Cardiac Monitoring Research Articles

Prediction of atrial fibrillation after a stroke event: a systematic review with meta-analysis.

Detecting atrial fibrillation (AF) after stroke is a key component of secondary prevention, but indiscriminate prolonged cardiac monitoring is costly and burdensome. Multivariable prediction models could be used to inform patient selection. To determine the performance of available models for predicting AF after a stroke. We searched for studies of multivariable models that were derived, validated and/or augmented for prediction of AF in patients with a stroke, using Medline and Embase from inception through 20/09/2024. Discrimination measures for tools with c-statistic data from ≥3 cohorts were pooled by Bayesian meta-analysis, with heterogeneity assessed through a 95% prediction interval (PI). The risk of bias was assessed using the Prediction Model Risk Of Bias tool (PROBAST). We included 75 studies with 58 prediction models. 66% had a high risk of bias. Fifteen multivariable models were eligible for meta-analysis. Three models showed excellent discrimination: SAFE (c-statistic 0.856, 95% CI 0.796-0.916), SURF (0.815, 95% CI 0.728-0.893), and iPAB (0.888, 95% CI 0.824-0.957). Excluding high-bias studies, only SAFE showed excellent discrimination (0.856, 95% CI 0.800-0.915). No model showed excellent discrimination when limited to external validation or studies with ≥100 AF events. No clinical impact studies were found. Three of the fifty-eight identified multivariable prediction models for AF after stroke demonstrated excellent statistical performance on meta-analysis. However, prospective validation is required to understand the effectiveness of these models in clinical practice before they can be recommended for inclusion in clinical guidelines.

Machine Learning Enabled In-Home ECG: A Review

Machine learning (ML)-based in-home electrocardiogram (ECG) systems have emerged as transformative tools, advancing beyond traditional cardiology methods by offering innovative techniques for cardiac care. These systems enable sustained data collection, real-time monitoring of cardiac status, and individualized treatment plans, all while minimizing the need for frequent clinic visits. By leveraging advanced analytics and ML algorithms, in-home ECG systems analyze large-scale datasets to detect patterns and anomalies that might otherwise go unnoticed, providing early alerts and improving patient outcomes. This review examines the latest trends in ML-enhanced in-home ECG technology, emphasizing its functionality in anomaly detection, continuous monitoring, and decision-making processes. The integration of ML not only enhances diagnostic precision but also opens avenues for scalable, personalized, and remote healthcare solutions. Despite these advancements, significant challenges remain, including issues related to data privacy, algorithmic biases, and the reliability of real-world implementations. Addressing these challenges is essential for optimizing the performance and ethical use of these systems. This review also explores opportunities for future research, particularly in improving algorithm robustness and addressing biases to ensure equitable and accurate cardiac care for diverse populations. By integrating state-of-the-art ML techniques, in-home ECG systems are poised to revolutionize contemporary cardiology, reducing healthcare costs and enabling a progressive shift toward accessible, patient-centered care. This comprehensive exploration highlights the potential of ML-based in-home ECG systems to redefine cardiac monitoring and treatment, contributing to the broader transformation of modern healthcare.

E_GSMaP precipitation dataset reforecasted by RF-WMRA: Description and validation.

Accurate precipitation data is an important state variable in various application fields such as geohazard early warning, flood, and drought hazard monitoring and evaluation. This study proposed a precipitation reforecast inversion model based on Random Forest and Wavelet Multi-Resolution Analysis (RF-WMRA) method. In the basin along the Sichuan-Tibet Railway, we constructed the reforecast inversion model by using the fifth generation of atmospheric reanalysis of the European Centre for Medium-Range Weather Forecasts (ERA5) and Global Satellite Mapping of Precipitation (GSMaP) precipitation data and considering several geo-environmental variables such as elevation, humidity, temperature, and wind speed. In turn, we could obtain a set of E_GSMaP precipitation data with high spatial resolution (0.1°) from 1961 to 2020 in the study area. In addition, we also compared and analyzed the accuracy of the E_GSMaP data with both the ERA5 and GSMaP data from the perspective of extreme precipitation event monitoring. The results showed that: 1) The Correlation Coefficient (CC) of the RF reforecast model was 0.89, Root Mean Squared Error (RMSE) was 1.65mm, Relative Bias (BIAS) was 0.01%, Mean Absolute Error (MAE) was 0.42mm, and Kling-Gupta efficiency (KGE) was 0.80. CC and KGE increased to various degrees before and after WMRA model correction, RMSE, BIAS, and MAE decreased to various degrees. It indicated that this study's RF-WMRA reforecast inversion model performed better. 2) If extreme precipitation events in the study area were analyzed, we recommend the E_GSMaP data given the performance of three datasets, E_GSMaP, ERA5, and GSMaP, on seasonal and monthly time scales as well as in total extreme precipitation. The results of this study can provide basic data for regional geological disasters and hydrometeorological research and help to respond to the risk of geological disasters and climate change.

