1
|
Fairley JL, Ross L, Quinlivan A, Hansen D, Paratz E, Stevens W, Kistler PM, McLellan A, La Gerche A, Nikpour M. Sudden cardiac death, arrhythmias and abnormal electrocardiography in systemic sclerosis: A systematic review and meta-analysis. Semin Arthritis Rheum 2023; 62:152229. [PMID: 37354723 DOI: 10.1016/j.semarthrit.2023.152229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To calculate the frequency of sudden cardiac death(SCD), arrhythmia and conduction defects in SSc. METHODS MEDLINE/EMBASE were searched to January 2023. English-language studies reporting the incidence/frequency of SCD, arrhythmia and electrocardiography(ECG) abnormalities in SSc were included. Odds ratios(OR), estimations of annual incidence or pooled frequencies were calculated. RESULTS Seventy-nine studies(n = 13,609 participants with SSc) were included in the meta-analysis. Methodology and outcomes were heterogeneous. Ten studies included cohorts with known/suspected SSc-associated heart involvement(SHI), generally defined as clinically-manifest cardiac disease/abnormal cardiac investigations. The incidence of SCD in SHI was estimated to be 3.3% annually(n = 4 studies, 301PY follow-up). On ambulatory ECG, 18% of SHI cohorts had non-sustained ventricular tachycardia(NSVT; n = 4, 95%CI3.2-39.3%), 70% frequent premature ventricular complexes (PVCs; n = 1, 95%CI34.8-93.3%), and 8% atrial fibrillation (AF; n = 1, 95%CI4.2-13.6%). Nineteen studies included participants without SHI, defined as normal cardiac investigations/absence of cardiac disease. The estimated incidence of SCD was approximately 2.9% annually (n = 1, 67.5PY). Compared to healthy controls, individuals without SHI demonstrated NSVT 13.3-times more frequently (n = 2, 95%CI2-102), and paroxysmal supraventricular tachycardia 7-times more frequently (n = 4, 95%CI3-15). Other ambulatory ECG abnormalities included NSVT in 9% (n = 7, 95%CI6-14%), >1000 PVCs/24 h in 6% (n = 2, 95%CI1-13%), and AF in 7% (n = 5, 0-21%). Fifty studies included general SSc cohorts unselected for cardiac disease. The incidence of SCD was estimated to be 2.0% annually(n = 4 studies, 1646PY). Unselected SSc cohorts were 10.5-times more likely to demonstrate frequent PVCs (n = 2, 95%CI 2-59) and 2.5-times more likely to have an abnormal electrocardiography (n = 2, 95%CI1-4). CONCLUSIONS The incidence of SCD in SSc is estimated to be 1.0-3.3% annually, at least 10-fold higher than general population estimates. Arrhythmias including NSVT and frequent PVCs appear common, including amongst those without known/suspected SHI.
Collapse
Affiliation(s)
- Jessica L Fairley
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Laura Ross
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alannah Quinlivan
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Dylan Hansen
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Paratz
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Wendy Stevens
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Peter M Kistler
- The University of Melbourne, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Australia
| | - Alex McLellan
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Andre La Gerche
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne, Melbourne, Victoria, Australia; St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
2
|
Tsunetoshi C, Tsunetoshi K, Komori O, Higashino Y, Isozaki M, Arai Y, Arai H, Yamada S, Arishima H, Hasegawa M, Kikuta K. Factors affecting reasonable duration of continuous electrocardiographic monitoring to detect atrial fibrillation in acute ischemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107173. [PMID: 37186969 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND To examine the reasonable duration of continuous electrocardiographic monitoring (CEM) to detect AF at acute ischemic stroke. MATERIALS AND METHOD 811 consecutive patients admitted to Tsuruga Municipal Hospital by acute ischemic stroke between April 2013 and December 2021 were enrolled in this study. Excluding 78 patients, 733 patients were analyzed by cluster analysis with SurvCART algorithm, followed by Kaplan-Meier analysis. RESULTS The analysis provided step graphs for 8 subgroups. The duration of CEM to achieve the sensitivity of 0.8, 0.9, and 0.95 in each could be calculated. The duration of CEM to achieve the sensitivity of 0.8 are 18 days in female patients with heart failure (HF) (subgroup 1), 24 days in male patients with HF (subgroup 2), 22 days in patients without HF with arterial occlusion and pulse rate (PR) more than 91 (subgroup 3), 24 days in patients without HF with occlusion with PR less than 91 (subgroup 4), 18 days in patients without HF without occlusion with lacuna (subgroup 5), 26 days in patients without HF, occlusion, and lacuna, with arterial stenosis (subgroup 6), 15 days in patients without HF, occlusion, lacuna, and stenosis with BMI more than 21%(subgroup 7), and 44 days in patients without HF, occlusion, lacuna, stenosis and with BMI less than 21% (subgroup 8). CONCLUSIONS Duration of CEM with the sensitivity of 0.8, 0.9, and 0.95 could be determined by presence of HF, female sex, arterial occlusion, PR more than 91/minute, presence of lacuna, presence of stenosis, and BMI more than 21%. (250).
