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Concept: Ventricle

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To examine whether there is a difference in the association between high pulse pressure and proteinuria, independent of other blood pressure (BP) indices, such as systolic or diastolic BP, among subjects with diabetes, prediabetes, or normal glucose tolerance.

Concepts: Nutrition, Insulin, Cardiology, Blood pressure, Glucose tolerance test, The Association, Ventricle, Pulse pressure

167

To synthesise current evidence for the effects of exenatide and liraglutide on heart rate, blood pressure and body weight.

Concepts: Blood, Evidence-based medicine, Systematic review, Artery, Pulse, Vein, Ventricle, Meta-analysis

167

INTRODUCTION: Blunt cardiac rupture is an exceedingly rare injury. CASE PRESENTATION: We report a case of blunt cardiac trauma in a 43-year-old Caucasian German mother with pectus excavatum who presented after a car accident in which she had been sitting in the front seat holding her two-year-old boy in her arms. The mother was awake and alert during the initial two hours after the accident but then proceeded to hemodynamically collapse. The child did not sustain any severe injuries. Intraoperatively, a combined one-cm laceration of the left atrium and right ventricle was found. CONCLUSION: Patients with pectus excavatum have an increased risk for cardiac rupture after blunt chest trauma because of compression between the sternum and spine. Therefore, patients with pectus excavatum and blunt chest trauma should be admitted to a Level I Trauma Center with a high degree of suspicion.

Concepts: Heart, Pectus excavatum, Chest, Sternum, Ventricle, Left ventricle, Physical trauma, Chest trauma

112

Patients with chronic heart failure (HF) secondary to left ventricular systolic dysfunction (LVSD) are frequently deficient in vitamin D. Low vitamin D levels are associated with a worse prognosis.

Concepts: Vitamin D, Blood, Cardiology, Heart, Ventricle, Mitral valve, Left ventricle, Beriberi

75

Background Cardiac pacemakers are limited by device-related complications, notably infection and problems related to pacemaker leads. We studied a miniaturized, fully self-contained leadless pacemaker that is nonsurgically implanted in the right ventricle with the use of a catheter. Methods In this multicenter study, we implanted an active-fixation leadless cardiac pacemaker in patients who required permanent single-chamber ventricular pacing. The primary efficacy end point was both an acceptable pacing threshold (≤2.0 V at 0.4 msec) and an acceptable sensing amplitude (R wave ≥5.0 mV, or a value equal to or greater than the value at implantation) through 6 months. The primary safety end point was freedom from device-related serious adverse events through 6 months. In this ongoing study, the prespecified analysis of the primary end points was performed on data from the first 300 patients who completed 6 months of follow-up (primary cohort). The rates of the efficacy end point and safety end point were compared with performance goals (based on historical data) of 85% and 86%, respectively. Additional outcomes were assessed in all 526 patients who were enrolled as of June 2015 (the total cohort). Results The leadless pacemaker was successfully implanted in 504 of the 526 patients in the total cohort (95.8%). The intention-to-treat primary efficacy end point was met in 270 of the 300 patients in the primary cohort (90.0%; 95% confidence interval [CI], 86.0 to 93.2, P=0.007), and the primary safety end point was met in 280 of the 300 patients (93.3%; 95% CI, 89.9 to 95.9; P<0.001). At 6 months, device-related serious adverse events were observed in 6.7% of the patients; events included device dislodgement with percutaneous retrieval (in 1.7%), cardiac perforation (in 1.3%), and pacing-threshold elevation requiring percutaneous retrieval and device replacement (in 1.3%). Conclusions The leadless cardiac pacemaker met prespecified pacing and sensing requirements in the large majority of patients. Device-related serious adverse events occurred in approximately 1 in 15 patients. (Funded by St. Jude Medical; LEADLESS II ClinicalTrials.gov number, NCT02030418 .).

Concepts: Clinical trial, Heart, Right ventricle, Ventricle, Left ventricle, Cardiac pacemaker, Artificial pacemaker, Transcutaneous pacing

60

The diagnosis of heart failure may be challenging because symptoms are rather nonspecific. Elevated left ventricular (LV) filling pressure may be used to confirm the diagnosis, but cardiac catheterization is often not practical. Echocardiographic indexes are therefore used as markers of filling pressure.

Concepts: Blood, Cardiology, Heart, Right ventricle, Ventricle, Aorta, Mitral valve, Left ventricle