The Conditions and Improvement Plan for 119 EMS Activities with Anaphylactic Reaction Patients: Focused on Daejeon Metropolitan City

This study examined the current state of emergency services (EMS) provided to patients experiencing anaphylactic reactions based on 119 EMS activity reports and proposed improvement measures. From January 1, 2021, to December 31, 2021, a total of 106 individuals with anaphylactic reactions in a metropolitan city were analyzed. The results showed that the most frequent locations for anaphylaxis were homes, mountains, and fields, with bee stings identified as the leading cause. Among the individuals with anaphylactic reactions, 26.4% were classified as severe, 36.8% as moderate, and 36.8% as mild reactions. Severe anaphylactic reactions were associated with increased cardiovascular and respiratory clinical manifestations. Implementation rates for cardiac rhythm monitoring and oxygen, fluid therapy, antihistamine, and epinephrine administration were 21.4%, 46.3%, 28.6%, 3.6%, and 7.1%, respectively. It is crucial to identify the suspected causative agent through accurate medical history taking to improve outcomes. Early prediction of severe anaphylaxis based on a patient’s clinical manifestations and vital signs after exposure is essential to ensure intensive monitoring and appropriate emergency treatment.

Cardiac rhythm profile and heart rate variability in cancer therapy-related cardiac dysfunction among non-Hodgkin lymphoma patients

Background. Predicting the baseline risk of cancer therapy-related cardiac dysfunction in clinical settings remains challenging, even with numerous established risk factors related to both cancer and cardiovascular health. The role of incorporating Holter ECG monitoring into the routine assessment of patients undergoing cancer therapy is not well established. It is not fully understood that this method can enhance the early detection of cancer therapy-related cardiac dysfunction, allowing for timely therapeutic adjustments and improving of the patient’s outcomes. Aim. Emphasize the utility of Holter ECG monitoring in routine clinical practice for the early detection and risk stratification of cancer therapy-related cardiac dysfunction (CTRCD), while also investigating the relationship between cumulative doxorubicin dose and changes in cardiac electrical activity. Materials and patients. The study involved 127 non-Hodgkin lymphoma patients set to begin antitumor treatment. The patients were evaluated at 2 visits: first one before initiation of anti-tumoral treatment and the second at the 6 months period. All patients performed comprehensive echocardiography, blood test analysis and Holter ECG 24h recording. Descriptive statistics for numerical variables included central tendency and dispersion measures. Group differences were assessed using the Mann-Whitney-Wilcoxon test and visualized with box plots, while correlations (Spearman test, 95% CI) were displayed in a heatmap. Categorical data frequencies were reported with 95% CIs, and Pearson's Chi-squared test (Monte Carlo) was used for hypothesis testing, maintaining a significance level of 0.05. Outcomes. At the 6-month follow-up, chemotherapy-induced cardiotoxicity (CTRCD) was identified in 18 patients (14.2%), including both symptomatic and asymptomatic cases. Patients with CTRCD exhibited significantly lower initial heart rate variability (HRV) indices, including SDNN (54.0 vs. 67.0, p=0.007) and SDNNi (42.5 vs. 64.0, p<0.001). Sinus tachycardia was more frequent in the CTRCD group (66.7% vs. 34.0%, p=0.010), highlighting the importance of HRV monitoring for early CTRCD detection. At 6 months, CTRCD patients had a significantly higher median 24-hour heart rate (81.0 bpm vs. 73.5 bpm, p=0.019) and a greater number of supraventricular (847.5 vs. 205.5, p=0.016) and ventricular extrasystoles (204.0 vs. 80.0, p=0.047). Additionally, they received a significantly higher cumulative doxorubicin dose (510.0 mg/m² vs. 200.0 mg/m², p=0.008), which correlated positively with Holter ECG parameters, including supraventricular (Spearman 0.35) and ventricular extrasystoles (Spearman 0.33), as well as QT interval (Spearman 0.23). These findings underscore the need for rigorous cardiac monitoring in chemotherapy patients. Conclusions. These findings highlight the utility of Holter ECG in monitoring rhythm variability and identifying early signs of cardiotoxicity among cancer patients undergoing therapy, especially those receiving cardiotoxic agents like doxorubicin.

