Clinical Observation of Peripartum Cardiomyopathy

Research relevance: the article presents the results after clinical observation of peripartum cardiomyopathy in a patient aged 30 years. Purpose of the study: to analyze the results of a clinical study conducted in the cardiology department of the Osh Medical United Clinical Hospital. Research methods: a differential diagnosis of acute myocarditis, idiopathic dilated cardiomyopathy and peripartum cardiomyopathy was carried out. Research results: taking into account the life history, laboratory and instrumental examination data, the diagnosis was peripartum cardiomyopathy. Conclusion: the treatment carried out gave a satisfactory clinical effect.

Imaging Challenges in the Diagnosis of Anatomical Variations of the Supra-Aortic Vessels: A Case Report and Review of Literature

A 73-year-old woman was referred to our Cardiology Department due to recurrent headaches and dizziness. She had a history of hypertension of 10 years. In the territorial hospital, left internal carotid artery significant stenosis was suspected. Neurological examination and laboratory tests were normal. A neck vascular ultrasound was performed, showing a low bifurcation of the left common carotid artery (CCA) and a hypoplastic left internal carotid artery (ICA) with a sinuous path at the cervical level. Therefore, a computed tomographic (CT) angiography examination of the head and neck vessels was performed. The images confirmed the presence of a hypoplastic left ICA, anatomic variation in the left CCA, and also showed that the left vertebral artery (VA) was stemming directly from the aortic arch, exhibiting a kinking trajectory.

Knowledge, Attitude and Practice of Ischemic Heart Disease Patients towards Their Medication

Objective: Ischemic heart disease is mostly seen among all Cardiovascular diseases and is responsible for more than 80% of cardiovascular disease deaths. This study has been developed to design and to validate a Knowledge, attitude and practice (KAP) Questionnaire in order to assess the knowledge, attitude and practice of ischemic heart disease patients towards their medications. Study Design: Prospective observational study Methods: The study was conducted for duration of six months among 336 patients. The study subjects taken were above 18 years of age, who was diagnosed with Coronary Artery Disease by a Consultant Cardiologist in Cardiology Department. Practice questionnaires and all the details were explained by the investigator before filling the KAP forms. The data was tabulated and statistically analysed by SPSS software. Results: 336 patients including both males and females were enrolled in the study. Majority of the patient were having good knowledge about the disease conditions that is 50% of the patients were aware about the ischemic heart disease. 326 (97%) of the 336 research participants were aware of the signs and symptoms of ischemic heart disease. Majority of the patient have an attitude towards the adverse conditions related to the disease i.e. 91.4% were aware of consulting a physician when they came across a side effect. 85.45% of the study subjects think that non-compliance to medication can lead to worsening of their condition. 98.2% of the study subjects are willing to take the treatment recommended by their doctor. Considering the practice, 81.5% the study subjects were ready to follow all the instructions given by the doctor. Conclusion: Findings from this study provide a better understanding of “knowledge, attitude and practice” in Ischemic heart disease patients towards their medications. Estimating the knowledge, attitude and practices of the community has sufficiently provided crucial baseline information for the implementation of primary and secondary preventive programs.

