Definitions of hypertension in relation to risk; the role of ambulatory monitoring

Introduction: Atrial fibrillation and flutter (AF/AFL) are common with transthyretin cardiac amyloidosis (ATTR-CM). These patients have higher risk for thromboembolism. Detection of AF/AFL may thus be especially important, but the role of routine ambulatory monitoring in asymptomatic patients is unclear. Methods: A single center observational study of patients seen at our Amyloidosis Center with wild-type or hereditary ATTR-CM diagnosed between 2005-2019. Records were reviewed to see if AF/AFL was present at baseline. In those without known AF/AFL, ambulatory monitor (duration 2-30 days) was done every 6 months when feasible as part of our routine practice. Patients with cardiovascular implantable electronic devices (CIED) instead had routine device interrogations. Results: Ninety-four patients with ATTR-CM (mean age 71.4±11.4 years, 88.3% male) had mean follow-up 2.2±1.9 years (200 patient-years). AF/AFL was seen in 62 patients (66.0%): 35 (56.5%) by symptoms, 18 (29.0%) incidentally by monitor or CIED, and 9 in whom method of AF/AFL diagnosis was unknown. Forty-one patients (66.1%) had AF/AFL before ATTR-CM diagnosis by of median 26.3 (IQR 4.3-40.9) months. New AF/AFL was diagnosed in 21/53 remaining patients with known ATTR-CM - 11 (52.4%) were incidentally diagnosed (Figure 1). Median time between ATTR-CM and AF/AFL diagnoses was 10.3 (IQR 7.0-25.8) months and 5.9 (IQR 2.2-22.3) months in symptomatic versus incidentally diagnosed patients (Mann-Whitney U=35, p=0.14). Anticoagulation (AC) was started in 9/11 (81.8%) due to incidental AF/AFL. One patient had AC for prior DVT; the other had no AC per patient preference. No strokes occurred in patients on AC. Conclusions: We found a high rate of incidentally diagnosed AF/AFL in patients with ATTR-CM. Detection of AF/AFL led to change in therapy. This finding affirms a need for routine ambulatory monitoring in asymptomatic patients with ATTR-CM. Optimal duration of monitoring needs further investigation.

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Absence or presence of myocardial ischemia during ambulatory monitoring in patients with positive exercise test: Role of heart rate profile and amplitude of R-wave

Journal of the American College of Cardiology ◽

10.1016/0735-1097(91)92215-8 ◽

1991 ◽

Vol 17 (2) ◽

pp. A312

Author(s):

Dirk Hausmann ◽

Peter Nikutta ◽

Werner G. Daniel ◽

Paul Wenzlaff ◽

Paul R. Lichtlen

Keyword(s):

Heart Rate ◽

Myocardial Ischemia ◽

Exercise Test ◽

Ambulatory Monitoring ◽

Rate Profile

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The Role of Ambulatory Monitoring of the Blood Pressure for Assessment of Antihypertensive Agents

The Journal of Clinical Pharmacology ◽

10.1177/009127009203200606 ◽

1992 ◽

Vol 32 (6) ◽

pp. 524-528 ◽

Cited By ~ 7

Author(s):

William B. White

Keyword(s):

Blood Pressure ◽

Ambulatory Monitoring ◽

Antihypertensive Agents

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Deleterious Effect of Participant Positioning on the Acceptability and Acceptance of a Wellness Management System under Development

Applied Sciences ◽

10.3390/app112311250 ◽

2021 ◽

Vol 11 (23) ◽

pp. 11250

Author(s):

Fabien Lemoine ◽

Kévin Nadarajah ◽

Guy Carrault ◽

Anaïs Guguen-Allain ◽

Alain Somat

Keyword(s):

A Priori ◽

Ambulatory Monitoring ◽

Second Phase ◽

Intention To Use ◽

Unified Theory ◽

Role Change ◽

User Test ◽

Use Of Technology ◽

The Subject

Managing everyday wellness using sensors requires user buy-in and acceptance. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to measure at D-0 the acceptability (a priori), and at D-21 the acceptance of an ambulatory monitoring system under development, the SHERPAM system. Interviews with the participants revealed that they no longer viewed the system in the same way at the different stages of the study. The results of the qualitative analysis suggest that the time of the research led the participants to stop seeing themselves as potential future users and to take on the role of critical testers of the technology (which corresponds more to a user test). This role change led participants to question the usefulness of the technology, which affected their intention to use the technology in the future (5.30 vs. 4.24; t = 2.58 *). This research identified the reasons why it was crucial to have a fully functional device in the second phase (acceptance study). The results of this study suggest that it is inappropriate to undertake an acceptability study when the technology is under development. While the SHERPAM platform has been the subject of several user tests, none have been carried out in a situation of use. Thus, this study seems to suggest that the dysfunctions observed are more related to the absence of a development phase in the daily activity of the users. Thus, to ensure a good appropriation of the technology and to predict its use, the technology must not only be in perfect working order, but must also have been developed according to the daily activities of the individuals.

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Differences Between Female Singers With Phonotrauma and Vocally Healthy Matched Controls in Singing and Speaking Voice Use During 1 Week of Ambulatory Monitoring

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-20-00227 ◽

2021 ◽

Vol 30 (1) ◽

pp. 199-209

Author(s):

Laura E. Toles ◽

Andrew J. Ortiz ◽

Katherine L. Marks ◽

James A. Burns ◽

Tiffiny Hron ◽

...

