Feasibility of CardioSecur®, a Mobile 4-Electrode/22-Lead ECG Device, in the Prehospital Emergency Setting

Stratified medicine for acute and chronic coronary syndromes: A patient-tailored approach

The traditional approach to management of cardiovascular disease relies on grouping clinical presentations with common signs and symptoms into pre-specified disease pathways, all uniformly treated according to evidence-based guidelines ("one-size-fits-all"). The goal of precision medicine is to provide the right treatment to the right patients at the right time, combining data from time honoured sources (e.g., history, physical examination, imaging, laboratory) and those provided by multi-omics technologies. In patients with ischemic heart disease, biomarkers and intravascular assessment can be used to identify endotypes with different pathophysiology who may benefit from distinct treatments. This review discusses strategies for the application of stratified management to patients with acute and chronic coronary syndromes.

Telemedicine in the Era of a Pandemic: Usefulness of a Novel Three-Lead ECG

The 12-lead electrocardiogram (ECG) is a first-line diagnostic tool for patients with cardiac symptoms. As observed during the COVID-19 pandemic, the ECG is essential to the initial patient evaluation. The novel KardioPal three-lead-based ECG reconstructive technology provides a potential alternative to a standard ECG, reducing the response time and cost of treatment and improving patient comfort. Our study aimed to evaluate the diagnostic accuracy of a reconstructed 12-lead ECG obtained by the KardioPal technology, comparing it with the standard 12-lead ECG, and to assess the feasibility and time required to obtain a reconstructed ECG in a real-life scenario. A prospective, nonrandomized, single-center, adjudicator-blinded trial was conducted on 102 patients during the COVID-19 pandemic at the Dedinje Cardiovascular Institute in Belgrade. The KardioPal system demonstrated a high feasibility rate (99%), with high specificity (96.3%), sensitivity (95.8%), and diagnostic accuracy (96.1%) for obtaining clinically relevant matching of reconstructed 12-lead compared to the standard 12-lead ECG recording. This novel technology provided a significant reduction in ECG acquisition time and the need for personnel and space for obtaining ECG recordings, thereby reducing the risk of viral transmission and the burden on an already overwhelmed healthcare system such as the one experienced during the COVID-19 pandemic.

Usefulness of wearable electrocardiography devices in patients experiencing paroxysmal cardiac-related symptoms: A case series of the "CardioSecur" system

Background

Electrocardiograms (ECGs) recorded with wearable devices and additional smartphone apps play an increasing role in cardiology.

Case summaries

We present two cases in which it was possible to record an ECG during cardiac-related symptoms using the patients' smartphones. Previous standard resting and 24-hour ECGs had revealed no pathologies. In one case, AV nodal reentry tachycardia was detected and treated accordingly. In the second case, ischemic ECG changes were recorded in a young woman without cardiovascular risk factors during a chest pain episode. Suspecting a coronary vasomotion disorder, an invasive diagnostic procedure was performed. The acetylcholine spasm provocation test revealed coronary microvascular spasm and appropriate therapy was initiated.

Discussion

Smartphone-based ECG systems which can be used by the patient independently while experiencing cardiac-related symptoms are a modern diagnostic tool. Considering the use of these systems is beneficial for early diagnosis and appropriate treatment for paroxysmal arrhythmias and coronary vasomotion disorders.

Monitoring and diagnosis of intermittent arrhythmias: evidence-based guidance and role of novel monitoring strategies

Technological advances have made diagnosis of heart rhythm disturbances much easier, with a wide variety of options, including single-lead portable devices, smartphones/watches to sophisticated implantable cardiac monitors, allowing accurate data to be collected over different time periods depending on symptoms frequency. This review provides an overview of the novel and existing heart rhythm testing options, including a description of the supporting evidence for their use. A description of each of the tests is provided, along with discussion of their advantages and limitations. This is intended to help clinicians towards choosing the most appropriate test, thus improving diagnostic yield management of patients with suspected arrhythmias.