Obstructive Sleep Apnea and a Maxillomandibular Advancement: Does Maxillomandibular Advancement have more success than nonsurgical treatment in decreasing OSA?

Introduction: Takotsubo syndrome (TTS) is a cardiomyopathy triggered by emotional or physical stress. This case report presents a unique instance of TTS associated with myasthenia gravis (MG) in which myasthenic crisis developed after TTS diagnosis and not before. Case Description: A 73-year-old man presented with difficulty swallowing, dysphonia, and dyspnea, showing moderate-severe left ventricular dysfunction. Blood tests revealed elevated troponin and BNP levels, while the ECG at the arrival showed an ST-elevation in anterior leads. Coronary angiography showed normal aspect of coronary vessels. Echocardiography confirmed TTS with apical ballooning. After few days, myasthenic symptoms emerged leading to a myasthenic crisis. The patient improved with acetylcholinesterase inhibitors and was discharged with pyridostigmine and prednisone. Follow-up revealed complete resolution of left ventricular dysfunction. Discussion: MG rarely affects the heart, but in this case, it led to TTS. Notably, TTS occurred before the myasthenic crisis, emphasizing the need for cardiac monitoring in patients with new neurological diagnoses and acute respiratory.

Gastrointestinal Efficacy of Omeprazole in Patients with Gastroesophageal Reflux Disease

Introduction: Gastroesophageal Reflux Disease (GERD) poses a significant global health burden, necessitating effective treatment strategies. Proton pump inhibitors, particularly omeprazole, are commonly prescribed for GERD management. However, comprehensive investigations into the gastrointestinal efficacy of omeprazole, considering symptom duration, frequency, severity, and quality of life improvements, are warranted. Methodology: This randomized controlled trial aimed to systematically investigate the gastrointestinal efficacy of omeprazole in individuals diagnosed with GERD. Following CONSORT guidelines, the study enrolled 180 adult participants to evaluate how omeprazole influenced the duration, frequency, and severity of symptoms, along with its impact on health-related quality of life. Adults aged 25 to 65 with GERD were randomly assigned to either the omeprazole intervention or control group. The intervention group received a standardized daily dose of 20 mg oral omeprazole over a four-week period. Baseline characteristics, including age, gender, BMI, smoking status, comorbidities, and dietary habits, were thoroughly examined. Continuous monitoring of daily vital signs and adverse events was implemented to ensure safety and tolerability. Results: The study revealed a significantly shorter mean duration of GERD symptoms in the omeprazole group (5.2 ± 1.3 days) compared to the control group (7.8 ± 1.5 days), emphasizing the rapid relief provided by omeprazole (p < 0.001). Efficacy analysis demonstrated a remarkable reduction in symptom frequency (92% vs. 65%, p < 0.001) and severity (p < 0.001) in the omeprazole group. Health-related quality of life significantly improved in the omeprazole group, as reflected in the GERD-QOL scores (p < 0.001). Conclusion: This trial provides robust evidence supporting the gastrointestinal efficacy of omeprazole in managing GERD symptoms. The rapid relief, significant reductions in symptom frequency and severity, and improvement in health-related quality of life underscore the clinical relevance of omeprazole. The study contributes valuable insights to GERD management and informs future research directions.