536 Intraoperative predictors of long-term pacing threshold improvement in leadless pacemakers

Aims Micra-VR transcatheter pacing system (TPS) has shown strong stability of electrical parameters over time. Nevertheless, a small percentage of patients develops high pacing threshold (PT) (>1 [email protected] ms) which can decrease the longevity of battery. Our study sought to investigate the intraoperative electrical parameters able to predict device electrical performances during the time. Methods and results Patients (pts) implanted with Micra-VR TPS from March 2018 to January 2021 were prospectively considered at the Cardiology Department of Spedali Civili Hospital (Brescia) and Luigi Sacco Hospital (Milan). R-wave sensing amplitude (mV), pacing impedance (Ohm), and PT ([email protected] ms) were recorded twice: upon Micra final positioning, and after removal of the delivery system. All pts received a follow-up visit at 1- and 12-month after discharge. Electrical parameters were recorded at each visit. A total of 93 pts underwent Micra-VR implantation were enrolled. When compared to the first assessment, R-wave amplitude increased of 19.1% at second control performed after 13 ± 4 min (+1.71 ± 0.2 mV, 95% CI: 1.4–2.02; P < 0.001). Conversely, PT significantly decreased of 22.1% at 12-month follow-up respect to baseline (−0.22 ± 0.03 V, 95% CI: −0.13 to − 0.31; P < 0.001) (Figure 1). Among patients with high PT, acute increase of R-wave sensing of 1.5 mV after 14 ± 4 min significantly predicted PT normalization (≤1 [email protected] ms) 12 months post-implant (R = 0.72, 95% CI: 0.13–0.33, P < 0.001) (Figure 2), with a sensitivity of 87.5% (95% CI: 0.61–0.98) and a specificity of 88.8% (95% CI: 0.51–0.99) (Figure 3). Conclusions A 1.5 mV increase in R-wave amplitude at implant time is predictive of PT normalization (<1.0 V/0.24 ms) at 12-month FU. This finding may have practical implications for device repositioning in case of HPT at implant. This parameter could be considered for acute device repositioning, particularly in HPT patients. 536 Figure

A comparison of over-the-counter available smartwatches and devices for electrocardiogram based detection of atrial fibrillation

Background There is an increasing number of smartwatches and devices commercially available that can generate and automatically interpret an electrocardiogram (ECG). Such devices have an enormous potential to improve population screening and telemonitoring of atrial fibrillation (AF). Purpose There is limited data on the sensitivity, specificity and interpretability of these devices and comparative studies are lacking. Our purpose was to compare three frequently used devices for AF detection. Methods We performed a single-center, prospective study in consecutive patients with AF presenting for electrical cardioversion (ECV). We collected a standard 12-lead ECG recording immediately followed by four times 30 seconds of ECG recordings from different devices for every patient prior to the ECV. These paired measurements were considered simultaneous. If the ECV was performed, the same measurements were repeated afterwards. The standard 12L-ECGs were interpreted by a cardiologist and used as golden standard for heart rhythm. The different devices used for the 30 second ECGs were: Withings Move ECG (lead I), Apple Watch series 5 (lead I), Kardia Mobile 6L (six leads) and Withings/Apple (1:1 ratio) on left knee (lead II). Sensitivity and specificity were determined for each AF detection algorithm excluding patients with atrial flutter (AFL) or uninterpretable ECGs. In addition, proportions of uninterpretable ECGs were determined including all patients and including only patients with sinus rhythm (SR) and compared between devices using McNemar's test. Results A total of 220 patients were included (age 70±10 years, female 35%, first ECV 44%) and in total 415 12-lead ECGs were performed (45% SR, 45% AF, 10% AFL). The sensitivity/specificity were overall similar for all devices (Withings 98%/95%, Apple 94%/98%, Kardia 99%/91%. P>0.05 for all). In detail, Kardia was the most sensitive test with highest proportion of suspected AF (57%) whereas Apple was the most specific, as shown by the highest proportion of normal heart rate results by the device (55%, P=0.003 compared to Kardia (43%)). Overall, Withings, Apple and Kardia had a comparable proportion of uninterpretable ECGs (20%, 20%, 24%, respectively. P>0.05 for all). Lead II had higher proportion of uninterpretable ECGs (32%, p<0.01 compared to all). More specifically, Kardia had a higher rate of uninterpretable ECGs in those with SR (P<0.05 compared to Withings (lead I) and Apple (lead I)). Conclusion In all devices, we found sensitivity/specificity for AF detection between 91%-99%, better than previous studies reported, and 20–24% of uninterpretable ECGs. Kardia was the most sensitive device, but less useful to rule out atrial fibrillation whereas Apple had numerically highest specificity. We aim to further evaluate both cardiologist interpretation and accuracy of atrial flutter detection using different leads to inform clinical use. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Tergooi Cardiology department, J.P. Bokma was supported with a research grant by Amsterdam Cardiovascular Sciences Overview and comparison