Collapse
Affiliation(s)
- Chie Tsunetoshi
- Department of Community Health Nursing, Division of Nursing, Faculty of Medical Sciences, University of Fukui, Japan
| | - Kenzo Tsunetoshi
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Osamu Komori
- Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Japan; School of Statistical Thinking, The Institute of Statistical Mathematics, Japan
| | - Yoshifumi Higashino
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Makoto Isozaki
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Yoshikazu Arai
- Department of Neurosurgery, Tsuruga Municipal Hospital, Japan
| | - Hiroshi Arai
- Department of Neurosurgery, Sugita Genpaku Memorial Obama Municipal Hospital, Japan
| | - Shintaro Yamada
- Department of Neurosurgery, Tsuruga Municipal Hospital, Japan
| | - Hidetaka Arishima
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Japan
| | - Mika Hasegawa
- Department of Community Health Nursing, Division of Nursing, Faculty of Medical Sciences, University of Fukui, Japan
| | - Kenichiro Kikuta
- Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Japan.
| |
Collapse
|
3
|
Santala OE, Lipponen JA, Jäntti H, Rissanen TT, Tarvainen MP, Väliaho ES, Rantula OA, Naukkarinen NS, Hartikainen JEK, Martikainen TJ, Halonen J. Novel Technologies in the Detection of Atrial Fibrillation: Review of Literature and Comparison of Different Novel Technologies for Screening of Atrial Fibrillation. Cardiol Rev 2023:00045415-990000000-00087. [PMID: 36946975 DOI: 10.1097/crd.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Atrial fibrillation (AF) is globally the most common arrhythmia associated with significant morbidity and mortality. It impairs the quality of the patient's life, imposing a remarkable burden on public health, and the healthcare budget. The detection of AF is important in the decision to initiate anticoagulation therapy to prevent thromboembolic events. Nonetheless, AF detection is still a major clinical challenge as AF is often paroxysmal and asymptomatic. AF screening recommendations include opportunistic or systematic screening in patients ≥65 years of age or in those individuals with other characteristics pointing to an increased risk of stroke. The popularities of well-being and taking personal responsibility for one's own health are reflected in the continuous development and growth of mobile health technologies. These novel mobile health technologies could provide a cost-effective solution for AF screening and an additional opportunity to detect AF, particularly its paroxysmal and asymptomatic forms.
Collapse
Affiliation(s)
- Onni E Santala
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka A Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika P Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Eemu-Samuli Väliaho
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli A Rantula
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Noora S Naukkarinen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha E K Hartikainen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Jari Halonen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
4
|
Kalarus Z, Mairesse GH, Sokal A, Boriani G, Średniawa B, Casado-Arroyo R, Wachter R, Frommeyer G, Traykov V, Dagres N, Lip GYH. Searching for atrial fibrillation: looking harder, looking longer, and in increasingly sophisticated ways. An EHRA position paper. Europace 2023; 25:185-198. [PMID: 36256580 PMCID: PMC10112840 DOI: 10.1093/europace/euac144] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zbigniew Kalarus
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Georges H Mairesse
- Department of Cardiology and Electrophysiology, Cliniques du Sud Luxembourg—Vivalia, Arlon, Belgium
| | - Adam Sokal
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Beata Średniawa
- Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | | | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II (Electrophysiology), University Hospital Münster, Münster, Germany
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
5
|
Yoshida H, Nishitani K. Useful Test for Classification of Cerebral Infarction at Hospital Specializing in Neurosurgery. Ann Vasc Dis 2022; 15:268-274. [PMID: 36644253 PMCID: PMC9816022 DOI: 10.3400/avd.oa.22-00099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Purpose: There are many cases of cerebral infarction of unknown etiology in which the embolic sources cannot be identified including atrial fibrillation despite achievement of complete revascularization after thrombectomy. Method: An analysis was conducted for 556 consecutive cases of patients who were hospitalized for cerebral infarction to determine the significance of accurate classification of disease type and investigation into causes of cerebral infarction of unknown cause. Result: According to the Trials of Org 10172 in Acute Stroke Treatment (TOAST) classification, cerebral infarction of other/unknown etiology was observed in 94 cases, of which 22 cases were found to have causes by additional workup. Implantable cardiac monitors were inserted in 15 of 76 cases of cryptogenic cerebral infarction, of which 4 cases (26%) showed detection of paroxysmal atrial fibrillation (PAF) during observation period (223-384 days). Conclusion: Brain natriuretic peptide (BNP) measurement, abdomen-pelvic computed tomography (CT), cardiac monitoring for 1 week, and implantable cardiac monitors (ICM) were useful for the classification of disease type and detection of cryptogenic atrial fibrillation. (This is secondary publication from J Jpn Coll Angiol 2021; 61: 49-55.).
Collapse
Affiliation(s)
- Hirotaka Yoshida
- Department of Neurosurgery, Tokyo General Hospital, Tokyo, Japan,Corresponding author: Hirotaka Yoshida, MD. Department of Neurosurgery, Tokyo General Hospital, 3-15-2 Egota, Nakano-ku, Tokyo 165-0022, Japan Tel: +81-3-3387-5421, Fax: +81-3-3387-5659, E-mail:
| | | |
Collapse
|
6
|
Matuja SS, Ahmed RA, Munseri P, Khanbhai K, Tessua K, Lyimo F, Rodriguez GJ, Gupta V, Maud A, Chaudhury MR, Manji M, Sheriff F. Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion. Front Neurol 2022; 13:882928. [PMID: 35911912 PMCID: PMC9330741 DOI: 10.3389/fneur.2022.882928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Large vessel ischemic strokes account for more than one-third of all strokes associated with substantial morbidity and mortality without early intervention. The incidence of large vessel occlusion (LVO) is not known in sub-Saharan Africa (SSA). Definitive vessel imaging is not routinely available in resource-limited settings. Aims We aimed to investigate the burden and outcomes of presumed LVO among patients with ischemic stroke admitted to a large tertiary academic hospital in Tanzania. Methods This cohort study recruited all consenting first-ever ischemic stroke participants admitted at a tertiary hospital in Tanzania. Demographic data were recorded, and participants were followed up to 1 year using the modified Rankin Scale (mRS). A diagnosis of presumed LVO was made by a diagnostic neuroradiologist and interventional neurologist based on contiguous ischemic changes in a pattern consistent with proximal LVO on a non-contrast computed tomography head. We examined factors associated with presumed LVO using logistic regression analysis. Inter-observer Kappa was calculated. Results We enrolled 158 first-ever ischemic strokes over 8 months with a mean age of 59.7 years. Presumed LVO accounted for 39.2% [95% confidence interval (CI) 31.6–47.3%] and an overall meantime from the onset of stroke symptoms to hospital arrival was 1.74 days. Participants with presumed LVO were more likely to involve the middle cerebral artery (MCA) territory (70.9%), p < 0.0001. Independent factors on multivariate analysis associated with presumed LVO were hypertension [adjusted odds ratio (aOR) 5.74 (95% CI: 1.74–18.9)] and increased waist-hip ratio [aOR 7.20 (95% CI: 1.83–28.2)]. One-year mortality in presumed LVO was 80% when compared with 73.1% in participants without presumed LVO. The Cohen's Kappa inter-observer reliability between the diagnostic neuroradiologist and interventional neurologist was 0.847. Conclusion There is a high burden of presumed LVO associated with high rates of 1-year morbidity and mortality at a tertiary academic hospital in Tanzania. Efforts are needed to confirm these findings with definitive vessel imaging, promoting cost-effective preventive strategies to reduce the burden of non-communicable diseases (NCDs), and a call for adopting endovascular therapies to reduce morbidity and mortality.