Prediction of the adverse course of heart failure of ischemic origin in patients with atrial fibrillation and diabetes mellitus

Objective — to establish predictors of re‑hospitalization (RH) of patients with heart failure (HF) of ischemic origin with concomitant atrial fibrillation (AF) and diabetes mellitus (DM). Materials and methods. We examined 398 patients with HF on the background of post‑infarction cardiosclerosis, including 198 women and 200 men of Caucasian race aged 54 to 67 years (mean 58 years). 226 (56.8%) patients had permanent AF, and 102 (25.6%) had concomitant type 2 diabetes mellitus (DM). 167 (42.0%) patients had a reduced left ventricular ejection fraction (LVEF) ≤40%; 133 (33.4%) patients had moderately reduced LVEF (41—49%); 98 (24.6%) patients had preserved LVEF (≥ 50%). The levels of galectin‑3, ST‑2, brain natriuretic peptide (BNP) and its N‑terminal fragment (NT‑proBNP) were determined. ECG registration, daily ECG monitoring, standardized echocardiographic examination during hospitalization were carried out. During 1 year, the patients were observed, taking into account the presence of repeated hospitalization (RH) due to HF decompensation. Statistical analysis was performed using Statistica and MedCalc programs. Results. HF patients with AF had a higher probability of RH compared to patients with sinus rhythm (SR) (37.9% vs. 26.2%, respectively; odds ratio (OR) 1.76; p=0.0064). The mean time to event development in the group of patients with HF and AF was 9.1±0.3 months, and in the group of patients with HF who had sinus rhythm — 11.0±0.2 months (relative risk (RR) 1.99; p <0.0001). Patients with HF with concomitant DM had a higher probability of RH, compared to patients without DM (68.0% vs. 26.2%, respectively; OR 8.60; p <0.0001). The average time of development of the event in the group with DM was (6.9±0.6) months, against (11.0±0.2) months among patients without diabetes (RR 4.11; p <0.0001). Patients with HF with concomitant DM and AF had a higher probability of RH, compared with HF patients with SR without DM (90.4%, vs. 26.2%, respectively; OR 54.48; p <0.0001). The average time of development of the event in the group of HF patients with a combination of DM and AF was (4.2±0.4) months, against (11.0±0.2) months among patients without diabetes (RR 6.84; p <0.0001). The cumulative risk of RH among patients with HF is the highest with a combination of AF and DM (OR 4.08 (2.47—6.73), p <0.0001). The median time of 50% probability of RH due to HF decompensation in this group was 3.0 (3.0—4.0) months. Conclusions. Comorbidity is associated with a severe course of heart failure. Taking into account the cumulative risk of re‑hospitalization during the year of observation, the combination of diabetes with atrial fibrillation is the most unfavorable (OR 4.08 (2.47—6.73), p <0.0001. Median time 50% probability of re‑hospitalization due to decompensation of heart failure is 3.0 (3.0—4.0) months. According to the logistic regression analysis, the prognostic factors for the course of HF were the functional class of HF according to the New York Heart Association (NYHA) criteria (β=4.61; p <0.0001), a history of diabetes mellitus (β=1.45; p=0.0005), serum galectin‑3 (β=0.52; p=0.0046) and LV EF (β=0.13; p <0.0001).

Integrating EPSOSA-BP neural network algorithm for enhanced accuracy and robustness in optimizing coronary artery disease prediction

Coronary artery disease represents a formidable health threat to middle-aged and elderly populations worldwide. This research introduces an advanced BP neural network algorithm, EPSOSA-BP, which integrates particle swarm optimization, simulated annealing, and a particle elimination mechanism to elevate the precision of heart disease prediction models. To address prior limitations in feature selection, the study employs single-hot encoding and Principal Component Analysis, thereby enhancing the model’s feature learning capability. The proposed method achieved remarkable accuracy rates of 93.22% and 95.20% on the UCI and Kaggle datasets, respectively, underscoring its exceptional performance even with small sample sizes. Ablation experiments further validated the efficacy of the data preprocessing and feature selection techniques employed. Notably, the EPSOSA algorithm surpassed classical optimization algorithms in terms of convergence speed, while also demonstrating improved sensitivity and specificity. This model holds significant potential for facilitating early identification of high-risk patients, which could ultimately save lives and optimize the utilization of medical resources. Despite implementation challenges, including technical integration and data standardization, the algorithm shows promise for use in emergency settings and community health services for regular cardiac risk monitoring.

