Detection and categorization of severe cardiac disorders based solely on pulse interval measurements

Cardiac disorders are common conditions associated with a high mortality rate. Due to their potential for causing serious symptoms, it is desirable to constantly monitor cardiac status using an accessible device such as a smartwatch. While electrocardiograms (ECGs) can make the detailed diagnosis of cardiac disorders, the examination is typically performed only once a year for each individual during health checkups, and it requires expert medical practitioners to make comprehensive judgments. Here we describe a newly developed automated system for alerting individuals about cardiac disorders solely based on pulse interval measurements. For this purpose, we examined two metrics of heart rate variability (HRV) and analyzed 1-day ECG recordings of more than 1,000 subjects in total. We found that a newly introduced metric of local variation was more efficient than conventional HRV metrics for detecting premature contraction, and furthermore, that a suitable combination of the old and new metrics resulted in much superior detectability particularly for atrial fibrillation, which requires more attention. Even with a 1-minute recording of pulse intervals, our new detection system had a diagnostic performance even better than that of the conventional analysis method applied to a 1-day recording.

DMBT1 expression and neutrophil-to-lymphocyte ratio during necrotizing enterocolitis are influenced by impaired perfusion due to cardiac anomalies

Background Deleted in malignant brain tumors 1 (DMBT1) is involved in innate immunity and epithelial differentiation. It has been proven to play a role in various states of inflammation or hypoxia of fetal gastrointestinal and pulmonary diseases. Discrimination of pathogenesis in necrotizing enterocolitis (NEC) based on cardiac status improves the understanding of NEC in different patient subgroups. We aimed at examining DMBT1 expressions regarding their association with cardiac status leading to impaired intestinal perfusion, intraoperative bacteria proof, and a fulminant course of NEC. Methods Twenty-eight patients with NEC were treated surgically between 2010 and 2019 at our institution. DMBT1 expression was examined in intestinal sections using immunohistochemistry to detect DMBT1 protein. Associations of clinical parameters and DMBT1 expression were analyzed. Results We examined DMBT1 levels in 10 patients without cardiac defects and 18 patients with persisting ductus arteriosus (PDA) and congenital heart defects (CHD). Compared to patients without cardiac malformations, DMBT1 levels tended to score higher in patients with PDA/CHD (p = 0.2113) and were negatively correlated with C-reactive protein in these infants (p = 0.0172; r = − 0.5533). The number of DMBT1-expressing macrophages was elevated in the PDA/CHD-subgroup (p = 0.0399). Ratios of neutrophils and monocytes to lymphocytes were significantly higher in infants with PDA/CHD (p = 0.0319 and 0.0493). DMBT1 expression was significantly associated with positive bacterial culture of intraoperative swabs (p = 0.0252) and DMBT1 expression of the serosa was associated with a fulminant course of NEC (p = 0.0239). Conclusions This study demonstrates that DMBT1 expression may be influenced by cardiac anomalies with an impaired intestinal perfusion in the neonatal intestine. NEC in PDA/CHD infants is associated with more DMBT1-positive macrophages and a significantly elevated neutrophil-to-lymphocyte ratio.

THE ESTIMATION OF THE SOMATIC SIGNIFICANCE OF HYPERVENTILATION SYNDROME IN THE STUDIED WITH DIFFERENTIATED CARDIOLOGICAL STATUS

В статье представлены данные оригинального исследования по оценке фактической частоты встречаемости и значимости в формировании тяжести соматического состояния организма у трех групп обследуемых с различным кардиологическим статусом - условно здоровых лиц молодого возраста, пациентов пожилого возраста с хронической сердечной недостаточностью и пациентов с нестабильной стенокардией, протекающей на фоне сахарного диабета второго типа. Установлено, что во всех трех группах фактическая встречаемость гипервентиляционного синдрома является выше таковой, чем это считалось ранее на уровне традиционных представлений. Помимо этого, его присутствие имеет соматическую значимость для обследуемых с любым кардиологическим статусом, причем она возрастает по мере увеличения тяжести вовлечения в патологический процесс сердечно-сосудистой системы. Для условно здоровых лиц молодого возраста он вызывает субклинические негативные последствия, для пациентов с хронической сердечной недостаточностью - умеренные клинически значимые негативные последствия, для пациентов с нестабильной стенокардией на фоне сахарного диабета второго типа - выраженные клинические негативные последствия в виде ухудшения течения и исходов заболевания. Полученные результаты отличает новизна и практическая значимость, что позволяет рекомендовать их к дальнейшему учету в практике специалистов клиники внутренних болезней The article presents data from an original study to assess the actual frequency of occurrence and significance in the formation of the severity of the somatic state of the body in three groups of subjects with different cardiac status - conventionally healthy young people, elderly patients with chronic heart failure and patients with unstable angina pectoris occurring against the background of type 2 diabetes mellitus. It was found that in all three groups the actual incidence of hyperventilation syndrome is higher than it was previously thought at the level of traditional ideas. In addition, its presence has somatic significance for subjects with any cardiac status, and it increases as the severity of involvement in the pathological process of the cardiovascular system increases. For conventionally healthy young people, it causes subclinical negative consequences, for patients with chronic heart failure - moderate clinically significant negative consequences, for patients with unstable angina pectoris associated with type 2 diabetes mellitus - pronounced clinical negative consequences in the form of worsening of the course and outcomes of the disease. The results obtained are distinguished by their novelty and practical significance, which makes it possible to recommend them for further consideration in the practice of specialists in the clinic of internal diseases