Collapse
Affiliation(s)
- Sarah Shali Matuja
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- *Correspondence: Sarah Shali Matuja
| | - Rashid Ali Ahmed
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Khuzeima Khanbhai
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Kezia Tessua
- Department of Internal Medicine, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Frederick Lyimo
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Gustavo J. Rodriguez
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
| | - Vikas Gupta
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
| | - Alberto Maud
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
| | - Mohammad Rauf Chaudhury
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
| | - Mohamed Manji
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Faheem Sheriff
- Department of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United States
| |
Collapse
|
7
|
Väliaho ES, Lipponen JA, Kuoppa P, Martikainen TJ, Jäntti H, Rissanen TT, Castrén M, Halonen J, Tarvainen MP, Laitinen TM, Laitinen TP, Santala OE, Rantula O, Naukkarinen NS, Hartikainen JEK. Continuous 24-h Photoplethysmogram Monitoring Enables Detection of Atrial Fibrillation. Front Physiol 2022; 12:778775. [PMID: 35058796 PMCID: PMC8764282 DOI: 10.3389/fphys.2021.778775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/29/2021] [Indexed: 01/12/2023] Open
Abstract
Aim: Atrial fibrillation (AF) detection is challenging because it is often asymptomatic and paroxysmal. We evaluated continuous photoplethysmogram (PPG) for signal quality and detection of AF. Methods: PPGs were recorded using a wrist-band device in 173 patients (76 AF, 97 sinus rhythm, SR) for 24 h. Simultaneously recorded 3-lead ambulatory ECG served as control. The recordings were split into 10-, 20-, 30-, and 60-min time-frames. The sensitivity, specificity, and F1-score of AF detection were evaluated for each time-frame. AF alarms were generated to simulate continuous AF monitoring. Sensitivities, specificities, and positive predictive values (PPVs) of the alarms were evaluated. User experiences of PPG and ECG recordings were assessed. The study was registered in the Clinical Trials database (NCT03507335). Results: The quality of PPG signal was better during night-time than in daytime (67.3 ± 22.4% vs. 30.5 ± 19.4%, p < 0.001). The 30-min time-frame yielded the highest F1-score (0.9536), identifying AF correctly in 72/76 AF patients (sensitivity 94.7%), only 3/97 SR patients receiving a false AF diagnosis (specificity 96.9%). The sensitivity and PPV of the simulated AF alarms were 78.2 and 97.2% at night, and 49.3 and 97.0% during the daytime. 82% of patients were willing to use the device at home. Conclusion: PPG wrist-band provided reliable AF identification both during daytime and night-time. The PPG data’s quality was better at night. The positive user experience suggests that wearable PPG devices could be feasible for continuous rhythm monitoring.
Collapse
Affiliation(s)
- Eemu-Samuli Väliaho
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka A Lipponen
- Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland
| | - Pekka Kuoppa
- Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland
| | - Tero J Martikainen
- Department of Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Helena Jäntti
- Center for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Maaret Castrén
- Department of Emergency Medicine, University of Helsinki, Helsinki, Finland.,Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Jari Halonen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Mika P Tarvainen
- Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | | | - Tomi P Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland.,Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Onni E Santala
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli Rantula
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Noora S Naukkarinen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha E K Hartikainen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
8
|
Hayano J, Yuda E. Enhanced detection of abnormalities in heart rate variability and dynamics by 7-day continuous ECG monitoring. Ann Noninvasive Electrocardiol 2021; 27:e12897. [PMID: 34546637 PMCID: PMC8739595 DOI: 10.1111/anec.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/10/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background The analysis of heart rate variability (HRV) and heart rate (HR) dynamics by Holter ECG has been standardized to 24 hs, but longer‐term continuous ECG monitoring has become available in clinical practice. We investigated the effects of long‐term ECG on the assessment of HRV and HR dynamics. Methods Intraweek variations in HRV and HR dynamics were analyzed in 107 outpatients with sinus rhythm. ECG was recorded continuously for 7 days with a flexible, codeless, waterproof sensor attached on the upper chest wall. Data were divided into seven 24‐h segments, and standard time‐ and frequency‐domain HRV and nonlinear HR dynamics indices were computed for each segment. Results The intraweek coefficients of variance of HRV and HR dynamics indices ranged from 2.9% to 26.0% and were smaller for frequency‐domain than for time‐domain indices, and for indices reflecting slower HR fluctuations than faster fluctuations. The indices with large variance often showed transient abnormalities from day to day over 7 days, reducing the positive predictive accuracy of the 24‐h ECG for detecting persistent abnormalities over 7 days. Conversely, 7‐day ECG provided 2.3‐ to 6.5‐fold increase in sensitivity to detect persistent plus transient abnormalities compared with 24‐h ECG. It detected an average of 1.74 to 2.91 times as many abnormal indices as 24‐h ECG. Conclusions Long‐term ECG monitoring increases the accuracy and sensitivity of detecting persistent and transient abnormalities in HRV and HR dynamics and allows discrimination between the two types of abnormalities. Whether this discrimination improves risk stratification deserves further studies.