KNOWLEDGE, ATTITUDE AND ASSOCIATED FACTORS TOWARDS HEART FAILURE MANAGEMENT AMONG NURSES WORKING IN CARDIAC UNITS

Heart failure is a growing public health concern in Pakistan, with nurses playing a pivotal role in its management. Effective knowledge and attitudes among nurses are crucial for optimizing patient outcomes and reducing complications. This study aimed to assess the knowledge, attitudes, and associated factors regarding heart failure management among nurses in tertiary care hospitals. Methods: A descriptive cross-sectional study was conducted among 130 nurses working in cardiac care units and ICUs of tertiary care hospitals in Lahore, Pakistan. Participants were selected using convenience sampling. Data were collected through a validated structured questionnaire, which included demographic information, knowledge assessment, and attitudes toward heart failure management. Statistical analysis was performed using SPSS version 26, employing descriptive and inferential methods to evaluate trends and associations. Results: The majority of nurses (66.9%) correctly identified common symptoms of heart failure, such as coughing and nausea. However, gaps were observed in recognizing specific indicators, such as abdominal swelling as a sign of fluid retention (60.1%). Positive attitudes toward heart failure management were prevalent, with 58.5% strongly agreeing on the critical role of nursing care in influencing patient outcomes. Practices, such as consistent ECG monitoring (48.0%) and proper patient positioning (36.7%), were suboptimal. Significant associations were found between education level, years of experience, and competency levels (p < 0.05). Conclusion: While nurses exhibited adequate knowledge and positive attitudes toward heart failure management, significant gaps in practice adherence and specific knowledge areas were identified. Structured training programs, regular competency assessments, and evidence-based practice interventions are essential to address these deficiencies and enhance patient care in cardiac units.

The Role of Metabolic Therapy in the Treatment of Chronic Coronary Syndrome. Results of Own Research

Ischemic heart disease (IHD) and stroke are the main causes of mortality and disability worldwide. One of the most controversial issues in modern cardiology is the feasibility of using metabolic drugs for the treatment of patients with angina. The main directions in metabolic therapy are optimization of energy production and expenditure and normalization of the balance between the intensity of free radical oxidation and antioxidant processes. The objective: to determine the clinical effectiveness of combined metabolic therapy with domestic drugs meldonium, ethylmethylhydroxypyridine succinate and armadin in the complex treatment of military personnel with IHD. Materials and methods. The study included 36 military personnel with coronary artery disease with stable angina pectoris of functional class II–III. Patients were treated in the cardiology department of the Military Medical Clinical Treatment and Rehabilitation Center (Irpin). All examined patients were male, the average age was 43.7 ± 2.7 years, the duration of the disease was 4.2 ± 2.3 years, the onset of angina attacks was 39.6 ± 2.8 years. All patients received standard therapy in accordance with the ESC recommendation. Additionally intravenous drip infusions of meldonium (100 mg/ml, 5 ml per 100.0 saline), ethylmethylhydroxypyridine succinate (50 mg/ml, 2 ml intravenously in a 1:2 dilution in saline, slowly in a jet) and armadin (300 mg, 1 tablet in the evening for 2 weeks, then 1 tablet solution twice a day for 4 weeks) were prescribed. The effectiveness of the prescribed complex was monitored based on the dynamics of clinical status, bicycle ergometry indicators, and Holter ECG monitoring before the start of treatment and after 14–16 days. Results. The use of metabolic therapy significantly improved the general condition of patients, reduced the number of angina attacks, and reduced the need for nitroglycerin tablets. Analysis of the sample with dosed physical activity before the start of therapy revealed a significant percentage of patients with ST segment depression of 2 mm at the height of physical activity, and the total relative number of patients with ST segment depression of 1.5–2 mm was 72.2%. During the repeated examination ST segment depression was not determined in 94.4% of patients. Before treatment, rhythm disturbances in the form of supraventricular and ventricular extrasystoles were recorded on the background of maximum exercise, and after treatment, no rhythm disturbances were detected. In the dynamics of the therapy, it was possible to achieve a decrease in blood pressure (BP) indicators during exercise, the level of systolic BP decreased by 16.4%, and diastolic BP – by 9.4% (p < 0.05). Recovery time significantly decreased by 35.2%, but oxygen consumption and tolerance index significantly increased. Conclusions. The results of the study demonstrated that combination therapy with domestically produced metabolic drugs (meldonium, ethylmethylhydroxypyridine succinate and armadine) with a combination of injectable and tablet forms showed high effectiveness in the treatment of military personnel with coronary artery disease. The combination of drugs that patients received during the study demonstrated good tolerability and the absence of adverse reactions.

