Assessment of heart failure parameters by telemonitoring patients with an implantable cardioverter defibrillator

Introduction

Different heart failure (HF) parameters have been evaluated in patients with an implantable cardioverter defibrillator (ICD). Recently, a multi-parameters HF index available in some ICDs has been proposed for patients monitoring in order to prevent hospitalizations for HF. We sought to analyze this index in our patients, based on the occurrence of hospitalizations for HF and/or all-cause mortality. As a second endpoint, the level of NT-pro-BNP, the treatment of HF and the Minnesota score (quality of life) were as well evaluated.

Method

This was on an open, single-center, case-control study. Inclusions started on March 2017 to end up in November 2020 with the main criteria of HF with left ventricular ejection fraction (LVEF) <35%, DDD or CRT-D implanted in primary prevention. A control group was composed of patients receiving telemonitoring and a control group composed of patients receiving standard monitoring. A 1/1 pairing was carried out, based on 3 criteria: age, sex and the date of ICD implantation. Data collection was carried out in August 2021.

Results

74 patients were included in the study; none was lost to follow-up. The occurrence of hospitalization for HF and/or death from any cause was found at the end of the study in 7 of 37 patients in the remote monitoring group versus 22 events of 37 in patients receiving standard monitoring (p=0.011). The number of deaths from any cause was 4 in the study group vs 8 in the control group (NS, p=0.21). The average length of hospital stay is 6.27 days (± 23.6) for patients receiving remote monitoring compared to 9.14 days (± 22.1) p=0.64. NT-pro-BNP was found with a median level of 553 pg/mL [146; 1541] in the remotely monitored group against 498 pg/mL [211; 1400] in controls (p=0.77). The assessment of quality of life by the Minnesota score shows a similar result (p=0.7). Analysis of the treatment of HF shows a significantly (p<0.01) greater presence of anti-aldosterone in patients receiving remote monitoring.

Conclusion

Our study demonstrates the benefit of the telemonitoring protocol on the occurrence of hospitalizations for heart failure and/or all-cause mortality in heart failure patients with an ICD. We observe a significantly higher percentage of anti-aldosterone treatment in monitored patients, suggesting a more optimized medical treatment.

Funding Acknowledgement

Type of funding sources: None.

Is cardiac magnetic resonance of additional help in premature ventricular contraction work-up?

Background

Premature ventricular contractions (PVCs) are common in routine medical practice. PVCs are commonly asymptomatic but can also result in palpitations, dyspnea, presyncope or PVC-induced cardiomyopathy that may lead to sudden death. Cardiovascular magnetic resonance (CMR) provides morphological, functional, and tissue characterization in a single setting. CMR imaging proved to reliably identify fibrotic lesions and, hence, has developed into a valuable tool for etiological orientation in patients with PVCs.

Objectives

The aims of this study were: 1) to evaluate which ventricular arrythmia (VA) characteristics predicted CMR abnormalities and 2) the diagnostic yield and the impact in the management of CMR-based imaging versus non-CMR-based imaging in patients referred for PVCs.

Methods

This monocentric retrospective study was conducted in patients with PVCs referred for CMR imaging. Their baseline interview and characteristics, physical examination, surface electrocardiogram (ECG) analysis, ambulatory monitoring, echocardiography and treadmill exercise test data were collected when they were available. The CMR (1,5 T and 3.0 T) protocol included cine imaging and late gadolinium enhancement (LGE) using standard cardiac geometries.

Results

We analyzed 168 patients (65% males, mean age 54.2±16.8 years) referred to our center for PVCs over a two-year period. CMR reported abnormal findings in 73 patients (43.5%) with the diagnosis of structural heart disease (SHD) in 46 patients (27.4%). Left-ventricular late gadolinium-enhancement was documented in 43 patients with abnormal CMR. Using a multivariate analysis, age (p=0.026), sustained ventricular tachycardia (p=0.002) and presence of cardiomyopathy on echocardiography (p<0.001) significantly predicted the presence of abnormal findings on CMR. Compared to non-CMR-based imaging, CMR had a diagnostic yield, by modifying the presumed diagnosis or by finding abnormalities requiring follow-up in 73 patients (43.5%).

Conclusions

Age, sustained ventricular tachycardia and presence of cardiomyopathy on echocardiography were the strongest predictors of positive CMR imaging results. Although echocardiography is generally used in first intention for the diagnosis of cardiomyopathy in patients with PVCs, this study showed that CMR-based imaging has a robust diagnostic yield in this indication.

Funding Acknowledgement

Type of funding sources: None.

Improved Upper Limit on the Neutrino Mass from a Direct Kinematic Method by KATRIN

We report on the neutrino mass measurement result from the first four-week science run of the Karlsruhe Tritium Neutrino experiment KATRIN in spring 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are energy analyzed by a high-resolution MAC-E filter. A fit of the integrated electron spectrum over a narrow interval around the kinematic end point at 18.57 keV gives an effective neutrino mass square value of (-1.0_{-1.1}^{+0.9})  eV^{2}. From this, we derive an upper limit of 1.1 eV (90% confidence level) on the absolute mass scale of neutrinos. This value coincides with the KATRIN sensitivity. It improves upon previous mass limits from kinematic measurements by almost a factor of 2 and provides model-independent input to cosmological studies of structure formation.

Software Engineering Education in Medical Informatics

Requirements and approaches of Software Engineering education in the field of Medical Informatics are described with respect to the impact of (1) experiences characterizing the “software misery”, (2) status and tendencies in software methodology, and (3) educational status and needs in computer science education influenced by the controversy “theoretical versus practical education”. Special attention is directed toward the growing importance of analysis, design methods, and techniques in the professional spectrum of Medical Informatics, the relevance of general principles of systems engineering in health care, the potential of non-procedural programming paradigms, and the intersection of Artificial Intelligence and education. Realizations of and experiences with programs in the field of Software Engineering are reported with respect to special requirements in Medical Informatics.

Quality of Life after traumatic brain injury: A systematic review of the literature

In modern industrial countries traumatic brain injury (TBI) is a common sequel after different kinds of accidents especially amongst young male adults. Apart from medical and economic consequences Quality of Life (QoL) after TBI becomes increasingly important in outcome assessment. Besides the classical domains of QoL (physical, psychological, social) cognitive impairments are playing an important role especially for TBI patients. In 1991 the Meran conference set important standards and formulated basic guidelines for defining and measuring QoL in surgery, but a special index for TBI patients has not yet been developed. Instead, QoL research concentrates on physical, medical, psychological and social problems only. Based on the existing QoL concept extended by the cognitive aspect it was the aim of this review to give an overview about the recent QoL research in TBI patients since 1991. Sixteen studies in TBI patients mentioning at least 2 domains of QoL (physical, psychological, social, cognitive) were published since 1991. Five of them considered all 4 domains of QoL. All studies except of one dealt with psychological and social problems. Only half of the studies considered cognitive impairments. Four studies tried to define QoL, but none of them included the cognitive component. There was no consensus regarding the definition and the choice of measurement instrument for QoL after TBI. This review of 16 studies considering outcome and QoL after TBI confirms that a homogenous and clinically relevant QoL concept for this group of patients is still missing. Further research in TBI patients should include all 4 domains of QoL.