Collapse
Affiliation(s)
- Junichiro Hayano
- Heart Beat Science Lab, Co., Ltd., Sendai, Japan.,Nagoya City University, Nagoya, Japan
| | - Emi Yuda
- Heart Beat Science Lab, Co., Ltd., Sendai, Japan.,Center for Data-driven Science and Artificial Intelligence, Tohoku University, Sendai, Japan
| |
Collapse
|
9
|
Liran O, Banon T, Grossman A. Detection of occult atrial fibrillation with 24-hour ECG after cryptogenic acute stroke or transient ischaemic attack: A retrospective cross-sectional study in a primary care database in Israel. Eur J Gen Pract 2021; 27:152-157. [PMID: 34240675 PMCID: PMC8274499 DOI: 10.1080/13814788.2021.1947237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Ischaemic stroke or cerebrovascular accident (CVA) due to occult atrial fibrillation (AF) may cause severe morbidity and mortality. Diagnosing occult AF can be challenging and there is no consensus regarding the optimal duration of screening. A 24-hour Holter electrocardiogram (ECG) is frequently employed to detect occult AF following ischaemic CVA. Objectives Demonstration of occult AF detection rate using a 24-hour Holter ECG in a primary care setting with descriptive analyses of independent variables to compare AF detected and non-detected patients. Methods This retrospective cross-sectional study utilised primary care data and included patients 50 years and older with a new CVA or transient ischaemic attack (TIA) diagnosis followed by a 24-hour Holter examination within 6 months, between 01 January 2013 and 01 June 2019. The analyses included descriptive statistics comparing demographics and clinical characteristics in patients who had AF or Atrial Flutter (AFL) detection to those who did not. Results Out of 5015 eligible patients, 66 (1.3%) were diagnosed with AF/AFL, with a number needed to screen of 88.5. Compared with those without AF/AFL detection, those diagnosed were older (75.42 ± 7.89 vs. 69.89 ± 9.88, p = 0.050), had a higher prevalence of hypertension (80.3% vs. 66.8%, p = 0.021) and chronic kidney disease (CKD) (71.2% vs. 44.2%, p < 0.001). Conclusion 24-hour Holter has a low AF/AFL detection rate. Older persons and those with hypertension or CKD are more likely to be detected with AF/AFL using this method.
Collapse
Affiliation(s)
- Ori Liran
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Tamar Banon
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Alon Grossman
- Maccabi Healthcare Services, Tel-Aviv, Israel.,Department of Internal Medicine B, Rabin Medical Center, Petah Tikva, Israel
| |
Collapse
|
10
|
Sharma AN, Baranchuk A. Ambulatory External Electrocardiography Monitoring: Holter, Extended Holter, Mobile Cardiac Telemetry Monitoring. Card Electrophysiol Clin 2021; 13:427-438. [PMID: 34330370 DOI: 10.1016/j.ccep.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ambulatory external electrocardiography (AECG) monitoring is effective as an evidence-based diagnostic tool when suspicion for cardiac arrhythmia is high. Multiple modalities of AECG monitoring exist, with unique advantages and limitations that predict effectiveness in a variety of clinical settings. Knowledge of these characteristics allows appropriate use of AECG, maximizing patient adherence, diagnostic yield, and cost-effectiveness. In addition, new technology has allowed the development of a modern generation of devices that offer increased efficacy and functionality compared with Holter monitors.
Collapse
Affiliation(s)
- Arjun N Sharma
- Internal Medicine, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada
| | - Adrian Baranchuk
- Department of Cardiac Electrophysiology and Pacing, Kingston General Hospital, Kingston, Ontario, Canada; Department of Cardiology, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
| |
Collapse
|
11
|
Vardas P, Cowie M, Dagres N, Asvestas D, Tzeis S, Vardas EP, Hindricks G, Camm J. The electrocardiogram endeavour: from the Holter single-lead recordings to multilead wearable devices supported by computational machine learning algorithms. Europace 2021; 22:19-23. [PMID: 31535151 DOI: 10.1093/europace/euz249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/12/2019] [Indexed: 01/07/2023] Open
Abstract
This review aims to provide a comprehensive recapitulation of the evolution in the field of cardiac rhythm monitoring, shedding light in recent progress made in multilead ECG systems and wearable devices, with emphasis on the promising role of the artificial intelligence and computational techniques in the detection of cardiac abnormalities.
Collapse
Affiliation(s)
- Panos Vardas
- Heart Sector, Hygeia Hospitals Group, Athens, Greece
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - Dimitrios Asvestas
- Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
| | - Stylianos Tzeis
- Cardiology Department, Mitera General Hospital, Hygeia Group, Athens, Greece
| | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany
| | - John Camm
- St. George's University of London, London, UK
| |
Collapse
|
12
|
Wańkowicz P, Nowacki P, Gołąb-Janowska M. Atrial fibrillation risk factors in patients with ischemic stroke. Arch Med Sci 2021; 17:19-24. [PMID: 33488851 PMCID: PMC7811312 DOI: 10.5114/aoms.2019.84212] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 02/27/2019] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common heart arrhythmia. The condition is known to increase the risk of ischemic stroke (IS). Classical risk factors for the development of AF include advanced age, hypertension, diabetes mellitus, coronary heart disease and lipid metabolism disorders. Importantly, these are also recognized risk factors for ischemic stroke. Therefore, the purpose of this study was to investigate AF risk factors in patients with IS. MATERIAL AND METHODS This is single-centre retrospective study which included 696 patients with acute ischemic stroke and nonvalvular atrial fibrillation and 1678 patients with acute ischemic stroke without atrial fibrillation. RESULTS In this study we found - based on a univariable and multivariable logistic regression model - that compared to the patients with IS without AF, the group of patients which suffered from IS with nonvalvular atrial fibrillation (NVAF) had a higher proportion of patients who smoked cigarettes (OR = 15.742, p < 0.01; OR = 41.1, p < 0.01), had hypertension (OR = 5.161, p < 0.01; OR = 5.666, p < 0.01), history of previous stroke (OR = 3.951, p < 0.01; OR = 4.792, p < 0.01), dyslipidemia (OR = 2.312, p < 0.01; OR = 1.592, p < 0.01), coronary heart disease (OR = 2.306, p < 0.01; OR = 1.988, p < 0.01), a greater proportion of female patients (OR = 1.717, p < 0.01; OR = 2.095, p < 0.01), higher incidence of diabetes mellitus (OR = 1.341, p < 0.01; OR = 1.261, p = 0.106) and more patients in old age (OR = 1.084, p < 0.01; OR = 1.101, p < 0.01). CONCLUSIONS Our study demonstrates a need for thorough and systematic monitoring of post-ischemic stroke patients in whom AF has not been detected and who display other important risk factors. Regardless of the stroke, these factors may be responsible for development of AF.