New wearable cardiac acoustic monitoring technology for evaluation of subclinical leaflet thrombosis after transcatheter aortic valve replacement

BackgroundSubclinical leaflet thrombosis (SLT) is a common complication after transcatheter aortic valve replacement (TAVR). Multidimensional CT (MDCT) is the main imaging mortality for the diagnosis of SLT but it enhances...

The Potential of Artificial Intelligence and Machine Learning in Pharmacovigilance: An Update

The integration of artificial intelligence (AI) and machine learning (ML) into pharmacovigilance (PV) marks a transformative step towards enhancing drug safety and patient outcomes. With their unparalleled ability to analyze vast and complex datasets, AI/ML technologies offer unprecedented opportunities to revolutionize adverse drug event (ADE) monitoring, signal detection, and causality assessment. This editorial explores the state-of-the-art applications, key challenges, and actionable strategies to unlock the full potential of AI in PV.

Low-dose Flecainide vs Propafenone for Supraventricular Ectopy Suppression in the Elderly

Frequent premature atrial contractions (PACs) and focal atrial tachycardias (FAT) are seen in one third of patients after ablation for atrial fibrillation. Sometimes first line therapy (beta blockers, verapamil, and diltiazem) is insufficient for proper control of supraventricular ectopy or there are some contraindications to their use. In these cases, antiarrhythmic agents of the IC class (flecainide and propafenone ) are administered. Despite the differences in their pharmacodynamic and pharmacokinetic properties, there is no direct comparison between these two agents regarding their efficacy in suppressing supraventricular ectopy. We report a case of switching from low dose propafenone to low dose flecainide in elderly with frequent PACs and episodes of FAT. An 81 year old man had a high number of symptomatic PACs and episodes of FAT in the settings of propafenone at the dose of 150 mg twice a day after cryoablation for atrial fibrillation. Propafenone was switched to flecainide at a dose of 50 mg twice daily and ambulatory ECG monitoring was repeated. The total number of PACs, FATs and premature ventricular contractions (PVCs) decreased significantly. PAC burden decreased from 18.4% to 7.9%. However, the number of blocked PACs increased from 189 to 2518 per day.Palpitations became less frequent. Thus, low dose flecainide is associated with a decrease in the number of PACs, episodes of FAT and PVCs compared with low dose propafenone, but the number of blocked PACs is higher in the setting of flecainide use.

A real-world pharmacovigilance analysis for agalsidase beta: findings from the FDA adverse event reporting database

ABSTRACT Background Fabry disease (FD), an X-linked lysosomal disorder, is marked by a lack of alpha-galactosidase A (α-Gal A). Agalsidase beta, a recombinant form of α-Gal A, is fundamental to enzyme replacement therapy for FD but requires close monitoring for adverse events (AEs). Research Design and Methods This study retrospectively analyzed the Food and Drug Administration Adverse Event Reporting System (FAERS) database for agalsidase beta-related AEs. Disproportionality analysis was used for data analysis. Results A total of 7,611 AE reports for agalsidase beta were analyzed. The most common AEs included pyrexia, pain, chills, malaise, and nausea. Several system organ classes including Cardiac Disorders, General Disorders and Administration Site Conditions, and Vascular Disorders, showed positive signals. Subgroup analysis by gender revealed differences in AE reporting, with males exhibiting a higher reporting odds ratio for certain preferred terms such as Renal Transplant and Drug Specific Antibody Present. Conclusion The FAERS database analysis of agalsidase beta AEs identified a significant number of cardiovascular, renal, and cerebrovascular system-related reports. While agalsidase beta is generally well-tolerated, the study underscores the necessity for gender-specific treatment approaches due to the higher incidence of certain AEs in males.