Relationship between quality of life indicators and cardiac status indicators in chemotherapy patients

Aim With the aim of improving personalized treatment of patients on chemotherapy, the objective of the study was to assess the degree of association between selected Quality of life (QoL) indicators and both clinical and imaging cardiac status indicators when detecting deterioration in QoL of these patients. Methods In a cohort clinical study in Hamburg, from August 2017 through October 2020, 59 cancer patients, aged 18-80 years, were evaluated before chemotherapy, and at several follow-ups, using EQ-5D and SF-36 QoL questionnaires, fast strain-encoded (fast-SENC) cardiac magnetic resonance (CMR), conventional CMR, and echocardiography, and further received a clinical and biomarker examination. Data was analyzed using survival analyses. A decline of more than 5% in each observed QoL metric value was defined as the observed event. Patient were separated into groups according to the presentation of cardiotoxicity as per its clinical definition, the establishment of the indication for cardioprotective therapy initiation, and by a worsening in the value of each observed imaging metric by more than 5% in the previous follow-up compared to the corresponding pre-chemotherapy baseline value. Results Among clinical cardiac status indicators, the indication for cardioprotective therapy showed statistically good association with QoL scores (EQ-5D p=0.028; SF-36 physical component p=0.016; SF-36 mental component p=0.012). In terms of imaging metrics, the MyoHealth segmental myocardial strain score was the only one demonstrating consistently good QoL score association (EQ-5D p=0.005; SF-36 physical component p=0.056; SF-36 mental component p=0.002). Conclusions Established fast-SENC CMR scores are capable of highlighting patients with reduced QoL, who require more frequent/optimal management.

Case Report: Syncopal atrioventricular block complicating primary hyperoxaluria type 1

Primary hyperoxaluria (PH) type 1 is a rare hereditary metabolic disorder resulting in accumulation of calcium oxalate in several organs, including the heart. Cardiac oxalosis in PH is poorly described in the medical literature. We report the case of a 42-year-old woman diagnosed with primary hyperoxaluria type 1 and end-stage renal failure who presented with syncope related to a paroxysmal third-degree atrioventricular block. The patient benefited from the implantation of a dual chamber pacemaker with a good outcome. Conduction blocks in case of primary hyperoxaluria type 1 are exceptional; in fact, less than five reports have previously been published in the medical literature. With this case, we would like to highlight the need for regular and careful monitoring of cardiac status in patients treated for primary oxalosis, especially when renal function is impaired.

A multidisciplinary team nursing model in the treatment of patients undergoing transapical mitral valve clamping: a prospective study

Background As a new surgical method for older adults with cardiac insufficiency, transapical mitral valve clamp surgery requires the cooperation of practitioners across multiple disciplines to ensure appropriate treatment and nursing care. This study aimed to explore the utility of a multidisciplinary team nursing model in the clinical treatment and nursing care of patients undergoing transapical mitral valve clamping. Methods Our sample of ten patients included four men (40%) and six women (60%), with a mean age of 71.4 ± 5.2 years. The multidisciplinary team comprised nurses that specialized in severe illness, cardiac health, rehabilitation, psychology, nutrition, and pain. The team engaged in comprehensive discussions regarding problems specific to the patients undergoing transapical mitral valve surgery, allowing them to formulate individualized nursing measures and implement precise policies. Results No serious postoperative complications occurred in any of the ten patients included in this study, and a significant improvement was noted in the cardiac status of all the patients. Color ultrasound findings at discharge indicated that the degree of reflux of all the patients was ≤2+. Among the ten patients, the Activity of Daily Living Scale scores at discharge were significantly higher than before the operation (69.0 ± 4.6 vs. 55.0 ± 5.8). In addition, the 6-min walking test results at discharge were significantly better than those observed before the operation (318.0 ± 21.7 m vs. 295.2 ± 18.4 m). Conclusions Utilization of a multidisciplinary team allows nurses across various specialties to provide more comprehensive and systematic care for patients undergoing a mitral valve clamping operation, thus promoting patient recovery.

