| 11. |
|
|
| 12. |
- Dziubiński, Marek J., et al.
(författare)
-
Diagnostic yield is dependent on monitoring duration. Insights from a full-disclosure mobile cardiac telemetry system
- 2022
-
Ingår i: Kardiologia Polska. - 0022-9032. ; 80:1, s. 56-63
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the advancement of electrocardiogram (ECG) monitoring methods, the most important factor influencing diagnostic yield (DY) may still be monitoring duration. Ambulatory ECG monitoring, typically with 24–48 hours duration, is widely used but may result in underdiagnosis of rare arrhythmias. Aims: This study aimed to examine the relationship between the DY and monitoring duration in a large patient cohort and investigate sex and age differences in the presentation of arrhythmias. Methods: The study population consisted of 25 151 patients (57.8% women; median [interquartile range, IQR], 71 [64–78] years), who were examined with mobile cardiac telemetry during 2017 in the United States, using the PocketECGTM that continuously transmits a signal on a beat-to-beat basis. We investigated the occurrence of atrial fibrillation at a burden of both ≤1% (atrial fibrillation [AF], ≤1%) and ≤10% (AF ≤10%), premature ventricular contractions (PVC; >10 000 per 24 hours), non-sustained ventricular tachycardias (nsVT), sustained ventricular tachycardias (VT ≥30 seconds), atrioventricular blocks (AVB), pauses of >3 seconds duration, and bradycardia (heart rate <40 beats per minute for ≥60 seconds). Results: The median (IQR) recording duration was 15.4, 8.2–28.2) days. The DY increased gradually with monitoring duration for all types of investigated arrhythmias. Compared to DY after up to 30 days of monitoring, a standard 24 hours monitoring resulted in DY for males/females of 20%/18% for AF ≤1%, 29%/28% for AF ≤10%, 45%/40% for PVCs, 17%/11% for nsVT, 17%/11% for VT ≥30 seconds, 49%/42 for AVB, 27%/20% for pauses, 36%/29% for bradycardia. Conclusion: A substantial number of patients suffering from arrhythmias may remain undiagnosed due to insufficient ECG monitoring time.
|
|
| 13. |
- Fedorowski, Artur, et al.
(författare)
-
Orthostatic hypotension and cardiovascular risk
- 2019
-
Ingår i: Kardiologia Polska. - 1897-4279. ; 77:11, s. 1020-1027
-
Tidskriftsartikel (refereegranskat)abstract
- Orthostatic hypotension (OH) is a cardinal sign of cardiovascular (CV) autonomic dysfunction as a result of autonomic nervous system failure to control the postural hemodynamic homeostasis. The proportion of individuals with OH increases with aging and chronic conditions, such as neurodegenerative diseases, hypertension, heart failure, diabetes, renal dysfunction, autoimmune diseases, and cancer. In individuals over 70 years of age, more than 20% can be affected. It is now increasingly recognized that there is a direct relationship between OH and each step of the CV disease continuum, eventually leading to end‑stage heart disease and CV death. In particular, prevalent OH is associated with cardiac functional and structural remodeling, left ventricular hypertrophy, elevated levels of circulating markers of inflammation, increased intima‑media thickness, subclinical atherosclerosis, and thrombosis. Beyond subclinical changes, the presence of OH independently predicts coronary events, stroke, atrial fibrillation, heart failure, and CV mortality. Furthermore, OH is associated with syncope, falls, and fragility fractures, presenting hurdles to be overcome in the delivery of the best management of CV risk factors. Taken together, OH heralds disruption of global circulatory homeostasis and flags overt autonomic dysfunction. The presence of OH is also an independent risk factor for mortality and CV disease; however, until now, the importance of this highly prevalent disorder has been given insufficient attention by clinicians and other healthcare providers. Consequently, more studies are needed to find effective treatment for this troublesome condition and to identify preventive measures that could reduce the burden of CV risk in OH and autonomic dysfunction.
|
|
| 14. |
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
|
|
| 19. |
- Nessler, Jadwiga, et al.