Collapse
Affiliation(s)
- Paweł Wańkowicz
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
| | | |
Collapse
|
13
|
Recurrent cerebrovascular events in patients after percutaneous closure of patent foramen ovale. J Stroke Cerebrovasc Dis 2020; 29:104860. [PMID: 32430239 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104860] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Recent published trials have shown the efficacy of transcatheter closure of patent foramen ovale (PFO) for preventing recurrent cryptogenic cerebrovascular events. However, the risk of recurrent cerebrovascular events (rCVEs) is up to 5.7%, and the etiology is unclear. OBJECTIVE This study aimed to investigate the risk factors for rCVEs after closure of PFO during long-term follow-up. METHODS In our center, 282 consecutive patients underwent PFO closure because of a cryptogenic cerebrovascular event between 2006 and 2014. Their Risk of Paradoxical Embolism (RoPE) score was calculated retrospectively. We followed up with the patients by telephone, using hospital records to identify those who suffered from rCVEs. Patients with rCVEs were matched with two control patients of the same sex and RoPE score without rCVEs who underwent PFO closure at approximately the same time. The patients with rCVEs and controls participated in a clinical examination, including contrast transthoracic echocardiography (TTE) and Holter electrocardiography, to investigate the possible cause of rCVEs compared with controls. RESULTS Fourteen (5%) out of the 282 consecutive patients who underwent PFO closure suffered from rCVEs during a mean follow-up of 8.4 years (1.7 rCVEs per 100 patient-years). The median RoPE score of the patients was 7. Recurrent CVE occurred in 3.2 patients per 100 patient-years in patients with residual shunting compared with 0.8 patients per 100 patient-years in those without residual shunt. These patients were on antiplatelet treatment or without any effective anticoagulant treatment at the time rCVE occurred. The risk ratio of rCVEs in patients with residual shunting was 2.9-times higher than in patients without residual shunting (95% CI: 1.4-6.1) at follow-up visit. Four patients who had the BioSTAR device implanted suffered from an rCVE despite lack of residual shunting. CONCLUSIONS This study indicates that residual shunting and choice of the device may be the major reasons for rCVEs.
Collapse
|
14
|
Goel D, Sharma V, Pran MM, Gupta R, Keshri T, Shettigar U. A case of recurrent stroke with underlying adenocarcinoma: Pseudo-cryptogenic stroke. Brain Circ 2020; 6:126-129. [PMID: 33033783 PMCID: PMC7511917 DOI: 10.4103/bc.bc_49_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/24/2020] [Accepted: 03/17/2020] [Indexed: 11/24/2022] Open
Abstract
Stroke is the most common neurological disorders leading to early death. Early recognition of underlying mechanisms and etiology of stroke is important to prevent recurrence, mortality and disability. The term cryptogenic stroke or embolic stroke of undetermined sources is used where no etiology could be detected. We are describing this rare case of “recurrent stroke with undetermined etiology” finally proved to have an uncommon underlying etiology.
Collapse
Affiliation(s)
- Deepak Goel
- Department of Neurology, Himalayan Institute of Medical Sciences, Swami Ram Himalayan University, Dehradun, Uttarakhand, India
| | - Vikram Sharma
- Department of Neurology, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| | - Madasu Mukhiya Pran
- Department of Radiology, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| | - Rekha Gupta
- Department of Neuro-Critical Care, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| | - Tulika Keshri
- Department of Neurology, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| | - Uttam Shettigar
- Department of Neurology, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| |
Collapse
|
15
|
Chua SK, Chen LC, Lien LM, Lo HM, Liao ZY, Chao SP, Chuang CY, Chiu CZ. Comparison of Arrhythmia Detection by 24-Hour Holter and 14-Day Continuous Electrocardiography Patch Monitoring. ACTA CARDIOLOGICA SINICA 2020; 36:251-259. [PMID: 32425440 DOI: 10.6515/acs.202005_36(3).20190903a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although 24-hour Holter monitoring is routinely used for patients with suspected paroxysmal arrhythmia, its sensitivity in detecting such arrhythmias is insufficient. METHODS We compared a 14-day electrocardiography (ECG) monitor patch - a single-use, noninvasive, waterproof, continuous monitoring patch - with a 24-hour Holter monitor in 32 consecutive patients with suspected arrhythmia. RESULTS The 14-day ECG patch was well tolerated, and its rates of detection of relevant arrhythmias on days 1, 3, 7, and 14 were 13%, 28%, 47%, and 66%, respectively. The detection rate of paroxysmal arrhythmias was significantly higher for the 14-day ECG patch than for the 24-hour Holter monitor (66% vs. 9%, p < 0.001). Among the 32 patients, 202 atrial fibrillation or atrial flutter episodes were detected in 6 patients (22%) with the 14-day ECG patch; however, only 1 atrial fibrillation episode was detected in a patient (3%, p < 0.05) with the 24-hour Holter monitor. Other clinically relevant arrhythmias recorded on the 14-day ECG patch included 21 (65.5%) episodes of supraventricular tachycardia, 2 (6.3%) long pause, and 2 (6.3%) ventricular arrhythmias. The mean dermal response score immediately after removal of the 14-day ECG patch from the patients was 0.64, which indicated minimal erythema. CONCLUSIONS The 14-day ECG patch was well tolerated and allowed for longer continuous monitoring than the 24-hour Holter monitor, thus resulting in improved clinical accuracy in the detection of paroxysmal arrhythmias. Future studies should examine the long-term effectiveness of 14-day ECG patches for managing selected patients.