Track Deflection Monitoring for Railway Construction Based on Dynamic Brillouin Optical Time-Domain Reflectometry.

Real-time online monitoring of track deformation during railway construction is crucial for ensuring the safe operation of trains. However, existing monitoring technologies struggle to effectively monitor both static and dynamic events, often resulting in high false alarm rates. This paper presents a monitoring technology for track deformation during railway construction based on dynamic Brillouin optical time-domain reflectometry (Dy-BOTDR), which effectively meets requirements in the monitoring of both static and dynamic events of track deformation. Dy-BOTDR can provide a two-dimensional spatial-temporal distribution map of track strain changes to characterize various events for better monitoring accuracy and lower false alarm rates.

Features of Holter ECG Monitoring in Pediatric Patients Hospitalized in Departments of Neurology, Rheumatology, Pathology of Newborns and Premature Infants

Introduction. Identification of life-threatening risk factors of sudden cardiac children’s death associated with cardiac arrhythmia is an urgent problem in modern pediatric cardiology. The most appropriate method used to diagnose all life-threatening arrhythmias is Holter ECG monitoring. Purpose. To study the results of 24-hour ECG monitoring in children aged 0 to 18 to identify life-threatening arrhythmias, as well as to evaluate the importance of Holter ECG monitoring in children depending on the gender and age of the patients. Materials and methods. The retrospective analysis of the Holter ECG monitoring results was conducted on the base of the department of functional diagnostics (N.F. Filatov Penza Region Children Clinical Hospital). 480 children (aged 0 to 18) were examined, monitored and treated in the neurological, rheumatological departments, the department of premature and pathology of newborns. Results. The examination of 480 children showed cardiac arrhythmias in 475 children (99%), including 90 children (18.75%) with life-threatening conditions. Conclusion. Results of the research proved that Holter ECG monitoring is the main method of diagnosis cardiac infantile arrhythmias, which are recorded during 24-hours. Bведение. Наиболее подходящим методом для диагностики всех жизнеугрожающих аритмий, представляющих собой фактор риска внезапной сердечной смерти детей, является холтеровское мониторирование ЭКГ. Исследование роли холтеровского мониторирования ЭКГ в профилактике синдрома внезапной сердечной смерти в педиатрической практике в зависимости от пола и возраста пациентов является актуальной проблемой детской кардиологии. Цель. Изучить результаты суточного мониторирования ЭКГ у детей в возрасте от 0 до 18 лет для выявления угрожающих жизни аритмий, оценить важность метода Холтер-ЭКГ в этом вопросе. Материалы и методы. Проведен ретроспективный анализ результатов холтеровского мониторирования ЭКГ детей в возрасте от 0 до 18 лет, находившихся на обследовании и лечении в неврологическом, ревматологическом отделениях, а также отделении патологии новорожденных и недоношенных детей. Результаты. Проведенные исследования позволили выявить нарушения сердечного ритма у детей, в том числе угрожающие жизни состояния. Была подтверждена роль холтеровского мониторирования ЭКГ в диагностике нарушения сердечного ритма. Заключение. Холтеровское мониторирование ЭКГ является основным методом диагностики всех жизнеугрожающих аритмий.

Cardiotoxicity in Breast Cancer: Impact of Clinical Classifications and Treatment on Heart Health.

Cardio-oncology has become essential in addressing cardiovascular complications from cancer therapies. While advancements in treatments have improved survival rates, they also increase cardiovascular risks. This study evaluates the cardiotoxic effects of cytostatic treatments, examining the relationship between tumor characteristics, such as histopathology and TNM classification, and cardiovascular complications, aiming to improve cardiotoxicity prevention and management in oncology patients. We conducted a retrospective analysis of cancer patients treated with anthracyclines, HER2-targeted therapies, and radiotherapy. Cardiac function was monitored via echocardiography, focusing on global longitudinal strain and left ventricular ejection fraction (LVEF). Cardiac troponins and natriuretic peptides were measured to detect subclinical cardiotoxicity, with patients stratified by TNM cancer stage and histopathology. Our analysis identified a significant association between certain cytostatic treatments, such as anthracyclines and HER2-targeted therapies, and a reduction in LVEF, particularly in patients with advanced-stage cancer. Biomarker assessments indicated early signs of cardiotoxicity in patients before clinical symptoms emerged. The findings also demonstrated a higher prevalence of cardiovascular complications in patients with pre-existing risk factors. This study highlights the importance of personalized treatment protocols in minimizing cardiotoxicity and improving the quality of life for oncology patients. Regular cardiac monitoring, combined with the use of biomarkers, can help identify high-risk patients early, allowing for timely interventions. Future research should focus on optimizing cardioprotective strategies to mitigate the cardiovascular risks associated with modern cancer therapies. N/A (retrospective study).