52

OBJECTIVES: The purpose of this study was to examine the impact of yoga on atrial fibrillation (AF) burden, quality of life (QoL), depression, and anxiety scores. BACKGROUND: Yoga is known to have significant benefit on cardiovascular health. The effect of yoga in reducing AF burden is unknown. METHODS: This single-center, pre-post study enrolled patients with symptomatic paroxysmal AF with an initial 3-month noninterventional observation period followed by twice-weekly 60-min yoga training for next 3 months. AF episodes during the control and study periods as well as SF-36, Zung self-rated anxiety, and Zung self-rated depression scores at baseline, before, and after the study phase were assessed. RESULTS: Yoga training reduced symptomatic AF episodes (3.8 ± 3 vs. 2.1 ± 2.6, p < 0.001), symptomatic non-AF episodes (2.9 ± 3.4 vs. 1.4 ± 2.0; p < 0.001), asymptomatic AF episodes (0.12 ± 0.44 vs. 0.04 ± 0.20; p < 0.001), and depression and anxiety (p < 0.001), and improved the QoL parameters of physical functioning, general health, vitality, social functioning, and mental health domains on SF-36 (p = 0.017, p < 0.001, p < 0.001, p = 0.019, and p < 0.001, respectively). There was significant decrease in heart rate, and systolic and diastolic blood pressure before and after yoga (p < 0.001). CONCLUSIONS: In patients with paroxysmal AF, yoga improves symptoms, arrhythmia burden, heart rate, blood pressure, anxiety and depression scores, and several domains of QoL. (Yoga on Arrythmia Burden and Quality of Life in Paroxysmal Atrial Fibrillation; NCT00798356).

Concepts: Blood, Heart, Stroke, Atrial fibrillation, Blood pressure, Ventricle, Cardiac cycle, Systole

51

This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone-based self-management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self-management system comprises modules for (1) self-reports of BP, pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self-reports. Daily use of the support system significantly reduced BP (systolic BP -7 mm Hg, diastolic BP -4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self-management support system may be a useful tool in clinical practice to help patients self-manage their hypertension.

Concepts: Longitudinal study, Clinical trial, Improve, Hypertension, Blood pressure, Ventricle, Orthostatic hypotension, Mobile phone

28

Purpose: The Ironman (IM) triathlon is a popular ultra endurance competition, consisting of a 3.8km swimming, 180.2km cycling, and a 42.2km run. The aim of this study was to investigate predictors of IM race time, comparing echocardiographic findings, anthropometric measures, and training characteristics.Methods: Amateur IM athletes (ATHL) participating in the Zurich IM race in 2010 were included. Participants were examined the day before the race by a comprehensive echocardiographic examination. Moreover, anthropometric measurements were obtained the same day. During the 3 months before the race, each IM-ATHL maintained a detailed training diary. Recorded data were related to total Ironman race time.Results: Thirty-eight Ironman finishers (average age 38±9 years, 32 male [84%]) were evaluated. Average total race time was 684±89 minutes. For right ventricular fractional area change (average: 45±7%, Spearman-ρ=-0.33; p=0.05) a weak correlation with race time was observed. Race performance exhibited stronger associations with percent body fat (15.2±5.6%, ρ=0.56; p=0.001), speed in running training (11.7±1.2 km/h, ρ=-0.52; p=0.002), and left ventricular myocardial mass index (98±24 g/m, ρ=-0.42; p=0.009). The strongest association was found between race time and right ventricular end-diastolic area (22±4 cm, ρ=-0.64; p<0.0001). In multivariate analysis, right ventricular end-diastolic area (beta=-16.7, 95% confidence interval: -27.3-[-6.1]; p=0.003) and percent body fat (beta=6.8, 95% confidence interval: 1.1-12.6; p=0.02) were independently predictive of Ironman race time.Conclusions: In amateur IM-ATHL, RV end-diastole area and percent body fat were independently related to race performance. RV end-diastolic area was the strongest predictor of race time. The role of the RV in endurance exercise may thus be more important than previously thought and needs to be further studied.

Concepts: Heart, Interval finite element, Anthropometry, Right ventricle, Ventricle, Left ventricle, Bulbus cordis, Primitive ventricle

28

Central aortic systolic blood pressure (SBP-C) can be estimated from a cuff oscillometric waveform derived during the pulse volume plethysmography (PVP) by applying a device-specific aortic pressure-to-PVP waveform-generalized transfer function (A2P(GTF)). The present study compared the performance of an aortic-to-brachial pressure waveforms generalized transfer function (A2B(GTF)), which is independent of any PVP devices, with an A2P(GTF). Generalized transfer function of aortic-to-brachial (A2B(GTF)) and aortic-to-PVP (A2P(GTF)) were generated from the simultaneously obtained central aortic and brachial pressure waveforms recorded by a high-fidelity dual pressure sensor catheter, and the PVP waveform recorded by a customized noninvasive blood pressure monitor during cardiac catheterization in 40 patients, and were then applied in another 100 patients with simultaneously recorded invasive aortic pressure and noninvasively calibrated (using cuff SBP and diastolic blood pressures) PVP waveforms. The mean difference±s.d. between the noninvasively estimated and invasively recorded SBP-C was -2.1±7.7 mm Hg for A2B(GTF), which was not greater than that of -3.0±7.7 mm Hg for A2P(GTF) (P<0.01). In conclusion, SBP-C can be measured reliably using a noninvasive blood pressure monitor by applying either an A2P(GTF) or A2B(GTF) to a noninvasively calibrated PVP waveform. The performance of an A2B(GTF) is not inferior to that of an A2P(GTF).

Concepts: Blood pressure, Artery, Pulse, Ventricle, Cardiac cycle, Systole, Brachial artery, Sphygmomanometer