Collapse
Affiliation(s)
- Su-Kiat Chua
- School of Medicine, Fu Jen Catholic University, New Taipei City.,Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital
| | - Lung-Ching Chen
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital
| | - Li-Ming Lien
- College of Medicine, Taipei Medical University.,Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Huey-Ming Lo
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital
| | - Zhen-Yu Liao
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital
| | - Shu-Ping Chao
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital
| | - Cheng-Yen Chuang
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital
| | - Chiung-Zuan Chiu
- School of Medicine, Fu Jen Catholic University, New Taipei City.,Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital
| |
Collapse
|
16
|
Goel D, Gupta R, Keshri T, Rana S. Prevalence of atrial fibrillation in acute ischemic stroke patients: A hospital-based study from India. Brain Circ 2020; 6:19-25. [PMID: 32166196 PMCID: PMC7045538 DOI: 10.4103/bc.bc_19_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/01/2019] [Accepted: 10/07/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND: Secondary stroke prevention is as important as the treatment of acute ischemic stroke in regards to halt neurological disability and to lower down mortality due to recurrent episodes. The effective secondary prevention depends on finding the specific risk factors leading to cerebro-vascular insult. AIMS AND OBJECTIVES: We aimed this study to find prevalence of persistent/Paroxysmal AF in stroke patients from single center hospital based study. METHODS: Hospital based study enrolled all prospective patients of acute ischemic stroke from January 2016 to December 2018. All patients were subjected to test for risk factors analysis after detail clinical history and examination of these patients. Following variables were recorded; age, gender, stroke territory, stroke severity by NIHSS (National Institute of Health Stroke Scale), LDL-C (Low Density Lipoprotein - cholesterol) of more than 100 mg/dl, HBA1C (Glycosylated Hemoglobin) of more than 6.5, Homocystine of more than 15 Mc Mol/L, 2D-Echocardiographic abnormalities, electrocardiography/24 hour Holter Monitoring, cerebral angiography of brain and neck findings and outcome of patients in 90 days follow-up based on Modified Rankin Scale. Results: Total 246 patients (69.5% men and 30.5% women) of Acute Ischemic stroke were recorded during study period. Mean age was 61.4 years, with 31 (12.4%) patients were below 45 years. Atrial fibrillation (AF) was detected either on conventional ECG or 24 hour Holter monitoring in 62 (25.2%) patients. CONCLUSION: Stroke with AF is found in 25% patients, more common in elderly, female large atrial size and associated with poor outcome.
Collapse
Affiliation(s)
- Deepak Goel
- Department of Neurology, Himalayan Hospital of Medical Sciences, Swami Ram Himalayan University, Dehradun, Uttarakhand, India
| | - Rekha Gupta
- Department of Neurocritical Care, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| | - Tulika Keshri
- Department of Neurology, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| | - Sanyal Rana
- Department of Neurology, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| |
Collapse
|
17
|
Shi K, Schellenberger S, Michler F, Steigleder T, Malessa A, Lurz F, Ostgathe C, Weigel R, Koelpin A. Automatic Signal Quality Index Determination of Radar-Recorded Heart Sound Signals Using Ensemble Classification. IEEE Trans Biomed Eng 2019; 67:773-785. [PMID: 31180834 DOI: 10.1109/tbme.2019.2921071] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Radar technology promises to be a touchless and thereby burden-free method for continuous heart sound monitoring, which can be used to detect cardiovascular diseases. However, the first and most crucial step is to differentiate between high- and low-quality segments in a recording to assess their suitability for a subsequent automated analysis. This paper gives a comprehensive study on this task and first addresses the specific characteristics of radar-recorded heart sound signals. METHODS To gather heart sound signals recorded from radar, a bistatic radar system was built and installed at the university hospital. Under medical supervision, heart sound data were recorded from 30 healthy test subjects. The signals were segmented and labeled as high- or low-quality by a medical expert. Different state-of-the-art pattern classification algorithms were evaluated for the task of automated signal quality determination and the most promising one was optimized and evaluated using leave-one-subject-out cross validation. RESULTS The proposed classifier is able to achieve an accuracy of up to 96.36% and demonstrates a superior classification performance compared with the state-of-the-art classifier with a maximum accuracy of 76.00%. CONCLUSION This paper introduces an ensemble classifier that is able to perform automated signal quality determination of radar-recorded heart sound signals with a high accuracy. SIGNIFICANCE Besides achieving a higher performance compared with state-of-the-art classifiers, this study is the first one to deal with the quality determination of heart sounds that are recorded by radar systems. The proposed method enables contactless and continuous heart sound monitoring for the detection of cardiovascular diseases.
Collapse
|
18
|
Alves M, Narciso MR, Cruz J, Rocha M, Fonseca T. Paroxysmal atrial fibrillation detection in patients with acute ischemic stroke through prolonged Holter: prospective study. Aging Clin Exp Res 2019; 31:469-474. [PMID: 30054893 DOI: 10.1007/s40520-018-1014-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/20/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The detection of paroxysmal atrial fibrillation (PAF) is crucial in the etiological study of an acute ischemic stroke (AIS), although this type of arrhythmia is often under-diagnosed. This prospective study aims to (1) evaluate the new-onset PAF detection rate among elderly patients with AIS in an acute setting, and (2) to assess the applicability of the STAF score (Score for the Targeting of Atrial Fibrillation) for such patients. METHODOLOGY An observational and prospective study was performed over a period of 11 months. Patients with acute ischemic stroke who had been admitted to the stroke unit were included. Exclusion criteria included prior AF, AF readings on ECG during admission, or stroke mimic. The patients were monitored with a bedside ECG monitor throughout the first 48 h, then simultaneously with an extended Holter recorder for a maximum of 6 days. The occurrence and duration of PAF events was evaluated. The STAF risk score for PAF was calculated and compared to the detection rate of PAF for each patient. RESULTS The sample population consisted of 67 patients, whose median age was 76 years (IQR 71-84) and who were 57% males. The median duration of Holter recording was 3.5 days per patient (IQR 2-5). We detected new PAF cases in 16% of patients, and a total of 31% had supraventricular arrhythmia episodes lasting 10 s or longer. Among the patients in which this arrhythmia was detected, 10% had it detected by the bedside ECG monitor in the first 48 h. The median risk score was 5 (IQR 4-6). There was no association between the risk score used and PAF. CONCLUSION In elderly patients with AIS, the use of an extended Holter recorder led to the detection of more cases of PAF, offering them the chance to initiate hypocoagulant therapy. Among this population, the STAF score was non-discriminative and did not prove useful in predicting PAF.