Keyword(s):

Ambulatory Monitoring ◽

Acceleration Signal ◽

Mixed Analysis ◽

Vocal Hyperfunction ◽

Cepstral Peak Prominence ◽

Speaking Voice ◽

Female Singers ◽

Vocal Dose ◽

Voice Use

Purpose Previous ambulatory voice monitoring studies have included many singers and have combined speech and singing in the analyses. This study applied a singing classifier to the ambulatory recordings of singers with phonotrauma and healthy controls to determine if analyzing speech and singing separately would reveal voice use differences that could provide new insights into the etiology and pathophysiology of phonotrauma in this at-risk population. Method Forty-two female singers with phonotrauma (vocal fold nodules or polyps) and 42 healthy matched controls were monitored using an ambulatory voice monitor. Weeklong statistics (average, standard deviation, skewness, kurtosis) for sound pressure level (SPL), fundamental frequency, cepstral peak prominence, the magnitude ratio of the first two harmonics ( H 1 –H 2 ), and three vocal dose measures were computed from the neck surface acceleration signal and separated into singing and speech using a singing classifier. Results Mixed analysis of variance models found expected differences between singing and speech in each voice parameter, except SPL kurtosis. SPL skewness, SPL kurtosis, and all H 1 –H 2 distributional parameters differentiated patients and controls when singing and speech were combined. Interaction effects were found in H 1 –H 2 kurtosis and all vocal dose measures. Patients had significantly higher vocal doses in speech compared to controls. Conclusions Consistent with prior work, the pathophysiology of phonotrauma in singers is characterized by more abrupt/complete glottal closure (decreased mean and variation for H 1 –H 2 ) and increased laryngeal forces (negatively skewed SPL distribution) during phonation. Application of a singing classifier to weeklong data revealed that singers with phonotrauma spent more time speaking on a weekly basis, but not more time singing, compared to controls. Results are used as a basis for hypothesizing about the role of speaking voice in the etiology of phonotraumatic vocal hyperfunction in singers.

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Accuracy of Self-Reported Estimates of Daily Voice Use in Adults With Normal and Disordered Voices

American Journal of Speech-Language Pathology ◽

10.1044/2016_ajslp-15-0105 ◽

2016 ◽

Vol 25 (4) ◽

pp. 634-641 ◽

Cited By ~ 11

Author(s):

Daryush D. Mehta ◽

Harold A. Cheyne ◽

Asa Wehner ◽

James T. Heaton ◽

Robert E. Hillman

Keyword(s):

Ambulatory Monitoring ◽

Voice Disorders ◽

Correlation Coefficients ◽

Absolute Error ◽

Self Report ◽

Accurate Estimation ◽

Control Group ◽

Self Reports ◽

Voice Use

Purpose Accurate estimation of daily patterns of vocal behavior is essential to understanding the role of voice use in voice disorders. Given that clinicians currently rely on patient self-report to assess daily vocal behaviors, this study sought to assess the accuracy with which adults with and without voice disorders can estimate their amount of daily voice use in terms of phonation time. Method Eighteen subjects (6 patients, 6 matched members of a control group without voice disorders, 6 low voice users) wore the accelerometer-based Ambulatory Phonation Monitor (APM; model 3200, KayPENTAX, Montvale, NJ) for at least 5 workdays. Subjects were instructed to provide hourly self-reports of time spent talking using a visual analog scale. Spearman correlation coefficients and errors between self-reported and APM-based estimates of phonation time revealed subject- and group-specific characteristics. Results A majority of subjects exhibited a significant bias toward overestimating their phonation times, with an average absolute error of 113%. Correlation coefficients between self-reported and APM-based estimates of phonation time ranged from statistically nonsignificant to .91, reflecting large intersubject variability. Conclusions Subjects in all 3 groups were moderately accurate at estimating their hourly voice use, with a consistent bias toward overestimation. The results support the potential role that ambulatory monitoring could play in improving the clinical assessment of voice disorders.

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Ambulatory Monitoring of Daily Voice Use

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd21.2.56 ◽

2011 ◽

Vol 21 (2) ◽

pp. 56-61 ◽

Cited By ~ 11

Author(s):

Robert E. Hillman ◽

Daryush D. Mehta

Keyword(s):

State Of The Art ◽

Ambulatory Monitoring ◽

Vocal Behavior ◽

Future Directions ◽

Vocal Function ◽

Current State ◽

Voice Use ◽

Insight Into

Many common voice disorders are chronic or recurring conditions likely to result from faulty and/or abusive patterns of vocal behavior. Such behaviorally based disorders can be difficult to assess accurately in the clinical setting and potentially could be much better characterized by long-term ambulatory monitoring of vocal function as individuals engage in their typical daily activities. Ambulatory monitoring also could provide new insight into the actual role of voice use in common disorders and missing quantitative data on what constitutes normal levels of daily voice use for different groups of individuals, activities, and occupations. This report describes the motivation, previous development efforts, current state-of-the-art technology, and future directions in ambulatory monitoring of voice use.

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