Results of active remote cardiac monitoring of oncohematological patients

BACKGROUND: Despite their targeted effects, targeted drug therapies also lead to adverse events, including various cardiac effects. AIM: This study aims to determine the possibility of treating cardiovascular diseases underlying or occurring as a side effect of ibrutinib treatment without blocking targeted therapy for chronic lymphocytic leukemia (CLL). MATERIALS AND METHODS: From 2016 to the present, we have examined and followed 217 patients with CLL who were continuously treated with ibrutinib targeted therapy for five years. The study included patients with CLL, aged 32 to 91 years [median age of 66.0 (32.091.0) years], including 136 men aged 66.0 (32.091.0) years and 81 women aged 65.0 (39.083.0) years. All patients underwent electrocardiography, echocardiography, 24-hour electrocardiographic Holter monitoring, 24-hour blood pressure monitoring, assessment of comorbidities using the Charlson Index, and screening for fragility using the G8 questionnaire. RESULTS: Active cardiac monitoring, including continuous remote monitoring of cardioprotective therapy intake and efficiency, allows oncohematological patients to achieve higher overall survival rates. The long-term monitoring group included a statistically significant number of patients with atrial fibrillation and/or arterial hypertension and patients who receive dual and triple antithrombotic therapy. This group included patients with CLL and more severe cardiac status than other patients, who were regularly observed by a cardiologist. CONCLUSIONS: Widespread introduction of the techniques for continuous remote monitoring of the oncological patients condition into clinical practice will improve the patients quality of life and increase their life expectancy.

SARS-CoV-2-Induced Multisystem Inflammatory Syndrome in a Young Adult: Case Report

We describe a case of a previous healthy 20-year-old male athlete who presented with an atypical clinical profile with multiorgan involvement within five weeks after confirmed SARS-CoV-2 infection, suggestive for multisystem inflammatory syndrome (MIS); MIS is a rare, potentially life-threatening complication associated with SARS-CoV-2. MIS shares similar clinical features compatible with several overlapping lifethreatening hyperinflammatory syndromes, such as incomplete Kawasaki Disease (KD) and toxic shock syndrome (TSS) associated to a cytokine storm suggestive of a macrophage activation syndrome (MAS) without fulfilling the criteria for hemophagocytic lymphohistiocytosis (HLH), that may create a great challenge to distinguish between them. MIS should promptly be considered and treated, as uncontrolled MIS has a high mortality.In MIS cardiac involvement, heart failure may present as an additional problem, especially because volume loading is advised in accordance with proposed therapy. Carefully monitoring of the respiratory and cardiac status in response of resuscitation is therefore warranted.

A case of septic shock which postmortem pathological autopsy revealed bacterial myocardial abscess

Background and purpose: The myocardial abscess is a scarce condition, but it is significant due to its high mortality. We aimed to seek insight into myocardial abscess by presenting a case report. Methods: A 73 years old male was emergently transferred to our hospital with disorientation and hypotension. He had a past medical history of diabetes mellitus, hypertension, myocardial infarction, atrial fibrillation, and calculous cholecystitis. He had complained of lumbago since 1 week before arrival at our hospital. We diagnosed him with septic shock due to pyogenic spondylitis and psoas abscess by the laboratory and imaging findings. We could not find abnormality in his cardiac status of echocardiography. Despite the treatment, his condition worsened rapidly, and he died after 24 hours of arrival. We performed a postmortem pathological autopsy, which revealed the condition of myocardial abscesses. We examined medical literature about a myocardial abscess. Results: According to a previous treatise, pyogenic spondylitis was reported as a causative disease of the myocardial abscess to the same extent as infective endocarditis. Bacterial myocarditis may lead to decreased cardiac function and arrhythmias. Our case did not show cardiac asynergy, decreased cardiac function, and sudden fatal arrhythmias during the course. We thought that the myocardial abscess was due to a hematogenous metastasis from the pyogenic spondylitis. And we thought the direct cause of death was septic shock, not the myocardial abscess. Conclusions: We experienced a fatal septic shock case that revealed myocardial abscess by the postmortem pathological autopsy. It is possible that we cannot notice the existence of myocardial abscess without a pathological autopsy.