Collapse
Affiliation(s)
- Mariana Alves
- CHLN, Hospital Pulido Valente, Medicina III, 117 Alameda das Linhas de Torres, 1769-001, Lisbon, Portugal.
| | - Marco Ribeiro Narciso
- CHLN, Hospital Pulido Valente, Medicina III, 117 Alameda das Linhas de Torres, 1769-001, Lisbon, Portugal
| | - João Cruz
- CHLN, Hospital Pulido Valente, Unidade Técnicas de Cardiologia, 117 Alameda das Linhas de Torres, 1769-001, Lisbon, Portugal
| | - Marina Rocha
- CHLN, Hospital Pulido Valente, Unidade Técnicas de Cardiologia, 117 Alameda das Linhas de Torres, 1769-001, Lisbon, Portugal
| | - Teresa Fonseca
- CHLN, Hospital Pulido Valente, Medicina III, 117 Alameda das Linhas de Torres, 1769-001, Lisbon, Portugal
| |
Collapse
|
19
|
Eysenck W, Freemantle N, Sulke N. A randomized trial evaluating the accuracy of AF detection by four external ambulatory ECG monitors compared to permanent pacemaker AF detection. J Interv Card Electrophysiol 2019; 57:361-369. [PMID: 30741360 DOI: 10.1007/s10840-019-00515-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/15/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Several external cardiac monitors (ECMs) have recently been developed. These have never been compared to 'gold standard' monitoring with concurrently implanted DDDRP pacemakers. The accuracy of AF detection of Zio XT Monitor (ZM), NUUBO Vest (NV) and Carnation Ambulatory Monitor (CAM) compared with Novacor 'R' Test 4 (RT) in patients (pts) with DDDRP PPM advanced Holters as the comparator, was evaluated. METHODS Twenty-one pts. with AF and a DDDRP PPM, each acting as their own control subject, wore every ECM for 2 weeks in randomized order. PPM downloads were performed at application and removal. Device ECGs were compared for AF burden and individual AF episodes with PPM Holters. Pt acceptability, wear time, costs and time expenditure were evaluated. RESULTS RT AF burden was less accurate than the ZM, NV or CAM (p < 0.05). Probability of inaccurate AF diagnosis was higher for RT than ZM or CAM OR 12.31 and 5.85, respectively (p = 0.025 and p = 0.042). ZM wear time was longer than the RT: 307 h vs. 224 h; p = 0.02. Acceptability was greater for CAM than RT (1.86 ± 2.63 compared with 0.57 ± 1.17 for CAM; p = 0.024). All ECMs were more expensive than RT (p < 0.00001). CONCLUSIONS All new ECMs were more expensive than the RT system; however, the ZM, NV and CAM are all more accurate than current standard practice RT device in AF burden assessment. The RT is more likely to give inaccurate diagnoses than ZM or CAM. This may have clinical implications.
Collapse
Affiliation(s)
- Will Eysenck
- Eastbourne General Hospital, East Sussex Healthcare NHS Trust, East Sussex, UK.
| | | | - Neil Sulke
- Eastbourne General Hospital, East Sussex Healthcare NHS Trust, East Sussex, UK
| |
Collapse
|
20
|
Carmona-Puerta R, Castro-Torres Y. Atrial fibrillation and cryptogenic stroke. What is the current evidence? Role of electrocardiographic monitoring. J Arrhythm 2018; 34:1-3. [PMID: 29721107 PMCID: PMC5828277 DOI: 10.1002/joa3.12016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 10/29/2017] [Indexed: 12/12/2022] Open
Abstract
The diagnosis of cryptogenic stroke is made by exclusion. However, current evidence supports the role of atrial fibrillation episodes as a cause of this condition. Prospective data have demonstrated the benefits of long‐term electrocardiographic monitoring to identify atrial fibrillation in association with cryptogenic stroke. This aim of this article was to analyze the contemporary evidence for the possible relationship between atrial fibrillation and cryptogenic stroke and the role of continuous electrocardiographic monitoring to clarify this hypothesis.
Collapse
|
21
|
The complexity of atrial fibrillation newly diagnosed after ischemic stroke and transient ischemic attack: advances and uncertainties. Curr Opin Neurol 2018; 30:28-37. [PMID: 27984303 PMCID: PMC5321114 DOI: 10.1097/wco.0000000000000410] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose of review Atrial fibrillation is being increasingly diagnosed after ischemic stroke and transient ischemic attack (TIA). Patient characteristics, frequency and duration of paroxysms, and the risk of recurrent ischemic stroke associated with atrial fibrillation detected after stroke and TIA (AFDAS) may differ from atrial fibrillation already known before stroke occurrence. We aim to summarize major recent advances in the field, in the context of prior evidence, and to identify areas of uncertainty to be addressed in future research. Recent findings Half of all atrial fibrillations in ischemic stroke and TIA patients are AFDAS, and most of them are asymptomatic. Over 50% of AFDAS paroxysms last less than 30 s. The rapid initiation of cardiac monitoring and its duration are crucial for its timely and effective detection. AFDAS comprises a heterogeneous mix of atrial fibrillation, possibly including cardiogenic and neurogenic types, and a mix of both. Over 25 single markers and at least 10 scores have been proposed as predictors of AFDAS. However, there are considerable inconsistencies across studies. The role of AFDAS burden and its associated risk of stroke recurrence have not yet been investigated. Summary AFDAS may differ from atrial fibrillation known before stroke in several clinical dimensions, which are important for optimal patient care strategies. Many questions remain unanswered. Neurogenic and cardiogenic AFDAS need to be characterized, as it may be possible to avoid some neurogenic cases by initiating timely preventive treatments. AFDAS burden may differ in ischemic stroke and TIA patients, with distinctive diagnostic and treatment implications. The prognosis of AFDAS and its risk of recurrent stroke are still unknown; therefore, it is uncertain whether AFDAS patients should be treated with oral anticoagulants.