Physician preferences associated with powered intraosseous access systems: Safety features, reliability, and ease of use

Objective

This study evaluated physician preferences and values related to the most commonly used (traditional) powered intraosseous (IO) system and a novel powered IO system featuring a passive safety needle, battery life indicator, and snap‐securement/skin attachment.

Methods

Emergency physicians participated in an IO simulation using both the traditional and novel IO systems. Participants completed a 27‐item postsimulation questionnaire to state their preferences toward each IO system and values related to the novel IO system features using a multiple choice, 11‐point value ranking scale (0 = no value, 10 = extremely valuable) and free‐text answer questions.

Results

Among the 22 study participants, 90.9% (95% confidence interval [CI]: 70.8%, 98.9%) preferred the novel IO system; top reasons for this preference were the novel IO system's passive safety needle and snap‐securement/skin attachment. Participants who preferred the traditional IO system (9.1%) noted its ease of use and familiarity. Many physicians preferred the novel IO system's needle (81.8%; 95% CI: 59.7%, 94.8%), powered driver (77.3%; 95% CI: 54.6%, 92.2%), and snap‐securement/skin attachment (100%; 95% CI: 84.6%, 100%) compared with the traditional IO system. Safety and ease of use were the most common preference explanations. Of the participants, 100% provided a value score ≥7 for the novel IO system's passive safety needle (mean score, 9.45), whereas fewer participants (59.1%) gave a value score ≥7 for the multilight battery life indicator (mean score, 6.68).

Conclusion

This study demonstrates that emergency physicians prefer and value a novel IO system with features that enhance safety and ease of use. These results provide insight into important factors related to IO systems for emergency physicians.

Continuum of Care: Positioning of the Virtual Hospital

Introduction

Patients with multiple chronic diseases suffer from reduced life expectancy. Care for these patients is often divided over multiple healthcare professionals. eHealth might help to integrate care for these patients and create a continuum. It is the primary purpose of this paper to describe an intervention that integrates first, second, and third line care in patients with multiple chronic conditions using remote monitoring, remote therapy and data automatization, all integrated in a virtual care center (VCC).

Methods

Patients diagnosed with three or more chronic conditions are included and given smartphone compatible devices for remote monitoring and a tablet for video consultations. Patients will be followed-up by the VCC, consisting of nurses who will coordinate care, supervised by general practitioners and medical specialists. Data is reviewed on a daily basis and patients are contacted on a weekly basis. Review of data is automated by computer algorithms. Patients are contacted in case of outcome abnormalities in the data. Patients can contact the VCC at any time. Follow-up of the study is 1 year.

Results

The primary outcome of this study is the median number of nights admitted to the hospital per patient compared to the hospitalization data 12 months before enrolment. Secondary outcomes include all-cause mortality, event free survival, quality of life and satisfaction with technology and care.

Conclusion

This study presents the concept of a VCC that integrates first, second, and third line care into a virtual ward using remote monitoring and video consultation.

Temporal trends in the pre-procedural TIMI flow grade among patients with ST- segment elevation myocardial infarction - From the ACSIS registry

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Preprocedural TIMI flow grade remains of prognostic significance.

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Patients with TIMI 0 have a poorer prognosis than their counterparts with TIMI 1-3.

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In-hospital complications have decreased among patients with TIMI 0 over time.

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30-d MACE and 1-year mortality remained unchanged in those with TIMI 0 or 1-3.

Background

Pre-procedural TIMI coronary flow grade in patients with ST segment elevation myocardial infarction (STEMI) is associated with adverse clinical outcomes. There have been great advances in pharmacologic and invasive treatment of STEMI patients in the current era. We aimed to assess the temporal trends in clinical outcomes according to the TIMI flow grade amongst these patients.

