cardiac CT was obtained, which showed left-sided ventral pneumothorax.The Hamman's sign is a loud precordial pulse synchronous sound, which is often postural. It is pathognomonic for left-sided pneumothorax or pneumomediastinum. Hamman's sign as a presenting symptom is rare, but if present is key to diagnosis. The awareness of rare clinical findings is important and will prevent unnecessary diagnostic tests.