(författare)
-
Concentration of BNP, endothelin 1, pro-inflammatory cytokines (TNF-alpha, IL-6) and exercise capacity in patients with heart failure treated with carvedilol
- 2008
-
Ingår i: Kardiologia Polska. - 1897-4279. ; 66:2, s. 144-153
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Recent studies on the pathophysiology of heart failure indicate the role of neurohormones and immune and inflammatory processes as potential mechanisms involved in the pathogenesis and clinical course of chronic heart failure (CHF). Aim: To analyse the relationship between concentrations of brain natriuretic peptide (BNP), endothelin-1 (ET-1), inflammatory cytokines (TNF-alpha, IL-6) and cardiopulmonary stress test parameters, and to evaluate their changes during carvedilol treatment. Methods: The study included 86 patients (81 men and 5 women) aged from 35 to 70 years (56.8 +/- 9.19) with symptomatic heart failure and left ventricular ejection fraction < 40%, receiving an inhibitor of angiotensin II converting enzyme, diuretic and/or digoxin but not beta-blockers. All patients at baseline, and then at 3 and 12 months after treatment, underwent a panel of studies to assess functional capacity according to NYHA, echocardiographic and cardiopulmonary stress test (CPX) parameters, and serum concentrations of BNP, ET-1, TNF-alpha and IL-6. Before introducing carvedilol we found a weak relationship between concentrations of BNP, ET-1, IL-6 and decreased VO2 (peak). Results: At 12 months exercise tolerance was significantly improved (exercise stress testing prolonged by 143.9 s, p=0.001) and an increase in metabolic equivalent (MET) by 1.41 (p=0.001) was observed. The VO2 (peak) was nonsignificantly increased by a mean of 0.9 ml/kg/min. In patients with baseline VO2 (peak) < 14 ml/kg/min the concentrations of ET-1 and TNF-alpha were significantly higher than in the remaining ones, and after treatment they were significantly reduced. In these patients VO2 (peak)%N was also significantly increased (39.5 +/- 7.5 vs. 50.1 +/- 15,0; p=0.013). The number of patients with VO2 (peak) < 14 ml/kg/min also significantly decreased from 39 to 21 (p=0.013). Conclusions: In patients with HF decreased value of VO2 (peak) is associated with LV systolic function disorders and increased levels of BNP, ET-1, TNF-alpha and IL-6. Chronic treatment with carvedilol improves LV systolic function, exercise tolerance and peak oxygen consumption and is associated with significant decrease of BNP, ET-1, TNF-alpha and IL-6 concentrations.
|
|
| 20. |
- Nessler, Jadwiga, et al.
(författare)
-
Sudden cardiac death risk factors in patients with heart failure treated with carvedilol
- 2007
-
Ingår i: Kardiologia Polska. - 1897-4279. ; 65:12, s. 1417-1424
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic heart failure (CHF) is associated with a high risk of sudden cardiac death (SCID). Most frequently SCID occurs in patients with NYHA class II and III. Aim: To evaluate the influence of prolonged carvedilol therapy on SCID risk in CHF patients. Methods: The study included 86 patients (81 men and 5 women) aged 56.8 +/- 9.19 (35-70) years with CHF in NYHA class II and III receiving an ACE inhibitor and diuretics but not beta-blockers. At baseline and after 12 months of carvedilol therapy the following risk factors for SCID were analysed: in angiography - occluded infarct-related artery; in echocardiography - left ventricular ejection fraction (LVEF) < 30%, volume of the left ventricle (LVEDV) > 140 ml; in ECG at rest - sinus heart rate (HRs) > 75/min, sustained atrial fibrillation, increased QTc; in 24-hour ECG recording - complex arrhythmia, blunted heart rate variability (SDNN < 100 ms) and abnormal turbulence parameters (TO and TS or one of them); in signal-averaged ECG - late ventricular potentials and prolonged QRS > 114 ms. The analysis of SCD risk factors in basic examination in patients who suddenly died was also performed. Results: During one-year carvedilol therapy heart transplantation was performed in 2 patients; 5 patients died. At 12 months the following risk factors for SCID were significantly changed: HRs > 75/min (50 vs. 16 patients, p=0.006), LVEF < 30% (37 vs. 14 patients, p=0.01), SDNN < 100 ms (19 vs. 9 patients, p=0.04). At 12 months the number of risk factors for SCD in each patient was significantly reduced (p=0.001). In patients who suddenly died we found a greater amount of SCID risk factors in basic examination (7 vs. 5) as compared to alive patients. Conclusions: Prolonged beta-adrenergic blockade reduces risk of sudden cardiac death through significant LVEF increase, reduction of HR at rest and improvement of HRV.
|
|