Methods

Data of patients with STEMI from the acute coronary syndrome Israeli Survey (ACSIS) registry. A time-dependent analysis stratifying patient by TIMI flow grade 0 and TIMI flow grade 1–3 was performed. Survey years were divided to early (2008–2010) and late period (2013–2018). Clinical outcomes included in-hospital complications, 30d MACE (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality.

Results and Conclusions: Included were 2453 patients. The majority of patients had pre-procedural TIMI flow 0 (58.9% in the early period and 58.7% in the late period, P = 0.97). In-hospital complications of patients with TIMI flow 0 has significantly decreased over time (36.1% vs 26.8%, P < 0.001) but not amongst patients with TIMI flow 1–3. Compared with TIMI flow 1–3, patients with TIMI flow 0 had worse 30d MACE and 1-year mortality. There was no temporal change of these outcomes in either TIMI flow grade group. TIMI flow grade 0 is still more common among patients with STEMI and is associated with poorer prognosis. Nevertheless, over time, in-hospital complications have decreased among patients with TIMI 0, while 30d MACE and 1-year mortality has remained unchanged.

Assessment of a Novel, 22-lead Mobile Electrocardiogram in Elite, Adolescent Footballers

The 12-lead electrocardiogram is a key component of cardiac screening in elite adolescent footballers. Current technology hampers mobile electrocardiogram monitoring that could reduce the time-to-diagnosis in symptomatic athletes. Recently, a 22-lead mobile electrocardiogram monitor, CardioSecur (Personal MedSystems GmbH), has been approved for use in adults. In this study, the differences in parameter accuracy between CardioSecur's 22-lead electrocardiogram and the gold standard 12-lead electrocardiogram were assessed in elite adolescent footballers (n=31) using Bland-Altman and paired t-tests/Wilcoxon analysis. Agreement between the two devices was clinically acceptable for heart rate (bias=- 0.633 bpm), PR Interval (bias=- 1.73 ms), Bazzett's corrected QTc interval (bias=2.03 ms), T-wave axis (bias=6.55°), P-wave duration (bias=- 0.941 ms), Q-wave amplitude (bias=0.0195 mV), Q-wave duration (bias=1.98 ms), rhythm (bias=0.0333), ST-segment (bias=- 0.0629), J-point analysis (bias=- 0.01) and extended T wave and QRS duration analysis. Unsatisfactory agreement was observed in QRS axis (bias=- 19.4°), P-wave axis (bias=- 0.670°), QRS amplitude (bias=- 0.660 mV), P-wave amplitude (bias=0.0400 mV) and T-wave amplitude (bias=- 0.0675 mV). CardioSecur's 22-lead electrocardiogram agrees with the gold standard in rhythm, durations, T-wave determination in all leads assessed, permitting its use in adolescent footballers for immediate pitch- or track-side analysis.

[Detection of ECG alterations typical for myocardial ischemia : New methods 2021]

BACKGROUND

The electrocardiogram (ECG) represents an essential diagnostic tool in cardiology and beyond. Classical ECG devices enable the registration of up to 12 leads, whereas modern ECG systems enable additional leads even with a reduced number of electrodes. Additionally, "smart" devices even enable patients to record an ECG at home.

OBJECTIVE

Evaluation of a potential additional benefit of using various modern ECG systems for the detection of ECG alterations typical for myocardial ischemia.

MATERIAL AND METHODS

Presentation of various signs of ischemia in the ECG according to the latest guidelines. Demonstration of modern ECG systems and their potential advantage in the detection of signs of ischemia in the ECG based on current study results.

RESULTS

Modern ECG systems with vector-based electrocardiography can facilitate and optimize the detection of ischemic ECG alterations. Smart nonvector-based devices for patients are primarily useful for detection of arrhythmias and do not replace the 12-lead ECG for detection of ischemia, even though they can be useful for documentation of temporary ECG alterations also within the ST-segment.

CONCLUSION

The ECG systems based on vector electrocardiography can improve the detection of ECG alterations typical for ischemia compared to the conventional 12-lead ECG.