The Influence of Long COVID on the Cardiovascular System and Predictors of Long COVID in Females: Data from the Polish Long COVID Cardiovascular (PoLoCOV-CVD) Study.

Background/Objectives: Female sex is one of the Long COVID (LC) risk factors; however, the LC predictors in females have not been established. This study was conducted to assess the influence of LC on the cardiovascular system and to assess the age-independent predictors of LC in females. Methods: Patient information and the course of the disease with symptoms were collected in women at least 12 weeks after COVID-19 recovery. The study participants were followed for 12 months. ECG monitoring, 24 h ECG monitoring, 24 h blood pressure monitoring, echocardiography, and biochemical tests were performed. Results: We studied 1946 consecutive female patients (age 53.0 [43.0-63.0] vs. 52.5 [41.0-63.0], p = 0.25). A more frequent occurrence of LC was observed in females with a severe SARS-CoV-2 infection (p = 0.0001). Women with LC compared to the control group had higher body mass index (p = 0.001), lower level of HDL cholesterol (p = 0.015), higher level of TG (p < 0.001) and higher TG/HDL ratio (p < 0.001), more often myocardial damage (p < 0.001), and lower LVEF (p = 0.01). LC women had more often QRS fragmentation, longer QTcB, and one of the ECG abnormalities. In a multivariate analysis in younger females with BMI > 24.8 kg/m2, TG/HDL ratio > 1.89 and severe course of COVID-19 and in older females, TG/HDL ratio > 1.89, lower LVEF, and also severe course of infection were independent LC predictors. Conclusions: Independent predictors of LC occurrence in women, regardless of age, are severe course of COVID-19 and TG/HDL ratio > 1.89. The presence of comorbidities and lifestyle before COVID-19 had no impact on the occurrence of LC in females regardless of age.

Using clinical data to reclassify ESUS patients to large artery atherosclerotic or cardioembolic stroke mechanisms.

Embolic stroke of unidentified source (ESUS) represents 10-25% of all ischemic strokes. Our goal was to determine whether ESUS could be reclassified to cardioembolic (CE) or large-artery atherosclerosis (LAA) with machine learning (ML) using conventional clinical data. We retrospectively collected conventional clinical features, including patient, imaging (MRI, CT/CTA), cardiac, and serum data from established cases of CE and LAA stroke, and factors with p < 0.2 in univariable analysis were used for creating a ML predictive tool. We then applied this tool to ESUS cases, with ≥ 75% likelihood serving as the threshold for reclassification to CE or LAA. In patients with longitudinal data, we evaluated future cardiovascular events. 191 ischemic stroke patients (80 CE, 61 LAA, 50 ESUS) were included. Seven and 6 predictors positively associated with CE and LAA etiology, respectively. The c-statistic for discrimination between CE and LAA was 0.88. The strongest predictors for CE were left atrial volume index (OR = 2.17 per 1 SD increase) and BNP (OR = 1.83 per 1 SD increase), while the number of non-calcified stenoses ≥ 30% upstream (OR = 0.34 per 1 SD increase) and not upstream (OR = 0.74 per 1 SD increase) from the infarct were for LAA. When applied to ESUS cases, the model reclassified 40% (20/50), with 11/50 reclassified to CE and 9/50 reclassified to LAA. In 21/50 ESUS with 30-day cardiac monitoring, 1/4 in CE and 3/16 equivocal reclassifications registered cardiac events, while 0/1 LAA reclassifications showed events. ML tools built using standard ischemic stroke workup clinical biomarkers can potentially reclassify ESUS stroke patients into cardioembolic or atherosclerotic etiology categories.