Collapse
|
22
|
Clinical Implications of Technological Advances in Screening for Atrial Fibrillation. Prog Cardiovasc Dis 2018; 60:550-559. [DOI: 10.1016/j.pcad.2018.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/18/2022]
|
23
|
Carrazco C, Golyan D, Kahen M, Black K, Libman RB, Katz JM. Prevalence and Risk Factors for Paroxysmal Atrial Fibrillation and Flutter Detection after Cryptogenic Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 27:203-209. [PMID: 29032886 DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/04/2017] [Accepted: 08/14/2017] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Long-term cardiac monitoring with implantable loop recorders (ILRs) has revealed occult paroxysmal atrial fibrillation and flutter (PAF) in a substantial minority of cryptogenic ischemic stroke (CIS) patients. Herein, we aim to define the prevalence, clinical relevance, and risk factors for PAF detection following early poststroke ILR implantation. MATERIALS AND METHODS A retrospective study of CIS patients (n = 100, mean age 65.8 years; 52.5% female) who underwent ILR insertion during, or soon after, index stroke admission. Patients were prospectively followed by the study cardiac electrophysiologist who confirmed the PAF diagnosis. Univariate and multivariate analyses compared clinical, laboratory, cardiac, and imaging variables between PAF patients and non-PAF patients. RESULTS PAF was detected in 31 of 100 (31%) CIS patients, and anticoagulation was initiated in almost all (30 of 31, 96.8%). Factors associated with PAF detection include older age (mean [year] 72.9 versus 62.9; P = .003), white race (odds ratio [OR], 4.5; confidence interval [CI], 1.8-10.8; P = .001), prolonged PR interval (PR > 175 ms; OR, 3.3; CI, 1.2-9.4; P = .022), larger left atrial (LA) diameter (mean [cm] 3.7 versus 3.5; P = .044) and LA volume index (mean [cc/m2]; 30.6 versus 24.2; P = .014), and lower hemoglobin (Hb)A1c (mean [%] 6.0 versus 6.4; P = .036). Controlling for age, obesity (body mass index > 30 kg/m2; OR, 1.2; CI, 1.1-1.4; P = .033) was independently associated with PAF detection. DISCUSSION PAF was detected with high prevalence following early postcryptogenic stroke ILR implantation and resulted in significant management changes. Older age, increased PR interval, LA enlargement, and lower HbA1c are significantly associated with PAF detection. Controlling for age, obesity is an independent risk factor. A larger prospective study is warranted to confirm these findings.
Collapse
Affiliation(s)
- Claire Carrazco
- Department of Neurology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Daniel Golyan
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Michael Kahen
- Department of Neurology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Karen Black
- Department of Radiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Richard B Libman
- Department of Neurology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital, Northwell Health, Manhasset, New York; Department of Radiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
| |
Collapse
|
24
|
Loftspring MC, Kissela BM, Flaherty ML, Khoury JC, Alwell K, Moomaw CJ, Kleindorfer DO, Woo D, Adeoye O, Ferioli S, Broderick JP, Khatri P. Practice Patterns for Acute Ischemic Stroke Workup: A Longitudinal Population-Based Study. J Am Heart Assoc 2017. [PMID: 28645938 PMCID: PMC5669157 DOI: 10.1161/jaha.116.005097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background We examined practice patterns of inpatient testing to identify stroke etiologies and treatable risk factors for acute ischemic stroke recurrence. Methods and Results We identified stroke cases and related diagnostic testing from four 1‐year study periods (July 1993 to June 1994, 1999, 2005, and 2010) of the Greater Cincinnati/Northern Kentucky Stroke Study. Patients aged ≥18 years were included. We focused on evaluation of extracranial arteries for carotid stenosis and assessment of atrial fibrillation because randomized controlled trials supported treatment of these conditions for stroke prevention across all 4 study periods. In each study period, we also recorded stroke etiology, as determined by diagnostic testing and physician adjudication. An increasing proportion of stroke patients received assessment of both extracranial arteries and the heart over time (50%, 58%, 74%, and 78% in the 1993–1994, 1999, 2005, and 2010 periods, respectively; P<0.0001 for trend), with the most dramatic individual increases in echocardiography (57%, 63%, 77%, and 83%, respectively). Concurrently, we observed a decrease in strokes of unknown etiology (47%, 48%, 41%, and 38%, respectively; P<0.0001 for trend). We also found a significant increase in strokes of other known causes (32%, 25%, 45% and 59%, respectively; P<0.0001 for trend). Conclusions Stroke workup for treatable causes of stroke are being used more frequently over time, and this is associated with a decrease in cryptogenic strokes. Future study of whether better determination of treatable stroke etiologies translates to a decrease in stroke recurrence at the population level will be essential.
Collapse
Affiliation(s)
- Matthew C Loftspring
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Brett M Kissela
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Matthew L Flaherty
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jane C Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kathleen Alwell
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Charles J Moomaw
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Dawn O Kleindorfer
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daniel Woo
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Opeolu Adeoye
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Simona Ferioli
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph P Broderick
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| |
Collapse
|